[Title 42 CFR ]
[Code of Federal Regulations (annual edition) - October 1, 1999 Edition]
[From the U.S. Government Printing Office]


          42



          Public Health



[[Page i]]

          PARTS 1 TO 399

                         Revised as of October 1, 1999

          CONTAINING
          A CODIFICATION OF DOCUMENTS
          OF GENERAL APPLICABILITY
          AND FUTURE EFFECT

          AS OF OCTOBER 1, 1999
          With Ancillaries
          Published by
          the Office of the Federal Register
          National Archives and Records
          Administration

          as a Special Edition of
          the Federal Register



[[Page ii]]

                                      




                     U.S. GOVERNMENT PRINTING OFFICE
                            WASHINGTON : 1999



               For sale by U.S. Government Printing Office
 Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328



[[Page iii]]




                            Table of Contents



                                                                    Page
  Explanation.................................................       v

  Title 42:

          Chapter I--Public Health Service, Department of 
          Health and Human Services...........................       3

          Chapters II-III [Reserved]

  Finding Aids:

      Materials Approved for Incorporation by Reference.......     685

      Table of CFR Titles and Chapters........................     687

      Alphabetical List of Agencies Appearing in the CFR......     705

      Redesignation Tables....................................     715

      List of CFR Sections Affected...........................     719



[[Page iv]]





                     ----------------------------

                     Cite this Code:  CFR
                     To cite the regulations in 
                       this volume use title, 
                       part and section number. 
                       Thus,  42 CFR 2.1 refers 
                       to title 42, part 2, 
                       section 1.

                     ----------------------------

[[Page v]]



                               EXPLANATION

    The Code of Federal Regulations is a codification of the general and 
permanent rules published in the Federal Register by the Executive 
departments and agencies of the Federal Government. The Code is divided 
into 50 titles which represent broad areas subject to Federal 
regulation. Each title is divided into chapters which usually bear the 
name of the issuing agency. Each chapter is further subdivided into 
parts covering specific regulatory areas.
    Each volume of the Code is revised at least once each calendar year 
and issued on a quarterly basis approximately as follows:

Title 1 through Title 16.................................as of January 1
Title 17 through Title 27..................................as of April 1
Title 28 through Title 41...................................as of July 1
Title 42 through Title 50................................as of October 1

    The appropriate revision date is printed on the cover of each 
volume.

LEGAL STATUS

    The contents of the Federal Register are required to be judicially 
noticed (44 U.S.C. 1507). The Code of Federal Regulations is prima facie 
evidence of the text of the original documents (44 U.S.C. 1510).

HOW TO USE THE CODE OF FEDERAL REGULATIONS

    The Code of Federal Regulations is kept up to date by the individual 
issues of the Federal Register. These two publications must be used 
together to determine the latest version of any given rule.
    To determine whether a Code volume has been amended since its 
revision date (in this case, October 1, 1999), consult the ``List of CFR 
Sections Affected (LSA),'' which is issued monthly, and the ``Cumulative 
List of Parts Affected,'' which appears in the Reader Aids section of 
the daily Federal Register. These two lists will identify the Federal 
Register page number of the latest amendment of any given rule.

EFFECTIVE AND EXPIRATION DATES

    Each volume of the Code contains amendments published in the Federal 
Register since the last revision of that volume of the Code. Source 
citations for the regulations are referred to by volume number and page 
number of the Federal Register and date of publication. Publication 
dates and effective dates are usually not the same and care must be 
exercised by the user in determining the actual effective date. In 
instances where the effective date is beyond the cut-off date for the 
Code a note has been inserted to reflect the future effective date. In 
those instances where a regulation published in the Federal Register 
states a date certain for expiration, an appropriate note will be 
inserted following the text.

OMB CONTROL NUMBERS

    The Paperwork Reduction Act of 1980 (Pub. L. 96-511) requires 
Federal agencies to display an OMB control number with their information 
collection request.

[[Page vi]]

Many agencies have begun publishing numerous OMB control numbers as 
amendments to existing regulations in the CFR. These OMB numbers are 
placed as close as possible to the applicable recordkeeping or reporting 
requirements.

OBSOLETE PROVISIONS

    Provisions that become obsolete before the revision date stated on 
the cover of each volume are not carried. Code users may find the text 
of provisions in effect on a given date in the past by using the 
appropriate numerical list of sections affected. For the period before 
January 1, 1986, consult either the List of CFR Sections Affected, 1949-
1963, 1964-1972, or 1973-1985, published in seven separate volumes. For 
the period beginning January 1, 1986, a ``List of CFR Sections 
Affected'' is published at the end of each CFR volume.

INCORPORATION BY REFERENCE

    What is incorporation by reference? Incorporation by reference was 
established by statute and allows Federal agencies to meet the 
requirement to publish regulations in the Federal Register by referring 
to materials already published elsewhere. For an incorporation to be 
valid, the Director of the Federal Register must approve it. The legal 
effect of incorporation by reference is that the material is treated as 
if it were published in full in the Federal Register (5 U.S.C. 552(a)). 
This material, like any other properly issued regulation, has the force 
of law.
    What is a proper incorporation by reference? The Director of the 
Federal Register will approve an incorporation by reference only when 
the requirements of 1 CFR part 51 are met. Some of the elements on which 
approval is based are:
    (a) The incorporation will substantially reduce the volume of 
material published in the Federal Register.
    (b) The matter incorporated is in fact available to the extent 
necessary to afford fairness and uniformity in the administrative 
process.
    (c) The incorporating document is drafted and submitted for 
publication in accordance with 1 CFR part 51.
    Properly approved incorporations by reference in this volume are 
listed in the Finding Aids at the end of this volume.
    What if the material incorporated by reference cannot be found? If 
you have any problem locating or obtaining a copy of material listed in 
the Finding Aids of this volume as an approved incorporation by 
reference, please contact the agency that issued the regulation 
containing that incorporation. If, after contacting the agency, you find 
the material is not available, please notify the Director of the Federal 
Register, National Archives and Records Administration, Washington DC 
20408, or call (202) 523-4534.

CFR INDEXES AND TABULAR GUIDES

    A subject index to the Code of Federal Regulations is contained in a 
separate volume, revised annually as of January 1, entitled CFR Index 
and Finding Aids. This volume contains the Parallel Table of Statutory 
Authorities and Agency Rules. A list of CFR titles, chapters, and parts 
and an alphabetical list of agencies publishing in the CFR are also 
included in this volume.
    An index to the text of ``Title 3--The President'' is carried within 
that volume.
    The Federal Register Index is issued monthly in cumulative form. 
This index is based on a consolidation of the ``Contents'' entries in 
the daily Federal Register.
    A List of CFR Sections Affected (LSA) is published monthly, keyed to 
the revision dates of the 50 CFR titles.

[[Page vii]]


REPUBLICATION OF MATERIAL

    There are no restrictions on the republication of material appearing 
in the Code of Federal Regulations.

INQUIRIES

    For a legal interpretation or explanation of any regulation in this 
volume, contact the issuing agency. The issuing agency's name appears at 
the top of odd-numbered pages.
    For inquiries concerning CFR reference assistance, call 202-523-5227 
or write to the Director, Office of the Federal Register, National 
Archives and Records Administration, Washington, DC 20408.

SALES

    The Government Printing Office (GPO) processes all sales and 
distribution of the CFR. For payment by credit card, call 202-512-1800, 
M-F, 8 a.m. to 4 p.m. e.s.t. or fax your order to 202-512-2233, 24 hours 
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Customer Service call 202-512-1803.

ELECTRONIC SERVICES

    The full text of the Code of Federal Regulations, The United States 
Government Manual, the Federal Register, Public Laws, Weekly Compilation 
of Presidential Documents and the Privacy Act Compilation are available 
in electronic format at www.access.gpo.gov/nara (``GPO Access''). For 
more information, contact Electronic Information Dissemination Services, 
U.S. Government Printing Office. Phone 202-512-1530, or 888-293-6498 
(toll-free). E-mail, [email protected].
    The Office of the Federal Register also offers a free service on the 
National Archives and Records Administration's (NARA) World Wide Web 
site for public law numbers, Federal Register finding aids, and related 
information. Connect to NARA's web site at www.nara.gov/fedreg. The NARA 
site also contains links to GPO Access.

                              Raymond A. Mosley,
                                    Director,
                          Office of the Federal Register.

October 1, 1999.



[[Page ix]]



                               THIS TITLE

    Title 42--Public Health is composed of three volumes. The parts in 
these volumes are arranged in the following order: Parts 1-399, parts 
400-429 and part 430 to end. The first volume (parts 1-399) contains 
current regulations issued under chapter I--Public Health Service (HHS). 
The second volume (parts 400-429) includes regulations issued under 
chapter IV--Health Care Financing Administration (HHS) and the third 
volume (part 430 to end) contains the remaining regulations in chapter 
IV and the regulations issued under chapter V by the Office of Inspector 
General-Health Care (HHS). The contents of these volumes represent all 
current regulations codified under this title of the CFR as of October 
1, 1999.

    The OMB control numbers for the Health Care Financing Administration 
appear in Sec. 400.310 of chapter IV. For the convenience of the user 
subpart C consisting of Secs. 400.300-400.310 is reprinted in the 
Finding Aids section of the third volume.

    Redesignation tables appear in the Finding Aids section of all 
volumes.

    For this volume Melanie L. Marcec was Chief Editor. The Code of 
Federal Regulations publication program is under the direction of 
Frances D. McDonald, assisted by Alomha S. Morris.

[[Page x]]





[[Page 1]]



                         TITLE 42--PUBLIC HEALTH




                   (This book contains parts 1 to 399)

  --------------------------------------------------------------------
                                                                    Part

Chapter I--Public Health Service, Department of Health and 
  Human Services............................................           3
Chapters II--III  [Reserved]

[[Page 3]]




      CHAPTER I--PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND       
                             HUMAN SERVICES                            



  --------------------------------------------------------------------

                    SUBCHAPTER A--GENERAL PROVISIONS
Part                                                                Page
1               [Reserved]
2               Confidentiality of alcohol and drug abuse 
                    patient records.........................           7
2a              Protection of identity--research subjects...           7
3               [Reserved]
4               National Library of Medicine................          31
5               Designation of health professional(s) 
                    shortage areas..........................          34
6               Federal tort claims act coverage of certain 
                    grantees and individuals................          52
7               Distribution of reference biological 
                    standards and biological preparations...          54

                         SUBCHAPTER B--PERSONNEL

21              Commissioned officers.......................          55
22              Personnel other than commissioned officers..          65
23              National Health Service Corps...............          66
24              Senior Biomedical Research Service..........          75

               SUBCHAPTER C--MEDICAL CARE AND EXAMINATIONS

31              Medical care for certain personnel of the 
                    Coast Guard, National Ocean Survey, 
                    Public Health Service, and former 
                    Lighthouse Service......................          79
32              Medical care for persons with Hansen's 
                    disease and other persons in emergencies          84
34              Medical examination of aliens...............          85
35              Hospital and station management.............          91
36              Indian health...............................          99
37              Specifications for medical examinations of 
                    underground coal miners.................         144

[[Page 4]]

38              Disaster assistance for crisis counseling 
                    and training............................         157

                          SUBCHAPTER D--GRANTS

50              Policies of general applicability...........         161
51              Requirements applicable to the protection 
                    and advocacy for individuals with mental 
                    illness program.........................         177
51a             Project grants for maternal and child health         190
51b             Project grants for preventive health 
                    services................................         193
51c             Grants for community health services........         199
51d-51g         [Reserved]
52              Grants for research projects................         215
52a             National Institutes of Health center grants.         219
52b             National Cancer Institute construction 
                    grants..................................         224
52c             Minority Biomedical Research Support Program         228
52d             National Cancer Institute Clinical Cancer 
                    Education Program.......................         230
52e             National Heart, Lung, and Blood Institute 
                    grants for prevention and control 
                    projects................................         233
52h             Scientific peer review of research grant 
                    applications and research and 
                    development contract projects...........         236
53              Grants, loans and loan guarantees for 
                    construction and modernization of 
                    hospitals and medical facilities........         241
55a             Program grants for Black Lung clinics.......         249
56              Grants for migrant health services..........         251
57              Grants for construction of teaching 
                    facilities, educational improvements, 
                    scholarships and student loans..........         271
58              Grants for training of public health and 
                    allied health personnel.................         388
59              Grants for family planning services.........         397
59a             National Library of Medicine grants.........         410
60              Health Education Assistance Loan Program....         414

            SUBCHAPTER E--FELLOWSHIPS, INTERNSHIPS, TRAINING

61              Fellowships.................................         446
62              National Health Service Corps Scholarship 
                    and Loan Repayment Programs.............         451
63              Traineeships................................         469
63a             National Institutes of Health training 
                    grants..................................         472
64              National Library of Medicine training grants         475
64a             Obligated service for mental health 
                    traineeships............................         478
65              National Institute of Environmental Health 
                    Sciences hazardous waste worker training         482

[[Page 5]]

65a             National Institute of Environmental Health 
                    Sciences hazardous substances basic 
                    research and training grants............         485
66              National Research Service Awards............         489
67              Agency for Health Care Policy and Research 
                    grants and contracts....................         495
68a             National Institutes of Health (NIH) Clinical 
                    Research Loan Repayment Program for 
                    Individuals from Disadvantaged 
                    Backgrounds (CR-LRP)....................         505

             SUBCHAPTER F--QUARANTINE, INSPECTION, LICENSING

71              Foreign quarantine..........................         511
72              Interstate shipment of etiologic agents.....         520
75              Standards for the accreditation of 
                    educational programs for and the 
                    credentialing of radiologic personnel...         529

   SUBCHAPTER G--OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED 
                               ACTIVITIES

80              Administrative functions, practices, and 
                    procedures..............................         542
84              Approval of Respiratory Protective Devices..         543
85              Requests for health hazard evaluations......         608
85a             Occupational safety and health 
                    investigations of places of employment..         613
86              Grants for education programs in 
                    occupational safety and health..........         618
87              National Institute for Occupational Safety 
                    and Health Research and demonstration 
                    grants..................................         626

SUBCHAPTER H--HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS 
                   SUBSTANCES RELEASES AND FACILITIES

90              Administrative functions, practices, and 
                    procedures..............................         629

                         SUBCHAPTER I [RESERVED]

                         SUBCHAPTER J--VACCINES

100             Vaccine injury compensation.................         634
110             [Reserved]

               SUBCHAPTER K--HEALTH RESOURCES DEVELOPMENT

121             Organ Procurement and Transplantation 
                    Network.................................         640
124             Medical facility construction and 
                    modernization...........................         649
125-399         [Reserved]

[[Page 7]]



                    SUBCHAPTER A--GENERAL PROVISIONS



                            PART 1 [RESERVED]



PART 2--CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS--Table of Contents




                         Subpart A--Introduction

Sec.
2.1  Statutory authority for confidentiality of drug abuse patient 
          records.
2.2  Statutory authority for confidentiality of alcohol abuse patient 
          records.
2.3  Purpose and effect.
2.4  Criminal penalty for violation.
2.5  Reports of violations.

                      Subpart B--General Provisions

2.11  Definitions.
2.12  Applicability.
2.13  Confidentiality restrictions.
2.14  Minor patients.
2.15  Incompetent and deceased patients.
2.16  Security for written records.
2.17  Undercover agents and informants.
2.18  Restrictions on the use of identification cards.
2.19  Disposition of records by discontinued programs.
2.20  Relationship to State laws.
2.21  Relationship to Federal statutes protecting research subjects 
          against compulsory disclosure of their identity.
2.22  Notice to patients of Federal confidentiality requirements.
2.23  Patient access and restriction on use.

              Subpart C--Disclosures With Patient's Consent

2.31  Form of written consent.
2.32  Prohibition on redisclosure.
2.33  Disclosures permitted with written consent.
2.34  Disclosures to prevent multiple enrollments in detoxification and 
          maintenance treatment programs.
2.35  Disclosures to elements of the criminal justice system which have 
          referred patients.

             Subpart D--Disclosures Without Patient Consent

2.51  Medical emergencies.
2.52  Research activities.
2.53  Audit and evaluation activities.

         Subpart E--Court Orders Authorizing Disclosures and Use

2.61  Legal effect of order.
2.62  Order not applicable to records disclosed without consent to 
          researchers, auditors and evaluators.
2.63  Confidential communications.
2.64  Procedures and criteria for orders authorizing disclosures for 
          noncriminal purposes.
2.65  Procedures and criteria for orders authorizing disclosure and use 
          of records to criminally investigate or prosecute patients.
2.66  Procedures and criteria for orders authorizing disclosure and use 
          of records to investigate or prosecute a program or the person 
          holding the records.
2.67  Orders authorizing the use of undercover agents and informants to 
          criminally investigate employees or agents of a program.

    Authority: Sec. 408 of Pub. L. 92-255, 86 Stat. 79, as amended by 
sec. 303 (a), (b) of Pub L. 93-282, 83 Stat. 137, 138; sec. 4(c)(5)(A) 
of Pub. L. 94-237, 90 Stat. 244; sec. 111(c)(3) of Pub. L. 94-581, 90 
Stat. 2852; sec. 509 of Pub. L. 96-88, 93 Stat. 695; sec. 973(d) of Pub. 
L. 97-35, 95 Stat. 598; and transferred to sec. 527 of the Public Health 
Service Act by sec. 2(b)(16)(B) of Pub. L. 98-24, 97 Stat. 182 and as 
amended by sec. 106 of Pub. L. 99-401, 100 Stat. 907 (42 U.S.C. 290ee-3) 
and sec. 333 of Pub. L. 91-616, 84 Stat. 1853, as amended by sec. 122(a) 
of Pub. L. 93-282, 88 Stat. 131; and sec. 111(c)(4) of Pub. L. 94-581, 
90 Stat. 2852 and transferred to sec. 523 of the Public Health Service 
Act by sec. 2(b)(13) of Pub. L. 98-24, 97 Stat. 181 and as amended by 
sec. 106 of Pub. L. 99-401, 100 Stat. 907 (42 U.S.C. 290dd-3), as 
amended by sec. 131 of Pub. L. 102-321, 106 Stat. 368, (42 U.S.C. 290dd-
2).

    Source: 52 FR 21809, June 9, 1987, unless otherwise noted.



                         Subpart A--Introduction



Sec. 2.1  Statutory authority for confidentiality of drug abuse patient records.

    The restrictions of these regulations upon the disclosure and use of 
drug abuse patient records were initially authorized by section 408 of 
the Drug Abuse Prevention, Treatment, and Rehabilitation Act (21 U.S.C. 
1175). That section as amended was transferred by Pub. L. 98-24 to 
section 527 of the Public Health Service Act which is codified

[[Page 8]]

at 42 U.S.C. 290ee-3. The amended statutory authority is set forth 
below:

           Sec. 290ee-3.  Confidentiality of patient records.

    (a) Disclosure authorization
    Records of the identity, diagnosis, prognosis, or treatment of any 
patient which are maintained in connection with the performance of any 
drug abuse prevention function conducted, regulated, or directly or 
indirectly assisted by any department or agency of the United States 
shall, except as provided in subsection (e) of this section, be 
confidential and be disclosed only for the purposes and under the 
circumstances expressly authorized under subsection (b) of this section.
    (b) Purposes and circumstances of disclosure affecting consenting 
patient and patient regardless of consent
    (1) The content of any record referred to in subsection (a) of this 
section may be disclosed in accordance with the prior written consent of 
the patient with respect to whom such record is maintained, but only to 
such extent, under such circumstances, and for such purposes as may be 
allowed under regulations prescribed pursuant to subsection (g) of this 
section.
    (2) Whether or not the patient, with respect to whom any given 
record referred to in subsection (a) of this section is maintained, 
gives his written consent, the content of such record may be disclosed 
as follows:
    (A) To medical personnel to the extent necessary to meet a bona fide 
medical emergency.
    (B) To qualified personnel for the purpose of conducting scientific 
research, management audits, financial audits, or program evaluation, 
but such personnel may not identify, directly or indirectly, any 
individual patient in any report of such research, audit, or evaluation, 
or otherwise disclose patient identities in any manner.
    (C) If authorized by an appropriate order of a court of competent 
jurisdiction granted after application showing good cause therefor. In 
assessing good cause the court shall weigh the public interest and the 
need for disclosure against the injury to the patient, to the physician-
patient relationship, and to the treatment services. Upon the granting 
of such order, the court, in determining the extent to which any 
disclosure of all or any part of any record is necessary, shall impose 
appropriate safeguards against unauthorized disclosure.
    (c) Prohibition against use of record in making criminal charges or 
investigation of patient
    Except as authorized by a court order granted under subsection 
(b)(2)(C) of this section, no record referred to in subsection (a) of 
this section may be used to initiate or substantiate any criminal 
charges against a patient or to conduct any investigation of a patient.
    (d) Continuing prohibition against disclosure irrespective of status 
as patient
    The prohibitions of this section continue to apply to records 
concerning any individual who has been a patient, irrespective of 
whether or when he ceases to be a patient.
    (e) Armed Forces and Veterans' Administration; interchange of 
records; report of suspected child abuse and neglect to State or local 
authorities
    The prohibitions of this section do not apply to any interchange of 
records--
    (1) within the Armed Forces or witrhin those components of the 
Veterans' Administration furnishing health care to veterans, or
    (2) between such components and the Armed Forces.
    The prohibitions of this section do not apply to the reporting under 
State law of incidents of suspected child abuse and neglect to the 
appropriate State or local authorities.
    (f) Penalty for first and subsequent offenses
    Any person who violates any provision of this section or any 
regulation issued pursuant to this section shall be fined not more than 
$500 in the case of a first offense, and not nore than $5,000 in the 
case of each subsequent offense.
    (g) Regulations; interagency consultations; definitions, safeguards, 
and procedures, including procedures and criteria for issuance and scope 
of orders
    Except as provided in subsection (h) of this section, the Secretary, 
after consultation with the Administrator of Veterans' Affairs and the 
heads of other Federal departments and agencies substantially affected 
thereby, shall prescribe regulations to carry out the purposes of this 
section. These regulations may contain such definitions, and may provide 
for such safeguards and procedures, including procedures and criteria 
for the issuance and scope of orders under subsection (b)(2)(C) of this 
section, as in the judgment of the Secretary are necessary or proper to 
effectuate the purposes of this section, to prevent circumvention or 
evasion thereof, or to facilitate compliance therewith.

(Subsection (h) was superseded by section 111(c)(3) of Pub. L. 94-581. 
The responsibility of the Administrator of Veterans' Affairs to write 
regulations to provide for confidentiality of drug abuse patient records 
under Title 38 was moved from 21 U.S.C. 1175 to 38 U.S.C. 4134.)



Sec. 2.2  Statutory authority for confidentiality of alcohol abuse patient records.

    The restrictions of these regulations upon the disclosure and use of 
alcohol

[[Page 9]]

abuse patient records were initially authorized by section 333 of the 
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and 
Rehabilitation Act of 1970 (42 U.S.C. 4582). The section as amended was 
transferred by Pub. L. 98-24 to section 523 of the Public Health Service 
Act which is codified at 42 U.S.C. 290dd-3. The amended statutory 
authority is set forth below:

            Sec. 290dd-3.  Confidentiality of patient records

    (a) Disclosure authorization
    Records of the identity, diagnosis, prognosis, or treatment of any 
patient which are maintained in connection with the performance of any 
program or activity relating to alcoholism or alcohol abuse education, 
training, treatment, rehabilitation, or research, which is conducted, 
regulated, or directly or indirectly assisted by any department or 
agency of the United States shall, except as provided in subsection (e) 
of this section, be confidential and be disclosed only for the purposes 
and under the circumstances expressly authorized under subsection (b) of 
this section.
    (b) Purposes and circumstances of disclosure affecting consenting 
patient and patient regardless of consent
    (1) The content of any record referred to in subsection (a) of this 
section may be disclosed in accordance with the prior written consent of 
the patient with respect to whom such record is maintained, but only to 
such extent, under such circumstances, and for such purposes as may be 
allowed under regulations prescribed pursuant to subsection (g) of this 
section.
    (2) Whether or not the patient, with respect to whom any given 
record referred to in subsection (a) of this section is maintained, 
gives his written consent, the content of such record may be disclosed 
as follows:
    (A) To medical personnel to the extent necessary to meet a bona fide 
medical emergency.
    (B) To qualified personnel for the purpose of conducting scientific 
research, management audits, financial audits, or program evaluation, 
but such personnel may not identify, directly or indirectly, any 
individual patient in any report of such research, audit, or evaluation, 
or otherwise disclose patient identities in any manner.
    (C) If authorized by an appropriate order of a court of competent 
jurisdiction granted after application showing good cause therefor. In 
assessing good cause the court shall weigh the public interest and the 
need for disclosure against the injury to the patient, to the physician-
patient relationship, and to the treatment services. Upon the granting 
of such order, the court, in determining the extent to which any 
disclosure of all or any part of any record is necessary, shall impose 
appropriate safeguards against unauthorized disclosure.
    (c) Prohibition against use of record in making criminal charges or 
investigation of patient
    Except as authorized by a court order granted under subsection 
(b)(2)(C) of this section, no record referred to in subsection (a) of 
this section may be used to initiate or substantiate any criminal 
charges against a patient or to conduct any investigation of a patient.
    (d) Continuing prohibition against disclosure irrespective of status 
as patient
    The prohibitions of this section continue to apply to records 
concerning any individual who has been a patient, irrespective of 
whether or when he ceases to be a patient.
    (e) Armed Forces and Veterans' Administration; interchange of record 
of suspected child abuse and neglect to State or local authorities
    The prohibitions of this section do not apply to any interchange of 
records--
    (1) within the Armed Forces or within those components of the 
Veterans' Administration furnishing health care to veterans, or
    (2) between such components and the Armed Forces.

The prohibitions of this section do not apply to the reporting under 
State law of incidents of suspected child abuse and neglect to the 
appropriate State or local authorities.
    (f) Penalty for first and subsequent offenses
    Any person who violates any provision of this section or any 
regulation issued pursuant to this section shall be fined not more than 
$500 in the case of a first offense, and not more than $5,000 in the 
case of each subsequent offense.
    (g) Regulations of Secretary; definitions, safeguards, and 
procedures, including procedures and criteria for issuance and scope of 
orders
    Except as provided in subsection (h) of this section, the Secretary 
shall prescribe regulations to carry out the purposes of this section. 
These regulations may contain such definitions, and may provide for such 
safeguards and procedures, including procedures and criteria for the 
issuance and scope of orders under subsection(b)(2)(C) of this section, 
as in the judgment of the Secretary are necessary or proper to 
effectuate the purposes of this section, to prevent circumvention or 
evasion thereof, or to facilitate compliance therewith.

(Subsection (h) was superseded by section 111(c)(4) of Pub. L. 94-581. 
The responsibility of the Administrator of Veterans' Affairs to write 
regulations to provide for confidentiality of alcohol abuse patient 
records under Title 38 was moved from 42 U.S.C. 4582 to 38 U.S.C. 4134.)

[[Page 10]]



Sec. 2.3  Purpose and effect.

    (a) Purpose. Under the statutory provisions quoted in Secs. 2.1 and 
2.2, these regulations impose restrictions upon the disclosure and use 
of alcohol and drug abuse patient records which are maintained in 
connection with the performance of any federally assisted alcohol and 
drug abuse program. The regulations specify:
    (1) Definitions, applicability, and general restrictions in subpart 
B (definitions applicable to Sec. 2.34 only appear in that section);
    (2) Disclosures which may be made with written patient consent and 
the form of the written consent in subpart C;
    (3) Disclosures which may be made without written patient consent or 
an authorizing court order in subpart D; and
    (4) Disclosures and uses of patient records which may be made with 
an authorizing court order and the procedures and criteria for the entry 
and scope of those orders in subpart E.
    (b) Effect. (1) These regulations prohibit the disclosure and use of 
patient records unless certain circumstances exist. If any circumstances 
exists under which disclosure is permitted, that circumstance acts to 
remove the prohibition on disclosure but it does not compel disclosure. 
Thus, the regulations do not require disclosure under any circumstances.
    (2) These regulations are not intended to direct the manner in which 
substantive functions such as research, treatment, and evaluation are 
carried out. They are intended to insure that an alcohol or drug abuse 
patient in a federally assisted alcohol or drug abuse program is not 
made more vulnerable by reason of the availability of his or her patient 
record than an individual who has an alcohol or drug problem and who 
does not seek treatment.
    (3) Because there is a criminal penalty (a fine--see 42 U.S.C. 
290ee-3(f), 42 U.S.C. 290dd-3(f) and 42 CFR 2.4) for violating the 
regulations, they are to be construed strictly in favor of the potential 
violator in the same manner as a criminal statute (see M. Kraus & 
Brothers v. United States, 327 U.S. 614, 621-22, 66 S. Ct. 705, 707-08 
(1946)).



Sec. 2.4  Criminal penalty for violation.

    Under 42 U.S.C. 290ee-3(f) and 42 U.S.C. 290dd-3(f), any person who 
violates any provision of those statutes or these regulations shall be 
fined not more than $500 in the case of a first offense, and not more 
than $5,000 in the case of each subsequent offense.



Sec. 2.5  Reports of violations.

    (a) The report of any violation of these regulations may be directed 
to the United States Attorney for the judicial district in which the 
violation occurs.
    (b) The report of any violation of these regulations by a methadone 
program may be directed to the Regional Offices of the Food and Drug 
Administration.



                      Subpart B--General Provisions



Sec. 2.11  Definitions.

    For purposes of these regulations:
    Alcohol abuse means the use of an alcoholic beverage which impairs 
the physical, mental, emotional, or social well-being of the user.
    Drug abuse means the use of a psychoactive substance for other than 
medicinal purposes which impairs the physical, mental, emotional, or 
social well-being of the user.
    Diagnosis means any reference to an individual's alcohol or drug 
abuse or to a condition which is identified as having been caused by 
that abuse which is made for the purpose of treatment or referral for 
treatment.
    Disclose or disclosure means a communication of patient indentifying 
information, the affirmative verification of another person's 
communication of patient identifying information, or the communication 
of any information from the record of a patient who has been identified.
    Informant means an individual:
    (a) Who is a patient or employee of a program or who becomes a 
patient or employee of a program at the request of a law enforcement 
agency or official: and
    (b) Who at the request of a law enforcement agency or official 
observes one or more patients or employees of

[[Page 11]]

the program for the purpose of reporting the information obtained to the 
law enforcement agency or official.
    Patient means any individual who has applied for or been given 
diagnosis or treatment for alcohol or drug abuse at a federally assisted 
program and includes any individual who, after arrest on a criminal 
charge, is identified as an alcohol or drug abuser in order to determine 
that individual's eligibility to participate in a program.
    Patient identifying information means the name, address, social 
security number, fingerprints, photograph, or similar information by 
which the identity of a patient can be determined with reasonable 
accuracy and speed either directly or by reference to other publicly 
available information. The term does not include a number assigned to a 
patient by a program, if that number does not consist of, or contain 
numbers (such as a social security, or driver's license number) which 
could be used to identify a patient with reasonable accuracy and speed 
from sources external to the program.
    Person means an individual, partnership, corporation, Federal, State 
or local government agency, or any other legal entity.
    Program means:
    (a) An individual or entity (other than a general medical care 
facility) who holds itself out as providing, and provides, alcohol or 
drug abuse diagnosis, treatment or referral for treatment; or
    (b) An identified unit within a general medical facility which holds 
itself out as providing, and provides, alcohol or drug abuse diagnosis, 
treatment or referral for treatment; or
    (c) Medical personnel or other staff in a general medical care 
facility whose primary function is the provision of alcohol or drug 
abuse diagnosis, treatment or referral for treatment and who are 
identified as such providers. (See Sec. 2.12(e)(1) for examples.)
    Program director means:
    (a) In the case of a program which is an individual, that 
individual:
    (b) In the case of a program which is an organization, the 
individual designated as director, managing director, or otherwise 
vested with authority to act as chief executive of the organization.
    Qualified service organization means a person which:
    (a) Provides services to a program, such as data processing, bill 
collecting, dosage preparation, laboratory analyses, or legal, medical, 
accounting, or other professional services, or services to prevent or 
treat child abuse or neglect, including training on nutrition and child 
care and individual and group therapy, and
    (b) Has entered into a written agreement with a program under which 
that person:
    (1) Acknowledges that in receiving, storing, processing or otherwise 
dealing with any patient records from the progams, it is fully bound by 
these regulations; and
    (2) If necessary, will resist in judicial proceedings any efforts to 
obtain access to patient records except as permitted by these 
regulations.
    Records means any information, whether recorded or not, relating to 
a patient received or acquired by a federally assisted alcohol or drug 
program.
    Third party payer means a person who pays, or agrees to pay, for 
diagnosis or treatment furnished to a patient on the basis of a 
contractual relationship with the patient or a member of his family or 
on the basis of the patient's eligibility for Federal, State, or local 
governmental benefits.
    Treatment means the management and care of a patient suffering from 
alcohol or drug abuse, a condition which is identified as having been 
caused by that abuse, or both, in order to reduce or eliminate the 
adverse effects upon the patient.
    Undercover agent means an officer of any Federal, State, or local 
law enforcement agency who enrolls in or becomes an employee of a 
program for the purpose of investigating a suspected violation of law or 
who pursues that purpose after enrolling or becoming employed for other 
purposes.

[52 FR 21809, June 9, 1987, as amended by 60 FR 22297, May 5, 1995]



Sec. 2.12  Applicability.

    (a) General--(1) Restrictions on disclosure. The restrictions on 
disclosure in

[[Page 12]]

these regulations apply to any information, whether or not recorded, 
which:
    (i) Would identify a patient as an alcohol or drug abuser either 
directly, by reference to other publicly available information, or 
through verification of such an identification by another person; and
    (ii) Is drug abuse information obtained by a federally assisted drug 
abuse program after March 20, 1972, or is alcohol abuse information 
obtained by a federally assisted alcohol abuse program after May 13, 
1974 (or if obtained before the pertinent date, is maintained by a 
federally assisted alcohol or drug abuse program after that date as part 
of an ongoing treatment episode which extends past that date) for the 
purpose of treating alcohol or drug abuse, making a diagnosis for that 
treatment, or making a referral for that treatment.
    (2) Restriction on use. The restriction on use of information to 
initiate or substantiate any criminal charges against a patient or to 
conduct any criminal investigation of a patient (42 U.S.C. 290ee-3(c), 
42 U.S.C. 290dd-3(c)) applies to any information, whether or not 
recorded which is drug abuse information obtained by a federally 
assisted drug abuse program after March 20, 1972, or is alcohol abuse 
information obtained by a federally assisted alcohol abuse program after 
May 13, 1974 (or if obtained before the pertinent date, is maintained by 
a federally assisted alcohol or drug abuse program after that date as 
part of an ongoing treatment episode which extends past that date), for 
the purpose of treating alcohol or drug abuse, making a diagnosis for 
the treatment, or making a referral for the treatment.
    (b) Federal assistance. An alcohol abuse or drug abuse program is 
considered to be federally assisted if:
    (1) It is conducted in whole or in part, whether directly or by 
contract or otherwise by any department or agency of the United States 
(but see paragraphs (c)(1) and (c)(2) of this section relating to the 
Veterans' Administration and the Armed Forces);
    (2) It is being carried out under a license, certification, 
registration, or other authorization granted by any department or agency 
of the United States including but not limited to:
    (i) Certification of provider status under the Medicare program;
    (ii) Authorization to conduct methadone maintenance treatment (see 
21 CFR 291.505); or
    (iii) Registration to dispense a substance under the Controlled 
Substances Act to the extent the controlled substance is used in the 
treatment of alcohol or drug abuse;
    (3) It is supported by funds provided by any department or agency of 
the United States by being:
    (i) A recipient of Federal financial assistance in any form, 
including financial assistance which does not directly pay for the 
alcohol or drug abuse diagnosis, treatment, or referral activities; or
    (ii) Conducted by a State or local government unit which, through 
general or special revenue sharing or other forms of assistance, 
receives Federal funds which could be (but are not necessarily) spent 
for the alcohol or drug abuse program; or
    (4) It is assisted by the Internal Revenue Service of the Department 
of the Treasury through the allowance of income tax deductions for 
contributions to the program or through the granting of tax exempt 
status to the program.
    (c) Exceptions--(1) Veterans' Administration. These regulations do 
not apply to information on alcohol and drug abuse patients maintained 
in connection with the Veterans' Administration provisions of hospital 
care, nursing home care, domiciliary care, and medical services under 
title 38, United States Code. Those records are governed by 38 U.S.C. 
4132 and regulations issued under that authority by the Administrator of 
Veterans' Affairs.
    (2) Armed Forces. These regulations apply to any information 
described in paragraph (a) of this section which was obtained by any 
component of the Armed Forces during a period when the patient was 
subject to the Uniform Code of Military Justice except:
    (i) Any interchange of that information within the Armed Forces; and
    (ii) Any interchange of that information between the Armed Forces 
and

[[Page 13]]

those components of the Veterans Administration furnishing health care 
to veterans.
    (3) Communication within a program or between a program and an 
entity having direct administrative control over that program. The 
restrictions on disclosure in these regulations do not apply to 
communications of information between or among personnel having a need 
for the information in connection with their duties that arise out of 
the provision of diagnosis, treatment, or referral for treatment of 
alcohol or drug abuse if the communications are
    (i) Within a program or
    (ii) Between a program and an entity that has direct administrative 
control over the program.
    (4) Qualified Service Organizations. The restrictions on disclosure 
in these regulations do not apply to communications between a program 
and a qualified service organization of information needed by the 
organization to provide services to the program.
    (5) Crimes on program premises or against program personnel. The 
restrictions on disclosure and use in these regulations do not apply to 
communications from program personnel to law enforcement officers 
which--
    (i) Are directly related to a patient's commission of a crime on the 
premises of the program or against program personnel or to a threat to 
commit such a crime; and
    (ii) Are limited to the circumstances of the incident, including the 
patient status of the individual committing or threatening to commit the 
crime, that individual's name and address, and that individual's last 
known whereabouts.
    (6) Reports of suspected child abuse and neglect. The restrictions 
on disclosure and use in these regulations do not apply to the reporting 
under State law of incidents of suspected child abuse and neglect to the 
appropriate State or local authorities. However, the restrictions 
continue to apply to the original alcohol or drug abuse patient records 
maintained by the program including their disclosure and use for civil 
or criminal proceedings which may arise out of the report of suspected 
child abuse and neglect.
    (d) Applicability to recipients of information--(1) Restriction on 
use of information. The restriction on the use of any information 
subject to these regulations to initiate or substantiate any criminal 
charges against a patient or to conduct any criminal investigation of a 
patient applies to any person who obtains that information from a 
federally assisted alcohol or drug abuse program, regardless of the 
status of the person obtaining the information or of whether the 
information was obtained in accordance with these regulations. This 
restriction on use bars, among other things, the introduction of that 
information as evidence in a criminal proceeding and any other use of 
the information to investigate or prosecute a patient with respect to a 
suspected crime. Information obtained by undercover agents or informants 
(see Sec. 2.17) or through patient access (see Sec. 2.23) is subject to 
the restriction on use.
    (2) Restrictions on disclosures--Third party payers, administrative 
entities, and others. The restrictions on disclosure in these 
regulations apply to:
    (i) Third party payers with regard to records disclosed to them by 
federally assisted alcohol or drug abuse programs;
    (ii) Entities having direct administrative control over programs 
with regard to information communicated to them by the program under 
Sec. 2.12(c)(3); and
    (iii) Persons who receive patient records directly from a federally 
assisted alcohol or drug abuse program and who are notified of the 
restrictions on redisclosure of the records in accordance with Sec. 2.32 
of these regulations.
    (e) Explanation of applicability--(1) Coverage. These regulations 
cover any information (including information on referral and intake) 
about alcohol and drug abuse patients obtained by a program (as the 
terms ``patient'' and ``program'' are defined in Sec. 2.11) if the 
program is federally assisted in any manner described in Sec. 2.12(b). 
Coverage includes, but is not limited to, those treatment or 
rehabilitation programs, employee assistance programs, programs within 
general hospitals, school-based programs, and private practitioners who 
hold themselves out as

[[Page 14]]

providing, and provide alcohol or drug abuse diagnosis, treatment, or 
referral for treatment. However, these regulations would not apply, for 
example, to emergency room personnel who refer a patient to the 
intensive care unit for an apparent overdose, unless the primary 
function of such personnel is the provision of alcohol or drug abuse 
diagnosis, treatment or referral and they are identified as providing 
such services or the emergency room has promoted itself to the community 
as a provider of such services.
    (2) Federal assistance to program required. If a patient's alcohol 
or drug abuse diagnosis, treatment, or referral for treatment is not 
provided by a program which is federally conducted, regulated or 
supported in a manner which constitutes Federal assistance under 
Sec. 2.12(b), that patient's record is not covered by these regulations. 
Thus, it is possible for an individual patient to benefit from Federal 
support and not be covered by the confidentiality regulations because 
the program in which the patient is enrolled is not federally assisted 
as defined in Sec. 2.12(b). For example, if a Federal court placed an 
individual in a private for-profit program and made a payment to the 
program on behalf of that individual, that patient's record would not be 
covered by these regulations unless the program itself received Federal 
assistance as defined by Sec. 2.12(b).
    (3) Information to which restrictions are applicable. Whether a 
restriction is on use or disclosure affects the type of information 
which may be available. The restrictions on disclosure apply to any 
information which would identify a patient as an alcohol or drug abuser. 
The restriction on use of information to bring criminal charges against 
a patient for a crime applies to any information obtained by the program 
for the purpose of diagnosis, treatment, or referral for treatment of 
alcohol or drug abuse. (Note that restrictions on use and disclosure 
apply to recipients of information under Sec. 2.12(d).)
    (4) How type of diagnosis affects coverage. These regulations cover 
any record of a diagnosis identifying a patient as an alcohol or drug 
abuser which is prepared in connection with the treatment or referral 
for treatment of alcohol or drug abuse. A diagnosis prepared for the 
purpose of treatment or referral for treatment but which is not so used 
is covered by these regulations. The following are not covered by these 
regulations:
    (i) Diagnosis which is made solely for the purpose of providing 
evidence for use by law enforcement authorities; or
    (ii) A diagnosis of drug overdose or alcohol intoxication which 
clearly shows that the individual involved is not an alcohol or drug 
abuser (e.g., involuntary ingestion of alcohol or drugs or reaction to a 
prescribed dosage of one or more drugs).

[52 FR 21809, June 9, 1987; 52 FR 42061, Nov. 2, 1987, as amended at 60 
FR 22297, May 5, 1995]



Sec. 2.13  Confidentiality restrictions.

    (a) General. The patient records to which these regulations apply 
may be disclosed or used only as permitted by these regulations and may 
not otherwise be disclosed or used in any civil, criminal, 
administrative, or legislative proceedings conducted by any Federal, 
State, or local authority. Any disclosure made under these regulations 
must be limited to that information which is necessary to carry out the 
purpose of the disclosure.
    (b) Unconditional compliance required. The restrictions on 
disclosure and use in these regulations apply whether the holder of the 
information believes that the person seeking the information already has 
it, has other means of obtaining it, is a law enforcement or other 
official, has obtained a subpoena, or asserts any other justification 
for a disclosure or use which is not permitted by these regulations.
    (c) Acknowledging the presence of patients: Responding to requests. 
(1) The presence of an identified patient in a facility or component of 
a facility which is publicly identified as a place where only alcohol or 
drug abuse diagnosis, treatment, or referral is provided may be 
acknowledged only if the patient's written consent is obtained in 
accordance with subpart C of these regulations or if an authorizing 
court order is entered in accordance with subpart E of these 
regulations. The regulations permit acknowledgement of the presence of 
an identified patient in a facility or part of a facility if the

[[Page 15]]

facility is not publicy identified as only an alcohol or drug abuse 
diagnosis, treatment or referral facility, and if the acknowledgement 
does not reveal that the patient is an alcohol or drug abuser.
    (2) Any answer to a request for a disclosure of patient records 
which is not permissible under these regulations must be made in a way 
that will not affirmatively reveal that an identified individual has 
been, or is being diagnosed or treated for alcohol or drug abuse. An 
inquiring party may be given a copy of these regulations and advised 
that they restrict the disclosure of alcohol or drug abuse patient 
records, but may not be told affirmatively that the regulations restrict 
the disclosure of the records of an identified patient. The regulations 
do not restrict a disclosure that an identified individual is not and 
never has been a patient.



Sec. 2.14  Minor patients.

    (a) Definition of minor. As used in these regulations the term 
``minor'' means a person who has not attained the age of majority 
specified in the applicable State law, or if no age of majority is 
specified in the applicable State law, the age of eighteen years.
    (b) State law not requiring parental consent to treatment. If a 
minor patient acting alone has the legal capacity under the applicable 
State law to apply for and obtain alcohol or drug abuse treatment, any 
written consent for disclosure authorized under subpart C of these 
regulations may be given only by the minor patient. This restriction 
includes, but is not limited to, any disclosure of patient identifying 
information to the parent or guardian of a minor patient for the purpose 
of obtaining financial reimbursement. These regulations do not prohibit 
a program from refusing to provide treatment until the minor patient 
consents to the disclosure necessary to obtain reimbursement, but 
refusal to provide treatment may be prohibited under a State or local 
law requiring the program to furnish the service irrespective of ability 
to pay.
    (c) State law requiring parental consent to treatment. (1) Where 
State law requires consent of a parent, guardian, or other person for a 
minor to obtain alcohol or drug abuse treatment, any written consent for 
disclosure authorized under subpart C of these regulations must be given 
by both the minor and his or her parent, guardian, or other person 
authorized under State law to act in the minor's behalf.
    (2) Where State law requires parental consent to treatment the fact 
of a minor's application for treatment may be communicated to the 
minor's parent, guardian, or other person authorized under State law to 
act in the minor's behalf only if:
    (i) The minor has given written consent to the disclosure in 
accordance with subpart C of these regulations or
    (ii) The minor lacks the capacity to make a rational choice 
regarding such consent as judged by the program director under paragraph 
(d) of this section.
    (d) Minor applicant for services lacks capacity for rational choice. 
Facts relevant to reducing a threat to the life or physical well being 
of the applicant or any other individual may be disclosed to the parent, 
guardian, or other person authorized under State law to act in the 
minor's behalf if the program director judges that:
    (1) A minor applicant for services lacks capacity because of extreme 
youth or mental or physical condition to make a rational decision on 
whether to consent to a disclosure under subpart C of these regulations 
to his or her parent, guardian, or other person authorized under State 
law to act in the minor's behalf, and
    (2) The applicant's situation poses a substantial threat to the life 
or physical well being of the applicant or any other individual which 
may be reduced by communicating relevant facts to the minor's parent, 
guardian, or other person authorized under State law to act in the 
minor's behalf.



Sec. 2.15  Incompetent and deceased patients.

    (a) Incompetent patients other than minors--(1) Adjudication of 
incompetence. In the case of a patient who has been adjudicated as 
lacking the capacity, for any reason other than insufficient age, to 
manage his or her own affairs, any consent which is required under these 
regulations may be given by the

[[Page 16]]

guardian or other person authorized under State law to act in the 
patient's behalf.
    (2) No adjudication of incompetency. For any period for which the 
program director determines that a patient, other than a minor or one 
who has been adjudicated incompetent, suffers from a medical condition 
that prevents knowing or effective action on his or her own behalf, the 
program director may exercise the right of the patient to consent to a 
disclosure under subpart C of these regulations for the sole purpose of 
obtaining payment for services from a third party payer.
    (b) Deceased patients--(1) Vital statistics. These regulations do 
not restrict the disclosure of patient identifying information relating 
to the cause of death of a patient under laws requiring the collection 
of death or other vital statistics or permitting inquiry into the cause 
of death.
    (2) Consent by personal representative. Any other disclosure of 
information identifying a deceased patient as an alcohol or drug abuser 
is subject to these regulations. If a written consent to the disclosure 
is required, that consent may be given by an executor, administrator, or 
other personal representative appointed under applicable State law. If 
there is no such appointment the consent may be given by the patient's 
spouse or, if none, by any responsible member of the patient's family.



Sec. 2.16  Security for written records.

    (a) Written records which are subject to these regulations must be 
maintained in a secure room, locked file cabinet, safe or other similar 
container when not in use; and
    (b) Each program shall adopt in writing procedures which regulate 
and control access to and use of written records which are subject to 
these regulations.



Sec. 2.17  Undercover agents and informants.

    (a) Restrictions on placement. Except as specifically authorized by 
a court order granted under Sec. 2.67 of these regulations, no program 
may knowingly employ, or enroll as a patient, any undercover agent or 
informant.
    (b) Restriction on use of information. No information obtained by an 
undercover agent or informant, whether or not that undercover agent or 
informant is placed in a program pursuant to an authorizing court order, 
may be used to criminally investigate or prosecute any patient.

[52 FR 21809, June 9, 1987; 52 FR 42061, Nov. 2, 1987]



Sec. 2.18  Restrictions on the use of identification cards.

    No person may require any patient to carry on his or her person 
while away from the program premises any card or other object which 
would identify the patient as an alcohol or drug abuser. This section 
does not prohibit a person from requiring patients to use or carry cards 
or other identification objects on the premises of a program.



Sec. 2.19  Disposition of records by discontinued programs.

    (a) General. If a program discontinues operations or is taken over 
or acquired by another program, it must purge patient identifying 
information from its records or destroy the records unless--
    (1) The patient who is the subject of the records gives written 
consent (meeting the requirements of Sec. 2.31) to a transfer of the 
records to the acquiring program or to any other program designated in 
the consent (the manner of obtaining this consent must minimize the 
likelihood of a disclosure of patient identifying information to a third 
party); or
    (2) There is a legal requirement that the records be kept for a 
period specified by law which does not expire until after the 
discontinuation or acquisition of the program.
    (b) Procedure where retention period required by law. If paragraph 
(a)(2) of this section applies, the records must be:
    (1) Sealed in envelopes or other containers labeled as follows: 
``Records of [insert name of program] required to be maintained under 
[insert citation to statute, regulation, court order or other legal 
authority requiring that records be kept] until a date not later than 
[insert appropriate date]''; and
    (2) Held under the restrictions of these regulations by a 
responsible person who must, as soon as practicable

[[Page 17]]

after the end of the retention period specified on the label, destroy 
the records.



Sec. 2.20  Relationship to State laws.

    The statutes authorizing these regulations (42 U.S.C. 290ee-3 and 42 
U.S.C. 290dd-3) do not preempt the field of law which they cover to the 
exclusion of all State laws in that field. If a disclosure permitted 
under these regulations is prohibited under State law, neither these 
regulations nor the authorizing statutes may be construed to authorize 
any violation of that State law. However, no State law may either 
authorize or compel any disclosure prohibited by these regulations.



Sec. 2.21  Relationship to Federal statutes protecting research subjects against compulsory disclosure of their identity.

    (a) Research privilege description. There may be concurrent coverage 
of patient identifying information by these regulations and by 
administrative action taken under: Section 303(a) of the Public Health 
Service Act (42 U.S.C. 242a(a) and the implementing regulations at 42 
CFR part 2a); or section 502(c) of the Controlled Substances Act (21 
U.S.C. 872(c) and the implementing regulations at 21 CFR 1316.21). These 
``research privilege'' statutes confer on the Secretary of Health and 
Human Services and on the Attorney General, respectively, the power to 
authorize researchers conducting certain types of research to withhold 
from all persons not connected with the research the names and other 
identifying information concerning individuals who are the subjects of 
the research.
    (b) Effect of concurrent coverage. These regulations restrict the 
disclosure and use of information about patients, while administrative 
action taken under the research privilege statutes and implementing 
regulations protects a person engaged in applicable research from being 
compelled to disclose any identifying characteristics of the individuals 
who are the subjects of that research. The issuance under subpart E of 
these regulations of a court order authorizing a disclosure of 
information about a patient does not affect an exercise of authority 
under these research privilege statutes. However, the research privilage 
granted under 21 CFR 291.505(g) to treatment programs using methadone 
for maintenance treatment does not protect from compulsory disclosure 
any imformation which is permitted to be disclosed under those 
regulations. Thus, if a court order entered in accordance with subpart E 
of these regulations authorizes a methadone maintenance treatment 
program to disclose certain information about its patients, that program 
may not invoke the research privilege under 21 CFR 291.505(g) as a 
defense to a subpoena for that information.



Sec. 2.22  Notice to patients of Federal confidentiality requirements.

    (a) Notice required. At the time of admission or as soon threreafter 
as the patient is capable of rational communication, each program shall:
    (1) Communicate to the patient that Federal law and regulations 
protect the confidentiality of alcohol and drug abuse patient records; 
and
    (2) Give to the patient a summary in writing of the Federal law and 
regulations.
    (b) Required elements of written summary. The written summary of the 
Federal law and regulations must include:
    (1) A general description of the limited circumstances under which a 
program may acknowledge that an individual is present at a facility or 
disclose outside the program information identifying a patient as an 
alcohol or drug abuser.
    (2) A statement that violation of the Federal law and regulations by 
a program is a crime and that suspected violations may be reported to 
appropriate authorities in accordance with these regulations.
    (3) A statement that information related to a patient's commission 
of a crime on the premises of the program or against personnel of the 
program is not protected.
    (4) A statement that reports of suspected child abuse and neglect 
made under State law to appropriate State or local authorities are not 
protected.
    (5) A citation to the Federal law and regulations.
    (c) Program options. The program may devise its own notice or may 
use the

[[Page 18]]

sample notice in paragraph (d) to comply with the requirement to provide 
the patient with a summary in writing of the Federal law and 
regulations. In addition, the program may include in the written summary 
information concerning State law and any program policy not inconsistent 
with State and Federal law on the subject of confidentiality of alcohol 
and drug abuse patient records.
    (d) Sample notice.

        Confidentiality of Alcohol and Drug Abuse Patient Records

    The confidentiality of alcohol and drug abuse patient records 
maintained by this program is protected by Federal law and regulations. 
Generally, the program may not say to a person outside the program that 
a patient attends the program, or disclose any information identifying a 
patient as an alcohol or drug abuser Unless:
    (1) The patient consents in writing:
    (2) The disclosure is allowed by a court order; or
    (3) The disclosure is made to medical personnel in a medical 
emergency or to qualified personnel for research, audit, or program 
evaluation.
    Violation of the Federal law and regulations by a program is a 
crime. Suspected violations may be reported to appropriate authorities 
in accordance with Federal regulations.
    Federal law and regulations do not protect any information about a 
crime committed by a patient either at the program or against any person 
who works for the program or about any threat to commit such a crime.
    Federal laws and regulations do not protect any information about 
suspected child abuse or neglect from being reported under State law to 
appropriate State or local authorities.

(See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal laws and 42 CFR 
part 2 for Federal regulations.)


(Approved by the Office of Management and Budget under control number 
0930-0099)



Sec. 2.23  Patient access and restrictions on use.

    (a) Patient access not prohibited. These regulations do not prohibit 
a program from giving a patient access to his or her own records, 
including the opportunity to inspect and copy any records that the 
program maintains about the patient. The program is not required to 
obtain a patient's written consent or other authorization under these 
regulations in order to provide such access to the patient.
    (b) Restriction on use of information. Information obtained by 
patient access to his or her patient record is subject to the 
restriction on use of his information to initiate or substantiate any 
criminal charges against the patient or to conduct any criminal 
investigation of the patient as provided for under Sec. 2.12(d)(1).



              Subpart C--Disclosures With Patient's Consent



Sec. 2.31  Form of written consent.

    (a) Required elements. A written consent to a disclosure under these 
regulations must include:
    (1) The specific name or general designation of the program or 
person permitted to make the disclosure.
    (2) The name or title of the individual or the name of the 
organization to which disclosure is to be made.
    (3) The name of the patient.
    (4) The purpose of the disclosure.
    (5) How much and what kind of information is to be disclosed.
    (6) The signature of the patient and, when required for a patient 
who is a minor, the signature of a person authorized to give consent 
under Sec. 2.14; or, when required for a patient who is incompetent or 
deceased, the signature of a person authorized to sign under Sec. 2.15 
in lieu of the patient.
    (7) The date on which the consent is signed.
    (8) A statement that the consent is subject to revocation at any 
time except to the extent that the program or person which is to make 
the disclosure has already acted in reliance on it. Acting in reliance 
includes the provision of treatment services in reliance on a valid 
consent to disclose information to a third party payer.
    (9) The date, event, or condition upon which the consent will expire 
if not revoked before. This date, event, or condition must insure that 
the consent will last no longer than reasonably necessary to serve the 
purpose for which it is given.
    (b) Sample consent form. The following form complies with paragraph 
(a) of this section, but other elements may be added.


[[Page 19]]


1. I (name of patient) {time}  Request {time}  Authorize:
2. (name or general designation of program which is to make the 
disclosure)
_______________________________________________________________________
3. To disclose: (kind and amount of information to be disclosed)
_______________________________________________________________________
4. To: (name or title of the person or organization to which disclosure 
is to be made)
_______________________________________________________________________
5. For (purpose of the disclosure)
_______________________________________________________________________
6. Date (on which this consent is signed)
_______________________________________________________________________
7. Signature of patient
_______________________________________________________________________
8. Signature of parent or guardian (where required)
_______________________________________________________________________
9. Signature of person authorized to sign in lieu of the patient (where 
required)
_______________________________________________________________________
10. This consent is subject to revocation at any time except to the 
extent that the program which is to make the disclosure has already 
taken action in reliance on it. If not previously revoked, this consent 
will terminate upon: (specific date, event, or condition)

    (c) Expired, deficient, or false consent. A disclosure may not be 
made on the basis of a consent which:
    (1) Has expired;
    (2) On its face substantially fails to conform to any of the 
requirements set forth in paragraph (a) of this section;
    (3) Is known to have been revoked; or
    (4) Is known, or through a reasonable effort could be known, by the 
person holding the records to be materially false.

(Approved by the Office of Management and Budget under control number 
0930-0099)



Sec. 2.32  Prohibition on redisclosure.

    Notice to accompany disclosure. Each disclosure made with the 
patient's written consent must be accompanied by the following written 
statement:

    This information has been disclosed to you from records protected by 
Federal confidentiality rules (42 CFR part 2). The Federal rules 
prohibit you from making any further disclosure of this information 
unless further disclosure is expressly permitted by the written consent 
of the person to whom it pertains or as otherwise permitted by 42 CFR 
part 2. A general authorization for the release of medical or other 
information is NOT sufficient for this purpose. The Federal rules 
restrict any use of the information to criminally investigate or 
prosecute any alcohol or drug abuse patient.

[52 FR 21809, June 9, 1987; 52 FR 41997, Nov. 2, 1987]



Sec. 2.33  Disclosures permitted with written consent.

    If a patient consents to a disclosure of his or her records under 
Sec. 2.31, a program may disclose those records in accordance with that 
consent to any individual or organization named in the consent, except 
that disclosures to central registries and in connection with criminal 
justice referrals must meet the requirements of Secs. 2.34 and 2.35, 
respectively.



Sec. 2.34  Disclosures to prevent multiple enrollments in detoxification and maintenance treatment programs.

    (a) Definitions. For purposes of this section:
    Central registry means an organization which obtains from two or 
more member progams patient identifying information about individuals 
applying for maintenance treatment or detoxification treatment for the 
purpose of avoiding an individual's concurrent enrollment in more than 
one program.
    Detoxification treatment means the dispensing of a narcotic drug in 
decreasing doses to an individual in order to reduce or eliminate 
adverse physiological or psychological effects incident to withdrawal 
from the sustained use of a narcotic drug.
    Maintenance treatment means the dispensing of a narcotic drug in the 
treatment of an individual for dependence upon heroin or other morphine-
like drugs.
    Member program means a detoxification treatment or maintenance 
treatment program which reports patient identifying information to a 
central registry and which is in the same State as that central registry 
or is not more than 125 miles from any border of the State in which the 
central registry is located.
    (b) Restrictions on disclosure. A program may disclose patient 
records to a central registry or to any detoxification or maintenance 
treatment program not more than 200 miles away for the purpose of 
preventing the multiple enrollment of a patient only if:

[[Page 20]]

    (1) The disclosure is made when:
    (i) The patient is accepted for treatment;
    (ii) The type or dosage of the drug is changed; or
    (iii) The treatment is interrupted, resumed or terminated.
    (2) The disclosure is limited to:
    (i) Patient identifying information;
    (ii) Type and dosage of the drug; and
    (iii) Relevant dates.
    (3) The disclosure is made with the patient's written consent 
meeting the requirements of Sec. 2.31, except that:
    (i) The consent must list the name and address of each central 
registry and each known detoxification or maintenance treatment program 
to which a disclosure will be made; and
    (ii) The consent may authorize a disclosure to any detoxification or 
maintenance treatment program established within 200 miles of the 
program after the consent is given without naming any such program.
    (c) Use of information limited to prevention of multiple 
enrollments. A central registry and any detoxification or maintenance 
treatment program to which information is disclosed to prevent multiple 
enrollments may not redisclose or use patient identifying information 
for any purpose other than the prevention of multiple enrollments unless 
authorized by a court order under subpart E of these regulations.
    (d) Permitted disclosure by a central registry to prevent a multiple 
enrollment. When a member program asks a central registry if an 
identified patient is enrolled in another member program and the 
registry determines that the patient is so enrolled, the registry may 
disclose--
    (1) The name, address, and telephone number of the member program(s) 
in which the patient is already enrolled to the inquiring member 
program; and
    (2) The name, address, and telephone number of the inquiring member 
program to the member program(s) in which the patient is already 
enrolled. The member programs may communicate as necessary to verify 
that no error has been made and to prevent or eliminate any multiple 
enrollment.
    (e) Permitted disclosure by a detoxification or maintenance 
treatment program to prevent a multiple enrollment. A detoxification or 
maintenance treatment program which has received a disclosure under this 
section and has determined that the patient is already enrolled may 
communicate as necessary with the program making the disclosure to 
verify that no error has been made and to prevent or eliminate any 
multiple enrollment.



Sec. 2.35  Disclosures to elements of the criminal justice system which have referred patients.

    (a) A program may disclose information about a patient to those 
persons within the criminal justice system which have made participation 
in the program a condition of the disposition of any criminal 
proceedings against the patient or of the patient's parole or other 
release from custody if:
    (1) The disclosure is made only to those individuals within the 
criminal justice system who have a need for the information in 
connection with their duty to monitor the patient's progress (e.g., a 
prosecuting attorney who is withholding charges against the patient, a 
court granting pretrial or posttrial release, probation or parole 
officers responsible for supervision of the patient); and
    (2) The patient has signed a written consent meeting the 
requirements of Sec. 2.31 (except paragraph (a)(8) which is inconsistent 
with the revocation provisions of paragraph (c) of this section) and the 
requirements of paragraphs (b) and (c) of this section.
    (b) Duration of consent. The written consent must state the period 
during which it remains in effect. This period must be reasonable, 
taking into account:
    (1) The anticipated length of the treatment;
    (2) The type of criminal proceeding involved, the need for the 
information in connection with the final disposition of that proceeding, 
and when the final disposition will occur; and
    (3) Such other factors as the program, the patient, and the 
person(s) who will receive the disclosure consider pertinent.
    (c) Revocation of consent. The written consent must state that it is 
revocable upon the passage of a specified amount of time or the 
occurrence of a specified,

[[Page 21]]

ascertainable event. The time or occurrence upon which consent becomes 
revocable may be no later than the final disposition of the conditional 
release or other action in connection with which consent was given.
    (d) Restrictions on redisclosure and use. A person who receives 
patient information under this section may redisclose and use it only to 
carry out that person's official duties with regard to the patient's 
conditional release or other action in connection with which the consent 
was given.



             Subpart D--Disclosures Without Patient Consent



Sec. 2.51  Medical emergencies.

    (a) General Rule. Under the procedures required by paragraph (c) of 
this section, patient identifying information may be disclosed to 
medical personnel who have a need for information about a patient for 
the purpose of treating a condition which poses an immediate threat to 
the health of any individual and which requires immediate medical 
intervention.
    (b) Special Rule. Patient identifying information may be disclosed 
to medical personnel of the Food and Drug Administration (FDA) who 
assert a reason to believe that the health of any individual may be 
threatened by an error in the manufacture, labeling, or sale of a 
product under FDA jurisdiction, and that the information will be used 
for the exclusive purpose of notifying patients or their physicians of 
potential dangers.
    (c) Procedures. Immediately following disclosure, the program shall 
document the disclosure in the patient's records, setting forth in 
writing:
    (1) The name of the medical personnel to whom disclosure was made 
and their affiliation with any health care facility;
    (2) The name of the individual making the disclosure;
    (3) The date and time of the disclosure; and
    (4) The nature of the emergency (or error, if the report was to 
FDA).

(Approved by the Office of Management and Budget under control number 
0930-0099)



Sec. 2.52  Research activities.

    (a) Patient identifying information may be disclosed for the purpose 
of conducting scientific research if the program director makes a 
determination that the recipient of the patient identifying information:
    (1) Is qualified to conduct the research;
    (2) Has a research protocol under which the patient identifying 
information:
    (i) Will be maintained in accordance with the security requirements 
of Sec. 2.16 of these regulations (or more stringent requirements); and
    (ii) Will not be redisclosed except as permitted under paragraph (b) 
of this section; and
    (3) Has provided a satisfactory written statement that a group of 
three or more individuals who are independent of the research project 
has reviewed the protocol and determined that:
    (i) The rights and welfare of patients will be adequately protected; 
and
    (ii) The risks in disclosing patient identifying information are 
outweighed by the potential benefits of the research.
    (b) A person conducting research may disclose patient identifying 
information obtained under paragraph (a) of this section only back to 
the program from which that information was obtained and may not 
identify any individual patient in any report of that research or 
otherwise disclose patient identities.

[52 FR 21809, June 9, 1987, as amended at 52 FR 41997, Nov. 2, 1987]



Sec. 2.53  Audit and evaluation activities.

    (a) Records not copied or removed. If patient records are not copied 
or removed, patient identifying information may be disclosed in the 
course of a review of records on program premises to any person who 
agrees in writing to comply with the limitations on redisclosure and use 
in paragraph (d) of this section and who:
    (1) Performs the audit or evaluation activity on behalf of:
    (i) Any Federal, State, or local governmental agency which provides 
financial assistance to the program or is

[[Page 22]]

authorized by law to regulate its activities; or
    (ii) Any private person which provides financial assistance to the 
program, which is a third party payer covering patients in the program, 
or which is a peer review organization performing a utilization or 
quality control review; or
    (2) Is determined by the program director to be qualified to conduct 
the audit or evaluation activities.
    (b) Copying or removal of records. Records containing patient 
identifying information may be copied or removed from program premises 
by any person who:
    (1) Agrees in writing to:
    (i) Maintain the patient identifying information in accordance with 
the security requirements provided in Sec. 2.16 of these regulations (or 
more stringent requirements);
    (ii) Destroy all the patient identifying information upon completion 
of the audit or evaluation; and
    (iii) Comply with the limitations on disclosure and use in paragraph 
(d) of this section; and
    (2) Performs the audit or evaluation activity on behalf of:
    (i) Any Federal, State, or local governmental agency which provides 
financial assistance to the program or is authorized by law to regulate 
its activities; or
    (ii) Any private person which provides financial assistance to the 
program, which is a third part payer covering patients in the program, 
or which is a peer review organization performing a utilization or 
quality control review.
    (c) Medicare or Medicaid audit or evaluation. (1) For purposes of 
Medicare or Medicaid audit or evaluation under this section, audit or 
evaluation includes a civil or administrative investigation of the 
program by any Federal, State, or local agency responsible for oversight 
of the Medicare or Medicaid program and includes administrative 
enforcement, against the program by the agency, of any remedy authorized 
by law to be imposed as a result of the findings of the investigation.
    (2) Consistent with the definition of program in Sec. 2.11, program 
includes an employee of, or provider of medical services under, the 
program when the employee or provider is the subject of a civil 
investigation or administrative remedy, as those terms are used in 
paragraph (c)(1) of this section.
    (3) If a disclosure to a person is authorized under this section for 
a Medicare or Medicaid audit or evaluation, including a civil 
investigation or administrative remedy, as those terms are used in 
paragraph (c)(1) of this section, then a peer review organization which 
obtains the information under paragraph (a) or (b) may disclose the 
information to that person but only for purposes of Medicare or Medicaid 
audit or evaluation.
    (4) The provisions of this paragraph do not authorize the agency, 
the program, or any other person to disclose or use patient identifying 
information obtained during the audit or evaluation for any purposes 
other than those necessary to complete the Medicare or Medicaid audit or 
evaluation activity as specified in this paragraph.
    (d) Limitations on disclosure and use. Except as provided in 
paragraph (c) of this section, patient identifying information disclosed 
under this section may be disclosed only back to the program from which 
it was obtained and used only to carry out an audit or evaluation 
purpose or to investigate or prosecute criminal or other activities, as 
authorized by a court order entered under Sec. 2.66 of these 
regulations.



         Subpart E--Court Orders Authorizing Disclosure and Use



Sec. 2.61  Legal effect of order.

    (a) Effect. An order of a court of competent jurisdiction entered 
under this subpart is a unique kind of court order. Its only purpose is 
to authorize a disclosure or use of patient information which would 
otherwise be prohibited by 42 U.S.C. 290ee-3, 42 U.S.C. 290dd-3 and 
these regulations. Such an order does not compel disclosure. A subpoena 
or a similar legal mandate must be issued in order to compel disclosure. 
This mandate may be entered at the same time as and accompany an 
authorizing court order entered under these regulations.

[[Page 23]]

    (b) Examples. (1) A person holding records subject to these 
regulations receives a subpoena for those records: a response to the 
subpoena is not permitted under the regulations unless an authorizing 
court order is entered. The person may not disclose the records in 
response to the subpoena unless a court of competent jurisdiction enters 
an authorizing order under these regulations.
    (2) An authorizing court order is entered under these regulations, 
but the person authorized does not want to make the disclosure. If there 
is no subpoena or other compulsory process or a subpoena for the records 
has expired or been quashed, that person may refuse to make the 
disclosure. Upon the entry of a valid subpoena or other compulsory 
process the person authorized to disclose must disclose, unless there is 
a valid legal defense to the process other than the confidentiality 
restrictions of these regulations.

[52 FR 21809, June 9, 1987; 52 FR 42061, Nov. 2, 1987]



Sec. 2.62  Order not applicable to records disclosed without consent to researchers, auditors and evaluators.

    A court order under these regulations may not authorize qualified 
personnel, who have received patient identifying information without 
consent for the purpose of conducting research, audit or evaluation, to 
disclose that information or use it to conduct any criminal 
investigation or prosecution of a patient. However, a court order under 
Sec. 2.66 may authorize disclosure and use of records to investigate or 
prosecute qualified personnel holding the records.



Sec. 2.63  Confidential communications.

    (a) A court order under these regulations may authorize disclosure 
of confidential communications made by a patient to a program in the 
course of diagnosis, treatment, or referral for treatment only if:
    (1) The disclosure is necessary to protect against an existing 
threat to life or of serious bodily injury, including circumstances 
which constitute suspected child abuse and neglect and verbal threats 
against third parties;
    (2) The disclosure is necessary in connection with investigation or 
prosecution of an extremely serious crime, such as one which directly 
threatens loss of life or serious bodily injury, including homicide, 
rape, kidnapping, armed robbery, assault with a deadly weapon, or child 
abuse and neglect; or
    (3) The disclosure is in connection with litigation or an 
administrative proceeding in which the patient offers testimony or other 
evidence pertaining to the content of the confidential communications.
    (b) [Reserved]



Sec. 2.64  Procedures and criteria for orders authorizing disclosures for noncriminal purposes.

    (a) Application. An order authorizing the disclosure of patient 
records for purposes other than criminal investigation or prosecution 
may be applied for by any person having a legally recognized interest in 
the disclosure which is sought. The application may be filed separately 
or as part of a pending civil action in which it appears that the 
patient records are needed to provide evidence. An application must use 
a fictitious name, such as John Doe, to refer to any patient and may not 
contain or otherwise disclose any patient identifying information unless 
the patient is the applicant or has given a written consent (meeting the 
requirements of these regulations) to disclosure or the court has 
ordered the record of the proceeding sealed from public scrunity.
    (b) Notice. The patient and the person holding the records from whom 
disclosure is sought must be given:
    (1) Adequate notice in a manner which will not disclose patient 
identifying information to other persons; and
    (2) An opportunity to file a written response to the application, or 
to appear in person, for the limited purpose of providing evidence on 
the statutory and regulatory criteria for the issuance of the court 
order.
    (c) Review of evidence: Conduct of hearing. Any oral argument, 
review of evidence, or hearing on the application must be held in the 
judge's chambers or in some manner which ensures that patient 
identifying information is not disclosed to anyone other than a party to 
the proceeding, the patient, or the person holding the record, unless 
the patient requests an open hearing in a

[[Page 24]]

manner which meets the written consent requirements of these 
regulations. The proceeding may include an examination by the judge of 
the patient records referred to in the application.
    (d) Criteria for entry of order. An order under this section may be 
entered only if the court determines that good cause exists. To make 
this determination the court must find that:
    (1) Other ways of obtaining the information are not available or 
would not be effective; and
    (2) The public interest and need for the disclosure outweigh the 
potential injury to the patient, the physician-patient relationship and 
the treatment services.
    (e) Content of order. An order authorizing a disclosure must:
    (1) Limit disclosure to those parts of the patient's record which 
are essential to fulfill the objective of the order;
    (2) Limit disclosure to those persons whose need for information is 
the basis for the order; and
    (3) Include such other measures as are necessary to limit disclosure 
for the protection of the patient, the physician-patient relationship 
and the treatment services; for example, sealing from public scrutiny 
the record of any proceeding for which disclosure of a patient's record 
has been ordered.



Sec. 2.65  Procedures and criteria for orders authorizing disclosure and use of records to criminally investigate or prosecute patients.

    (a) Application. An order authorizing the disclosure or use of 
patient records to criminally investigate or prosecute a patient may be 
applied for by the person holding the records or by any person 
conducting investigative or prosecutorial activities with respect to the 
enforcement of criminal laws. The application may be filed separately, 
as part of an application for a subpoena or other compulsory process, or 
in a pending criminal action. An application must use a fictitious name 
such as John Doe, to refer to any patient and may not contain or 
otherwise disclose patient identifying information unless the court has 
ordered the record of the proceeding sealed from public scrutiny.
    (b) Notice and hearing. Unless an order under Sec. 2.66 is sought 
with an order under this section, the person holding the records must be 
given:
    (1) Adequate notice (in a manner which will not disclose patient 
identifying information to third parties) of an application by a person 
performing a law enforcement function;
    (2) An opportunity to appear and be heard for the limited purpose of 
providing evidence on the statutory and regulatory criteria for the 
issuance of the court order; and
    (3) An opportunity to be represented by counsel independent of 
counsel for an applicant who is a person performing a law enforcement 
function.
    (c) Review of evidence: Conduct of hearings. Any oral argument, 
review of evidence, or hearing on the application shall be held in the 
judge's chambers or in some other manner which ensures that patient 
identifying information is not disclosed to anyone other than a party to 
the proceedings, the patient, or the person holding the records. The 
proceeding may include an examination by the judge of the patient 
records referred to in the application.
    (d) Criteria. A court may authorize the disclosure and use of 
patient records for the purpose of conducting a criminal investigation 
or prosecution of a patient only if the court finds that all of the 
following criteria are met:
    (1) The crime involved is extremely serious, such as one which 
causes or directly threatens loss of life or serious bodily injury 
including homicide, rape, kidnapping, armed robbery, assault with a 
deadly weapon, and child abuse and neglect.
    (2) There is a reasonable likelihood that the records will disclose 
information of substantial value in the investigation or prosecution.
    (3) Other ways of obtaining the information are not available or 
would not be effective.
    (4) The potential injury to the patient, to the physician-patient 
relationship and to the ability of the program to provide services to 
other patients is outweighed by the public interest and the need for the 
disclosure.
    (5) If the applicant is a person performing a law enforcement 
function that:
    (i) The person holding the records has been afforded the opportunity 
to be

[[Page 25]]

represented by independent counsel; and
    (ii) Any person holding the records which is an entity within 
Federal, State, or local government has in fact been represented by 
counsel independent of the applicant.
    (e) Content of order. Any order authorizing a disclosure or use of 
patient records under this section must:
    (1) Limit disclosure and use to those parts of the patient's record 
which are essential to fulfill the objective of the order;
    (2) Limit disclosure to those law enforcement and prosecutorial 
officials who are responsible for, or are conducting, the investigation 
or prosecution, and limit their use of the records to investigation and 
prosecution of extremely serious crime or suspected crime specified in 
the application; and
    (3) Include such other measures as are necessary to limit disclosure 
and use to the fulfillment of only that public interest and need found 
by the court.

[52 FR 21809, June 9, 1987; 52 FR 42061, Nov. 2, 1987]



Sec. 2.66  Procedures and criteria for orders authorizing disclosure and use of records to investigate or prosecute a program or the person holding the records.

    (a) Application. (1) An order authorizing the disclosure or use of 
patient records to criminally or administratively investigate or 
prosecute a program or the person holding the records (or employees or 
agents of that program or person) may be applied for by any 
administrative, regulatory, supervisory, investigative, law enforcement, 
or prosecutorial agency having jurisdiction over the program's or 
person's activities.
    (2) The application may be filed separately or as part of a pending 
civil or criminal action against a program or the person holding the 
records (or agents or employees of the program or person) in which it 
appears that the patient records are needed to provide material 
evidence. The application must use a fictitious name, such as John Doe, 
to refer to any patient and may not contain or otherwise disclose any 
patient identifying information unless the court has ordered the record 
of the proceeding sealed from public scrutiny or the patient has given a 
written consent (meeting the requirements of Sec. 2.31 of these 
regulations) to that disclosure.
    (b) Notice not required. An application under this section may, in 
the discretion of the court, be granted without notice. Although no 
express notice is required to the program, to the person holding the 
records, or to any patient whose records are to be disclosed, upon 
implementation of an order so granted any of the above persons must be 
afforded an opportunity to seek revocation or amendment of that order, 
limited to the presentation of evidence on the statutory and regulatory 
criteria for the issuance of the court order.
    (c) Requirements for order. An order under this section must be 
entered in accordance with, and comply with the requirements of, 
paragraphs (d) and (e) of Sec. 2.64 of these regulations.
    (d) Limitations on disclosure and use of patient identifying 
information: (1) An order entered under this section must require the 
deletion of patient identifying information from any documents made 
available to the public.
    (2) No information obtained under this section may be used to 
conduct any investigation or prosecution of a patient, or be used as the 
basis for an application for an order under Sec. 2.65 of these 
regulations.



Sec. 2.67  Orders authorizing the use of undercover agents and informants to criminally investigate employees or agents of a program.

    (a) Application. A court order authorizing the placement of an 
undercover agent or informant in a program as an employee or patient may 
be applied for by any law enforcement or prosecutorial agency which has 
reason to believe that employees or agents of the program are engaged in 
criminal misconduct.
    (b) Notice. The program director must be given adequate notice of 
the application and an opportunity to appear and be heard (for the 
limited purpose of providing evidence on the statutory and regulatory 
criteria for the issuance of the court order), unless the application 
asserts a belief that:

[[Page 26]]

    (1) The program director is involved in the criminal activities to 
be investigated by the undercover agent or informant; or
    (2) The program director will intentionally or unintentionally 
disclose the proposed placement of an undercover agent or informant to 
the employees or agents who are suspected of criminal activities.
    (c) Criteria. An order under this section may be entered only if the 
court determines that good cause exists. To make this determination the 
court must find:
    (1) There is reason to believe that an employee or agent of the 
program is engaged in criminal activity;
    (2) Other ways of obtaining evidence of this criminal activity are 
not available or would not be effective; and
    (3) The public interest and need for the placement of an undercover 
agent or informant in the program outweigh the potential injury to 
patients of the program, physician-patient relationships and the 
treatment services.
    (d) Content of order. An order authorizing the placement of an 
undercover agent or informant in a program must:
    (1) Specifically authorize the placement of an undercover agent or 
an informant;
    (2) Limit the total period of the placement to six months;
    (3) Prohibit the undercover agent or informant from disclosing any 
patient identifying information obtained from the placement except as 
necessary to criminally investigate or prosecute employees or agents of 
the program; and
    (4) Include any other measures which are appropriate to limit any 
potential disruption of the program by the placement and any potential 
for a real or apparent breach of patient confidentiality; for example, 
sealing from public scrutiny the record of any proceeding for which 
disclosure of a patient's record has been ordered.
    (e) Limitation on use of information. No information obtained by an 
undercover agent or informant placed under this section may be used to 
criminally investigate or prosecute any patient or as the basis for an 
application for an order under Sec. 2.65 of these regulations.



PART 2a--PROTECTION OF IDENTITY--RESEARCH SUBJECTS--Table of Contents




Sec.
2a.1  Applicability.
2a.2  Definitions.
2a.3  Application; coordination.
2a.4  Contents of application; in general.
2a.5  Contents of application; research projects in which drugs will be 
          administered.
2a.6  Issuance of Confidentiality Certificates; single project 
          limitation.
2a.7  Effect of Confidentiality Certificate.
2a.8  Termination.

    Authority: Sec. 3(a), Pub. L. 91-513 as amended by sec. 122(b), Pub. 
L. 93-282; 84 Stat. 1241 (42 U.S.C. 242a(a)), as amended by 88 Stat. 
132.

    Source: 44 FR 20384, Apr. 4, l979, unless otherwise noted.



Sec. 2a.1  Applicability.

    (a) Section 303(a) of the Public Health Service Act (42 U.S.C. 
242a(a)) provides that ``[t]he Secretary [of Health and Human Services] 
may authorize persons engaged in research on mental health, including 
research on the use and effect of alcohol and other psychoactive drugs, 
to protect the privacy of individuals who are the subject of such 
research by withholding from all persons not connected with the conduct 
of such research the names or other identifying characteristics of such 
individuals. Persons so authorized to protect the privacy of such 
individuals may not be compelled in any Federal, State, or local civil, 
criminal, administrative, legislative, or other proceedings to identify 
such individuals.'' The regulations in this part establish procedures 
under which any person engaged in research on mental health including 
research on the use and effect of alcohol and other psychoactive drugs 
(whether or not the research is federally funded) may, subject to the 
exceptions set forth in paragraph (b) of this section, apply for such an 
authorization of confidentiality.
    (b) These regulations do not apply to:
    (1) Authorizations of confidentiality for research requiring an 
Investigational New Drug exemption under section 505(i) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 355(i)) or to approved new 
drugs, such as methadone, requiring continuation of long-

[[Page 27]]

term studies, records, and reports. Attention is called to 21 CFR 
291.505(g) relating to authorizations of confidentiality for patient 
records maintained by methadone treatment programs.
    (2) Authorizations of confidentiality for research which are related 
to law enforcement activities or otherwise within the purview of the 
Attorney General's authority to issue authorizations of confidentiality 
pursuant to section 502(c) of the Controlled Substances Act (21 U.S.C. 
872(c)) and 21 CFR 1316.21.
    (c) The Secretary's regulations on confidentiality of alcohol and 
drug abuse patient records (42 CFR part 2) and the regulations of this 
part may, in some instances, concurrently cover the same transaction. As 
explained in 42 CFR 2.24 and 2.24-1, 42 CFR part 2 restricts voluntary 
disclosures of information from applicable patient records while a 
Confidentiality Certificate issued pursuant to the regulations of this 
part protects a person engaged in applicable research from being 
compelled to disclose identifying characteristics of individuals who are 
the subject of such research.



Sec. 2a.2  Definitions.

    (a) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (b) Person means any individual, corporation, government, or 
governmental subdivision or agency, business trust, partnership, 
association, or other legal entity.
    (c) Research means systematic study directed toward new or fuller 
knowledge and understanding of the subject studied. The term includes, 
but is not limited to, behavioral science studies, surveys, evaluations, 
and clinical investigations.
    (d) Drug has the meaning given that term by section 201(g)(1) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(g)(1)).
    (e) Controlled drug means a drug which is included in schedule I, 
II, III, IV, or V of part B of the Controlled Substances Act (21 U.S.C. 
811-812).
    (f) Administer refers to the direct application of a drug to the 
body of a human research subject, whether such application be by 
injection, inhalation, ingestion, or any other means, by (1) a qualified 
person engaged in research (or, in his or her presence, by his or her 
authorized agent), or (2) a research subject in accordance with 
instructions of a qualified person engaged in research, whether or not 
in the presence of a qualified person engaged in research.
    (g) Identifying characteristics refers to the name, address, any 
identifying number, fingerprints, voiceprints, photographs or any other 
item or combination of data about a research subject which could 
reasonably lead directly or indirectly by reference to other information 
to identification of that research subject.
    (h) Psychoactive drug means, in addition to alcohol, any drug which 
has as its principal action an effect on thought, mood, or behavior.



Sec. 2a.3  Application; coordination.

    (a) Any person engaged in (or who intends to engage in) the research 
to which this part applies, who desires authorization to withhold the 
names and other identifying characteristics of individuals who are the 
subject of such research from any person or authority not connected with 
the conduct of such research may apply to the Office of the Director, 
National Institute on Drug Abuse, the Office of the Director, National 
Institute of Mental Health, or the Office of the Director, National 
Institute on Alcohol Abuse and Alcoholism, 5600 Fishers Lane, Rockville, 
Maryland 20857 for an authorization of confidentiality.
    (b) If there is uncertainty with regard to which Institute is 
appropriate or if the research project falls within the purview of more 
than one Institute, an application need be submitted only to one 
Institute. Persons who are uncertain with regard to the applicability of 
these regulations to a particular type of research may apply for an 
authorization of confidentiality under the regulations of this part to 
one of the Institutes. Requests which are within the scope of the 
authorities described

[[Page 28]]

in Sec. 2a.1(b) will be forwarded to the appropriate agency for 
consideration and the person will be advised accordingly.
    (c) An application may accompany, precede, or follow the sumission 
of a request for DHHS grant or contract assistance, though it is not 
necessary to request DHHS grant or contract assistance in order to apply 
for a Confidentiality Certificate. If a person has previously submitted 
any information required in this part in connection with a DHHS grant or 
contract, he or she may substitute a copy of information thus submitted, 
if the information is current and accurate. If a person requests a 
Confidentiality Certificate at the same time he or she submits an 
application for DHHS grant or contract assistance, the application for a 
Confidentiality Certificate may refer to the pertinent section(s) of the 
DHHS grant or contract application which provide(s) the information 
required to be submitted under this part. (See Secs. 2a.4 and 2a.5.)
    (d) A separate application is required for each research project for 
which an authorization of confidentiality is requested.



Sec. 2a.4  Contents of application; in general.

    In addition to any other pertinent information which the Secretary 
may require, each application for an authorization of confidentiality 
for a research project shall contain:
    (a) The name and address of the individual primarily responsible for 
the conduct of the research and the sponsor or institution with which he 
or she is affiliated, if any. Any application from a person affiliated 
with an institution will be considered only if it contains or is 
accompanied by documentation of institutional approval. This 
documentation may consist of a written statement signed by a responsible 
official of the institution or of a copy of or reference to a valid 
certification submitted in accordance with 45 CFR part 46.
    (b) The location of the research project and a description of the 
facilities available for conducting the research, including the name and 
address of any hospital, institution, or clinical laboratory facility to 
be utilized in connection with the research.
    (c) The names, addresses, and summaries of the scientific or other 
appropriate training and experience of all personnel having major 
responsibilities in the research project and the training and experience 
requirements for major positions not yet filled.
    (d) An outline of the research protocol for the project including a 
clear and concise statement of the purpose and rationale of the research 
project and the general research methods to be used.
    (e) The date on which research will begin or has begun and the 
estimated date for completion of the project.
    (f) A specific request, signed by the individual primarily 
responsible for the conduct of the research, for authority to withhold 
the names and other identifying characteristics of the research subjects 
and the reasons supporting such request.
    (g) An assurance (1) From persons making application for a 
Confidentiality Certificate for a research project for which DHHS grant 
or contract support is received or sought that they will comply with all 
the requirements of 45 CFR part 46, ``Protection of Human Subjects,'' or
    (2) From all other persons making application that they will comply 
with the informed consent requirements of 45 CFR 46.103(c) and document 
legally effective informed consent in a manner consistent with the 
principles stated in 45 CFR 46.110, if it is determined by the 
Secretary, on the basis of information submitted by the person making 
application, that subjects will be placed at risk. If a modification of 
paragraphs (a) or (b) of 45 CFR 46.110 is to be used, as permitted under 
paragraph (c) of that section, the applicant will describe the proposed 
modification and submit it for approval by the Secretary.
    (h) An assurance that if an authorization of confidentiality is 
given it will not be represented as an endorsement of the research 
project by the Secretary or used to coerce individuals to participate in 
the research project.
    (i) An assurance that any person who is authorized by the Secretary 
to protect the privacy of research subjects

[[Page 29]]

will use that authority to refuse to disclose identifying 
characteristics of research subjects in any Federal, State, or local 
civil, criminal, administrative, legislative, or other proceedings to 
compel disclosure of the identifying characteristics of research 
subjects.
    (j) An assurance that all research subjects who participate in the 
project during the period the Confidentiality Certificate is in effect 
will be informed that:
    (1) A Confidentiality Certificate has been issued;
    (2) The persons authorized by the Confidentiality Certificate to 
protect the identity of research subjects may not be compelled to 
identify research subjects in any civil, criminal, administrative, 
legislative, or other proceedings whether Federal, State, or local;
    (3) If any of the following conditions exist the Confidentiality 
Certificate does not authorize any person to which it applies to refuse 
to reveal identifying information concerning research subjects:
    (i) The subject consents in writing to disclosure of identifying 
information,
    (ii) Release is required by the Federal Food, Drug, and Cosmetic Act 
(21 U.S.C. 301) or regulations promulgated thereunder (title 21, Code of 
Federal Regulations), or
    (iii) Authorized personnel of DHHS request identifying information 
for audit or program evaluation of a research project funded by DHHS or 
for investigation of DHHS grantees or contractors and their employees or 
agents carrying out such a project. (See Sec. 2a.7(b));
    (4) The Confidentiality Certificate does not govern the voluntary 
disclosure of identifying characteristics of research subjects;
    (5) The Confidentiality Certificate does not represent an 
endorsement of the research project by the Secretary.
    (k) An assurance that all research subjects who enter the project 
after the termination of the Confidentiality Certificate will be 
informed that the authorization of confidentiality has ended and that 
the persons authorized to protect the identity of research subjects by 
the Confidentiality Certificate may not rely on the Certificate to 
refuse to disclose identifying characteristics of research subjects who 
were not participants in the project during the period the Certificate 
was in effect. (See Sec. 2a.8(c)).



Sec. 2a.5  Contents of application; research projects in which drugs will be administered.

    (a) In addition to the information required by Sec. 2a.4 and any 
other pertinent information which the Secretary may require, each 
application for an authorization of confidentiality for a research 
project which involves the administering of a drug shall contain:
    (1) Identification of the drugs to be administered in the research 
project and a description of the methods for such administration, which 
shall include a statement of the dosages to be administered to the 
research subjects;
    (2) Evidence that individuals who administer drugs are authorized to 
do so under applicable Federal and State law; and
    (3) In the case of a controlled drug, a copy of the Drug Enforcement 
Administration Certificate of Registration (BND Form 223) under which 
the research project will be conducted.
    (b) An application for an authorization of confidentiality with 
respect to a research project which involves the administering of a 
controlled drug may include a request for exemption of persons engaged 
in the research from State or Federal prosecution for possession, 
distribution, and dispensing of controlled drugs as authorized under 
section 502(d) of the Controlled Substances Act (21 U.S.C. 872(d)) and 
21 CFR 1316.22. If the request is in such form, and is supported by such 
information, as is required by 21 CFR 1316.22, the Secretary will 
forward it, together with his or her recommendation that such request be 
approved or disapproved, for the consideration of the Administrator of 
the Drug Enforcement Administration.



Sec. 2a.6  Issuance of Confidentiality Certificates; single project limitation.

    (a) In reviewing the information provided in the application for a 
Confidentiality Certificate, the Secretary will take into account:

[[Page 30]]

    (1) The scientific or other appropriate training and experience of 
all personnel having major responsibilities in the research project;
    (2) Whether the project constitutes bona fide ``research'' which is 
within the scope of the regulations of this part; and
    (3) Such other factors as he or she may consider necessary and 
appropriate. All applications for Confidentiality Certificates shall be 
evaluated by the Secretary through such officers and employees of the 
Department and such experts or consultants engaged for this purpose as 
he or she determines to be appropriate.
    (b) After consideration and evaluation of an application for an 
authorization of confidentiality, the Secretary will either issue a 
Confidentiality Certificate or a letter denying a Confidentiality 
Certificate, which will set forth the reasons for such denial, or will 
request additional information from the person making application. The 
Confidentiality Certificate will include:
    (1) The name and address of the person making application;
    (2) The name and address of the individual primarily responsible for 
conducting the research, if such individual is not the person making 
application;
    (3) The location of the research project;
    (4) A brief description of the research project;
    (5) A statement that the Certificate does not represent an 
endorsement of the research project by the Secretary;
    (6) The Drug Enforcement Administration registration number for the 
project, if any; and
    (7) The date or event upon which the Confidentiality Certificate 
becomes effective, which shall not be before the later of either the 
commencement of the research project or the date of issuance of the 
Certificate, and the date or event upon which the Certificate will 
expire.
    (c) A Confidentiality Certificate is not transferable and is 
effective only with respect to the names and other identifying 
characteristics of those individuals who are the subjects of the single 
research project specified in the Confidentiality Certificate. The 
recipient of a Confidentiality Certificate shall, within 15 days of any 
completion or discontinuance of the research project which occurs prior 
to the expiration date set forth in the Certificate, provide written 
notification to the Director of the Institute to which application was 
made. If the recipient determines that the research project will not be 
completed by the expiration date set forth in the Confidentiality 
Certificate he or she may submit a written request for an extension of 
the expiration date which shall include a justification for such 
extension and a revised estimate of the date for completion of the 
project. Upon approval of such a request, the Secretary will issue an 
amended Confidentiality Certificate.
    (d) The protection afforded by a Confidentiality Certificate does 
not extend to significant changes in the research project as it is 
described in the application for such Certificate (e.g., changes in the 
personnel having major responsibilities in the research project, major 
changes in the scope or direction of the research protocol, or changes 
in the drugs to be administered and the persons who will administer 
them). The recipient of a Confidentiality Certificate shall notify the 
Director of the Institute to which application was made of any proposal 
for such a significant change by submitting an amended application for a 
Confidentiality Certificate in the same form and manner as an original 
application. On the basis of such application and other pertinent 
information the Secretary will either:
    (1) Approve the amended application and issue an amended 
Confidentiality Certificate together with a Notice of Cancellation 
terminating original the Confidentiality Certificate in accordance with 
Sec. 2a.8; or
    (2) Disapprove the amended application and notify the applicant in 
writing that adoption of the proposed significant changes will result in 
the issuance of a Notice of Cancellation terminating the original 
Confidentiality Certificate in accordance with Sec. 2a.8.



Sec. 2a.7  Effect of Confidentiality Certificate.

    (a) A Confidentiality Certificate authorizes the withholding of the 
names and other identifying characteristics of

[[Page 31]]

individuals who participate as subjects in the research project 
specified in the Certificate while the Certificate is in effect. The 
authorization applies to all persons who, in the performance of their 
duties in connection with the research project, have access to 
information which would identify the subjects of the research. Persons 
so authorized may not, at any time, be compelled in any Federal, State, 
or local civil, criminal, administrative, legislative, or other 
proceedings to identify the research subjects encompassed by the 
Certificate, except in those circumstances specified in paragraph (b) of 
this section.
    (b) A Confidentiality Certificate granted under this part does not 
authorize any person to refuse to reveal the name or other identifying 
characteristics of any research subject in the following circumstances:
    (1) The subject (or, if he or she is legally incompetent, his or her 
guardian) consents, in writing, to the disclosure of such information,
    (2) Authorized personnel of DHHS request such information for audit 
or program evaluation of a research project funded by DHHS or for 
investigation of DHHS grantees or contractors and their employees or 
agents carrying out such a project. (See 45 CFR 5.71 for confidentiality 
standards imposed on such DHHS personnel), or
    (3) Release of such information is required by the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 301) or the regulations promulgated 
thereunder (title 21, Code of Federal Regulations).
    (c) Neither a Confidentiality Certificate nor the regulations of 
this part govern the voluntary disclosure of identifying characteristics 
of research subjects.



Sec. 2a.8  Termination.

    (a) A Confidentiality Certificate is in effect from the date of its 
issuance until the effective date of its termination. The effective date 
of termination shall be the earlier of:
    (1) The expiration date set forth in the Confidentiality 
Certificate; or
    (2) Ten days from the date of mailing a Notice of Cancellation to 
the applicant, pursuant to a determination by the Secretary that the 
research project has been completed or discontinued or that retention of 
the Confidentiality Certificate is otherwise no longer necessary or 
desirable.
    (b) A Notice of Cancellation shall include: an identification of the 
Confidentiality Certificate to which it applies; the effective date of 
its termination; and the grounds for cancellation. Upon receipt of a 
Notice of Cancellation the applicant shall return the Confidentiality 
Certificate to the Secretary.
    (c) Any termination of a Confidentiality Certificate pursuant to 
this section is operative only with respect to the names and other 
identifying characteristics of individuals who begin their participation 
as research subjects after the effective date of such termination. (See 
Sec. 2a.4(k) requiring researchers to notify subjects who enter the 
project after the termination of the Confidentiality Certificate of 
termination of the Certificate). The protection afforded by a 
Confidentiality Certificate is permanent with respect to subjects who 
participated in research during any time the authorization was in 
effect.

                            PART 3 [RESERVED]



PART 4--NATIONAL LIBRARY OF MEDICINE--Table of Contents




Sec.
4.1  Programs to which these regulations apply.
4.2  Definitions.
4.3  Purpose of the Library.
4.4  Use of Library facilities.
4.5  Use of materials from the collections.
4.6  Reference, bibliographic, reproduction, and consultation services.
4.7  Fees.
4.8  Publication of the Library and information about the Library.

    Authority: 42 U.S.C. 216, 286.

    Source: 56 FR 29188, June 26, 1991, unless otherwise noted.



Sec. 4.1  Programs to which these regulations apply.

    (a) The regulations of this part govern access to the National 
Library of Medicine's facilities and library collections and the 
availability of its bibliographic, reproduction, reference, and

[[Page 32]]

related services. These functions are performed by the Library directly 
for the benefit of the general public and health-sciences professionals 
as required by sections 465(b) (3)-(6) of the Act (42 U.S.C. 286(b) (3)-
(6)).
    (b) The regulations of this part do not apply to:
    (1) The Library's internal functions relating to the acquisition and 
preservation of materials and the organization of these materials as 
required by sections 465(b) (1) and (2) of the Act (42 U.S.C. 286(b) (1) 
and (2)).
    (2) The availability of ``records'' under the Freedom of Information 
Act or the Privacy Act of 1974 (5 U.S.C. 552, 552a). These matters are 
covered in 45 CFR parts 5 and 5b.
    (3) Federal assistance for medical libraries and other purposes 
which are authorized by sections 469-477 of the Act (42 U.S.C. 286b to 
286b-8). (See parts 59a, 61 and 64 of this chapter.)
    (4) The availability of facilities, collections, and related 
services of Regional Medical Libraries established or maintained under 
the authority in section 475 of the Act (42 U.S.C. 286b-6). (See part 
59a, subpart B of this chapter.)



Sec. 4.2  Definitions.

    As used in this part:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.).
    Collections means all books, periodicals, prints, audiovisual 
materials, films, videotapes, recordings, manuscripts, and other 
resource materials of the library. It does not include data processing 
tapes or programs used solely for internal processing activities to 
generate reference materials, nor does it include ``records'' of the 
Library as defined in 45 CFR 5.5. Records of the Library are available 
in accordance with the regulations under the Freedom of Information Act 
and Privacy Act of 1974. (See 45 CFR parts 5 and 5b.)
    Director means the Director of the National Library of Medicine or 
the Director's delegate.
    Health-sciences professional means any person engaged in: (1) The 
administration of health activities; (2) the provision of health 
services; or (3) research, teaching, or education concerned with the 
advancement of medicine or other sciences related to health or 
improvement of the public health.
    Historical collection means: (1) Materials in the collections 
published or printed prior to 1914; (2) manuscripts and prints; (3) the 
archival film collection; and (4) other materials of the collections 
which, because of age, or unique or unusual value, require special 
handling, storage, or protection for their preservation, as determined 
by the Director.
    Library means the National Library of Medicine, established by 
section 465 of the Act (42 U.S.C. 286).
    Regional Medical Library means a medical library established or 
maintained as a regional medical library under section 475 of the Act 
(42 U.S.C. 286b-6).



Sec. 4.3  Purpose of the Library.

    The purpose of the Library is to assist the advancement of medical 
and related sciences and aid the dissemination and exchange of 
scientific and other information important to the progress of medicine 
and the public health. The Library acquires and maintains library 
materials pertinent to medicine, including audiovisual materials; 
compiles, publishes, and disseminates catalogs, indices, and 
bibliographies of these materials, as appropriate; makes available 
materials, through loan or otherwise; provides reference and other 
assistance to research; and engages in other activities in furtherance 
of this purpose.



Sec. 4.4  Use of Library facilities.

    (a) General. The Library facilities are available to any person 
seeking to make use of the collections. The Director may prescribe 
reasonable rules to assure the most effective use of facilities by 
health-sciences professionals and to protect the collections from misuse 
or damage. These rules must be consistent with the regulations in this 
part and applicable Department regulations and policies on 
nondiscrimination.
    (b) Reading rooms. Public reading rooms are available for obtaining 
and reading materials from the collections. The Director may prescribe 
reasonable rules designed to provide adequate

[[Page 33]]

reading space and orderly conditions and procedures.
    (c) Study rooms. Upon request a limited number of study rooms may be 
made available to individuals requiring extensive use of Library 
materials. Requests for study rooms shall be addressed in writing to the 
Director. The Director shall give priority, in the following order, for 
study room use to:
    (1) Persons engaged in ``special scientific projects'' under section 
473 of the Act (42 U.S.C. 286b-4),
    (2) Health-sciences professionals, and
    (3) The general public.



Sec. 4.5  Use of materials from the collections.

    (a) Unrestricted materials. Except as otherwise provided in this 
section, materials from the collections are generally available to any 
interested person only in facilities provided by the Library for this 
purpose. The Director may prescribe additional reasonable rules to 
assure the most effective use of the Library's resources by health-
sciences professionals and to protect the collections from misuse or 
damage. The rules must be consistent with the regulations in this part 
and applicable Department regulations and policies on nondiscrimination. 
Materials in the collections are available upon each request which 
assures, to the Director's satisfaction, that the materials will be 
safeguarded from misuse, damage, loss, or misappropriation, and will be 
returned promptly after use or upon request of the Library.
    (b) Restricted materials--(1) Historical collection. Materials from 
the historical collection are available only as the Director may permit 
to assure their maximum preservation and protection. Copies of these 
materials may be made available in the form of microfilm and other 
copies, for which reasonable fees may be charged.
    (2) Gifts. Materials in the collections are available only in 
accordance with any limitations imposed as a condition of the 
acquisition of those materials, whether the acquisition was by gift or 
purchase.
    (c) Loans--(1) General. Requests for loans of materials must assure 
the Library that (i) the materials will be safeguarded from misuse, 
damage, loss, or misappropriation and (ii) the materials will be 
returned promptly after use or upon request of the Library. The Library 
may provide copies in lieu of original materials, which need not be 
returned unless otherwise stated at the time of the loan.
    (2) Loans of audiovisual materials. Audiovisual materials are 
available for loan under the same general terms as printed materials.
    (3) Loans to other libraries. Upon request materials or copies are 
available for use through libraries of public or private agencies or 
institutions. The requesting library must assure that it has first 
exhausted its own collection resources, those of other local libraries 
in the geographic area, and those of the Regional Medical Library 
network (including Regional and Resource Libraries) before making a 
request for a loan.
    (4) Loans to health-sciences professionals. The Director may make 
loans of materials directly to health-sciences professionals. An 
individual wishing a loan of library materials must assure to the 
satisfaction of the Director that the individual is geographically 
isolated, in terms of distance or available transportation, from medical 
literature resources likely to contain the desired material.

(Approved by the Office of Management and Budget under control number 
0925-0276)



Sec. 4.6  Reference, bibliographic, reproduction, and consultation services.

    (a) General. To the extent resources permit, the Library will make 
available, upon request, reference, bibliographic, reproduction, and 
consultation services. Priority will be given to requests from health-
sciences professionals for services not reasonably available through 
local or regional libraries.
    (b) Specialized bibliographic services. The Director may provide 
bibliographies on individually selected medical or scientific topics 
upon request where it is consistent with the Library's purpose. The 
Director may publish and make available for general distribution by the 
Library, bibliographic searches determined to be of general interest. 
The Library may also produce

[[Page 34]]

and distribute a limited number of bibliographies on topics of general 
interest to public or nonprofit health-related professional societies, 
research organizations, and other group users. These bibliographies may 
be produced on a regularly recurring or intermittent basis under 
contract between the Library and public or nonprofit agencies, when 
determined in each case by the Director to be necessary to assure more 
effective distribution of the bibliographic information.
    (c) Information retrieval system computer tapes. To the extent 
Library resources permit and in order to further the Library's purpose, 
the Director may make available upon request by agencies, organizations, 
and institutions copies of all or part of the Library's magnetic tapes.



Sec. 4.7  Fees.

    The Director may charge reasonable fees for any service provided by 
the Library under this part, in accordance with a schedule available at 
the Library upon request, which are designed to recover all or a portion 
of the cost to the Library of providing the service.



Sec. 4.8  Publication of the Library and information about the Library.

    Lists of bibliographies, Library publications sold by the Government 
Printing Office, necessary application forms, and other information 
concerning the organization, operation, functions, and services of the 
Library, are available from the National Library of Medicine, Bethesda, 
Maryland 20894.



PART 5--DESIGNATION OF HEALTH PROFESSIONAL(S) SHORTAGE AREAS--Table of Contents




Sec.
5.1  Purpose.
5.2  Definitions.
5.3  Procedures for designation of health professional(s) shortage 
          areas.
5.4  Notification and publication of designations and withdrawals.

Appendix A to Part 5--Criteria for Designation of Areas having Shortages 
          of Primary Medical Care Professional(s)
Appendix B to Part 5--Criteria for Designation of Areas having Shortages 
          of Dental Professional(s)
Appendix C to Part 5--Criteria for Designation of Areas Having Shortages 
          of Mental Health Professionals
Appendix D to Part 5--Criteria for Designation of Areas having Shortages 
          of Vision Care Professional(s)
Appendix E to Part 5--Criteria for Designation of Areas having Shortages 
          of Podiatric Professional(s)
Appendix F to Part 5--Criteria for Designation of Areas having Shortages 
          of Pharmacy Professional(s)
Appendix G to Part 5--Criteria for Designation of Areas having Shortages 
          of Veterinary Professional(s)

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690 
(42 U.S.C. 216); sec. 332 of the Public Health Service Act, 90 Stat. 
2270-2272 (42 U.S.C. 254e).

    Source: 45 FR 76000, Nov. 17, 1980, unless otherwise noted.

    Editorial Note: Nomenclature changes to part 5 appear at 57 FR 2480, 
Jan. 22, 1992.



Sec. 5.1  Purpose.

    These regulations establish criteria and procedures for the 
designation of geographic areas, population groups, medical facilities, 
and other public facilities, in the States, as health professional(s) 
shortage areas.



Sec. 5.2  Definitions.

    Act means the Public Health Service Act, as amended.
    Health professional(s) shortage area means any of the following 
which the Secretary determines has a shortage of health professional(s): 
(1) An urban or rural area (which need not conform to the geographic 
boundaries of a political subdivision and which is a rational area for 
the delivery of health services); (2) a population group; or (3) a 
public or nonprofit private medical facility.
    Health service area means a health service area whose boundaries 
have been designated by the Secretary, under section 1511 of the Act, 
for purposes of health planning activities.
    Health systems agency or HSA means the health systems agency 
designated, under section 1515 of the Act, to carry out health planning 
activities for a specific health service area.
    Medical facility means a facility for the delivery of health 
services and includes: (1) A community health center,

[[Page 35]]

public health center, outpatient medical facility, or community mental 
health center; (2) a hospital, State mental hospital, facility for long-
term care, or rehabilitation facility; (3) a migrant health center or an 
Indian Health service facility; (4) a facility for delivery of health 
services to inmates in a U.S. penal or correctional institution (under 
section 323 of the Act) or a State correctional institution; (5) a 
Public Health Service medical facility (used in connection with the 
delivery of health services under section 320, 321, 322, 324, 325, or 
326 of the Act); or (6) any other Federal medical facility.
    Metropolitan area means an area which has been designated by the 
Office of Management and Budget as a standard metropolitan statistical 
area (SMSA). All other areas are ``non-metropolitan areas.''
    Poverty level means the povery level as defined by the Bureau of the 
Census, using the poverty index adopted by a Federal Interagency 
Committee in 1969, and updated each year to reflect changes in the 
Consumer Price Index.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department to whom the authority 
involved has been delegated.
    State includes, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, 
the Virgin Islands, Guam, American Samoa, and the Trust Territory of the 
Pacific Islands.
    State health planning and development agency or SHPDA means a State 
health planning and development agency designated under section 1521 of 
the Act.



Sec. 5.3  Procedures for designation of health professional(s) shortage areas.

    (a) Using data available to the Department from national, State, and 
local sources and based upon the criteria in the appendices to this 
part, the Department will annually prepare listings (by State and health 
service area) of currently designated health professional(s) shortage 
areas and potentially designatable areas, together with appropriate 
related data available to the Department. Relevant portions of this 
material will then be forwarded to each health systems agency, State 
health planning and development agency, and Governor, who will be asked 
to review the listings for their State, correct any errors of which they 
are aware, and offer their recommendations, if any, within 90 days, as 
to which geographic areas, population groups, and facilities in areas 
under their jurisdiction should be designated. An information copy of 
these listings will also be made available, upon request, to interested 
parties for their use in providing comments or recommendations to the 
Secretary and/or to the appropriate HSA, SHPDA, or Governor.
    (b) In addition, any agency or individual may request the Secretary 
to designate (or withdraw the designation of) a particular geographic 
area, population group, or facility as a health professional(s) shortage 
area. Each request will be forwarded by the Secretary to the appropriate 
HSA, SHPDA, and Governor, who will be asked to review it and offer their 
recommendations, if any, within 30 days. An information copy will also 
be made available to other interested parties, upon request, for their 
use in providing comments or recommendations to the Secretary and/or to 
the appropriate HSA, SHPDA, or Governor.
    (c) In each case where the designation of a public facility 
(including a Federal medical facility) is under consideration, the 
Secretary will give written notice of the proposed designation to the 
chief administrative officer of the facility, who will be asked to 
review it and offer their recommendations, if any, within 30 days.
    (d) After review of the available information and consideration of 
the comments and recommendations submitted, the Secretary will designate 
health professional(s) shortage areas and withdraw the designation of 
any areas which have been determined no longer to have a shortage of 
health professional(s).



Sec. 5.4  Notification and publication of designations and withdrawals.

    (a) The Secretary will give written notice of the designation (or 
withdrawal of designation) of a health professional(s) shortage area, 
not later

[[Page 36]]

than 60 days from the date of the designation (or withdrawal of 
designation), to:
    (1) The Governor of each State in which the area, population group, 
medical facility, or other public facility so designated is in whole or 
in part located;
    (2) Each HSA for a health service area which includes all or any 
part of the area, population group, medical facility, or other public 
facility so designated;
    (3) The SHPDA for each State in which the area, population group, 
medical facility, or other public facility so designated is in whole or 
in part located; and
    (4) Appropriate public or nonprofit private entities which are 
located in or which have a demonstrated interest in the area so 
designated.
    (b) The Secretary will periodically publish updated lists of 
designated health professional(s) shortage areas in the Federal 
Register, by type of professional(s) shortage. An updated list of areas 
for each type of professional(s) shortage will be published at least 
once annually.
    (c) The effective date of the designation of an area shall be the 
date of the notification letter to the individual or agency which 
requested the designation, or the date of publication in the Federal 
Register, whichever comes first.
    (d) Once an area is listed in the Federal Register as a designated 
health professional(s) shortage area, the effective date of any later 
withdrawal of the area's designation shall be the date when notification 
of the withdrawal, or an updated list of designated areas which does not 
include it, is published in the Federal Register.

Appendix A to Part 5--Criteria for Designation of Areas Having Shortages 
                 of Primary Medical Care Professional(s)

                        Part I--Geographic Areas

    A. Federal and State Correctional Institutions.
    1. Criteria.
    Medium to maximum security Federal and State correctional 
institutions and youth detention facilities will be designated as having 
a shortage of primary medical care professional(s) if both the following 
criteria are met:
    (a) The institution has at least 250 inmates.
    (b) The ratio of the number of internees per year to the number of 
FTE primary care physicians serving the institution is at least 1,000:1.
    Here the number of internees is defined as follows:
    (i) If the number of new inmates per year and the average length-of-
stay are not specified, or if the information provided does not indicate 
that intake medical examinations are routinely performed upon entry, 
then--Number of internees=average number of inmates.
    (ii) If the average length-of-stay is specified as one year or more, 
and intake medical examinations are routinely performed upon entry, 
then--Number of internees=average number of inmates+(0.3) x number of 
new inmates per year.
    (iii) If the average length-of-stay is specified as less than one 
year, and intake examinations are routinely performed upon entry, then--
Number of internees=average number of inmates+(0.2) x (1+ALOS/
2) x number of new inmates per year where ALOS=average length-of-stay 
(in fraction of year). (The number of FTE primary care physicians is 
computed as in part I, section B, paragraph 3 above.)
    2. Determination of Degree of Shortage.
    Designated correctional institutions will be assigned to degree-of-
shortage groups based on the number of inmates and/or the ratio (R) of 
internees to primary care physicians, as follows:
    Group 1--Institutions with 500 or more inmates and no physicians.
    Group 2--Other institutions with no physicians and institutions with 
R greater than (or equal to) 2,000:1.
    Group 3--Institutions with R greater than (or equal to) 1,000:1 but 
less than 2,000:1.
    B. Methodology.
    In determining whether an area meets the criteria established by 
paragraph A of this part, the following methodology will be used:
    1. Rational Areas for the Delivery of Primary Medical Care Services.
    (a) The following areas will be considered rational areas for the 
delivery of primary medical care services:
    (i) A county, or a group of contiguous counties whose population 
centers are within 30 minutes travel time of each other.
    (ii) A portion of a county, or an area made up of portions of more 
than one county, whose population, because of topography, market or 
transportation patterns, distinctive population characteristics or other 
factors, has limited access to contiguous area resources, as measured 
generally by a travel time greater than 30 minutes to such resources.

[[Page 37]]

    (iii) Established neighborhoods and communities within metropolitan 
areas which display a strong self-identity (as indicated by a 
homogeneous socioeconomic or demographic structure and/or a tradition of 
interaction or interdependency), have limited interaction with 
contiguous areas, and which, in general, have a minimum population of 
20,000.
    (b) The following distances will be used as guidelines in 
determining distances corresponding to 30 minutes travel time:
    (i) Under normal conditions with primary roads available: 20 miles.
    (ii) In mountainous terrain or in areas with only secondary roads 
available: 15 miles.
    (iii) In flat terrain or in areas connected by interstate highways: 
25 miles.
    Within inner portions of metropolitan areas, information on the 
public transportation system will be used to determine the distance 
corresponding to 30 minutes travel time.
    2. Population Count.
    The population count used will be the total permanent resident 
civilian population of the area, excluding inmates of institutions, with 
the following adjustments, where appropriate:
    (a) Adjustments to the population for the differing health service 
requirements of various age-sex population groups will be computed using 
the table below of visit rates for 12 age-sex population cohorts. The 
total expected visit rate will first be obtained by multiplying each of 
the 12 visit rates in the table by the size of the area population 
within that particular age-sex cohort and adding the resultant 12 visit 
figures together. This total expected visit rate will then be divided by 
the U.S. average per capita visit rate of 5.1, to obtain the adjusted 
population for the area.

----------------------------------------------------------------------------------------------------------------
                                                                        Age groups
                                         -----------------------------------------------------------------------
                   Sex                                                                                  65 and
                                            Under 5      5-14        15-24       25-44       45-64       over
----------------------------------------------------------------------------------------------------------------
Male....................................         7.3         3.6         3.3         3.6         4.7         6.4
Female..................................         6.4         3.2         5.5         6.4         6.5         6.8
----------------------------------------------------------------------------------------------------------------

    (b) The effect of transient populations on the need of an area for 
primary care professional(s) will be taken into account as follows:
    (i) Seasonal residents, i.e., those who maintain a residence in the 
area but inhabit it for only 2 to 8 months per year, may be included but 
must be weighted in proportion to the fraction of the year they are 
present in the area.
    (ii) Other tourists (non-resident) may be included in an area's 
population but only with a weight of 0.25, using the following formula: 
Effective tourist contribution to population=0.25 x (fraction of year 
tourists are present in area) x (average daily number of tourists during 
portion of year that tourists are present).
    (iii) Migratory workers and their families may be included in an 
area's population, using the following formula: Effective migrant 
contribution to population=(fraction of year migrants are present in 
area) x (average daily number of migrants during portion of year that 
migrants are present).
    3. Counting of Primary Care Practitioners.
    (a) All non-Federal doctors of medicine (M.D.) and doctors of 
osteopathy (D.O.) providing direct patient care who practice principally 
in one of the four primary care specialities--general or family 
practice, general internal medicine, pediatrics, and obstetrics and 
gynecology--will be counted. Those physicians engaged solely in 
administration, research, and teaching will be excluded. Adjustments for 
the following factors will be made in computing the number of full-time-
equivalent (FTE) primary care physicians:
    (i) Interns and residents will be counted as 0.1 full-time 
equivalent (FTE) physicians.
    (ii) Graduates of foreign medical schools who are not citizens or 
lawful permanent residents of the United States will be excluded from 
physician counts.
    (iii) Those graduates of foreign medical schools who are citizens or 
lawful permanent residents of the United States, but do not have 
unrestricted licenses to practice medicine, will be counted as 0.5 FTE 
physicians.
    (b) Practitioners who are semi-retired, who operate a reduced 
practice due to infirmity or other limiting conditions, or who provide 
patient care services to the residents of the area only on a part-time 
basis will be discounted through the use of full-time equivalency 
figures. A 40-hour work week will be used as the standard for 
determining full-time equivalents in these cases. For practitioners 
working less than a 40-hour week, every four (4) hours (or \1/2\ day) 
spent providing patient care, in either ambulatory or inpatient 
settings, will be counted as 0.1 FTE (with numbers obtained for FTE's 
rounded to the nearest 0.1 FTE), and each physician providing patient 
care 40 or more hours a week will be counted as 1.0 FTE physician. (For 
cases where data are available only for the

[[Page 38]]

number of hours providing patient care in office settings, equivalencies 
will be provided in guidelines.)
    (c) In some cases, physicians located within an area may not be 
accessible to the population of the area under consideration. Allowances 
for physicians with restricted practices can be made, on a case-by-case 
basis. However, where only a portion of the population of the area 
cannot access existing primary care resources in the area, a population 
group designation may be more appropriate (see part II of this 
appendix).
    (d) Hospital staff physicians involved exclusively in inpatient care 
will be excluded. The number of full-time equivalent physicians 
practicing in organized outpatient departments and primary care clinics 
will be included, but those in emergency rooms will be excluded.
    (e) Physicians who are suspended under provisions of the Medicare-
Medicaid Anti-Fraud and Abuse Act for a period of eighteen months or 
more will be excluded.
    4. Determination of Unusually High Needs for Primary Medical Care 
Services.
    An area will be considered as having unusually high needs for 
primary health care services if at least one of the following criteria 
is met:
    (a) The area has more than 100 births per year per 1,000 women aged 
15-44.
    (b) The area has more than 20 infant deaths per 1,000 live births.
    (c) More than 20% of the population (or of all households) have 
incomes below the poverty level.
    5. Determination of Insufficient Capacity of Existing Primary Care 
Providers.
    An area's existing primary care providers will be considered to have 
insufficient capacity if at least two of the following criteria are met:
    (a) More than 8,000 office or outpatient visits per year per FTE 
primary care physician serving the area.
    (b) Unusually long waits for appointments for routine medical 
services (i.e., more than 7 days for established patients and 14 days 
for new patients).
    (c) Excessive average waiting time at primary care providers (longer 
than one hour where patients have appointments or two hours where 
patients are treated on a first-come, first-served basis).
    (d) Evidence of excessive use of emergency room facilities for 
routine primary care.
    (e) A substantial proportion (2/3 or more) of the area's physicians 
do not accept new patients.
    (f) Abnormally low utilization of health services, as indicated by 
an average of 2.0 or less office visits per year on the part of the 
area's population.
    6. Contiguous Area Considerations.
    Primary care professional(s) in areas contiguous to an area being 
considered for designation will be considered excessively distant, 
overutilized or inaccessible to the population of the area under 
consideration if one of the following conditions prevails in each 
contiguous area:
    (a) Primary care professional(s) in the contiguous area are more 
than 30 minutes travel time from the population center(s) of the area 
being considered for designation (measured in accordance with paragraph 
B.1(b) of this part).
    (b) The contiguous area population-to-full-time-equivalent primary 
care physician ratio is in excess of 2000:1, indicating that 
practitioners in the contiguous area cannot be expected to help 
alleviate the shortage situation in the area being considered for 
designation.
    (c) Primary care professional(s) in the contiguous area are 
inaccessible to the population of the area under consideration because 
of specified access barriers, such as:
    (i) Significant differences between the demographic (or socio-
economic) characteristics of the area under consideration and those of 
the contiguous area, indicating that the population of the area under 
consideration may be effectively isolated from nearby resources. This 
isolation could be indicated, for example, by an unusually high 
proportion of non-English-speaking persons.
    (ii) A lack of economic access to contiguous area resources, as 
indicated particularly where a very high proportion of the population of 
the area under consideration is poor (i.e., where more than 20 percent 
of the population or the households have incomes below the poverty 
level), and Medicaid-covered or public primary care services are not 
available in the contiguous area.
    C. Determination of Degree of Shortage.
    Designated areas will be assigned to degree-of-shortage groups, 
based on the ratio (R) of population to number of full-time equivalent 
primary care physicians and the presence or absence of unusually high 
needs for primary health care services, according to the following 
table:

------------------------------------------------------------------------
                                    High needs not        High needs
                                       indicated           indicated
------------------------------------------------------------------------
Group 1.........................  No physicians.....  No physicians; or
                                                       R5,000
Group 2.........................  R5,000............  5,000>R4,000
Group 3.........................  5,000>R4,000......  4,000>R3,500
Group 4.........................  4,000>R3,500......  3,500>R3,000
------------------------------------------------------------------------

    D. Determination of size of primary care physician shortage. Size of 
Shortage (in number of FTE primary care physicians needed) will be 
computed using the following formulas:
    (1) For areas without unusually high need or insufficient capacity:
Primary care physician shortage=area population/3,500-number of FTE 
primary care physicians

[[Page 39]]

    (2) For areas with unusually high need or insufficient capacity:
Primary care physician shortage=area population/3,000-number of FTE 
primary care physicians

                       Part II--Population Groups

    A. Criteria.
    1. In general, specific population groups within particular 
geographic areas will be designated as having a shortage of primary 
medical care professional(s) if the following three criteria are met:
    (a) The area in which they reside is rational for the delivery of 
primary medical care services, as defined in paragraph B.1 of part I of 
this appendix.
    (b) Access barriers prevent the population group from use of the 
area's primary medical care providers. Such barriers may be economic, 
linguistic, cultural, or architectural, or could involve refusal of some 
providers to accept certain types of patients or to accept Medicaid 
reimbursement.
    (c) The ratio of the number of persons in the population group to 
the number of primary care physicians practicing in the area and serving 
the population group is at least 3,000 : 1.
    2. Indians and Alaska Natives will be considered for designation as 
having shortages of primary care professional(s) as follows:
    (a) Groups of members of Indian tribes (as defined in section 4(d) 
of Pub. L. 94-437, the Indian Health Care Improvement Act of 1976) are 
automatically designated.
    (b) Other groups of Indians or Alaska Natives (as defined in section 
4(c) of Pub. L. 94-437) will be designated if the general criteria in 
paragraph A are met.
    B. Determination of Degree of Shortage.
    Each designated population group will be assigned to a degree-of-
shortage group, based on the ratio (R) of the group's population to the 
number of primary care physicians serving it, as follows:

Group 1--No physicians or R>5,000.
Group 2--5,000>R4,000.
Group 3--4,000>R3,500.
Group 4--3,500>R3,000.

    Population groups which have received ``automatic'' designation will 
be assigned to degree-of-shortage group 4 if no information on the ratio 
of the number of persons in the group to the number of FTE primary care 
physicians serving them is provided.
    C. Determination of size of primary care physician shortage. Size of 
shortage (in number of primary care physicians needed) will be computed 
as follows:
    Primary care physician shortage=number of persons in population 
group/3,000-number of FTE primary care physicians

                          Part III--Facilities

    A. Federal and State Correctional Institutions.
    1. Criteria.
    Medium to maximum security Federal and State correctional 
institutions and youth detention facilities will be designated as having 
a shortage of primary medical care professional(s) if both the following 
criteria are met:
    (a) The institution has at least 250 inmates.
    (b) The ratio of the number of internees per year to the number of 
FTE primary care physicians serving the institution is at least 1,000:1. 
(Here the number of internees is the number of inmates present at the 
beginning of the year plus the number of new inmates entering the 
institution during the year, including those who left before the end of 
the year; the number of FTE primary care physicians is computed as in 
part I, section B, paragraph 3 above.)
    2. Determination of Degree of Shortage.
    Designated correctional institutions will be assigned to degree-of-
shortage groups based on the number of inmates and/or the ratio (R) of 
internees to primary care physicians, as follows:

Group 1--Institutions with 500 or more inmates and no physicians.
Group 2--Other institutions with no physicians and institutions with 
R2,000.
Group 3--Institutions with 2,000>R1,000.

    B. Public or Non-Profit Medical Facilities.
    1. Criteria.
    Public or non-profit private medical facilities will be designated 
as having a shortage of primary medical care professional(s) if:
    (a) the facility is providing primary medical care services to an 
area or population group designated as having a primary care 
professional(s) shortage; and
    (b) the facility has insufficient capacity to meet the primary care 
needs of that area or population group.
    2. Methodology
    In determining whether public or nonprofit private medical 
facilities meet the criteria established by paragraph B.1 of this Part, 
the following methodology will be used:
    (a) Provision of Services to a Designated Area or Population Group.
    A facility will be considered to be providing services to a 
designated area or population group if either:
    (i) A majority of the facility's primary care services are being 
provided to residents of designated primary care professional(s) 
shortage areas or to population groups designated as having a shortage 
of primary care professional(s); or
    (ii) The population within a designated primary care shortage area 
or population group

[[Page 40]]

has reasonable access to primary care services provided at the facility. 
Reasonable access will be assumed if the area within which the 
population resides lies within 30 minutes travel time of the facility 
and non-physical barriers (relating to demographic and socioeconomic 
characteristics of the population) do not prevent the population from 
receiving care at the facility.
    Migrant health centers (as defined in section 319(a)(1) of the Act) 
which are located in areas with designated migrant population groups and 
Indian Health Service facilities are assumed to be meeting this 
requirement.
    (b) Insufficient capacity to meet primary care needs.
    A facility will be considered to have insufficient capacity to meet 
the primary care needs of the area or population it serves if at least 
two of the following conditions exist at the facility:
    (i) There are more than 8,000 outpatient visits per year per FTE 
primary care physician on the staff of the facility. (Here the number of 
FTE primary care physicians is computed as in Part I, Section B, 
paragraph 3 above.)
    (ii) There is excessive usage of emergency room facilities for 
routine primary care.
    (iii) Waiting time for appointments is more than 7 days for 
established patients or more than 14 days for new patients, for routine 
health services.
    (iv) Waiting time at the facility is longer than 1 hour where 
patients have appointments or 2 hours where patients are treated on a 
first-come, first-served basis.
    3. Determination of Degree of Shortage.
    Each designated medical facility will be assigned to the same 
degree-of-shortage group as the designated area or population group 
which it serves.

[45 FR 76000, Nov. 17, 1980, as amended at 54 FR 8737, Mar. 2, 1989; 57 
FR 2480, Jan. 22, 1992]

Appendix B to Part 5--Criteria for Designation of Areas Having Shortages 
                        of Dental Professional(s)

                        Part I--Geographic Areas

    A. Federal and State Correctional Institutions.
    1. Criteria
    Medium to maximum security Federal and State correctional 
institutions and youth detention facilities will be designated as having 
a shortage of dental professional(s) if both the following criteria are 
met:
    (a) The institution has at least 250 inmates.
    (b) The ratio of the number of internees per year to the number of 
FTE dentists serving the institution is at least 1,500:1.
    Here the number of internees is defined as follows:
    (i) If the number of new inmates per year and the average length-of-
stay are not specified, or if the information provided does not indicate 
that intake dental examinations are routinely performed by dentists upon 
entry, then--Number of internees=average number of inmates.
    (ii) If the average length-of-stay is specified as one year or more, 
and intake dental examinations are routinely performed upon entry, 
then--Number of internees=average number of inmates+number of new 
inmates per year.
    (iii) If the average length-of-stay is specified as less than one 
year, and intake dental examinations are routinely performed upon entry, 
then--Number of internees=average number of inmates+\1/
3\ x (1+2 x ALOS) x number of new inmates per year where ALOS=average 
length-of-stay (in fraction of year).

    (The number of FTE dentists is computed as in part I, section B, 
paragraph 3 above.)

    2. Determination of Degree of Shortage.
    Designated correctional institutions will be assigned to degree-of-
shortage groups based on the number of inmates and/or the ratio (R) of 
internees to dentists, as follows:
    Group 1--Institutions with 500 or more inmates and no dentists.
    Group 2--Other institutions with no dentists and institutions with R 
greater than (or equal to) 3,000:1.
    Group 3--Institutions with R greater than (or equal to) 1,500:1 but 
less than 3,000:1.
    B. Methodology.
    In determining whether an area meets the criteria established by 
paragraph A of this part, the following methodology will be used:
    1. Rational Area for the Delivery of Dental Services.
    (a) The following areas will be considered rational areas for the 
delivery of dental health services:
    (i) A county, or a group of several contiguous counties whose 
population centers are within 40 minutes travel time of each other.
    (ii) A portion of a county (or an area made up of portions of more 
than one county) whose population, because of topography, market or 
transportation patterns, distinctive population characteristics, or 
other factors, has limited access to contiguous area resources, as 
measured generally by a travel time of greater than 40 minutes to such 
resources.
    (iii) Established neighborhoods and communities within metropolitan 
areas which display a strong self-identity (as indicated by a homogenous 
socioeconomic or demographic structure and/or a traditional of 
interaction or intradependency), have limited interaction with 
contiguous areas, and which, in general, have a minimum population of 
20,000.

[[Page 41]]

    (b) The following distances will be used as guidelines in 
determining distances corresponding to 40 minutes travel time:
    (i) Under normal conditions with primary roads available: 25 miles.
    (ii) In mountainous terrain or in areas with only secondary roads 
available: 20 miles.
    (iii) In flat terrain or in areas connected by interstate highways: 
30 miles.
    Within inner portions of metropolitan areas, information on the 
public transportation system will be used to determine the distance 
corresponding to 40 minutes travel time.
    2. Population Count.
    The population count use will be the total permanent resident 
civilian population of the area, excluding inmates of institutions, with 
the following adjustments:
    (a) Seasonal residents, i.e., those who maintain a residence in the 
area but inhabit it for only 2 to 8 months per year, may be included but 
must be weighted in proportion to the fraction of the year they are 
present in the area.
    (b) Migratory workers and their families may be included in an 
area's population using the following formula: Effective migrant 
contribution to population=(fraction of year migrants are present in 
area) x (average daily number of migrants during portion of year that 
migrants are present).
    3. Counting of Dental Practitioners.
    (a) All non-Federal dentists providing patient care will be counted, 
except in those areas where it is shown that specialists (those dentists 
not in general practice or pedodontics) are serving a larger area and 
are not addressing the general dental care needs of the area under 
consideration.
    (b) Full-time equivalent (FTE) figures will be used to reflect 
productivity differences among dental practices based on the age of the 
dentists, the number of auxiliaries employed, and the number of hours 
worked per week. In general, the number of FTE dentists will be computed 
using weights obtained from the matrix in Table 1, which is based on the 
productivity of dentists at various ages, with different numbers of 
auxiliaries, as compared with the average productivity of all dentists. 
For the purposes of these determinations, an auxiliary is defined as any 
non-dentist staff employed by the dentist to assist in operation of the 
practice.

     Table 1--Equivalency Weights, by Age and Number of Auxiliaries
------------------------------------------------------------------------
                                            <55    55-59   60-64    65+
------------------------------------------------------------------------
No auxiliaries..........................     0.8     0.7     0.6     0.5
One auxiliary...........................     1.0     0.9     0.8     0.7
Two auxiliaries.........................     1.2     1.0     1.0     0.8
Three auxiliaries.......................     1.4     1.2     1.0     1.0
Four or more auxiliaries................     1.5     1.5     1.3     1.2
------------------------------------------------------------------------

    If information on the number of auxiliaries employed by the dentist 
is not available, Table 2 will be used to compute the number of full-
time equivalent dentists.

                  Table 2--Equivalency Weights, by Age
------------------------------------------------------------------------
                                            55     55-59   60-64    65+
------------------------------------------------------------------------
Equivalency weights.....................     1.2     0.9     0.8     0.6
------------------------------------------------------------------------

    The number of FTE dentists within a particular age group (or age/
auxiliary group) will be obtained by multiplying the number of dentists 
within that group by its corresponding equivalency weight. The total 
supply of FTE dentists within an area is then computed as the sum of 
those dentists within each age (or age/auxiliary) group.
    (c) The equivalency weights specified in tables 1 and 2 assume that 
dentists within a particular group are working full-time (40 hours per 
week). Where appropriate data are available, adjusted equivalency 
figures for dentists who are semi-retired, who operate a reduced 
practice due to infirmity or other limiting conditions, or who are 
available to the population of an area only on a part-time basis will be 
used to reflect the reduced availability of these dentists. In computing 
these equivalency figures, every 4 hours (or \1/2\ day) spent in the 
dental practice will be counted as 0.1 FTE except that each dentist 
working more than 40 hours a week will be counted as 1.0. The count 
obtained for a particular age group of dentists will then be multiplied 
by the appropriate equivalency weight from table 1 or 2 to obtain a 
full-time equivalent figure for dentists within that particular age or 
age/auxiliary category.
    4. Determination of Unusually High Needs for Dental Services.
    An area will be considered as having unusually high needs for dental 
services if at least one of the following criteria is met:
    (a) More than 20% of the population (or of all households) has 
incomes below the poverty level.
    (b) The majority of the area's population does not have a 
fluoridated water supply.
    5. Determination of Insufficient Capacity of Existing Dental Care 
Providers.
    An area's existing dental care providers will be considered to have 
insufficient capacity if at least two of the following criteria are met:
    (a) More than 5,000 visits per year per FTE dentist serving the 
area.
    (b) Unusually long waits for appointments for routine dental 
services (i.e., more than 6 weeks).

[[Page 42]]

    (c) A substantial proportion (\2/3\ or more) of the area's dentists 
do not accept new patients.
    6. Contiguous Area Considerations.
    Dental professional(s) in areas contiguous to an area being 
considered for designation will be considered excessively distant, 
overutilized or inaccessible to the population of the area under 
consideration if one of the following conditions prevails in each 
contiguous area:
    (a) Dental professional(s) in the contiguous area are more than 40 
minutes travel time from the center of the area being considered for 
designation (measured in accordance with Paragraph B.1.(b) of this 
part).
    (b) Contiguous area population-to-(FTE) dentist ratios are in excess 
of 3,000 : 1, indicating that resources in contiguous areas cannot be 
expected to help alleviate the shortage situation in the area being 
considered for designation.
    (c) Dental professional(s) in the contiguous area are inaccessible 
to the population of the area under consideration because of specified 
access barriers, such as:
    (i) Significant differences between the demographic (or 
socioeconomic) characteristics of the area under consideration and those 
of the contiguous area, indicating that the population of the area under 
consideration may be effectively isolated from nearby resources. Such 
isolation could be indicated, for example, by an unusually high 
proportion of non-English-speaking persons.
    (ii) A lack of economic access to contiguous area resources, 
particularly where a very high proportion of the population of the area 
under consideration is poor (i.e., where more than 20 percent of the 
population or of the households have incomes below the poverty level) 
and Medicaid-covered or public dental services are not available in the 
contiguous area.
    C. Determination of Degree of Shortage.
    The degree of shortage of a given geographic area, designated as 
having a shortage of dental professional(s), will be determined using 
the following procedure:
    Designated areas will be assigned to degree-of-shortage groups, 
based on the ratio (R) of population to number of full-time-equivalent 
dentists and the presence or absence of unusually high needs for dental 
services, or insufficient capacity of existing dental care providers 
according to the following table:

------------------------------------------------------------------------
                                     High needs or
                                     insufficient        High needs or
                                     capacity not        insufficient
                                       indicated      capacity indicated
------------------------------------------------------------------------
Group 1.........................  No dentists.......  No dentists or
                                                       R8,000.
Group 2.........................  R8,000............  8,000>R6,000.
Group 3.........................  8,000>R6,000......  6,000>R5,000.
Group 4.........................  6,000>R5,000......  5,000>R4,000.
------------------------------------------------------------------------

    D. Determination of size of dental shortage. Size of Dental Shortage 
(in number of FTE dental practitioners needed) will be computed using 
the following formulas:
    (1) For areas without unusually high need:
Dental shortage=area population/5,000-number of FTE dental practitioners
    (2) For areas with unusually high need:
Dental shortage=area population/4,000-number of FTE dental practitioners

                       Part II--Population Groups

    A. Criteria.
    1. In general, specified population groups within particular 
geographic areas will be designated as having a shortage of dental care 
professional(s) if the following three criteria are met:
    a. The area in which they reside is rational for the delivery of 
dental care services, as defined in paragraph B.1 of part I of this 
appendix.
    b. Access barriers prevent the population group from use of the 
area's dental providers.
    c. The ratio (R) of the number of persons in the population group to 
the number of dentists practicing in the area and serving the population 
group is at least 4,000:1.
    2. Indians and Alaska Natives will be considered for designation as 
having shortages of dental professional(s) as follows:
    (a) Groups of members of Indian tribes (as defined in section 4(d) 
of Pub. L. 94-437, the Indian Health Care Improvement Act of 1976) are 
automatically designated.
    (b) Other groups of Indians or Alaska Natives (as defined in section 
4(c) of Pub. L. 94-437) will be designated if the general criteria in 
paragraph 1 are met.
    B. Determination of Degree of Shortage.
    Each designated population group will be assigned to a degree-of-
shortage group as follows:

Group 1--No dentists or R8,000.
Group 2--8,000>R6,000.
Group 3--6,000>R5,000.
Group 4--5,000>R4,000.

Population groups which have received ``automatic'' designation will be 
assigned to degree-of-shortage group 4 unless information on the ratio 
of the number of persons in the group to the number of FTE dentists 
serving them is provided.
    C. Determination of size of dental shortage. Size of dental shortage 
will be computed as follows:
Dental shortage=number of persons in population group/4,000-number of 
FTE dental practitioners

                          Part III--Facilities

    A. Federal and State Correctional Institutions.
    1. Criteria.

[[Page 43]]

    Medium to maximum security Federal and State correctional 
institutions and youth detention facilities will be designated as having 
a shortage of dental professional(s) if both the following criteria are 
met:
    (a) The institution has at least 250 inmates.
    (b) The ratio of the number of internees per year to the number of 
FTE dentists serving the institution is at least 1,500:1. (Here the 
number of internees is the number of inmates present at the beginning of 
the year plus the number of new inmates entering the institution during 
the year, including those who left before the end of the year; the 
number of FTE dentists is computed as in part I, section B, paragraph 3 
above.)
    2. Determination of Degree-of-Shortage.
    Designated correctional institutions will be assigned to degree-of-
shortage groups as follows, based on number of inmates and/or the ratio 
(R) of internees to dentists:

Group 1--Institutions with 500 or more inmates and no dentists.
Group 2--Other institutions with no dentists and institutions with R 
> 3,000.
Group 3--Institutions with 3,000 > R > 1,500.

    B. Public or Non-Profit Private Dental Facilities.
    1. Criteria.
    Public or nonprofit private facilties providing general dental care 
services will be designated as having a shortage of dental 
professional(s) if both of the following criteria are met:
    (a) The facility is providing general dental care services to an 
area or population group designated as having a dental professional(s) 
shortage; and
    (b) The facility has insufficent capacity to meet the dental care 
needs of that area or population group.
    2. Methodology.
    In determining whether public or nonprofit private facilities meet 
the criteria established by paragraph B.1. of this part, the following 
methodology will be used:
    (a) Provision of Services to a Designated Area or Population Group.
    A facility will be considered to be providing services to an area or 
population group if either:
    (i) A majority of the facility's dental care services are being 
provided to residents of designated dental professional(s) shortage 
areas or to population groups designated as having a shortage of dental 
professional(s); or
    (ii) The population within a designated dental shortage area or 
population group has reasonable access to dental services provided at 
the facility. Reasonable access will be assumed if the population lies 
within 40 minutes travel time of the facility and non-physical barriers 
(relating to demographic and socioeconomic characteristics of the 
population) do not prevent the population from receiving care at the 
facility.
    Migrant health centers (as defined in section 319(a)(1) of the Act) 
which are located in areas with designated migrant population groups and 
Indian Health Service facilities are assumed to be meeting this 
requirement.
    (b) Insufficient Capacity To Meet Dental Care Needs.
    A facility will be considered to have insufficient capacity to meet 
the dental care needs of a designated area or population group if either 
of the following conditions exists at the facility.
    (i) There are more than 5,000 outpatient visits per year per FTE 
dentist on the staff of the facility. (Here the number of FTE dentists 
is computed as in part I, section B, paragraph 3 above.)
    (ii) Waiting time for appointments is more than 6 weeks for routine 
dental services.
    3. Determination of Degree of Shortage.
    Each designated dental facility will be assigned to the same degree-
of-shortage group as the designated area or population group which it 
serves.

[45 FR 76000, Nov. 17, 1980, as amended at 54 FR 8738, Mar. 2, 1989; 57 
FR 2480, Jan. 22, 1992]

Appendix C to Part 5--Criteria for Designation of Areas Having Shortages 
                     of Mental Health Professionals

                        Part I--Geographic Areas

    A. Criteria. A geographic area will be designated as having a 
shortage of mental health professionals if the following four criteria 
are met:
    1. The area is a rational area for the delivery of mental health 
services.
    2. One of the following conditions prevails within the area:
    (a) The area has--
    (i) A population-to-core-mental-health-professional ratio greater 
than or equal to 6,000:1 and a population-to-psychiatrist ratio greater 
than or equal to 20,000:1, or
    (ii) A population-to-core-professional ratio greater than or equal 
to 9,000:1, or
    (iii) A population-to-psychiatrist ratio greater than or equal to 
30,000:1;
    (b) The area has unusually high needs for mental health services, 
and has--
    (i) A population-to-core-mental-health-professional ratio greater 
than or equal to 4,500:1 and
    A population-to-psychiatrist ratio greater than or equal to 
15,000:1, or
    (ii) A population-to-core-professional ratio greater than or equal 
to 6,000:1, or
    (iii) A population-to-psychiatrist ratio greater than or equal to 
20,000:1;

[[Page 44]]

    3. Mental health professionals in contiguous areas are overutilized, 
excessively distant or inaccessible to residents of the area under 
consideration.

    B. Methodology.
    In determining whether an area meets the criteria established by 
paragraph A of this part, the following methodology will be used:
    1. Rational Areas for the Delivery of Mental Health Services.
    (a) The following areas will be considered rational areas for the 
delivery of mental health services:
    (i) An established mental health catchment area, as designated in 
the State Mental Health Plan under the general criteria set forth in 
section 238 of the Community Mental Health Centers Act.
    (ii) A portion of an established mental health catchment area whose 
population, because of topography, market and/or transportation patterns 
or other factors, has limited access to mental health resources in the 
rest of the catchment area, as measured generally by a travel time of 
greater than 40 minutes to these resources.
    (iii) A county or metropolitan area which contains more than one 
mental health catchment area, where data are unavailable by individual 
catchment area.
    (b) The following distances will be used as guidelines in 
determining distances corresponding to 40 minutes travel time:
    (i) Under normal conditions with primary roads available: 25 miles.
    (ii) In mountainous terrain or in areas with only secondary roads 
available: 20 miles.
    (iii) In flat terrain or in areas connected by interstate highways: 
30 miles.
    Within inner portions of metropolitan areas, information on the 
public transportation system will be used to determine the distance 
corresponding to 40 minutes travel time.
    2. Population Count.
    The population count used will be the total permanent resident 
civilian population of the area, excluding inmates of institutions.
    3. Counting of mental health professionals. (a) All non-Federal core 
mental health professionals (as defined below) providing mental health 
patient care (direct or other, including consultation and supervision) 
in ambulatory or other short-term care settings to residents of the area 
will be counted. Data on each type of core professional should be 
presented separately, in terms of the number of full-time-equivalent 
(FTE) practitioners of each type represented.
    (b) Definitions:
    (i) Core mental health professionals or core professionals includes 
those psychiatrists, clinical psychologists, clinical social workers, 
psychiatric nurse specialists, and marriage and family therapists who 
meet the definitions below.
    (ii) Psychiatrist means a doctor of medicine (M.D.) or doctor of 
osteopathy (D.O.) who
    (A) Is certified as a psychiatrist or child psychiatrist by the 
American Medical Specialities Board of Psychiatry and Neurology or by 
the American Osteopathic Board of Neurology and Psychiatry, or, if not 
certified, is ``broad-eligible'' (i.e., has successfully completed an 
accredited program of graduate medical or osteopathic education in 
psychiatry or child psychiatry); and
    (B) Practices patient care psychiatry or child psychiatry, and is 
licensed to do so, if required by the State of practice.
    (iii) Clinical psychologist means an individual (normally with a 
doctorate in psychology) who is practicing as a clinical or counseling 
psychologist and is licensed or certified to do so by the State of 
practice; or, if licensure or certification is not required in the State 
of practice, an individual with a doctorate in psychology and two years 
of supervised clinical or counseling experience. (School psychologists 
are not included.)
    (iv) Clinical social worker means an individual who--
    (A) Is certified as a clinical social worker by the American Board 
of Examiners in Clinical Social Work, or is listed on the National 
Association of Social Workers' Clinical Register, or has a master's 
degree in social work and two years of supervised clinical experience; 
and
    (B) Is licensed to practice as a social worker, if required by the 
State of practice.
    (v) Psychiatric nurse specialist means a registered nurse (R.N.) 
who--
    (A) Is certified by the American Nurses Association as a psychiatric 
and mental health clinical nurse specialist, or has a master's degree in 
nursing with a specialization in psychiatric/mental health and two years 
of supervised clinical experience; and
    (B) Is licensed to practice as a psychiatric or mental health nurse 
specialist, if required by the State of practice.
    (vi) Marriage and family therapist means an individual (normally 
with a master's or doctoral degree in marital and family therapy and at 
least two years of supervised clinical experience) who is practicing as 
a marital and family therapist and is licensed or certified to do so by 
the State of practice; or, if licensure or certification is not required 
by the State of practice, is eligible for clinical membership in the 
American Association for Marriage and Family Therapy.
    (c) Practitioners who provide patient care to the population of an 
area only on a part-time basis (whether because they maintain another 
office elsewhere, spend some of their time providing services in a 
facility, are semi-retired, or operate a reduced practice for other 
reasons), will be counted on a partial basis through the use of full-
time-equivalency calculations based on a 40-hour

[[Page 45]]

week. Every 4 hours (or \1/2\ day) spent providing patient care services 
in ambulatory or inpatient settings will be counted as 0.1 FTE, and each 
practitioner providing patient care for 40 or more hours per week as 1.0 
FTE. Hours spent on research, teaching, vocational or educational 
counseling, and social services unrelated to mental health will be 
excluded; if a practitioner is located wholly or partially outside the 
service area, only those services actually provided within the area are 
to be counted.
    (d) In some cases, practitioners located within an area may not be 
accessible to the general population of the area under consideration. 
Practitioners working in restricted facilities will be included on an 
FTE basis based on time spent outside the facility. Examples of 
restricted facilities include correctional institutions, youth detention 
facilities, residential treatment centers for emotionally disturbed or 
mentally retarded children, school systems, and inpatient units of State 
or county mental hospitals.
    (e) In cases where there are mental health facilities or 
institutions providing both inpatient and outpatient services, only 
those FTEs providing mental health services in outpatient units or other 
short-term care units will be counted.
    (f) Adjustments for the following factors will also be made in 
computing the number of FTE providers:
    (i) Practitioners in residency programs will be counted as 0.5 FTE.
    (ii) Graduates of foreign schools who are not citizens or lawful 
permanent residents of the United States will be excluded from counts.
    (iii) Those graduates of foreign schools who are citizens or lawful 
permanent residents of the United States, and practice in certain 
settings, but do not have unrestricted licenses to practice, will be 
counted on a full-time-equivalency basis up to a maximum of 0.5 FTE.
    (g) Practitioners suspended for a period of 18 months or more under 
provisions of the Medicare-Medicaid Anti-Fraud and Abuse Act will not be 
counted.
    4. Determination of unusually high needs for mental health services. 
An area will be considered to have unusually high needs for mental 
health services if one of the following criteria is met:
    (a) 20 percent of the population (or of all households) in the area 
have incomes below the poverty level.
    (b) The youth ratio, defined as the ratio of the number of children 
under 18 to the number of adults of ages 18 to 64, exceeds 0.6.
    (c) The elderly ratio, defined as the ratio of the number of persons 
aged 65 and over to the number of adults of ages 18 to 64, exceeds 0.25.
    (d) A high prevalence of alcoholism in the population, as indicated 
by prevalence data showing the area's alcoholism rates to be in the 
worst quartile of the nation, region, or State.
    (e) A high degree of substance abuse in the area, as indicated by 
prevalence data showing the area's substance abuse to be in the worst 
quartile of the nation, region, or State.
    5. Contiguous area considerations. Mental health professionals in 
areas contiguous to an area being considered for designation will be 
considered excessively distant, overutilized or inaccessible to the 
population of the area under consideration if one of the following 
conditions prevails in each contiguous area:
    (a) Core mental health professionals in the contiguous area are more 
than 40 minutes travel time from the closest population center of the 
area being considered for designation (measured in accordance with 
paragraph B.1(b) of this part).
    (b) The population-to-core-mental-health-professional ratio in the 
contiguous area is in excess of 3,000:1 and the population-to-
psychiatrist ratio there is in excess of 10,000:1, indicating that core 
mental health professionals in the contiguous areas are overutilized and 
cannot be expected to help alleviate the shortage situation in the area 
for which designation is being considered. (If data on core mental 
health professionals other than psychiatrists are not available for the 
contiguous area, a population-to-psychiatrist ratio there in excess of 
20,000:1 may be used to demonstrate overutilization.)
    (c) Mental health professionals in contiguous areas are inaccessible 
to the population of the requested area due to geographic, cultural, 
language or other barriers or because of residency restrictions of 
programs or facilities providing such professionals.
    C. Determination of degree of shortage. Designated areas will be 
assigned to degree-of-shortage groups according to the following table, 
depending on the ratio (RC) of population to number of FTE 
core-mental-health-service providers (FTEC); the ratio 
(RP) of population to number of FTE psychiatrists 
(FTEP); and the presence or absence of high needs:

                        High Needs Not Indicated

Group 1--FTEC=0 and FTEP=0
Group 2--RC gte * 6,000:1 and FTEP=0
Group 3--RC gte 6,000:1 and RP gte 20,000
Group 4(a)--For psychiatrist placements only: All other areas with 
FTEP=0 or RP gte 30,000
Group 4(b)--For other mental health practitioner placements: All other 
areas with RC gte 9,000:1.

    * Note: ``gte'' means ``greater than or equal to''.

[[Page 46]]

                          High Needs Indicated

Group 1--FTEC=0 and FTEP=0
Group 2--RC gte 4,500:1 and FTEP=0
Group 3--RC gte 4,500:1 and RP gte 15,000
Group 4(a)--For psychiatrist placements only: All other areas with 
FTEP=0 or RP gte 20,000
Group 4(b)--For other mental health practitioner placements: All other 
areas with RC gte 6,000:1.
    D. Determination of Size of Shortage. Size of Shortage (in number of 
FTE professionals needed) will be computed using the following formulas:
    (1) For areas without unusually high need:

Core professional shortage=area population/6,000-number of FTE core 
professionals
Psychiatrist shortage=area population/20,000-number of FTE psychiatrists

    (2) For areas with unusually high need:

Core professional shortage=area population/4,500-number of FTE core 
professionals
Psychiatrist shortage=area population/15,000-number of FTE psychiatrists

                       Part II--Population Groups

    A. Criteria. Population groups within particular rational mental 
health service areas will be designated as having a mental health 
professional shortage if the following criteria are met:
    1. Access barriers prevent the population group from using those 
core mental health professionals which are present in the area; and
    2. One of the following conditions prevails:
    (a) The ratio of the number of persons in the population group to 
the number of FTE core mental health professionals serving the 
population group is greater than or equal to 4,500:1 and the ratio of 
the number of persons in the population group to the number of FTE 
psychiatrists serving the population group is greater than or equal to 
15,000:1; or,
    (b) The ratio of the number of persons in the population group to 
the number of FTE core mental health professionals serving the 
population group is greater than or equal to 6,000:1; or,
    (c) The ratio of the number of persons in the population group to 
the number of FTE psychiatrists serving the population group is greater 
than or equal to 20,000:1.
    B. Determination of degree of shortage. Designated population groups 
will be assigned to the same degree-of-shortage groups defined in part 
I.C of this appendix for areas with unusually high needs for mental 
health services, using the computed ratio (RC) of the number 
of persons in the population group to the number of FTE core mental 
health service providers (FTEC) serving the population group, 
and the ration (RP) of the number of persons in the 
population group to the number of FTE psychiatrists (FTEP) 
serving the population group.
    C. Determination of size of shortage. Size of shortage will be 
computed as follows:
Core professional shortage=number of persons in population group/
4,500-number of FTE core professionals
Psychiatrist shortage=number of persons in population group/
15,000-number of FTE psychiatrists

                          Part III--Facilities

    A. Federal and State Correctional Institutions
    1. Criteria.
    Medium to maximum security Federal and State correctional 
institutions for adults or youth, and youth detention facilities, will 
be designated as having a shortage of psychiatric professional(s) if 
both of the following criteria are met:
    (a) The institution has more than 250 inmates, and
    (b) The ratio of the number of internees per year to the number of 
FTE psychiatrists serving the institution is at least 2,000:1. (Here the 
number of internees is the number of inmates or residents present at the 
beginning of the year, plus the number of new inmates or residents 
entering the institution during the year, including those who left 
before the end of the year; the number of FTE psychiatrists is computed 
as in part I, section B, paragraph 3 above.)
    2. Determination of Degree of Shortage.
    Correctional facilities and youth detention facilities will be 
assigned to degree-of-shortage groups, based on the number of inmates 
and/or the ratio (R) of internees to FTE psychiatrists, as follows:

    Group 1--Facilities with 500 or more inmates or residents and no 
psychiatrist.
    Group 2--Other facilities with no psychiatrists and facilities with 
500 or more inmates or residents and R>3,000.
    Group 3--All other facilities.

    B. State and County Mental Hospitals.
    1. Criteria.
    A State or county hospital will be designated as having a shortage 
of psychiatric professional(s) if both of the following criteria are 
met:
    (a) The mental hospital has an average daily inpatient census of at 
least 100; and
    (b) The number of workload units per FTE psychiatrists available at 
the hospital exceeds 300, where workload units are calculated using the 
following formula:
    Total workload units = average daily inpatient census + 2  x  
(number of inpatient admissions per year) + 0.5  x  (number of 
admissions to day care and outpatient services per year).
    2. Determination of Degree of Shortage.
    State or county mental hospitals will be assigned to degree-of-
shortage groups, based

[[Page 47]]

on the ratio (R) of workload units to number of FTE psychiatrists, as 
follows:

    Group 1--No psychiatrists, or R>1,800.
    Group 2--1,800>R>1,200.
    Group 3--1,200>R>600.
    Group 4--600>R>300.

    C. Community Mental Health Centers and Other Public or Nonprofit 
Private Facilities.
    1. Criteria.
    A community mental health center (CMHC), authorized by Pub. L. 94-
63, or other public or nonprofit private facility providing mental 
health services to an area or population group, may be designated as 
having a shortage of psychiatric professional(s) if the facility is 
providing (or is responsible for providing) mental health services to an 
area or population group designated as having a mental health 
professional(s), and the facility has insufficient capacity to meet the 
psychiatric needs of the area or population group.
    2. Methodology.
    In determining whether CMHCs or other public or nonprofit private 
facilities meet the criteria established in paragraph C.1 of this Part, 
the following methodology will be used.
    (a) Provision of Services to a Designated Area or Population Group.
    The facility will be considered to be providing services to a 
designated area or population group if either:
    (i) A majority of the facility's mental health services are being 
provided to residents of designated mental health professional(s) 
shortage areas or to population groups designated as having a shortage 
of mental health professional(s); or
    (ii) The population within a designated psychiatric shortage area or 
population group has reasonable access to mental health services 
provided at the facility. Such reasonable access will be assumed if the 
population lies within 40 minutes travel time of the facility and 
nonphysical barriers (relating to demographic and socioeconomic 
characteristics of the population) do not prevent the population from 
receiving care at the facility.
    (b) Responsibility for Provision of Services.
    This condition will be considered to be met if the facility, by 
Federal or State statute, administrative action, or contractual 
agreement, has been given responsibility for providing and/or 
coordinating mental health services for the area or population group, 
consistent with applicable State plans.
    (c) Insufficient capacity to meet mental health service needs. A 
facility will be considered to have insufficient capacity to meet the 
mental health service needs of the area or population it serves if:
    (i) There are more than 1,000 patient visits per year per FTE core 
mental health professional on staff of the facility, or
    (ii) There are more than 3,000 patient visits per year per FTE 
psychiatrist on staff of the facility, or
    (iii) No psychiatrists are on the staff and this facility is the 
only facility providing (or responsible for providing) mental health 
services to the designated area or population.
    3. Determination of Degree-of-Shortage.
    Each designated facility will be assigned to the same degree-of-
shortage group as the designated area or population group which it 
serves.

[45 FR 76000, Nov. 17, 1980, as amended at 54 FR 8738, Mar. 2, 1989; 57 
FR 2477, Jan. 22, 1992]

Appendix D to Part 5--Criteria for Designation of Areas Having Shortages 
                     of Vision Care Professional(s)

                        Part I--Geographic Areas

    A. Criteria.
    A geographic area will be designated as having a shortage of vision 
care professional(s) if the following three criteria are met:
    1. The area is a rational area for the delivery of vision care 
services.
    2. The estimated number of optometric visits supplied by vision care 
professional(s) in the area is less than the estimated requirements of 
the area's population for these visits, and the computed shortage is at 
least 1,500 optometric visits.
    3. Vision care professional(s) in contiguous areas are excessively 
distant, overutilized, or inaccessible to the population of the area 
under consideration.
    B. Methodology.
    In determining whether an area meets the criteria established by 
paragraph A of this part, the following methodology will be used:
    1. Rational Areas for the Delivery of Vision Care Services.
    (a) The following areas will be considered rational areas for the 
delivery of vision care services:
    (i) A county, or a group of contiguous counties whose population 
centers are within 40 minutes travel time of each other;
    (ii) A portion of a county (or an area made up of portions of more 
than one county) whose population, because of topography, market or 
transportation patterns, or other factors, has limited access to 
contiguous area resources, as measured generally by a travel time of 
greater than 40 minutes to these resources.
    (b) The following distances will be used as guidelines in 
determining distances corresponding to 40 minutes travel time:
    (i) Under normal conditions with primary roads available: 25 miles.

[[Page 48]]

    (ii) In mountainous terrain or in areas with only secondary roads 
available: 20 miles.
    (iii) In flat terrain or in areas connected by interstate highways: 
30 miles.
    Within inner portions of metropolitan areas, information on the 
public transportation system will be used to determine the distance 
corresponding to 40 minutes travel time.
    2. Determination of Estimated Requirement for Optometric Visits.
    The number of optometric visits required by an area's population 
will be estimated by multiplying each of the following visit rates by 
the size of the population within that particular age group and then 
adding the figures obtained together.

----------------------------------------------------------------------------------------------------------------
                                              Annual number of optometric visits required per person, by age
                                         -----------------------------------------------------------------------
                   Age                                                                                  60 and
                                           Under 20      20-29       30-39       40-49       50-59       over
----------------------------------------------------------------------------------------------------------------
Number of visits........................        0.11        0.20        0.24        0.35        0.41        0.48
----------------------------------------------------------------------------------------------------------------

    For geographic areas where the age distribution of the population is 
not known, it will be assumed that the percentage distribution, by age 
groups, for the area is the same as the distribution for the county of 
which it is a part.
    (3) Determination of Estimated Supply of Optometric Visits.
    The estimated supply of optometric services will be determined by 
use of the following formula:

    Optometric visits supplied = 3,000  x  (number of optometrists under 
65)
    Optometric visits supplied + 2,000  x  (number of optometrists 65 
and over)
    Optometric visits supplied + 1,500  x  (number of ophthamologists)

    (4) Determination of Size of Shortage.
    Size of shortage (in number of optometric visits) will be computed 
as follows:
    Optometric visit shortage = visits required - visits supplied
    (5) Contiguous Area Considerations.
    Vision care professional(s) in area contiguous to an area being 
considered for designation will be considered execessively distant, 
overutilized or inaccessible to the population of the area if one of the 
following conditions prevails in each contiguous area:
    (a) Vision care professional(s) in the contiguous area are more than 
40 minutes travel time from the center of the area being considered for 
designation (measured in accordance with paragraph B.1(b) of this part).
    (b) The estimated requirement for vision care services in the 
contiguous area exceeds the estimated supply of such services there, 
based on the requirements and supply calculations previously described.
    (c) Vision care professional(s) in the contiguous area are 
inaccessible to the population of the area because of specified access 
barriers (such as economic or cultural barriers).
    C. Determination of Degree-of-Shortage.
    Designated areas (and population groups) will be assigned to degree-
of-shortage groups, based on the ratio of optometric visits supplied to 
optometric visits required for the area (or group), as follows:

    Group 1--Areas (or groups) with no optometric visits being supplied 
(i.e., with no optometrists or ophthalmologists).
    Group 2--Areas (or groups) where the ratio of optometric visits 
supplied to optometric visits required is less than 0.5.
    Group 3--Areas (or groups) where the ratio of optometric visits 
supplied to optometric visits required is between 0.5 and 1.0.

                       Part II--Population Groups

    A. Criteria.
    Population groups within particular geographic areas will be 
designated if both the following criteria are met:
    (1) Members of the population group do not have access to vision 
care resources within the area (or in contiguous areas) because of non-
physical access barriers (such as economic or cultural barriers).
    (2) The estimated number of optometric visits supplied to the 
population group (as determined under paragraph B.3 of part I of this 
Appendix) is less than the estimated number of visits required by that 
group (as determined under paragraph B.2 of part I of this Appendix), 
and the computed shortage is at least 1,500 optometric visits.
    B. Determination of Degree of Shortage.
    The degree of shortage of a given population group will be 
determined in the same way as described for areas in paragraph C of part 
I of this appendix.

Appendix E to Part 5--Criteria for Designation of Areas Having Shortages 
                      of Podiatric Professional(s)

                        Part I--Geographic Areas

    A. Criteria.
    A geographic area will be designated as having a shortage of 
podiatric professional(s) if the following three criteria are met:

[[Page 49]]

    1. The area is a rational area for the delivery of podiatric 
services.
    2. The area's ratio of population to foot care practitioners is at 
least 28,000:1, and the computed podiatrist shortage to meet this ratio 
is at least 0.5.
    3. Podiatric professional(s) in contiguous areas are overutilized, 
excessively distant, or inaccessible to the population of the area under 
consideration.
    B. Methodology.
    In determining whether an area meets the criteria established by 
paragraph A of this Part, the following methodology will be used:
    1. Rational Areas for the Delivery of Podiatric Services.
    (a) The following areas will be considered rational areas for the 
delivery of podiatric services:
    (i) A county or a group of contiguous counties whose population 
centers are within 40 minutes travel time of each other.
    (ii) A portion of a county, or an area made up of portions of more 
than one county, whose population, because of topography, market and/or 
transportation patterns or other factors, has limited access to 
contiguous area resources, as measured generally by a travel time of 
greater than 40 minutes from its population center to these resources.
    (b) The following distances will be used as guidelines in 
determining distances corresponding to 40 minutes travel time:
    (i) Under normal conditions with primary roads available: 25 miles.
    (ii) In mountainous terrain or in areas with only secondary roads 
available: 20 miles.
    (iii) In flat terrain or in areas connected by interstate highways: 
30 miles.
    Within inner portions of metropolitan areas, information on the 
public transportation system will be used to determine the area 
corresponding to 40 minutes travel time.
    2. Population Count.
    The population count used will be the total permanent resident 
civilian population of the area, excluding inmates of institutions, 
adjusted by the following formula to take into account the differing 
utilization rates of podiatric services by different age groups within 
the population:

Adjusted population=total population  x  (1 + 2.2  x  (percent of 
          population 65 and over) - 0.44  x  (percent of population 
          under 17)).

    3. Counting of Foot Care Practitioners.
    (a) All podiatrists providing patient care will be counted. However, 
in order to take into account productivity differences in podiatric 
practices associated with the age of the podiatrists, the following 
formula will be utilized:

Number of FTE podiatrists = 1.0  x  (podiatrists under age 55)
+ .8  x  (podiatrists age 55 and over)

    (b) In order to take into account the fact that orthopedic surgeons 
and general and family practitioners devote a percentage of their time 
to foot care, the total available foot care practitioners will be 
computed as follows:

Number of foot care practitioners = number of FTE podiatrists
+ .15  x  (number of orthopedic surgeons)
+ .02  x  (number of general and family practioners).

    4. Determination of Size of Shortage.
    Size of shortage (in number of FTE podiatrists) will be computed as 
follows:

Podiatrist shortage = adjusted population/28,000 - number of FTE foot 
          care practitioners.

    5. Contiguous Area Considerations.
    Podiatric professional(s) in areas contiguous to an area being 
considered for designation will be considered excessively distant, 
overutilized or inaccessible to the population of the area under 
consideration if one of the following conditions prevails in each 
contiguous area:
    (a) Podiatric professional(s) in the contiguous area are more than 
40 minutes travel time from the center of the area being considered for 
designation.
    (b) The population-to-foot care practitioner ratio in the contiguous 
areas is in excess of 20,000 : 1, indicating that contiguous area 
podiatric professional(s) cannot be expected to help alleviate the 
shortage situation in the area for which designation is requested.
    (c) Podiatric professional(s) in the contiguous area are 
inaccessible to the population of the area under consideration because 
of specified access barriers (such as economic or cultural barriers).
    C. Determination of Degree of Shortage.
    Designated areas will be assigned to groups, based on the ratio (R) 
of adjusted population to number of foot care practitioners, as follows:

Group 1 Areas with no foot care practitioners, and areas with R > 50,000 
          and no podiatrists.
Group 2 Other areas with R > 50,000.
Group 3 Areas with 50,000 > R > 28,000.

Appendix F to Part 5--Criteria for Designation of Areas Having Shortages 
                       of Pharmacy Professional(s)

                        Part I--Geographic Areas

    A. Criteria.

[[Page 50]]

    A geographic area will be designated as having a shortage of 
pharmacy professional(s) if the following three criteria are met:
    1. The area is a rational area for the delivery of pharmacy 
services.
    2. The number of pharmacists serving the area is less than the 
estimated requirement for pharmacists in the area, and the computed 
pharmacist shortage is at least 0.5.
    3. Pharmacists in contiguous areas are overutilized or excessively 
distant from the population of the area under consideration.
    B. Methodology.
    In determining whether an area meets the criteria established by 
paragraph A of this Part, the following methodology will be used:
    1. Rational Areas for the Delivery of Pharmacy Services.
    (a) The following areas will be considered rational areas for the 
delivery of pharmacy services:
    (i) A county, or a group of contiguous counties whose population 
centers are within 30 minutes travel time of each other; and
    (ii) A portion of a county, or an area made up of portions of more 
than one county, whose population, because of topography, market or 
transportation patterns or other factors, has limited access to 
contiguous area resources, as measured generally by a travel time of 
greater than 30 minutes to these resources.
    (b) The following distances will be used as guidelines in 
determining distances corresponding to 30 minutes travel time:
    (i) Under normal conditions with primary roads available: 20 miles.
    (ii) In mountainous terrain or in areas with only secondary roads 
available: 15 miles.
    (iii) In flat terrain or in areas connected by interstate highways: 
25 miles.
    Within inner portions of metropolitan areas, information on the 
public transportation system will be used to determine the area 
corresponding to 30 minutes travel time.
    2. Counting of Pharmacists.
    All active pharmacists within the area will be counted, except those 
engaged in teaching, administration, or pharmaceutical research.
    3. Determination of Estimated Requirement for Pharmacists.
    (a) Basic estimate. The basic estimated requirement for pharmacists 
will be calculated as follows:

Basic pharmacist requirement = .15  x  (resident civilian population/
          1,000) + .035  x  (total number of physicians engaged in 
          patient care in the area).

    (b) Adjusted estimate. For areas with less than 20,000 persons, the 
following adjustment is made to the basic estimate to compensate for the 
lower expected productivity of small practices.

Estimated pharmacist requirement = (2 - population/20,000)  x  basic 
          pharmacist requirement.

    4. Size of Shortage Computation.
    The size of the shortage will be computed as follows:

Pharmacist shortage = estimated pharmacist requirement - number of 
          pharmacists available.

    5. Contiguous Area Considerations.
    Pharmacists in areas contiguous to an area being considered for 
designation will be considered excessively distant or overutilized if 
either:
    (a) Pharmacy professional(s) in contiguous areas are more than 30 
minutes travel time from the center of the area under consideration, or
    (b) The number of pharmacists in each contiguous area is less than 
or equal to the estimated requirement for pharmacists for that 
contiguous area (as computed above).
    C. Determination of Degree-of-Shortage.
    Designated areas will be assigned to degree-of-shortage groups, 
based on the proportion of the estimated requirement for pharmacists 
which is currently available in the area, as follows:

    Group 1--Areas with no pharmacists.
    Group 2--Areas where the ratio of available pharmacists to 
pharmacists required is less than 0.5.
    Group 3--Areas where the ratio of available pharmacists to 
pharmacists required is between 0.5 and 1.0.

   Appendix G to Part 5--Criteria for the Designation of Areas Having 
                 Shortages of Veterinary Professional(s)

                        Part I--Geographic Areas

    A. Criteria for Food Animal Veterinary Shortage.
    A geographic area will be designated as having a shortage of food 
animal veterinary professional(s) if the following three criteria are 
met:
    1. The area is a rational area for the delivery of veterinary 
services.
    2. The ratio of veterinary livestock units to food animal 
veterinarians in the area is at least 10,000 : 1, and the computed food 
animal veterinarian shortage to meet this ratio is at least 0.5.
    3. Food animal veterinarians in contiguous areas are overutilized or 
excessively distant from the population of the area under consideration.
    B. Criteria for Companion Animal Veterinary Shortage.

[[Page 51]]

    A geographic area will be designated as having a shortage of 
companion animal veterinary professional(s) if the following three 
criteria are met:
    1. The area is a rational area for the delivery of veterinary 
services.
    2. The ratio of resident civilian population to number of companion 
animal veterinarians in the area is at least 30,000 : 1 and the computed 
companion animal veterinary shortage to meet this ratio is at least 0.5.
    3. Companion animal veterinarians in contiguous areas are 
overutilized or excessively distant from the population of the area 
under consideration.
    C. Methodology.
    In determining whether an area meets the criteria established by 
paragraphs A and B of this part, the following methodology will be used:
    1. Rational Areas for the Delivery of Veterinary Services.
    (a) The following areas will be considered rational areas for the 
delivery of veterinary services:
    (i) A county, or a group of contiguous counties whose population 
centers are within 40 minutes travel time of each other.
    (ii) A portion of a county (or an area made up of portions of more 
than one county) which, because of topography, market and/or 
transportation patterns or other factors, has limited access to 
contiguous area resources, as measured generally by a travel time of 
greater than 40 minutes to these resources.
    (b) The following distances will be used as guidelines in 
determining distances corresponding to 40 minutes travel time:
    (i) Under normal conditions with primary roads available: 25 miles.
    (ii) In mountainous terrain or in areas with only secondary roads 
available: 20 miles.
    (iii) In flat terrain or in areas connected by interstate highways: 
30 miles.
    2. Determination of Number of Veterinary Livestock Units (VLU) 
Requiring Care.
    Since various types of food animals require varying amounts of 
veterinary care, each type of animal has been assigned a weight 
indicating the amount of veterinary care it requires relative to that 
required by a milk cow. Those weights are used to compute the number of 
``Veterinary Livestock Units'' (VLU) for which veterinary care is 
required.
    The VLU is computed as follows:

Veterinary Livestock Units (VLU)=(number of milk cows)
+.2 x (number of other cattle and calves)
+.05 x (number of hogs and pigs)
+.05 x (number of sheep)
+.002 x (number of poultry).

    3. Counting of Food Animal Veterinarians.
    The number of food animal veterinarians is determined by weighting 
the number of veterinarians within each of several practice categories 
according to the average fraction of practice time in that category 
which is devoted to food animal veterinary care, as follows:

Number of Food Animal Veterinarians=(number of veterinarians in large 
          animal practice, exclusively)
+(number of veterinarians in bovine practice, exclusively)
+(number of veterinarians in poultry practice, exclusively)
+.75 x (mixed practice veterinarians with greater than 50% of practice 
          in large animal care)
+.5 x (mixed practice veterinarians with approximately 50% of practice 
          in large animal care)
+.25 x (mixed practice veterinarians with less than 50% of practice in 
          large animal care).

    4. Counting of Companion Animal Veterinarians (that is, those who 
provide services for dogs, cats, horses, and any other animals 
maintained as companions to the owner rather than as food animals).
    The number of full-time equivalent companion animal veterinarians is 
determined by weighting the number of veterinarians within each of 
several practice categories by the average portion of their practice 
which is devoted to companion animal care by the practitioners within 
that category, as follows:

Number of Companion Animal Veterinarians=(number of veterinarians in 
          large animal practice, exclusively)
+(number of veterinarians in equine practice, exclusively)
+.75 x (mixed practice veterinarians with greater than 50% of practice 
          in small animal care)
+.5 x (mixed practice veterinarians with approximately 50% of practice 
          in small animal care)
+.25 x (mixed practice veterinarians with less than 50% of practice in 
          small animal care).

    5. Size of Shortage Computation.
    The size of shortage will be computed as follows:
    (a) Food animal veterinarian shortage=(VLU/10,000)-(number of food 
animal veterinarians).
    (b) Companion animal veterinarian shortage=(resident civilian pop./
30,000)-(number of companion animal veterinarians).
    6. Contiguous Area Considerations.
    Veterinary professional(s) in areas contiguous to an area being 
considered for designation will be considered excessively distant from 
the population of the area or overutilized if one of the following 
conditions prevails in each contiguous area:
    (a) Veterinary professional(s) in the contiguous area are more than 
60 minutes travel

[[Page 52]]

time from the center of the area being considered for designation 
(measured in accordance with paragraph C.1.(b) of this part).
    (b) In the case of food animal veterinary professional(s), the VLU-
to-food animal veterinarian ratio in the contiguous area is in excess of 
5,000 : 1.
    (c) In the case of companion animal veterinary professional(s), the 
population-to-companion animal veterinarian ratio in the contiguous area 
is in excess of 15,000 : 1.
    C. Determination of Degree-of-Shortage.
    Designated areas will be assigned to degree-of-shortage groups as 
follows:

    Group 1--Areas with a food animal veterinarian shortage and no 
veterinarians.
    Group 2--Areas (not included above) with a food animal veterinarian 
shortage and no food animal veterinarians.
    Group 3--All other food animal veterinarian shortage areas.
    Group 4--All companion animal shortage areas (not included above) 
having no veterinarians.
    Group 5--All other companion animal shortage areas.



PART 6--FEDERAL TORT CLAIMS ACT COVERAGE OF CERTAIN GRANTEES AND INDIVIDUALS--Table of Contents




Sec.
6.1  Applicability.
6.2  Definitions.
6.3  Eligible entities.
6.4  Covered individuals.
6.5  Deeming process for eligible entities.
6.6  Covered acts and omissions.

    Authority: Sections 215 and 224 of the Public Health Service Act, 42 
U.S.C. 216 and 233.

    Source: 60 FR 22532, May 8, 1995, unless otherwise noted.



Sec. 6.1  Applicability.

    This part applies to entities and individuals whose acts and 
omissions related to the performance of medical, surgical, dental, or 
related functions are covered by the Federal Tort Claims Act (28 U.S.C. 
1346(b) and 2671-2680) in accordance with the provisions of section 
224(g) of the Public Health Service Act (42 U.S.C. 233(g)).



Sec. 6.2  Definitions.

    Act means the Public Health Service Act, as amended.
    Attorney General means the Attorney General of the United States and 
any other officer or employee of the Department of Justice to whom the 
authority involved has been delegated.
    Covered entity means an entity described in Sec. 6.3 which has been 
deemed by the Secretary, in accordance with Sec. 6.5, to be covered by 
this part.
    Covered individual means an individual described in Sec. 6.4.
    Effective date as used in Sec. 6.5 and Sec. 6.6 refers to the date 
of the Secretary's determination that an entity is a covered entity.
    Secretary means the Secretary of Health and Human Services (HHS) and 
any other officer or employee of the Department of HHS to whom the 
authority involved has been delegated.
    Subrecipient means an entity which receives a grant or a contract 
from a covered entity to provide a full range of health services on 
behalf of the covered entity.



Sec. 6.3  Eligible entities.

    (a) Grantees. Entities eligible for coverage under this part are 
public and nonprofit private entities receiving Federal funds under any 
of the following grant programs:
    (1) Section 329 of the Act (relating to grants for migrant health 
centers);
    (2) Section 330 of the Act (relating to grants for community health 
centers);
    (3) Section 340 of the Act (relating to grants for health services 
for the homeless); and
    (4) Section 340A of the Act (relating to grants for health services 
for residents of public housing).
    (b) Subrecipients. Entities that are subrecipients of grant funds 
described in paragraph (a) of this section are eligible for coverage 
only if they provide a full range of health care services on behalf of 
an eligible grantee and only for those services carried out under the 
grant funded project.



Sec. 6.4  Covered individuals.

    (a) Officers and employees of a covered entity are eligible for 
coverage under this part.
    (b) Contractors of a covered entity who are physicians or other 
licensed or certified health care practitioners are eligible for 
coverage under this part if they meet the requirements of section 
224(g)(5) of the Act.
    (c) An individual physician or other licensed or certified health 
care practitioner who is an officer, employee, or

[[Page 53]]

contractor of a covered entity will not be covered for acts or omissions 
occurring after receipt by the entity employing such individual of 
notice of a final determination by the Attorney General that he or she 
is no longer covered by this part, in accordance with section 224(i) of 
the Act.



Sec. 6.5  Deeming process for eligible entities.

    Eligible entities will be covered by this part only on and after the 
effective date of a determination by the Secretary that they meet the 
requirements of section 224(h) of the Act. In making such determination, 
the Secretary will receive such assurances and conduct such 
investigations as he or she deems necessary.



Sec. 6.6  Covered acts and omissions.

    (a) Only acts and omissions occurring on and after the effective 
date of the Secretary's determination under Sec. 6.5 and before the 
later date specified in section 224(g)(3) of the Act are covered by this 
part.
    (b) Only claims for damage for personal injury, including death, 
resulting from the performance of medical, surgical, dental, or related 
functions are covered by this part.
    (c) With respect to covered individuals, only acts and omissions 
within the scope of their employment (or contract for services) are 
covered. If a covered individual is providing services which are not on 
behalf of the covered entity, such as on a volunteer basis or on behalf 
of a third-party (except as described in paragraph (d) of this section), 
whether for pay or otherwise, acts and omissions which are related to 
such services are not covered.
    (d) Only acts and omissions related to the grant-supported activity 
of entities are covered. Acts and omissions related to services provided 
to individuals who are not patients of a covered entity will be covered 
only if the Secretary determines that:
    (1) The provision of the services to such individuals benefits 
patients of the entity and general populations that could be served by 
the entity through community-wide intervention efforts within the 
communities served by such entity;
    (2) The provision of the services to such individuals facilitates 
the provision of services to patients of the entity; or
    (3) Such services are otherwise required to be provided to such 
individuals under an employment contract or similar arrangement between 
the entity and the covered individual.
    (e) Examples. The following are examples of situations within the 
scope of paragraph (d) of this section:
    (1) A community health center deemed to be a covered entity 
establishes a school-based or school-linked health program as part of 
its grant supported activity. Even though the students treated are not 
necessarily registered patients of the center, the center and its health 
care practitioners will be covered for services provided, if the 
Secretary makes the determination in paragraph (d)(1) of this section.
    (2) A migrant health center requires its physicians to obtain staff 
privileges at a community hospital. As a condition of obtaining such 
privileges, and thus being able to admit the center's patients to the 
hospital, the physicians must agree to provide occasional coverage of 
the hospital's emergency room. The Secretary would be authorized to 
determine that this coverage is necessary to facilitate the provision of 
services to the grantee's patients, and that it would therefore be 
covered by paragraph (d)(2) of this section.
    (3) A homeless health services grantee makes arrangements with local 
community providers for after-hours coverage of its patients. The 
grantee's physicians are required by their employment contracts to 
provide periodic cross-coverage for patients of these providers, in 
order to make this arrangement feasible. The Secretary may determine 
that the arrangement is within the scope of paragraph (d)(3) of this 
section.

[60 FR 22532, May. 8, 1995; 60 FR 36073, July 13, 1995]

[[Page 54]]



PART 7--DISTRIBUTION OF REFERENCE BIOLOGICAL STANDARDS AND BIOLOGICAL PREPARATIONS--Table of Contents




Sec.
7.1  Applicability.
7.2  Establishment of a user charge.
7.3  Definitions.
7.4  Schedule of charges.
7.5  Payment procedures.
7.6  Exemptions.

    Authority: Sec. 215, 58 Stat. 690, as amended (42 U.S.C. 216); title 
V of the Independent Offices Appropriation Act of 1952 (31 U.S.C. 9701); 
and sec. 352 of the Public Health Service Act, as amended (42 U.S.C. 
263).

    Source: 52 FR 11073, Apr. 7, 1987, unless otherwise noted.



Sec. 7.1  Applicability.

    The provisions of this part are applicable to private entities 
requesting from the Centers for Disease Control (CDC) reference 
biological standards and biological preparations for use in their 
laboratories.



Sec. 7.2  Establishment of a user charge.

    Except as otherwise provided in Sec. 7.6, a user charge shall be 
imposed to cover the cost to CDC of producing and distributing reference 
biological standards and biological preparations.



Sec. 7.3  Definitions.

    Biological standards means a uniform and stable reference biological 
substance which allows measurements of relative potency to be made and 
described in a common currency of international and national units of 
activity.
    Biological preparations means a reference biological substance which 
may be used for a purpose similar to that of a standard, but which has 
been established without a full collaborative study, or where a 
collaborative study has shown that it is not appropriate to establish 
the preparation as an international standard.



Sec. 7.4  Schedule of charges.

    The charges imposed in Sec. 7.2 are based on the amount published in 
CDC's price list of available products. These charges will reflect 
direct costs (such as salaries and equipment), indirect costs (such as 
rent, telephone service, and a proportionate share of management and 
administrative costs), and the costs of particular ingredients. Charges 
may vary over time and between different biological standards or 
biological preparations, depending upon the cost of ingredients and the 
complexity of production. An up-to-date schedule of charges is available 
from the Biological Products Branch, Center for Infectious Diseases, 
Centers for Disease Control, 1600 Clifton Road, Atlanta, Georgia 30333.



Sec. 7.5  Payment procedures.

    The requester may obtain information on terms of payment and a fee 
schedule by writing the ``Centers for Disease Control,'' Financial 
Management Office, Buckhead Facility, Room 200, Centers for Disease 
Control, 1600 Clifton Road, Atlanta, Georgia 30333.



Sec. 7.6  Exemptions.

    State and local health departments, governmental institutions (e.g., 
State hospitals and universities), the World Health Organization, and 
ministries of health of foreign governments may be exempted from paying 
user charges, when using biological standards or biological preparations 
for public health purposes.

[[Page 55]]



                         SUBCHAPTER B--PERSONNEL





PART 21--COMMISSIONED OFFICERS--Table of Contents




                         Subpart A--Definitions

Sec.
21.1  Meaning of terms.

                         Subpart B--Appointment

         Provisions Applicable Both to Regular and Reserve Corps

21.21  Meaning of terms.
21.22  Submission of application and evidence of qualifications.
21.23  False statements as disqualification.
21.24  Physical examinations.
21.25  Eligibility; junior assistant grade.
21.26  Eligibility; assistant grade.
21.27  Eligibility; senior assistant grade.
21.28  Age requirements, Regular Corps, senior assistant grade and 
          below.
21.29  Eligibility; grades above senior assistant grade.
21.30  Determination of creditable years of educational and professional 
          training and experience.
21.31  Eligibility; all grades; academic and professional education and 
          professional training and experience.
21.32  Boards; appointment of; powers and duties.
21.33  General service.
21.34  Certification by candidate; requirement of new physical 
          examination.

               Provisions Applicable Only to Regular Corps

21.41  Professional examinations, holding of; subjects to be included.
21.42  Examinations; junior assistant, assistant, or senior assistant 
          grade.
21.43  Examination; full grade and above.
21.44  Clinical or other practical demonstration.
21.45  Rating values.
21.46  Merit roll.
21.47  Examination; anticipation of meeting qualifications.

               Provisions Applicable Only to Reserve Corps

21.51  Appointment of officers having specialized training or experience 
          in administration and management.
21.52  Waiver of entrance qualifications for original appointment in 
          time of war or national emergency.
21.53  Examination.
21.54  Students.
21.55  Appointment to higher grades; candidates exceptionally qualified 
          in specialized fields.
21.56  Reappointment.
21.57  Examination for reappointment.
21.58  Physical examination for reappointment.

       Subpart C--Involuntary Child and Spousal Support Allotments

21.70  Purpose.
21.71  Applicability and scope.
21.72  Definitions.
21.73  Policy.
21.74  Responsibilities.
21.75  Procedures.



                         Subpart A--Definitions

    Authority: Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216.



Sec. 21.1  Meaning of terms.

    As used in this part, the term:
    (a) Act means the Public Health Service Act, 58 Stat. 682, as now or 
hereafter amended.
    (b) Department means the Department of Health and Human Services.
    (c) Secretary means the Secretary of Health and Human Services.
    (d) Service means the Public Health Service.
    (e) Surgeon General means the Surgeon General of the Public Health 
Service.
    (f) Commissioned officer or officer, unless otherwise indicated, 
means either an officer of the Regular Corps or an officer of the 
Reserve Corps.

[21 FR 9806, Dec. 12, 1956]



                         Subpart B--Appointment

    Authority: Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216; sec. 
208, 58 Stat. 685, as amended; 42 U.S.C. 209.

    Source: 21 FR 9806, Dec. 12, 1956, unless otherwise noted.

         Provisions Applicable Both to Regular and Reserve Corps



Sec. 21.21  Meaning of terms.

    The terms approved school, approved college, approved postgraduate 
school, or

[[Page 56]]

approved training course means, except as otherwise provided by law:
    (a) A school, college, postgraduate school, or training course which 
has been accredited or approved by a professional body or bodies 
recognized by the Surgeon General for such purpose, or which, in the 
absence of such a body, meets generally accepted professional standards 
as determined by the Surgeon General, or
    (b) In the case of a candidate who is applying for appointment as a 
medical officer, any non-approved medical school provided that the 
candidate has passed examinations given by a professional body or bodies 
recognized by the Surgeon General for such purpose.

[24 FR 1790, Mar. 12, 1959]



Sec. 21.22  Submission of application and evidence of qualifications.

    (a) Application form. Every candidate for examination for 
appointment as an officer shall submit a written application on such 
form as may be prescribed by the Surgeon General.
    (b) Documentary evidence. The application shall be accompanied by 
such documentary evidence as may be required by the Surgeon General.



Sec. 21.23  False statements as disqualification.

    Willfully false statements shall be cause for rejection of the 
application or, as provided in subpart N of this part, for dismissal.



Sec. 21.24  Physical examinations.

    Every candidate for appointment as an officer shall undergo such 
physical examination as the Surgeon General may direct, and no candidate 
who is not found to be physically qualified shall be appointed as an 
officer.



Sec. 21.25  Eligibility; junior assistant grade.

    (a) Requirements; all candidates. Except as provided in Sec. 21.54, 
and as otherwise provided in this section, every candidate for 
examination for appointment in the grade of junior assistant:
    (1) Shall be a citizen of the United States;
    (2) Shall be at least 18 years of age; and
    (3) Shall have been granted an academic or professional degree from 
an approved school, college, or postgraduate school, and, unless the 
required professional training has been otherwise obtained from an 
approved school, college, or postgraduate school, shall have majored in 
the profession in which the examination is being held.
    (b) [Reserved]
    (c) Special requirement; therapists. Every candidate for examination 
for appointment as a therapist shall have received a certificate from an 
approved school of physical therapy or an approved school of 
occupational therapy.

[21 FR 9806, Dec. 12, 1956, as amended at 30 FR 9437, July 29, 1965]



Sec. 21.26  Eligibility; assistant grade.

    (a) Requirements; all candidates. Except as otherwise provided in 
this section every candidate for examination for appointment in the 
grade of assistant:
    (1) Shall meet the requirements for eligibility for examination for 
appointment in the grade of junior assistant;
    (2) Shall be at least 21 years of age; and
    (3) Shall have had at least 7 years of educational and professional 
training or experience subsequent to high school, except that a 
candidate who applies for examination for appointment in the Reserve 
Corps to serve as a medical or dental intern may be examined for such 
appointment upon the completion of 6 years of such education, training, 
or experience.
    (b) Additional requirements; dietitians. Every candidate for 
examination for appointment as a dietitian shall have successfully 
completed an approved training course for dietetic interns.



Sec. 21.27  Eligibility; senior assistant grade.

    Every candidate for examination for appointment in the grade of 
senior assistant shall meet the requirements for eligibility for 
examination for appointment in the grade of assistant and shall have 
completed at least 10 years of educational and professional training or 
experience subsequent to high school.

[[Page 57]]



Sec. 21.28  Age requirements, Regular Corps, senior assistant grade and below.

    No candidate for appointment to the Regular Corps, except in the 
nurse category, shall be appointed (a) after age 31 to the permanent 
junior assistant grade, (b) after age 34 to the permanent assistant 
grade, or (c) after age 37 to the permanent senior assistant grade: 
Provided, That the Surgeon General may waive these age limitations, 
subject to other provisions of law, in the case of any officer of the 
Reserve Corps who is recommended for appointment to the Regular Corps by 
the Chief of the Bureau to which he is assigned and who has been on 
continuous active duty for at least two years immediately preceding the 
date of such recommendation. The age limitations for candidates who have 
had prior active service in the Commissioned Corps of the Public Health 
Service shall be increased by the period of such service.

[27 FR 3886, Apr. 24, 1962]



Sec. 21.29  Eligibility; grades above senior assistant grade.

    Every candidate for examination for appointment in grades above that 
of senior assistant shall meet the requirements for eligibility for 
examination for appointment in the grade of senior assistant. Candidates 
for examination for appointment in the full, senior, or director grade 
shall have completed at least 7, 14, or 15 additional years, 
respectively, of postgraduate professional training for experience. When 
officers of the Service are unavailable for the performance of duties 
requiring highly specialized training and experience in special fields 
related to public health, the Surgeon General may specify that a 
candidate for appointment to the Regular Corps with such highly 
specialized training and experience shall be examined for appointment in 
the full or senior grade upon completion of at least 5 or 12 additional 
years, respectively, of postgraduate professional training or 
experience, except that the total number of such appointments during a 
fiscal year shall not exceed three.

[21 FR 9806, Dec. 12, 1956. Redesignated at 25 FR 5184, June 10, 1960]



Sec. 21.30  Determination of creditable years of educational and professional training and experience.

    The level of academic attainment, the number of calendar years and 
the quality of educational and professional training and experience 
shall be considered in determining the number of years of such training 
and experience with which each candidate for appointment may be 
credited.

[25 FR 5184, June 10, 1960]



Sec. 21.31  Eligibility; all grades; academic and professional education and professional training and experience.

    The Surgeon General is authorized, subject to the other provisions 
of this subpart to adopt additional standards by which the education, 
training, and experience required under this subpart, and evidence 
thereof, shall be of such specific kind and quality, pertinent to the 
particular profession concerned, as in his judgment are necessary to 
limit the examination to qualified candidates.

[21 FR 9806, Dec. 12, 1956. Redesignated at 25 FR 5184, June 10, 1960]



Sec. 21.32  Boards; appointment of; powers and duties.

    The Surgeon General shall from time to time appoint boards and 
subboards of officers to consider the qualifications of candidates for 
appointment as officers, and shall refer to such boards the applications 
of those candidates who are eligible for examination for appointment. 
Such boards and subboards shall consist of three or more officers, the 
majority of whom, so far as practicable, shall be of the same profession 
as the candidate. The Surgeon General shall prescribe the duties of 
boards and subboards in relation to the examination process not 
otherwise prescribed in this subpart.

[21 FR 9806, Dec. 12, 1956. Redesignated at 25 FR 5184, June 10, 1960]



Sec. 21.33  General service.

    Officers shall be appointed only to general service and shall be 
subject to change of station.

[21 FR 9806, Dec. 12, 1956. Redesignated at 25 FR 5184, June 10, 1960]

[[Page 58]]



Sec. 21.34  Certification by candidate; requirement of new physical examination.

    If a candidate for appointment in the Regular Corps or an officer of 
the Reserve Corps on inactive service has passed a physical examination 
within a period of one year from the date on which it is contemplated 
that he will be appointed or called to active duty, he shall, prior to 
being appointed or called to active duty, certify that to the best of 
his knowledge and belief he is free from all disease or injury not noted 
in his record at the time of his examination and that he is willing to 
serve in any climate. If a candidate for appointment in the Regular 
Corps, or an officer of the Reserve Corps on inactive service, has not 
passed a physical examination within a period of one year from the date 
on which it is contemplated that he will be appointed or called to 
active duty, he may, prior to being appointed or called to active duty, 
be required to undergo such physical examination as the Surgeon General 
may direct to determine his physical qualification for appointment or 
call to active duty in accordance with standards prescribed for original 
appointment, or he may be appointed or called to active duty after 
executing the certificate described in this section, but shall be 
physically examined to determine his physical qualification for 
continued active service in accordance with standards prescribed for 
original appointment within a period of 15 days after reporting for duty 
at his first station.

[21 FR 9806, Dec. 12, 1956, as amended at 24 FR 1790, Mar. 12, 1959. 
Redesignated at 25 FR 5184, June 10, 1960]

               Provisions Applicable Only to Regular Corps



Sec. 21.41  Professional examinations, holding of; subjects to be included.

    From time to time the Surgeon General may order examinations to be 
held in such professions or specialties within professions and for such 
grades as he deems necessary for the purpose of providing merit rolls of 
eligible candidates for appointment in the Regular Corps and shall, if a 
professional examination is to be required, prescribe the subjects 
relating to each profession or specialty within such profession in which 
candidates will be examined.

[21 FR 9806, Dec. 12, 1956, as amended at 24 FR 1790, Mar. 12, 1959]



Sec. 21.42  Examinations; junior assistant, assistant, or senior assistant grade.

    The examination for appointment to the junior assistant, assistant, 
or senior assistant grade in the Regular Corps shall consist of (a) a 
written professional examination relating to the fundamentals of the 
candidate's profession or specialty within his profession and their 
relationship to the activities of the Service, and (b) an examination as 
to the candidate's general fitness, which shall include an oral 
interview, and a review and evaluation of the candidate's academic and 
professional education and professional training and experience, and may 
include other written tests to determine the candidate's fitness for 
appointment as an officer. If an applicant for appointment to any of 
these grades is an officer of the Reserve Corps who has been on active 
duty for not less than one year immediately preceding his application, 
the Surgeon General may direct that the officer be examined as provided 
in Sec. 21.43.

[21 FR 9806, Dec. 12, 1956, as amended at 24 FR 1790, Mar. 12, 1959; 25 
FR 11099, Nov. 23, 1960]



Sec. 21.43  Examination; full grade and above.

    The examination for appointment to the full, senior, or director 
grade in the Regular Corps shall consist of a review and evaluation of 
the candidate's academic and professional education and professional 
training and experience. The Surgeon General may, however, direct that 
the examination of a candidate for appointment to any such grade shall 
also include an oral interview, a written or oral professional 
examination, or both.



Sec. 21.44  Clinical or other practical demonstration.

    In the discretion of the Surgeon General a candidate for appointment 
to any grade up to and including the senior assistant grade in the 
Regular

[[Page 59]]

Corps may be required to perform successfully a clinical or other 
practical demonstration which, if required, shall constitute a part of 
the professional examination.



Sec. 21.45  Rating values.

    The examination of every candidate for appointment to any grade in 
the Regular Corps shall be rated by a board appointed pursuant to 
Sec. 21.30 in accordance with such relative values for each part of the 
examination as are prescribed by the Surgeon General. No candidate who 
receives a final rating below 80 shall be appointed in the Regular 
Corps.



Sec. 21.46  Merit roll.

    Each board appointed pursuant to Sec. 21.30 to consider the 
qualifications of candidates for appointment as officers shall assign a 
numerical rating to each candidate for appointment in the Regular Corps 
who passes the examination, and shall submit a report to the Surgeon 
General of the ratings and the relative standing of all such candidates 
for each grade in each profession or specialty within a profession. The 
Surgeon General shall submit each such report with his recommendations 
to the Secretary, and, if approved by the Secretary, the report shall 
constitute a merit roll from which the Secretary shall, in accordance 
with relative standing, recommend available persons to the President for 
nomination as commissioned officers of the Regular Corps. A board may 
consider any newly discovered evidence relating to the physical, 
professional, or personal qualifications of any candidate examined for 
appointment. Upon recommendation of such board after review of such 
evidence, the Surgeon General, with the approval of the Secretary, may 
correct the rating of a candidate or may qualify or disqualify a 
candidate. The placing of a candidate's name on a merit roll shall give 
no assurance of an appointment. A merit roll shall expire when a new 
merit roll in the same profession or specialty within a profession and 
grade has been established, but no merit roll shall continue in effect 
longer than two years after its approval by the Secretary. Every 
candidate who has not been nominated by the President for appointment 
prior to the expiration of a merit roll on which his name appears, 
shall, unless he requests the opportunity to be reexamined, be rated 
with the next group of candidates of the same profession or specialty 
within a profession for appointment in the same grade and shall be given 
the same rating he had on the expired merit roll. If two candidates who 
were examined at the same time receive the same numerical rating the 
elder candidate shall assume relative standing on the merit roll over 
the younger candidate. If a candidate whose name is being transferred 
from an expired to a new merit roll has the same numerical rating as a 
candidate whose name is being placed on the new merit roll for the first 
time, the former shall assume relative standing on the merit roll over 
the latter. The name of a candidate may be removed from a merit roll in 
the event that he refuses an appointment when offered. No candidate's 
eligibility for appointment shall exceed two years unless he again 
becomes eligible as the result of another examination.

[21 FR 9806, Dec. 12, 1956, as amended at 24 FR 1790, Mar. 12, 1959]



Sec. 21.47  Examination; anticipation of meeting qualifications.

    A potential candidate for appointment in any grade in the Regular 
Corps may be examined within a period of nine months prior to the date 
upon which it is anticipated that he will qualify for appointment under 
this subpart. Upon successful completion of the examination, his name 
will be entered on a merit roll. In the event that his name, in order of 
relative standing among all candidates, precedes that of fully qualified 
candidates, his name, for purpose of appointment, shall be passed over 
in favor of fully qualified candidates until such time as he becomes 
fully qualified, but in no event shall he otherwise lose his relative 
standing on the merit roll, except as provided in Sec. 21.46. If the 
candidate fails to qualify for appointment at the time that it was 
anticipated that he would qualify, his name shall be removed from the 
merit roll.

[[Page 60]]

               Provisions Applicable Only to Reserve Corps



Sec. 21.51  Appointment of officers having specialized training or experience in administration and management.

    The Surgeon General may recommend for original appointment in the 
Reserve Corps candidates who have specialized training or experience in 
administration and management relating to the functions of the Service. 
All such candidates shall be subject to the same eligibility 
requirements for original appointment as are applicable to other 
candidates, except that such a candidate may substitute experience in 
administration or management for the requirement of professional 
training or experience.



Sec. 21.52  Waiver of entrance qualifications for original appointment in time of war or national emergency.

    If, in time of war or national emergency proclaimed by the 
President, the Secretary determines that there is need for commissioned 
personnel to meet the needs of the Service, other than persons eligible 
for examination for original appointment under the eligibility 
requirements prescribed in this subpart, he may prescribe standards of 
eligibility for examination for the original appointment of officers in 
the Reserve Corps without regard to such eligibility requirements. Such 
standards shall, however, authorize the examination only of candidates 
with specialized experience in administration or management or 
candidates with training or experience in fields relating to public 
health. The permanent grade of an officer who becomes eligible for 
examination for appointment pursuant to such standards and who becomes 
eligible for appointment after passage of an examination shall be 
limited to the junior assistant or the assistant grade, except that, if 
upon examination a candidate is found to be exceptionally qualified for 
the performance of highly specialized duties with the Service pursuant 
to Sec. 21.55, he may be recommended for appointment to any grade up to 
and including the director grade.

[21 FR 9806, Dec. 12, 1956, as amended at 24 FR 1790, Mar. 12, 1959]



Sec. 21.53  Examination.

    The examination of candidates for original appointment as officers 
to any grade in the Reserve Corps shall consist of a review and 
evaluation of their academic and other education and their training and 
experience. In the discretion of the Surgeon General the examination of 
any such candidate may include an oral interview, a written examination, 
or both.



Sec. 21.54  Students.

    A potential candidate for appointment in the Regular Corps who is 
pursuing a course of instruction which, upon completion, would qualify 
him under Sec. 21.25 or Sec. 21.26 for examination for appointment in 
the junior assistant or assistant grade may be examined for and 
appointed in the Reserve Corps in the junior assistant grade but shall 
not be called to extended active duty until the successful completion of 
such course of instruction, except that: (a) He may be called to active 
duty for purposes of training for periods not to exceed 120 days during 
any fiscal year, and (b) those students who have completed at least 3 
years of collegiate or professional study leading to the qualifying 
degree for appointment may be called to active duty for the purpose of 
completing the requirements of Sec. 21.25(a)(3). An appointment made 
under this subpart shall be terminated upon the officer's failure to 
continue a full-time course of study or failure to meet the requirements 
of Sec. 21.25(a)(3) within 18 months after entering on active duty.

[34 FR 706, Jan. 17, 1969]



Sec. 21.55  Appointment to higher grades; candidates exceptionally qualified in specialized fields.

    Any candidate eligible for examination for appointment in the grade 
of assistant pursuant to Sec. 21.26 who, upon examination for such 
purpose, is found

[[Page 61]]

exceptionally qualified for the performance of duties requiring highly 
specialized training or experience may be recommended for appointment in 
the Reserve Corps in any grade up to and including the director grade 
without regard to the additional years of postgraduate training or 
experience prescribed for grades above the assistant grade.



Sec. 21.56  Reappointment.

    An officer of the Reserve Corps, after being examined and found 
qualified for reappointment, may be recommended for reappointment to the 
same grade in the event that his commission expires before he becomes 
eligible for reappointment to a higher grade, or may be recommended for 
reappointment to a higher grade to be effective on or after the date on 
which he meets the qualifications prescribed in this subpart for 
original appointment to such higher grade.



Sec. 21.57  Examination for reappointment.

    The examination of an officer of the Reserve Corps on active duty 
who is being considered for reappointment in such corps shall consist of 
a review and evaluation of his record with the Service. The examination 
of an officer of the Reserve Corps on inactive duty who is being 
considered for reappointment in such corps shall consist of (a) a review 
and evaluation of his record with the Service while on active duty, if 
any, and (b) the record of his training or experience during the period 
of his inactive duty preceding such examination. In the discretion of 
the Surgeon General the examination for reappointment of an officer, 
whether on active or inactive duty, may include an oral interview.



Sec. 21.58  Physical examination for reappointment.

    Every officer of the Reserve Corps being considered for 
reappointment shall undergo such physical examination as the Surgeon 
General may direct. An officer on active duty may be recommended for 
reappointment unless he is found to have a physical disability which is 
determined to render him physically unfit to perform the duties of his 
office under section 402 of the Career Compensation Act of 1949, as 
amended. An officer may be recommended for promotion only if he meets 
the physical qualifications for original appointment. If an officer is 
not available to be physically examined because of circumstances which 
make it impracticable for the Service to require such examination, he 
may, in the discretion of the Surgeon General, be reappointed without 
such examination, but shall be examined as soon thereafter as 
practicable and his physical qualification or disqualification for 
continued or future active service shall be determined on the same basis 
as if the physical examination had been given prior to reappointment.



       Subpart C--Involuntary Child and Spousal Support Allotments

    Authority: 37 U.S.C. 101, 15 U.S.C. 1673, 42 U.S.C. 665.

    Source: 49 FR 7235, Feb. 24, 1984, unless otherwise noted.



Sec. 21.70  Purpose.

    Under references 37 U.S.C. 101, 15 U.S.C. 1673, and 42 U.S.C. 665, 
this subpart provides implementing policies governing involuntary child 
or child and spousal support allotments, assigns responsibilities, and 
prescribes procedures.



Sec. 21.71  Applicability and scope.

    (a) This subpart applies to officers in the Public Health Service 
Commissioned Corps. The term ``Public Health Service,'' hereinafter 
shall be referred to as Service.
    (b) Its provisions pertain to officers of the Service under a call 
or order to active duty for a period of six months or more.



Sec. 21.72   Definitions.

    (a) Child support. Periodic payments for the support and maintenance 
of a child or children, subject to and in accordance with State or local 
law. This includes, but is not limited to payments to provide for health 
care, education, recreation, clothing, or to meet

[[Page 62]]

other specific needs of such a child or children.
    (b) Spousal support. Periodic payments for the support and 
maintenance of a spouse or former spouse in accordance with State or 
local law. It includes, but is not limited to, separate maintenance, 
alimony pendente lite, and maintenance. Spousal support does not include 
any payment for transfer of property or its value by an individual to 
his or her spouse or former spouse in compliance with any community 
property settlement, equitable distribution of property, or other 
division of property between spouse or former spouse.
    (c) Notice. A court order, letter, or similar documentation issued 
by an authorized person, which provides notification that an officer has 
failed to make periodic support payments under a support order.
    (d) Support order. Any order providing for child or child and 
spousal support issued by a court of competent jurisdiction or by 
administrative procedures established under State law that affords 
substantially due process and is subject to judicial review. A court of 
competent jurisdiction includes Indian tribal courts within any State, 
territory, or possession of the United States and the District of 
Columbia.
    (e) Authorized person. (1) Any agent or attorney of any State having 
in effect a plan approved under part D of title IV of the Social 
Security Act (42 U.S.C. 651-665), who has the duty or authority to seek 
recovery of any amounts owed as child or child and spousal support 
(including, when authorized under a State plan, any official of a 
political subdivision); and (2) the court which has authority to issue 
an order against the officer for the support and maintenance of a child, 
or any agent of such court.
    (f) Active duty. Full-time duty in the Service, including full-time 
training duty.
    (g) Legal officer. Shall be an officer of the Service or employee of 
the Department who is a lawyer and who has substantial knowledge of the 
regulations, policies, and procedures relating to the implementation of 
section 172 of Pub. L. 97-248.



Sec. 21.73  Policy.

    (a) It is the policy of the Department of Health and Human Services 
to withhold allotments from pay and allowances of commissioned officers 
on active duty in the Service to make involuntary allotments from pay 
and allowances as payment of child, or child and spousal, support 
payments when the officer has failed to make periodic payments under a 
support order in a total amount equal to the support payable for two 
months or longer. Failure to make such payments shall be established by 
notice from an authorized person to the designated official of the 
Department. Such notice shall specify the name and address of the payee 
to whom the allotment is payable. The amount of the allotment shall be 
the amount necessary to comply with the support order including amounts 
for arrearages as well as for current support. However the amount of the 
allotment, when added to any other amounts withheld from the officer's 
pay pursuant to a support order, shall not exceed the limits for 
involuntary allotments from pay as prescribed in section 303 (b) and (c) 
of the Consumer Credit Protection Act, 15 U.S.C. 1673. An allotment 
under this Subpart shall be adjusted or discontinued upon notice from 
any authorized person.
    (b) Notwithstanding the above, no action shall be taken to withhold 
an allotment from the pay and allowances of any officer until such 
officer has had an opportunity to consult with a legal officer of the 
Department to discuss the legal and other factors involved with respect 
to the officer's support obligation and his or her failure to make 
payments. The Department shall exercise continuing good faith efforts to 
arrange such a consultation, but must begin to withhold allotments on 
the first end-of-month payday after 30 days have elapsed since notice of 
an opportunity to consult was sent to the officer.



Sec. 21.74  Responsibilities.

    (a) The General Counsel, Office of the Secretary, Department of 
Health and Human Services, shall be the Designated Official for the 
Department

[[Page 63]]

and shall provide guidance to the Service regarding administration of 
the provisions of these regulations.
    (b) The Commissioned Personnel Operations Division, Office of 
Personnel Management, Office of Management, Office of the Assistant 
Secretary for Health, shall implement the provisions of these 
regulations.



Sec. 21.75  Procedures.

    (a) Service of notice. (1) An authorized person shall serve on the 
designated official of the Department a signed notice including:
    (i) Full name of the officer;
    (ii) Social security number of the officer;
    (iii) Duty station location of the officer, if known;
    (iv) A statement that support payments are delinquent by an amount 
at least equal to the amount of support payable for two months;
    (v) A photocopy, along with any modifications, of the underlying 
support order;
    (vi) A statement of the amount of arrearages provided for in the 
court order and the amount which is to be applied each month toward 
liquidation of the arrearages, if applicable;
    (vii) The full name and address of the payee to whom the allotment 
will be payable;
    (viii) Any limitations on the duration of the support allotment.
    (2) The service of notice shall be accomplished by certified or 
registered mail, return receipt requested, or by personal service, upon 
the appropriate designated official of the Department. The designated 
official shall note the date and time of receipt on the notice.
    (3) Valid service is not accomplished until the notice is received 
in the office of the designated official.
    (4) If the order of a court or duly authorized administrative agency 
seeks collection of arrearages, the notice must state that the support 
allotment qualifies for the additional 5 percent in excess of the 
maximum percentage limitations found in 15 U.S.C. 1673. Supporting 
evidence must be submitted to the Department establishing that the 
support order is 12 or more weeks in arrears.
    (5) When the information submitted is not sufficient to identify the 
officer the notice shall be returned directly to the authorized person 
with an explanation of the deficiency. However, before returning the 
notice, an attempt should be made to inform the authorized person who 
caused the notice to be served that it will not be honored unless 
adequate information is supplied.
    (6) Upon proper service of notice of delinquent support payments and 
together with all required supplementary documents and information, the 
Service shall identify the officer from whom moneys are due and payable. 
The pay of the officer shall be reduced by the amount necessary to 
comply with the support order and liquidate arrearages if any, if 
provided by order of a court or duly authorized administrative agency. 
The maximum amount to be alloted under the provision together with any 
other moneys withheld from the officer for support pursuant to a court 
order may not exceed:
    (i) 50 percent of the officer's disposable earnings for any month 
when the officer asserts by affidavit or other acceptable evidence that 
he or she is supporting a spouse or dependent child or both, other than 
a party in the support order. When the officer submits evidence, copies 
shall be sent to the authorized person, together with notification that 
the officer's support claim will be honored. If the support claim is 
contested by the authorized person, the authorized person may refer it 
to the appropriate court or other authority for resolution. Pending 
resolution of a contested support claim, the allotment shall be made but 
the amount of such allotment may not exceed 50 percent of the officer's 
disposable earnings;
    (ii) 60 percent of the officer's disposable earnings for any month 
when the officer fails to assert by affidavit or other acceptable 
evidence, that he or she is supporting a spouse or dependent child or 
both;
    (iii) Regardless of the limitations above, an additional five 
percent of the officer's disposable earnings shall be withheld when it 
is stated in the notice that the officer is in arrears in an amount 
equivalent to 12 or more weeks' support.

[[Page 64]]

    (b) Disposable earnings. (1) The following moneys, as defined in the 
U.S. Public Health Service Commissioned Corps Personnel Manual, are 
subject to inclusion in computation of the officer's disposable 
earnings:
    (i) Basic pay;
    (ii) Basic allowances for quarters for officers with dependents and 
officers without dependents;
    (iii) Basic allowance for subsistence;
    (iv) Special pay for physicians, dentists, optometrists, and 
veterinarians;
    (v) Hazardous duty pay;
    (vi) Flying pay; and
    (vii) Family separation allowances (only for officers assigned 
outside the contiguous United States).
    (c) Exclusions. The following moneys are excluded from the 
computation of the officer's disposable earnings. Amounts due from or 
payable by the United States shall be offset by any amounts:
    (1) Owed by the officer to the United States.
    (2) Required by law to be deducted from the remuneration or other 
payment involved including but not limited to:
    (i) Amounts withheld from benefits payable under title II of the 
Social Security Act when the withholding is required by law;
    (ii) FICA.
    (3) Properly withheld for Federal and State income tax purposes if 
the withholding of the amounts is authorized or required by law and if 
amounts withheld are not greater than would be the case if the 
individual claimed all dependents to which he or she were entitled. The 
withholding of additional amounts pursuant to 26 U.S.C. 3402(i) may be 
permitted only when the officer presents evidence of a tax obligation 
which supports the additional withholding.
    (4) Deducted for the Servicemen's Group Life Insurance coverage.
    (5) Advances of pay that may be due and payable by the officer in 
the future.
    (d) Officer Notification. (1) As soon as possible, but not later 
than 30 calendar days after the date of receipt of notice, the 
Commissioned Personnel Operations Division shall send to the officer at 
his or her duty station, written notice:
    (i) That notice has been served, including a copy of the documents 
submitted;
    (ii) Of the maximum limitations set forth, with a request that the 
officer submit supporting affidavits or other documentation necessary 
for determining the applicable percentage limitation;
    (iii) That by submitting supporting affidavits or other necessary 
documentation, the officer consents to the disclosure of such 
information to the party requesting the support allotment;
    (iv) Of the amount of percentage that will be deducted if the 
officer fails to submit the documentation necessary to enable the 
designated official of the Service to respond to the legal process 
within the time limits set forth;
    (v) That a consultation with a legal officer is authorized and will 
be provided by the Department. The name, address, and telephone number 
of the legal officer will be provided;
    (vi) That the officer may waive the personal consultation with a 
legal officer; however if consultation is waived action will be taken to 
initiate the allotment by the first end-of-month payday after 
notification is received that the officer has waived his/her 
consultation;
    (vii) That the allotment will be initiated without the officer 
having received a personal consultation with a legal officer if the 
legal officer provides documentation that consultation could not be 
arranged even though good faith attempts to do so had been made; and
    (viii) Of the date that the allotment is scheduled to begin.
    (2) The Commissioned Personnel Operations Division shall inform the 
appropriate legal officer of the need for consultation with the officer 
and shall provide the legal officer with a copy of the notice and other 
legal documentation served on the designated official.
    (3) If possible, the Commissioned Personnel Operations Division 
shall provide the officer with the following:
    (i) A consultation in person with the appropriate legal officer to 
discuss the legal and other factors involved with

[[Page 65]]

the officer's support obligation and his/her failures to make payment;
    (ii) Copies of any other documents submitted with the notice.
    (4) The legal officer concerned will confirm in writing to the 
Commissioned Personnel Operations Division within 30 days of notice that 
the officer received a consultation concerning the officer's support 
obligation and the consequences of failure to make payments. The legal 
officer concerned must advise the Commissioned Personnel Operations 
Division of the inability to arrange such consultation and the status of 
continuing efforts to contact the officer.
    (e) Lack of money. (1) When notice is served and the identified 
officer is found not to be entitled to any moneys due from or payable by 
the Department of Health and Human Services, the Commissioned Personnel 
Operations Division shall return the notice to the authorized person, 
and advise in writing that no moneys are due from or payable by the 
Department of Health and Human Services to the named individual.
    (2) Where it appears that moneys are only temporarily exhausted or 
otherwise unavailable, the Commissioned Personnel Operations Division 
shall advise the authorized person in writing on a timely basis as to 
why, and for how long, the moneys will be unavailable.
    (3) In instances where the officer separates from active duty, the 
authorized person shall be informed in writing on a timely basis that 
the allotment is discontinued.
    (f) Effective date of allotment. Allotments shall be withheld 
beginning on the first end-of-month payday after the Commissioned 
Personnel Operations Division is notified that the officer has had a 
consultation with a legal officer, has waived his/her right to such 
consultation, or the legal officer has submitted documentation that a 
consultation with the officer could not be arranged after good faith 
attempts to do so were made by the legal officer. The Service shall not 
be required to vary its normal allotment payment cycle to comply with 
the notice.
    (g) Designated official. Department of Health and Human Services, 
General Counsel, Room 5362 North Building, 330 Independence Avenue, SW., 
Washington, DC 20201.

(Approved by the Office of Management and Budget under control number 
0937-0123)



PART 22--PERSONNEL OTHER THAN COMMISSIONED OFFICERS--Table of Contents




   Hansen's Disease Duty by Personnel Other Than Commissioned Officers

Sec.
22.1  Duty at a station of the Service devoted to the care of Hansen's 
          disease patients; additional pay.

                           Special Consultants

22.3  Appointment of special consultants.
22.5  Leave without pay while on detail.

    Authority: Sec. 208(e) of the Public Health Service Act, 42 U.S.C. 
210(e); E.O. 11140, 29 FR 1637.

   Hansen's Disease Duty by Personnel Other Than Commissioned Officers



Sec. 22.1  Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay.

    (a) Non-commissioned officers and other employees of the Service 
shall not receive any additional compensation by reason of being 
assigned to any duty requiring intimate contact with persons with 
Hansen's disease. However, any such officer or employee who was 
entitled, on January 4, 1986, to receive additional pay by reason of 
being assigned to full-time duty, for a period of 30 days or more, at a 
station of the Service devoted to the care of Hansen's disease patients 
and who continues to be assigned to such duty, shall receive special pay 
as long as such assignment continues without a break.
    (b) Such special pay shall, on any future date, be at an annual 
dollar level equal to the lower of the levels that would be paid under 
the following subparagraphs:
    (1) 25% of the lowest level of basic pay that he or she has been 
receiving on any date from January 4, 1986, through that future date;
    (2) The amount by which the level of an employee's basic pay plus 
special pay on January 4, 1986, exceeds the level of that employee's 
basic pay on that on that future date, except that

[[Page 66]]

the special pay under this subparagraph shall not be less that 12 times 
the monthly special pay then paid to Commissioned Officers entitled to 
special pay for duty involving intimate contact with persons who have 
Hansen's disease. (As of October 24, 1985, that monthly rate was $110.)
    (c) An officer or employee may be paid special pay for any pay 
period, under paragraphs (a) and (b) of this section, only to the extent 
that it does not cause his or her aggregate pay for that pay period to 
exceed the biweekly rate of basic pay for Level V of the Executive 
Schedule. As used in this paragraph, ``aggregate pay'' comprises basic 
pay, this special pay, and premiums for overtime, nightwork, irregular 
duty, standby status, and Sunday or holiday work.

[50 FR 43146, Oct. 24, 1985]

                           Special Consultants



Sec. 22.3  Appointment of special consultants.

    (a) When the Public Health Service requires the services of 
consultants who cannot be obtained when needed through regular Civil 
Service appointment or under the compensation provisions of the 
Classification Act of 1949, special consultants to assist and advise in 
the operations of the Service may be appointed, subject to the 
provisions of the following paragraphs and in accordance with such 
instructions as may be issued from time to time by the Secretary of 
Health and Human Services.
    (b) Appointments, pursuant to the provisions of this section, may be 
made by those officials of the Service to whom authority has been 
delegated by the Secretary or his designee.
    (c) The per diem or other rates of compensation shall be fixed by 
the appointing officer in accordance with criteria established by the 
Surgeon General.

(Sec. 208(c), 58 Stat. 686, as amended; 42 U.S.C. 209(e); sec. 207(f), 
58 Stat. 686 as amended by 62 Stat. 40; 42 U.S.C. 209(f))

[21 FR 9821, Dec. 12, 1956, as amended at 31 FR 12939, Oct. 5, 1966]



Sec. 22.5  Leave without pay while on detail.

    The Secretary or his delegate may, pursuant to section 214(d) of the 
Public Health Service Act, 42 U.S.C. 215(d), and with the consent of the 
officer or employee concerned, arrange, through agreements or otherwise, 
for a civilian officer or employee of the Public Health Service to be 
placed on leave without pay for the period of a detail to a State, a 
subdivision thereof, or a private non-profit institution and be paid by 
the non-Federal organization. Such an arrangement may be for a period of 
not to exceed 2 years, but may be extended for additional periods of not 
to exceed 2 years each.

(Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216)

[33 FR 18981, Dec. 20, 1968]



PART 23--NATIONAL HEALTH SERVICE CORPS--Table of Contents




    Subpart A--Assignment of National Health Service Corps Personnel

Sec.
23.1  To what entities does this regulation apply?
23.2  Definitions.
23.3  What entities are eligible to apply for assignment?
23.4  How must an entity apply for assignment?
23.5  What are the criteria for deciding which applications for 
          assignment will be approved?
23.6  What are the criteria for determining the entities to which 
          National Health Service Corps personnel will be assigned?
23.7  What must an entity agree to do before the assignment is made?
23.8  What operational requirements apply to an entity to which National 
          Health Service Corps personnel are assigned?
23.9  What must an entity to which National Health Service Corps 
          personnel are assigned (i.e., a National Health Service Corps 
          site) charge for the provision of health services by assigned 
          personnel?
23.10  Under what circumstances may a National Health Service Corps 
          site's reimbursement obligation to the Federal Government be 
          waived?
23.11  Under what circumstances may the Secretary sell equipment or 
          other property of the United States used by the National 
          Health Service Corps site?
23.12  Who will supervise and control the assigned personnel?

[[Page 67]]

23.13  What nondiscrimination requirements apply to National Health 
          Service Corps sites?

   Subpart B--Private Practice Special Loans for Former Corps Members

23.21  Definitions.
23.22  What is the purpose of a private practice loan?
23.23  Who is eligible to receive a private practice option loan?
23.24  In what amounts are loans made?
23.25  How will interest rates for loans be determined?
23.26  How is the loan repaid?
23.27  What happens if scheduled payments are late?
23.28  What events constitute default?
23.29  What happens in the case of a default?
23.30  May the loan be prepaid?
23.31  May loan payments be postponed or waived?
23.32  What conditions are imposed on the use of the loan funds?
23.33  What security must be given for these loans?
23.34  What other conditions are imposed?
23.35  What criteria are used in making loans?

                    Subpart C--Private Startup Loans

23.41  What conditions are applicable to loans under this subpart?

    Authority: Secs. 333, 338E(c), and 338C(e)(1), Public Health Service 
Act. 90 Stat. 2272, as amended, 95 Stat. 905, 97 Stat. 1345 (42 U.S.C. 
254f et seq.), 95 Stat. 912 (42 U.S.C. 254p(c)), 95 Stat. 910 (42 U.S.C. 
254n(e)(1)).

    Source: 45 FR 12790, Feb. 27, 1980, unless otherwise noted.



    Subpart A--Assignment of National Health Service Corps Personnel



Sec. 23.1  To what entities does this regulation apply?

    This regulation applies to the assignment of National Health Service 
Corps personnel under section 333 et seq. of the Public Health Service 
Act (42 U.S.C. 254f) to provide health services in or to health manpower 
shortage areas as designated under section 332 of the Public Health 
Service Act (42 U.S.C. 254e).



Sec. 23.2  Definitions.

    As used in this subpart:
    Act means the Public Health Service Act, as amended.
    Assigned National Health Service Corps personnel or Corps personnel 
means health personnel of the Regular and Reserve Corps of the Public 
Health Service Commissioned Corps and civilian personnel as designated 
by the Secretary including, but not limited to, physicians, dentists, 
nurses, and other health professions personnel who are assigned under 
section 333 of the Act and this regulation.
    Health manpower shortage area means the geographic area, the 
population group, the public or nonprofit private medical facility or 
any other public facility which has been determined by the Secretary to 
have a shortage of health manpower under section 332 of the Act and its 
implementing regulation (42 CFR part 5).
    National Health Service Corps site means the entity to which 
personnel have been assigned under section 333 of the Act and this 
regulation to provide health services in or to health manpower shortage 
area.
    Nonprofit private entity means as entity which may not lawfully hold 
or use any part of its net earnings to the benefit of any private 
shareholder or individual and which does not hold or use its net 
earnings for that purpose.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of that Department to whom the authority 
involved has been delegated.



Sec. 23.3  What entities are eligible to apply for assignment?

    Any public or nonprofit private entity which is located in a health 
manpower shortage area, or has a demonstrated interest in the shortage 
area, may apply for the assignment of National Health Service Corps 
personnel.



Sec. 23.4  How must an entity apply for assignment?

    (a) An application for the assignment of National Health Service 
Corps personnel must be submitted to the Secretary by an eligibe 
applicant in the form and at the time prescribed by the

[[Page 68]]

Secretary.1 The application must be signed by an individual 
authorized to act for the applicant and to assume on behalf of the 
applicant the obligations imposed by law, the Act, this regulation, and 
any additional conditions of assignment imposed under these authorities.
---------------------------------------------------------------------------

    1  Applications and instructions may be obtained from 
Regional Offices of the Department of Health and Human Services at the 
addresses set forth at 45 CFR 5.31(b).
---------------------------------------------------------------------------

    (b) In addition to other pertinent information required by the 
Secretary, an application for the assignment of Corps personnel must 
include--
    (1) A description of the applicant's overall organizational 
structure;
    (2) A justification of the request for the assignment of personnel 
based upon the needs of the health manpower shortage area;
    (3) A description of the applicant's financial plan for operating 
the National Health Service Corps site including a proposed budget, 
sources of non-Federal support obtained, and the proposed expenditures 
for obtaining adequate support staff, equipment and supplies;
    (4) A list of the proposed fees and discounted fees to be charged 
for the provision of health services; and
    (5) If an entity wishes to request an interest free loan (not to 
exceed $50,000) under section 335(c) of the Act to assist the applicant 
in establishing the practice of the assigned National Health Service 
Corps personnel, a detailed justification of the amount requested must 
be included.
    (c) An application for assignment must include evidence that the 
applicant has provided a copy of the completed application for review to 
(1) each health systems agency designated under section 1515 of the Act 
for the health service area which includes all or part of the health 
manpower shortage area for which as assignment of National Health 
Service Corps personnel is sought or (2) if no health systems agency has 
been designated for such a health service area, to each State health 
planning and development agency designated under section 1521 of the Act 
for each State which includes all or part of the health manpower 
shortage area for which an assignment of National Health Service Corps 
personnel is sought.
    (d) If an application for assignment is filed by an applicant which 
had previously been assigned National Health Service Corps personnel 
under an agreement entered into under section 329 of the Act as in 
effect before October 1, 1977, or under section 334 of the Act, the 
applicant must provide the information the Secretary considers necessary 
to make the determinations required by section 333(a)(1)(D) of the Act.

[45 FR 12790, Feb. 27, 1980, as amended at 51 FR 31948, Sept. 8, 1986]



Sec. 23.5  What are the criteria for deciding which applications for assignment will be approved?

    (a) In approving or disapproving an application for assignment of 
Corps personnel, the Secretary will consider, among other pertinent 
factors:
    (1) The applicant's ability and plans to meet the operational 
requirements in Sec. 23.8.
    (2) The administrative and managerial capability of the applicant.
    (3) The soundness of the applicant's financial plan for operating 
the National Health Service Corps site.
    (4) The extent to which community resources will be used in 
operating the National Health Service Corps site.
    (5) Comments received from any designated health systems agency or 
any designated State health planning and development agency to which an 
application was submitted for review under Sec. 23.4(c).
    (6) Comments received from health professional societies serving the 
health manpower shortage area.
    (b) Special consideration for the assignment of Corps personnel will 
be given to the entity which is located in a health manpower shortage 
area over an entity which is not located in a health manpower shortage 
area but has a demonstrated interest in it.



Sec. 23.6  What are the criteria for determining the entities to which National Health Service Corps personnel will be assigned?

    (a) The Secretary may, upon approving an application for the 
assignment of personnel and after entering into an

[[Page 69]]

agreement with an applicant under Sec. 23.7, assign National Health 
Service Corps personnel to provide health services in or to a health 
manpower shortage area.
    (b) In assigning National Health Service Corps personnel to serve in 
a health manpower shortage area, the Secretary will seek to assign 
personnel who have those characteristics which will increase the 
probability of their remaining to serve in the health manpower shortage 
area upon completion of the period of assignment. In addition, the 
Secretary will apply a weighted-value system in which the first factor 
listed below is assigned the greatest weight and the second, and third 
factors are assigned lesser weights in descending order:
    (1) The need of the health manpower shortage area as determined by 
criteria established under section 332(b) of the Act.
    (2) The willingness of individuals, government agencies, or health 
entities within the health manpower shortage area to cooperate with the 
National Health Service Corps in providing effective health services.
    (3) The comments of health professional societies serving the health 
manpower shortage area.

[45 FR 12790, Feb. 27, 1980, as amended at 51 FR 31948, Sept. 8, 1986]



Sec. 23.7  What must an entity agree to do before the assignment is made?

    (a) Requirements. To carry out the purposes of section 334 of the 
Act, each National Health Service Corps site must enter into an 
agreement with the Secretary under which the site agrees to:
    (1) Be responsible for charging for health services provided by 
assigned National Health Service Corps personnel;
    (2) Take reasonable action for the collection of the charges for 
those health services;
    (3) Reimburse the United States the sums required under section 334 
of the Act; and
    (4) Prepare and submit an annual report. The agreement will set 
forth the period of assignment (not to exceed 4 years), the number and 
type of Corps personnel to be assigned to the site, and other 
requirements which the Secretary determines necessary to carry out the 
purposes of the Act.
    (b) Termination. An agreement entered into under this section may be 
terminated by either party on 30-days written notice or modified by 
mutual consent consistent with section 333 of the Act.

[45 FR 12790, Feb. 27, 1980, as amended at 51 FR 31948, Sept. 8, 1986]



Sec. 23.8  What operational requirements apply to an entity to which National Health Service Corps personnel are assigned?

    Each National Health Service Corps site must:
    (a) Operate a health care delivery system within a planned or 
existing community structure to assure:
    (1) The provision of high quality comprehensive health care;
    (2) To the extent feasible, full professional health care coverage 
for the health manpower shortage area;
    (3) Continuum of care; and
    (4) The availability and accessibility of secondary and tertiary 
health care (the two more sophisticated levels of health care beyond 
primary care);
    (b) Establish and maintain a patient record system;
    (c) Implement a system for maintaining the confidentiality of 
patient records;
    (d) Meet the requirements of applicable fire and safety codes;
    (e) Develop, to the extent feasible, linkages with other health care 
facilities for the provision of services which supplement or complement 
the services furnished by the assigned Corps personnel;
    (f) Operate a quality assurance system which meets the requirements 
of 42 CFR 51c.303(c) for the establishment and operation of a quality 
assurance system in a community health center; and
    (g) Establish basic data, cost accounting, and management 
information and reporting systems as prescribed by the Secretary.

[[Page 70]]



Sec. 23.9  What must an entity to which National Health Service Corps personnel are assigned (i.e., a National Health Service Corps site) charge for the 
          provision of health services by assigned personnel?

    (a) Except as provided in paragraph (b) of this section, individuals 
receiving services from assigned National Health Service Corps personnel 
must be charged on a fee-for-service or other basis at a rate which is 
computed to permit recovery of the value of the services and is approved 
by the Secretary.
    (b) In determining whether to approve fees to be charged for health 
services, the Secretary will consider: The costs to the National Health 
Service Corps of providing the health services; the costs to the health 
manpower shortage area for providing the services; and the charges for 
similar services by other practitioners or facilities in or nearby the 
health manpower shortage area. However, if assigned National Health 
Service Corps personnel are providing services within the framework of 
an established health services delivery system, the Secretary may 
approve the fees charged under that system without regard to the 
foregoing factors.
    (c)(1) No charge or a nominal charge will be made for health 
services provided by assigned National Health Service Corps personnel to 
individuals within the health manpower shortage area with annual incomes 
at or below the ``CSA Income Poverty Guidelines'' (45 CFR 1060.2). 
However, no individual will be denied health services based upon 
inability to pay for the services. Any individual who has an annual 
income above the ``CSA Income Poverty Guidelines,'' but whose income 
does not exceed 200 percent of the CSA levels, will receive health 
services at a nominal charge. However, charges will be made for services 
to the extent that payment will be made by a third party which is 
authorized or under legal obligation to pay the charges.
    (2) The provisions of this paragraph also apply with respect to 
services provided by an individual who is fulfilling an NHSC scholarship 
obligation under section 753 or who received a special grant under 
section 755.



Sec. 23.10  Under what circumstances may a National Health Service Corps site's reimbursement obligation to the Federal Government be waived?

    (a) The Secretary may waive in whole or in part the reimbursement 
requirements of section 334(a)(3) of the Act if he determines that:
    (1) The National Health Service Corps site is financially unable to 
meet the reimbursement requirements or that compliance with those 
requirements will unreasonably limit the ability of the site to 
adequately support the provision of services by assigned Corps 
personnel. In making these determinations, the Secretary will consider--
    (i) The costs necessary to adequately support the health services 
provided by the assigned National Health Service Corps personnel and the 
income and financial resources available to meet the costs;
    (ii) The ability of the applicant to obtain credit from suppliers, 
lending institutions, private organizations and individuals;
    (iii) The need of the health manpower shortage area for health 
services; and
    (iv) The extent to which the National Health Service Corps site 
utilizes health professions personnel.
    (2) A significant percentage of the individuals who are located in 
the health manpower shortage area and are receiving the health services 
of the assigned National Health Service Corps personnel are elderly, 
living in poverty, or have other characteristics which indicate an 
inability to pay. For purposes of this section, ``elderly'' means 
persons 65 years or older and the ``CSA Income Poverty Guidelines'' will 
be used as the standard for determining whether individuals are living 
in poverty. Other characteristics indicating inability to pay include, 
but are not to be limited to, the ratio of unemployment in the health 
manpower shortage area and the area's cost-of-living index.
    (b) The Secretary may waive in whole or in part the reimbursement 
requirements of section 334(f)(1) of the Act if he or she determines 
that the National Health Service Corps site is a small health center (as 
defined by section 334(f)(5) of the Act) that needs all

[[Page 71]]

or part of the amount otherwise payable to--
    (1) Expand or improve its provision of health services;
    (2) Increase the number of individuals served;
    (3) Renovate or modernize facilities for its provision of health 
services;
    (4) Improve the administration of its health service programs; or
    (5) Establish a financial reserve to assure its ability to continue 
providing health services;
    (c) Where the Secretary determines that a National Health Service 
Corps site is eligible for a waiver under paragraph (a) (1) or (2) of 
this section. the Secretary may waive the application of the 
reimbursement requirements of section 334(a)(3) of the Act and apply the 
reimbursement requirements of section 334(f)(1) of the Act. The 
Secretary may waive in whole or in part the reimbursement requirements 
of section 334(f)(1) for such a site if he or she determines that the 
National Health Service Corps site meets the requirements of paragraph 
(a)(1) of this section. Funds retained by a National Health Service 
Corps site as a result of such waiver must be used for the purposes set 
forth in paragraphs (b) (1) through (5) of this section.
    (d) Requests for a prospective or retrospective waiver must be made 
at the time and in the manner and contain the documentation prescribed 
by the Secretary.

[45 FR 12790, Feb. 27, 1980, as amended at 51 FR 31948, Sept. 8, 1986]



Sec. 23.11  Under what circumstances may the Secretary sell equipment or other property of the United States used by the National Health Service Corps site?

    (a) Upon expiration of the assignment of all Corps personnel to a 
health manpower shortage area, the Secretary may sell equipment and 
other property of the United States used by the assigned personnel. The 
equipment may be sold at the fair market value or less than the fair 
market value to any entity providing health services in or to a health 
manpower shortage area if the Secretary determines that an entity is 
unable to pay the fair market value. In determining whether an entity is 
financially unable to purchase equipment or property at fair market 
value, the Secretary will consider (1) the present financial resources 
of the entity available to purchase the equipment or property based upon 
its current liabilities, and (2) the entity's ability to obtain the 
funds necessary to purchase the equipment or property. However, the 
Secretary will not sell the equipment or property for less than fair 
market value to a profitmaking organization unless the organization 
gives reasonable assurance that it will use the equipment or property to 
provide health services in or to the health manpower shortage area.
    (b) The Secretary will give priority to sales to an entity providing 
reasonable assurance that it will use the equipment or property for the 
purpose of retaining within the health manpower shortage area National 
Health Service Corps personnel who have completed their assignments.



Sec. 23.12  Who will supervise and control the assigned personnel?

    Assigned National Health Service Corps personnel will at all times 
remain under the direct supervision and control of the Secretary. 
Observance of institutional rules and regulations by the assigned 
personnel is a mere incident of the performance of their Federal 
functions and does not alter their direct professional and 
administrative responsibility to the Secretary.



Sec. 23.13  What nondiscrimination requirements apply to National Health Service Corps sites?

    National Health Service Corps sites are advised that in addition to 
complying with the terms and conditions of this regulation, the 
following laws and regulations are applicable--
    (a) Title VI of the Civil Rights Act of 1964 (43 U.S.C. 2000d et 
seq.) and its implementing regulations, 45 CFR part 80 (prohibiting 
discrimination in federally assisted programs on the grounds of race, 
color, or national origin); and
    (b) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) 
and its implementing regulations, 45 CFR part 84 (prohibiting 
discrimination in federally assisted programs on the basis of handicap).

[[Page 72]]

    (c) The Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.) and 
its implementing regulations, 45 CFR part 91 (prohibiting 
nondiscrimination on the basis of age in HHS programs or activities 
receiving Federal financial assistance).

[45 FR 12790, Feb. 27, 1980, as amended at 49 FR 38109, Sept. 27, 1984]



   Subpart B--Private Practice Special Loans for Former Corps Members

    Source: 51 FR 31948, Sept. 8, 1986, unless otherwise noted.



Sec. 23.21  Definitions.

    As used in this subpart, terms have the same meanings as those given 
to them in subpart A, Sec. 23.2. In addition:
    National Health Service Corps scholarship recipient means an 
individual receiving a scholarship under the Public Health and National 
Health Service Corps Scholarship Training Program authorized by section 
225 of the Act as in effect on September 30, 1977, and repealed on 
October 1, 1977, or a scholarship under the NHSC Scholarship Program 
authorized by section 338A of the Act, formerly section 751 of the Act.
    Private full-time clinical practice means the provision of 
ambulatory clinical services for a minimum of 40 hours per week for at 
least 45 weeks a year, including the provision of hospital coverage 
services appropriate to meet the needs of patients treated and to assure 
continuity of care. The 40 hours per week must be performed in no less 
than 4 days per week with no more than 12 hours of work being performed 
in any 24-hour period.



Sec. 23.22  What is the purpose of a private practice loan?

    The purpose of the private practice loan is to assist NHSC 
scholarship recipients in establishing private full-time clinical 
practices in designated health manpower shortage areas.



Sec. 23.23  Who is eligible to receive a private practice option loan?

    (a) Eligibility for loans is limited to NHSC scholarship recipients 
who have completed at least 2 years of their service obligations at a 
NHSC site. NHSC scholarship recipients remain eligible for loans under 
this subpart for 1 year after they have completed their service 
obligations at a NHSC site.
    (b) Scholarship recipients who are in arrears 31 days or more on a 
Health Professions Student Loan (42 U.S.C. 294m et seq.), Health 
Education Assistance Loan (42 U.S.C. 294, et seq.), Nursing Student Loan 
(42 U.S.C. 297a et seq.), or any other Federally guaranteed or direct 
student loan are ineligible for this loan program.
    (c) NHSC scholarship recipients who have received loans under either 
this subpart or subpart C of this part are ineligible for loans under 
this subpart.



Sec. 23.24  In what amounts are loans made?

    The Secretary may make loans either in the amount of $12,500, if the 
recipient agrees to practice in accordance with the loan agreement for a 
period of at least 1 year but less than 2 years, or $25,000, if the 
recipient agrees to practice in accordance with the loan agreement for a 
period of at least 2 years.



Sec. 23.25  How will interest rates for loans be determined?

    Interest will be charged at the Treasury Current Value of Funds 
(CVF) rate in effect on April 1 immediately preceding the date on which 
the loan is approved and will accrue from the date the loan funds are 
disbursed to the borrower.



Sec. 23.26  How is the loan repaid?

    Payments shall be made at monthly intervals, beginning 1 month from 
the date of the loan disbursement, in accordance with the repayment 
schedule established by the Secretary and set forth in the loan 
agreement. Only interest payments are required during the first 2 years. 
The repayment schedule may be extended in accordance with Sec. 23.31(a).



Sec. 23.27  What happens if scheduled payments are late?

    (a) Failure to make full payment of principal and/or interest when 
due will subject the borrower to the assessment of administrative costs 
and penalty

[[Page 73]]

charges, in addition to the regular interest charge, in accordance with 
45 CFR part 30.
    (b) Failure to make full payment of principal and/or interest when 
due may result in the Secretary placing the borrower in default of the 
loan. See Sec. 23.28(a).



Sec. 23.28  What events constitute default?

    The following events will constitute defaults of the loan agreement:
    (a) Failure to make full payment of principal and/or interest when 
due, and continuance of that failure for a period of sixty (60) days, or 
a lesser period of time if the Secretary determines that more immediate 
action is necessary in order to protect the interests of the Government.
    (b) Failure to perform or observe any of the terms and conditions of 
the loan agreement and continuance of that failure for a period of sixty 
(60) days.
    (c) The institution of bankruptcy proceedings, either voluntary or 
involuntary, under any State or Federal statute, which may adversely 
affect the borrower's ability to comply with the terms and conditions of 
the agreement or the promissory note.



Sec. 23.29  What happens in the case of a default?

    (a) In the event of default, the Secretary may declare the entire 
amount owed (including principal, accrued interest and any applicable 
charges) immediately due and payable. Collection of the amount owed will 
be made in accordance with 45 CFR part 30.
    (b) The borrower is not entitled to written notice of any default 
and the failure to deliver written notice of default in no way affects 
the Secretary's right to declare the loan in default and take any 
appropriate action under the loan agreement or the promissory note.
    (c) The failure of the Secretary to exercise any remedy available 
under law or regulation shall in no event be construed as a waiver of 
his or her right to exercise that remedy if any subsequent or continued 
default or breach occurs.



Sec. 23.30  May the loan be prepaid?

    The borrower shall have the option to prepay the balance of any part 
of the loan, together with accrued interest, at any time without 
prepayment penalty.



Sec. 23.31  May loan payments be postponed or waived?

    (a) Whenever health, economic, or other personal problems affect the 
borrower's ability to make scheduled payments on the loan, the Secretary 
may allow the borrower an extension of time or allow the borrower to 
make smaller payments than were previously scheduled; however, interest 
will continue to accrue at the rate specified in the promissory note 
until the loan is repaid in full. The loan must be fully repaid within 
10 years after it was made.
    (b) No waiver, full or partial, of repayment of the loan will be 
granted; except that the obligation of a borrower to repay a loan shall 
be cancelled upon the death or total and permanent disability of the 
borrower, as determined by the Secretary.
    (c) In order to make a determination under paragraph (a) or (b) of 
this section, the Secretary may require supporting medical, financial, 
or other documentation.



Sec. 23.32  What conditions are imposed on the use of the loan funds?

    (a) The borrower must use the total amount of the loan to purchase 
or lease, or both, equipment and supplies, to hire authorized personnel 
to assist in providing health services and/or to renovate facilities for 
use in providing health services in his or her private practice. 
Equipment and supplies purchased and/or leased, personnel hired and 
facilities renovated shall be limited to the items requested in the loan 
application and approved by the Secretary.
    (b) The borrower must expend the loan funds within 6 months from the 
date of the loan or within such other time as the Secretary may approve. 
Documentation of the expenditure of funds must be furnished to the 
Secretary upon request.



Sec. 23.33  What security must be given for these loans?

    The Secretary may require the borrower to pledge to the Secretary a 
security interest in specified collateral.

[[Page 74]]



Sec. 23.34  What other conditions are imposed?

    (a) The borrower must sign a loan agreement describing the loan and 
practice conditions, and a promissory note agreeing to repay the loan 
plus interest.
    (b) The borrower must agree to enter into private full-time clinical 
practice in a HMSA for the time period specified in the loan agreement.
    (c) The borrower must accept assignment, for the time period 
specified in the loan agreement, under section 1842(b)(3)(B)(ii) of the 
Social Security Act as full payment for all services for which payment 
may be made under part B of title XVIII of that Act.
    (d) The borrower must enter into an appropriate agreement, for the 
time period specified in the loan agreement, with the State agency which 
administers the State plan for medical assistance under title XIX of the 
Social Security Act to provide services to individuals entitled to 
medical assistance under the plan.
    (e) During the time period specified in the loan agreement, the 
borrower must provide health services to individuals at the usual and 
customary rate prevailing in the HMSA in which services are provided; 
however, services must be provided at no charge or at a nominal charge 
to those persons unable to pay for these services.
    (f) The borrower must keep and preserve all documents, including 
bills, receipts, checks, and correspondence which affect the operation 
of the private practice and the expenditure of loan funds for the period 
of the practice obligation specified in the loan agreement plus 3 years. 
Accounts will be maintained under one of the accounting principles 
identified by the Secretary in the loan agreement.
    (g) The borrower must provide the Secretary and the Controller 
General of the United States, or their representatives, access during 
normal working hours to accounts, documents, and records for the 
purposes of audit or evaluation; and must permit the Secretary or his or 
her representative to inspect the private practice at reasonable times 
during the period of the practice obligation specified in the loan 
agreement plus 3 years. All information as to personal facts and 
circumstances about recipients of services shall be held confidential, 
and shall not be divulged without the individual's consent except as may 
be required by law or as may be necessary to provide medical service to 
the individual or to provide for medical or fiscal audits by the 
Secretary or his or her designee with appropriate safeguards for 
confidentiality of records.
    (h) For the entire period of loan repayment, the borrower must 
acquire, maintain, and when requested, must provide the Secretary with 
copies of policies of insurance on equipment and supplies in amounts 
adequate to reasonably protect the borrower from risk, including public 
liability, fire, theft, and worker's compensation.
    (i) If the Secretary retains a security interest pursuant to 
Sec. 23.33, the borrower must keep and preserve all documents which 
affect that security interest for the period of the loan repayment and 
allow the Secretary or his or her designee access, during normal working 
hours, to those documents.
    (j) The borrower must maintain the loan proceeds in a separate 
account from his or her other transactions and must agree to draw upon 
this account and expend the loan proceeds in accordance with Sec. 23.32.
    (k) The Secretary may impose other conditions which he or she deems 
appropriate under law or regulation to protect the Government's 
interests.



Sec. 23.35  What criteria are used in making loans?

    Approval of loan applications will be based on the criteria set 
forth below:
    (a) The need in the HMSA for the applicant's health profession as 
determined under section 332 of the Act;
    (b) The applicant's need for the loan funds; and
    (c) The comments from State or local health professional societies 
on the appropriateness of the applicant's intended private practice; and
    (d) The applicant's credit worthiness and projected financial 
ability to repay the loan.

[[Page 75]]



                    Subpart C--Private Startup Loans



Sec. 23.41  What conditions are applicable to loans under this subpart?

    The regulations set out in subpart B of this part are fully 
applicable to loans awarded under section 338C(e)(1) of the Public 
Health Service Act, except as noted below;
    (a) Eligibility. (1) In lieu of Sec. 23.23(a), the following applies 
to loans made under this subpart:
    (i) Eligibility for loans is limited to NHSC scholarship recipients 
who plan to enter private practice and have not begun fulfilling their 
scholarship service obligation or are currently fulfilling their 
scholarship service obligation under section 338B of the Act and have 
completed less than 2 years of this obligation.
    (2) In lieu of Sec. 23.23(c), the following applies to loans made 
under this subpart:
    (i) NHSC scholarship recipients who have received loans under either 
this subpart or subpart B of this part are ineligible for loans under 
this subpart.
    (b) Loan amounts. (1) In lieu of Sec. 23.24, the following applies 
to loans made under this subpart:
    (i) The Secretary may make loans in the amount of $12,500 if the 
recipient agrees to practice in accordance with the loan agreement for a 
period of at least 1 year but less than 2 years or the remaining period 
of the borrower's NHSC scholarship service obligation, whichever is 
shorter.
    (ii) The Secretary may make loans in the amount of $25,000 if the 
recipient agrees to practice in accordance with the loan agreement for a 
period of at least 2 years or the remaining period of the borrower's 
NHSC scholarship service obligation, whichever is shorter.
    (c) Use of funds. (1) In lieu of Sec. 23.32(a), the following 
applies to loans made under this subpart:
    (i) The borrower must use the total amount of the loan only to 
purchase or lease, or both, the equipment and supplies needed for 
providing health services in his or her private practice. Equipment and 
supplies purchased and/or leased shall be limited to the items requested 
in the loan application and approved by the Secretary.

[51 FR 31950, Sept. 8, 1986]



PART 24--SENIOR BIOMEDICAL RESEARCH SERVICE--Table of Contents




Sec.
24.1  Establishment.
24.2  Allocation.
24.3  Policy Board.
24.4  Eligibility.
24.5  Peer review.
24.6  Pay and compensation.
24.7  Performance appraisal system.
24.8  Applicability of provisions of Title 5, U.S. Code.
24.9  Removal from the Service.
24.10  Reporting.

    Authority: Section 228(g) of the Public Health Service Act; 5 U.S.C. 
301.

    Source: 61 FR 6557, Feb. 21, 1996, unless otherwise noted.



Sec. 24.1  Establishment.

    There is established in the Public Health Service (PHS) a Senior 
Biomedical Research Service (SBRS) consisting of members the maximum 
number of which is prescribed by law.



Sec. 24.2  Allocation.

    (a) The Secretary, within the number authorized in the PHS Act, 
shall determine the number of SBRS slots to be allocated to each 
participating Operating Division.
    (b) The SBRS Policy Board may advise the Secretary to make 
adjustments to the allocation at any time.
    (c) The majority of the SBRS allocation is to be reserved for 
recruitment. The remaining SBRS allocation may be used for the retention 
of current employees.
    (d) SBRS slots will be used judiciously, resulting in SBRS 
appointments only where other senior-level appointing authorities are 
not sufficient to recruit or retain scientific talent.
    (e) The Secretary will ensure that SBRS slots are used in support of 
high priority programs authorized by Congress and which directly support 
the research goals and priorities of the Department.



Sec. 24.3  Policy Board.

    The Secretary or his/her designee shall establish an SBRS Policy 
Board to serve in an advisory capacity, recommending SBRS allocations 
among the participating Operating Divisions,

[[Page 76]]

reviewing the operations of the SBRS and ensuring consistent application 
of regulations, policies, and procedural guidelines, and recommending 
changes to the Secretary as necessary. Membership, to the extent 
possible, will include SBRS eligibles nominated by their respective 
Operating Divisions, will be weighted in proportion to Operating 
Divisions' SBRS allocations, and will include representation from the 
Office of the Secretary. The Secretary or his/her designee will select 
the board membership and the Chair.



Sec. 24.4  Eligibility.

    To be eligible for appointment to the Service an individual must 
have a doctoral-level degree in biomedicine or a related field and must 
meet the qualification standards prescribed by the U.S. Office of 
Personnel Management for appointment to a position at GS-15 of the 
General Schedule. In addition, the individual must be outstanding in the 
field of biomedical research or clinical research evaluation. 
Appointment to the Service will be made only to individuals actively 
engaged in either biomedical research or clinical research evaluation.
    (a) Outstanding in the field of biomedical research means an 
individual who is actively engaged in peer-reviewed original biomedical 
research and whose work in this area is considered by his or her peers 
to be outstanding. In order to meet the eligibility criteria, an 
individual must have conducted original peer-reviewed biomedical 
research resulting in major accomplishments reflected by a steady and 
current record of highly cited publications in peer-reviewed journals of 
high stature. In addition, the individual should be the recipient of 
major prizes and awards (such as visiting professorships and named 
lectureships) in recognition of original contributions to research.
    (b) Outstanding in the field of clinical research evaluation means 
that an individual is actively engaged in clinical research evaluation 
and is considered by his or her peers to be outstanding. In order to 
meet the eligibility criteria, an individual, by force of his or her own 
technical expertise, must be in a position to shape the course of drug 
or device evaluation or exert a similar influence on the PHS handling of 
other agents that may affect the public health. The individual would 
normally have dealt with complex, precedent-setting evaluation issues 
that involved significant scientific controversy, had far reaching 
implications for clinical research or resulted in a widespread economic 
effect in the health-care delivery system. In addition, the individual 
should have been involved in the development of scientific or regulatory 
guidelines for clinical research and been the recipient of invitations 
to speak at or to chair major national or international meetings and 
symposia.



Sec. 24.5  Peer review.

    An individual may not be considered for appointment into the SBRS 
unless his/her qualifications have been reviewed by a PHS peer review 
committee and the committee has recommended appointment to the Service.



Sec. 24.6  Pay and compensation.

    The SBRS is an ungraded system, with a single, flexible pay range to 
include all members.
    (a) Pay of the members of the Service shall be determined by the 
Secretary or his/her designee.
    (b) The pay of a member of the Service shall be not less than the 
minimum rate payable for GS-15 of the General Schedule and shall not 
exceed:
    (1) The rate payable for level I of the Executive Schedule unless a 
higher rate of pay is expressly approved on an individual basis by the 
President, pursuant to 5 U.S.C. 5377(d)(2), or
    (2) The rate payable for level II of the Executive Schedule unless a 
higher rate of pay is expressly approved on an individual basis by the 
Secretary.
    (c) While the full pay range will be used, individual pay at the 
higher end of the range will be used only as needed to recognize 
individual scientific value and as necessary to recruit or retain an 
exceptionally well-qualified scientist.
    (d) The following factors will be used in establishing appropriate 
pay rates for individual members:
    (1) Impact of the individual on the scientific field;

[[Page 77]]

    (2) Recognition of the individual by the scientific community;
    (3) Originality of the individual's ideas/work products;
    (4) Specific ``clinical'' or highly technical skills of the 
individual which are of benefit to the agency and which are in addition 
to requirements of the basic scientific assignment;
    (5) The individual's earnings and monetary benefits;
    (6) Salary surveys of similar skills in pertinent labor markets; and
    (7) Other relevant factors.
    (e) Annual adjustments to pay rates may be made effective on the 
first day of the first pay period on or after January 1 of each calendar 
year. The rate of such adjustments will be at the discretion of the 
Secretary or his/her designee, except that the minimum rate payable in 
the SBRS will be increased to the amount of the minimum rate of the GS-
15 of the General Schedule.
    (f) Other pay adjustments will be made on an individual basis by the 
Secretary or his/her designee.
    (g) Except as provided in paragraph (h) of this section, new 
appointees to the Service, who are not covered by the Civil Service 
Retirement System, will be covered by the Federal Employees Retirement 
System.
    (h) Upon the request of a member who performed service in the employ 
of an institution of higher education immediately prior to his 
appointment as a member of the Service, and retains the right to make 
contributions to the retirement system of such institution, the 
Department of Health and Human Services may contribute an amount not to 
exceed ten percent per annum of the member's basic pay to such 
institution's retirement system on behalf of such member. A member who 
participates in this program shall not be covered by any retirement 
system established for employees of the United States under title 5, 
United States Code.



Sec. 24.7  Performance appraisal system.

    The members of the Service shall be subject to a performance 
appraisal system which shall be designed to encourage excellence in 
performance and shall provide for a periodic and systematic appraisal of 
the performance of the members.



Sec. 24.8   Applicability of provisions of Title 5, U.S. Code.

    (a) Appointments to the Service shall be made without regard to the 
provisions of title 5, U.S. Code regarding appointments.
    (b) Members of the Service shall not be covered by the following 
provisions of title 5, U.S. Code:
    (1) Subchapter I of Chapter 35 (relating to retention preference in 
the event of reduction in force);
    (2) Chapter 43, Performance Appraisal (and performance-based 
actions);
    (3) Chapter 51 (relating to classification);
    (4) Subchapter III of Chapter 53, The General Schedule; and
    (5) Chapter 75, Adverse Actions.
    (c) Other provisions of Title 5 will be applied as administratively 
determined by the Secretary or his/her designee.



Sec. 24.9  Removal from the Service.

    (a) A member of the Service may be subject to disciplinary action, 
including removal from the Service, for substandard performance of duty 
as a member of the service, for misconduct, for reasons of national 
security or for other reasons as determined by the Secretary.
    (b) A member for whom disciplinary action is proposed is entitled 
to:
    (1) Written notice of the proposed action and the basis therefor;
    (2) A reasonable opportunity to answer the notice of proposed action 
both orally and in writing;
    (3) The right to be represented by an attorney or other 
representative in making such answer; and
    (4) A written decision on the proposal.
    (c) The decision may be made by an official with delegated authority 
to take such action, but in no case may the official be at a level below 
the head of the Operating Division where the member is assigned.
    (d) A member who is separated from the Service involuntarily and 
without cause and who, immediately prior to his appointment to the 
Service, was a career appointee in the civil service or the Senior 
Executive Service, may be

[[Page 78]]

appointed to a position in the competitive civil service at grade GS-15 
of the General Schedule. Such an appointment may be made by the 
Secretary or his/her designee without regard to the provisions of title 
5, U.S. Code regarding appointments in the civil service.
    (e) A member who is separated from the Service involuntarily and 
without cause and who, immediately prior to appointment to the Service, 
was not a career appointee in the civil service or the Senior Executive 
Service may be appointed to a position in the excepted civil service at 
grade GS-15 of the General Schedule for a period not to exceed two 
years.
    (f) There shall be no right to further review of the final decision 
on a disciplinary action. At his/her discretion, the Secretary may 
review an action taken under this section and may reduce, suspend, or 
overrule the action taken.
    (g) A member of the Service may be removed from the Service for such 
other reasons as may be prescribed by the Secretary.



Sec. 24.10  Reporting.

    For each quarter of the first year of implementation and annually 
thereafter, participating Operating Divisions shall maintain reports on 
the operation of the SBRS. At a minimum, these reports should include 
the number of appointees, the source of those appointees, their earnings 
immediately prior to appointment, and their SBRS pay at appointment.

[[Page 79]]



               SUBCHAPTER C--MEDICAL CARE AND EXAMINATIONS





PART 31--MEDICAL CARE FOR CERTAIN PERSONNEL OF THE COAST GUARD, NATIONAL OCEAN SURVEY, PUBLIC HEALTH SERVICE, AND FORMER LIGHTHOUSE SERVICE--Table of Contents




                               Definitions

Sec.
31.1  Meaning of terms.

 Provisions Applicable to Coast Guard, National Ocean Survey and Public 
                             Health Service

31.2  Persons entitled to treatment.
31.3  Use of Service facilities.
31.4  Use of other than Service facilities.
31.5  Application for treatment; active duty personnel.
31.6  Personnel absent without leave.
31.7  Continuance of medical relief after loss of status.
31.8  Retired personnel; extent of treatment.
31.9  Dependent members of families; treatment.
31.10  Dependent members of families; use of Service facilities.

     Provisions Applicable to Personnel of Former Lighthouse Service

31.11  Persons entitled to treatment.
31.12  Use of Service facilities.
31.13  Use of other than Service facilities.
31.14  Application for treatment; active duty personnel.
31.15  Continuance of medical relief after loss of status.
31.16  Retired personnel; extent of treatment.

    Source: 21 FR 9821, Dec. 12, 1956, unless otherwise noted.

                               Definitions



Sec. 31.1  Meaning of terms.

    As used in this part, the term:
    (a) Act means the Public Health Service Act, approved July 1, 1944, 
58 Stat. 682, as amended.
    (b) Service means the Public Health Service.
    (c) Surgeon General means the Surgeon General of the Public Health 
Service.
    (d) Medical relief station means a first-, second-, third-, or 
fourth-class station of the Service.
    (e) First-class stations means a hospital operated by the Service.
    (f) Second-class station means a medical relief facility, other than 
a hospital of the Service, under the charge of a commissioned officer.
    (g) Third-class station means a medical relief facility, other than 
a hospital of the Service, under the charge of a medical officer or 
employee of the Service other than a commissioned officer.
    (h) Fourth-class station means a medical relief facility designated 
by the Surgeon General, other than a first-, second-, or third-class 
station.
    (i) Designated physician means a physician holding an appointment to 
act regularly for the Service for a class or classes of specified 
beneficiaries at a place where there is no medical relief station.
    (j) Designated dentist means a dentist holding an appointment to 
perform dental service for the Service for a class or classes of 
specified beneficiaries.
    (k) Active duty means active duty status as distinguished from being 
on inactive status or retired and includes periods of authorized leave 
or liberty.
    (l) Dependent members of families in the case of male personnel 
means the lawful wife, the unmarried children (including stepchildren or 
adopted children) under 21 years of age, and the father or mother if in 
fact dependent upon such son for his or her chief support; and in the 
case of female personnel, the unmarried children (including stepchildren 
or adopted children) under 21 years of age if their father is dead or 
they are in fact dependent on such mother for their chief support, the 
father or mother if in fact dependent upon such daughter for his or her 
chief support, and the husband if in fact dependent upon such wife for 
his chief support: Provided, however, That in the case of members of the 
Women's Reserve of the Coast Guard the husbands of such members shall 
not be considered dependents.

(Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216)

[[Page 80]]

 Provisions Applicable to Coast Guard, National Ocean Survey and Public 
                             Health Service



Sec. 31.2  Persons entitled to treatment.

    To the extent and under the circumstances prescribed in Secs. 31.2 
to 31.10, the following persons shall be entitled to medical, surgical, 
and dental treatment and hospitalization by the Service:
    (a) Coast Guard. (1) Commissioned officers, chief warrant officers, 
warrant officers, cadets, and enlisted personnel of the Regular Coast 
Guard, including those on shore duty and those on detached duty, whether 
on active duty or retired;
    (2) Regular members of the Coast Guard Reserve when on active duty 
or when retired for disability;
    (3) Temporary members of the Coast Guard Reserve when on active duty 
or in case of physical injury incurred or sickness or disease contracted 
while performing active Coast Guard duty;
    (4) Members of the Women's Reserve of the Coast Guard when on active 
duty or when retired for disability;
    (5) Members of the Coast Guard Auxiliary in case of physical injury 
incurred or sickness or disease contracted while performing active Coast 
Guard duty.
    (b) National Ocean Survey. Commissioned officers, ships' officers, 
and members of the crews of vessels of the National Ocean Survey, 
including those on shore duty and those on detached duty whether on 
active duty or retired.
    (c) Public Health Service. (1) Commissioned officers of the Regular 
Corps of the Service, whether on active duty or retired;
    (2) Commissioned officers of the Reserve Corps of the Service when 
on active duty or when retired for disability.

(Sec. 326, 58 Stat. 697, as amended 42 U.S.C. 253)



Sec. 31.3  Use of Service facilities.

    Except as otherwise provided in Secs. 31.3 to 31.10, the persons 
specified in Sec. 31.2 shall be entitled to medical, surgical, and 
dental treatment and hospitalization only at medical relief stations and 
by designated physicians and designated dentists, and the cost of 
services procured elsewhere shall not be borne by the Service.

(Sec. 326, 58 Stat. 697, as amended 42 U.S.C. 253)



Sec. 31.4  Use of other than Service facilities.

    (a) When a person specified in Sec. 31.2 who is on active duty 
requires immediate medical, surgical, or dental treatment or 
hospitalization and the urgency of the situation does not permit 
treatment at a medical relief station or by a designated physician or 
designated dentist, an officer of the same service as the patient may 
arrange for treatment or hospitalization at the expense of the Service.
    (b) When the circumstances are such that an officer of the same 
service as the patient is not available to make the necessary 
arrangements, the treatment or hospitalization may be obtained by or on 
behalf of the patient at the expense of the Service.
    (c) In every case of treatment or hospitalization as defined in 
paragraph (b) of this section, the responsible superior officer of the 
patient shall be notified as promptly as possible and a full report 
shall be submitted by such officer to the Surgeon General through 
appropriate official channels. As soon as practicable, unless the 
interests of the patient or the Government require otherwise, treatment 
or hospitalization shall be continued at a medical relief station or by 
a designated physician or designated dentist or at another appropriate 
Federal medical facility.
    (d) When the necessary medical relief cannot be obtained from a 
medical relief station or a designated physician or designated dentist, 
preference shall be given to other Federal medical facilities when 
reasonably available and when conditions permit.
    (e) Vouchers on proper forms covering expenses for treatment or 
hospitalization under the circumstances specified in paragraphs (a) and 
(b) of this section shall be forwarded to the Surgeon General through 
appropriate official channels. Each such voucher shall be accompanied by 
or contain a statement of the facts necessitating the treatment or 
hospitalization. Unreasonable charges for emergency

[[Page 81]]

treatment or hospitalization will not be allowed.
    (f) Expenses for consultants or special services, or for dental 
treatment other than emergency measures to relieve pain, shall not be 
allowed except when authorized in advance by the headquarters of the 
Service or, in extraordinary cases, when subsequently approved by such 
headquarters upon receipt of report and satisfactory explanation as to 
the necessity and urgency therefor.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.5  Application for treatment; active duty personnel.

    (a) An applicant for medical relief who is on active duty shall 
furnish a certificate identifying him. Such certificate, in the case of 
Coast Guard personnel, shall be signed by an officer of the Coast Guard, 
and in the case of National Ocean Survey personnel, shall be signed by 
an officer of the National Ocean Survey. Commissioned officers of any of 
the services mentioned in Sec. 31.2 and officers in charge of units may 
sign their own certificates. In an emergency, the officer in charge of a 
medical relief station, or a designated physician or designated dentist, 
may accept other evidence of status satisfactory to him.
    (b) A temporary member of the Coast Guard Reserve except when on 
active duty or a member of the Coast Guard Auxiliary shall, when 
applying for medical relief, furnish a statement signed by a responsible 
superior officer setting forth the facts and circumstances giving rise 
to the need for medical relief. In emergencies, such statement shall be 
furnished promptly after the member has received the immediately 
required care and treatment. Such statement shall be presumptive 
evidence of the facts stated, but if investigation indicates that the 
injury, sickness, or disease was not incurred or contracted in the 
manner stated, further treatment may be denied.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.6  Personnel absent without leave.

    No member of any of the services enumerated in Sec. 31.2 shall be 
entitled when absent without leave to medical relief except at a medical 
relief station or by a designated physician or designated dentist.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.7  Continuance of medical relief after loss of status.

    If a member is separated from any of the services enumerated in 
Sec. 31.2, except persons specified in Sec. 31.2(a) (3) and (5) who 
shall be entitled to treatment after separation under the conditions set 
forth in such paragraphs, while undergoing treatment by the Service, his 
treatment shall be discontinued immediately unless the physician in 
charge determines that the condition of the patient does not permit 
interruption of treatment, in which case the treatment shall be 
discontinued as soon as practicable and the condition of the patient 
permits. At that time he shall be discharged from treatment and shall 
not thereafter be afforded medical relief by the Service by reason of 
his previous service.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.8  Retired personnel; extent of treatment.

    (a) A retired member of the Coast Guard, National Ocean Survey, or 
Public Health Service specified in Sec. 31.2 shall be entitled to 
medical, surgical, and dental treatment and hospitalization at medical 
relief stations of the first-, second-, and third-class, upon 
presentation of satisfactory evidence of his status.
    (b) Elective medical or surgical treatment requiring hospitalization 
shall be furnished only at hospitals operated by the Service.
    (c) Dental treatment shall be furnished to the extent of available 
facilities only at medical relief stations where full-time dental 
officers are on duty; at other medical relief stations the dental 
treatment shall be limited

[[Page 82]]

to emergency measures necessary to relieve pain.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.9  Dependent members of families; treatment.

    To the extent and under the circumstances prescribed in this part, 
the Service shall provide medical advice and outpatient treatment at 
first-, second-, and third-class medical relief stations and 
hospitalization at first-class stations to the dependent members of 
families of the following persons:
    (a) Coast Guard. Commissioned officers, chief warrant officers, 
warrant officers, cadets, and enlisted personnel of the Regular Coast 
Guard, including those on shore duty and those on detached duty, whether 
on active duty or retired; and regular members of the United States 
Coast Guard Reserve and members of the Women's Reserve of the Coast 
Guard, when on active duty or when retired for disability.
    (b) National Ocean Survey. Commissioned officers, ships' officers, 
and members of the crews of vessels of the United States National Ocean 
Survey, including those on shore duty and those on detached duty, 
whether on active duty or retired.
    (c) Public Health Service. Commissioned officers of the Regular 
Corps of the Service, whether on active duty or retired, and 
commissioned officers of the Reserve Corps of the Service when on active 
duty or when retired for disability.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)



Sec. 31.10  Dependent members of families; use of Service facilities.

    (a) A dependent member of the family of any person specified in 
Sec. 31.9 shall, upon presentation of satisfactory evidence of such 
status, be entitled to medical advice and out-patient treatment at 
first-, second-, and third-class medical relief stations and 
hospitalization at first-class stations if suitable accommodations are 
available therein and if the condition of the dependent is such as to 
require hospitalization, both as determined by the medical officer in 
charge.
    (b) Hospitalization at first-class stations shall be at a per diem 
cost to the officer, enlisted person, member of a crew or other person 
concerned. Such cost shall be at such uniform rate as may be prescribed 
from time to time by the President for the hospitalization of dependents 
of naval and Marine Corps personnel at any naval hospital.
    (c) Hospitalization at first-class stations and out-patient 
treatment at first-, second-, and third-class stations may include such 
services and supplies as, in the judgment of the medical officer in 
charge, are necessary for reasonable and adequate treatment.
    (d) Dental treatment shall be furnished to the extent of available 
facilities only at medical relief stations where full-time officers are 
on duty.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)

     Provisions Applicable to Personnel of Former Lighthouse Service



Sec. 31.11  Persons entitled to treatment.

    To the extent and under the circumstances prescribed in this part, 
the following persons shall be entitled to medical, surgical, and dental 
treatment and hospitalization by the Service: Lightkeepers, assistant 
lightkeepers, and officers and crews of vessels of the former Lighthouse 
Service, including any such persons who subsequent to June 30, 1939, 
have involuntarily been assigned to other civilian duty in the Coast 
Guard, who were entitled to medical relief at hospitals and other 
stations of the Service prior to July 1, 1944, and who are now or 
hereafter on active duty or who have been or may hereafter be retired 
under the provisions of section 6 of the act of June 20, 1918, as 
amended (33 U.S.C. 763).

(Sec. 610(b), 58 Stat. 714, as amended; 33 U.S.C. 763c)



Sec. 31.12  Use of Service facilities.

    Except as otherwise provided herein, the persons specified in 
Sec. 31.11 shall be entitled to medical, surgical, and dental treatment 
and hospitalization only at medical relief stations and by designated 
physicians and designated dentists, and the cost of services procured

[[Page 83]]

elsewhere shall not be borne by the Service.

(Sec. 610(b), 58 Stat. 714, as amended; 33 U.S.C. 763c)



Sec. 31.13  Use of other than Service facilities.

    (a) When a person specified in Sec. 31.11 who is on active duty 
requires immediate medical, surgical, or dental treatment or 
hospitalization and the urgency of the situation does not permit 
treatment at a medical relief station or by a designated physician or 
designated dentist, an officer or other appropriate supervisory official 
of the Coast Guard may arrange for treatment or hospitalization.
    (b) In every such case of treatment or hospitalization, a full 
report thereof shall be submitted to the Surgeon General through Coast 
Guard headquarters. As soon as practicable, unless the interests of the 
patient or the Government require otherwise, treatment or 
hospitalization shall be continued at a medical relief station or by a 
designated physician or designated dentist or at another appropriate 
Federal medical facility.
    (c) When the necessary medical relief cannot be obtained from a 
medical relief station or a designated physician or designated dentist, 
preference shall be given to other Federal medical facilities when 
reasonably available and when conditions permit.
    (d) Vouchers on proper forms covering expenses for treatment or 
hospitalization under the circumstances specified in paragraph (a) of 
this section shall be forwarded to the Surgeon General through Coast 
Guard headquarters. Each such voucher shall be accompanied by or contain 
a statement of the facts necessitating the treatment or hospitalization. 
Unreasonable charges for emergency treatment or hospitalization will not 
be allowed.
    (e) Expenses for consultants or special services, or for dental 
treatment other than emergency measures to relieve pain, shall not be 
allowed except when authorized in advance by the headquarters of the 
Service or, in extraordinary cases, when subsequently approved by such 
headquarters upon receipt of report and satisfactory explanation as to 
the necessity and urgency therefor.

(Sec. 610(b), 58 Stat. 714 as amended; 33 U.S.C. 763c)



Sec. 31.14  Application for treatment; active duty personnel.

    An applicant for medical relief who is on active duty shall furnish 
a certificate identifying him. Such certificate shall be signed by an 
officer or other appropriate supervisory official of the Coast Guard. In 
an emergency, the officer in charge of a medical relief station, or a 
designated physician or designated dentist, may accept other evidence of 
status satisfactory to him.

(Sec. 610(b), 58 Stat. 714 as amended; 33 U.S.C. 763c)



Sec. 31.15  Continuance of medical relief after loss of status.

    If a person is separated while undergoing treatment by the Service, 
his treatment shall be discontinued immediately unless the physician or 
dentist in charge determines that the condition of the patient does not 
permit interruption of treatment, in which case the treatment shall be 
discontinued as soon as practicable and the condition of the patient 
permits. At that time he shall be discharged from treatment and shall 
not thereafter be afforded medical relief by the Service by reason of 
his previous service.

(Sec. 610(b), 58 Stat. 714, as amended; 33 U.S.C. 763c)



Sec. 31.16  Retired personnel; extent of treatment.

    (a) Any retired person specified in Sec. 31.11 shall be entitled to 
medical, surgical, and dental treatment and hospitalization at medical 
relief stations of the first, second, and third class, upon presentation 
of satisfactory evidence of his status.
    (b) Elective medical or surgical treatment requiring hospitalization 
shall be furnished only at hospitals operated by the Service.
    (c) Dental treatment shall be furnished to the extent of available 
facilities only at medical relief stations where full-time dental 
officers are on duty; at other medical relief stations the dental 
treatment shall be limited

[[Page 84]]

to emergency measures necessary to relieve pain.

(Sec. 610(b), 58 Stat. 714, as amended; 33 U.S.C. 763c)



PART 32--MEDICAL CARE FOR PERSONS WITH HANSEN'S DISEASE AND OTHER PERSONS IN EMERGENCIES--Table of Contents




                               Definitions

Sec.
32.1  Meaning of terms.

                              Beneficiaries

32.6  Persons eligible.

                      Persons With Hansen's Disease

32.86  Admissions to Service facilities.
32.87  Confirmation of diagnosis.
32.88  Examinations and treatment.
32.89  Discharge.
32.90  Notification to health authorities regarding discharged patients.
32.91  Purchase of services for Hansen's disease patients.

           Nonbeneficiaries: Temporary Treatment in Emergency

32.111  Conditions and extent of treatment; charges.

    Authority: Secs. 320, 321 and 322(b), Public Health Service Act (42 
U.S.C. 247e, 248 and 249(b)).

    Source: 40 FR 25816, June 19, 1975, unless otherwise noted.

                               Definitions



Sec. 32.1  Meaning of terms.

    All terms not defined herein shall have the same meaning as given 
them in the Act.
    (a) Act means the Public Health Service Act, approved July 1, 1944, 
58 Stat. 682, as amended;
    (b) Service means the Public Health Service;
    (c) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved may have been delegated.
    (d) Authorizing official means Service officers or employees duly 
designated by the Director, Bureau of Health Care Delivery and 
Assistance, to authorize and provide care and treatment to beneficiaries 
at Service expense.

[40 FR 25816, June 19, 1975, as amended at 48 FR 10318, Mar. 11, 1983]

                              Beneficiaries



Sec. 32.6  Persons eligible.

    (a) Under this part the following persons are entitled to care and 
treatment by the Service as hereinafter prescribed:
    (1) Persons afflicted with Hansen's disease; and
    (2) Non-beneficiaries for temporary treatment and care in cases of 
emergency.
    (b) Separate regulations govern: (1) The medical care of certain 
personnel, and their dependents, of the Coast Guard, National Oceanic 
and Atmospheric Administration, and Public Health Service (see part 31 
of this chapter);
    (2) Physical and mental examination of aliens (see part 34 of this 
chapter); and
    (3) Medical care for Native Americans (see part 36 of this chapter).

[48 FR 10318, Mar. 11, 1983]

                      Persons With Hansen's Disease



Sec. 32.86  Admissions to Service facilities.

    Any person with Hansen's disease who presents himself for care or 
treatment or who is referred to the Service by the proper health 
authority of any State, Territory, or the District of Columbia shall be 
received into the Service hospital at Carville, Louisiana, or into any 
other hospital of the Service which has been designated by the Secretary 
as being suitable for the accommodation of persons with Hansen's 
disease.



Sec. 32.87  Confirmation of diagnosis.

    At the earliest practicable date, after the arrival of a patient at 
the Service hospital at Carville, Louisiana, or at another hospital of 
the Service the medical staff shall confirm or disprove the diagnosis of 
Hansen's disease. If the diagnosis of Hansen's disease is confirmed, the 
patient shall be provided appropriate inpatient or outpatient

[[Page 85]]

treatment. If the diagnosis is not confirmed, the patient shall be 
discharged.

[40 FR 25816, June 19, 1975; 40 FR 36774, Aug. 22, 1975]



Sec. 32.88  Examinations and treatment.

    Patients will be provided necessary clinical examinations which may 
be required for the diagnosis of primary or secondary conditions, and 
such treatment as may be prescribed.



Sec. 32.89  Discharge.

    Patients with Hansen's disease will be discharged when, in the 
opinion of the medical staff of the hospital, optimum hospital benefits 
have been received.



Sec. 32.90  Notification to health authorities regarding discharged patients.

    Upon the discharge of a patient the medical officer in charge shall 
give notification of such discharge to the appropriate health officer of 
the State, Territory, or other jurisdiction in which the discharged 
patient is to reside. The notification shall also set forth the clinical 
findings and other essential facts necessary to be known by the health 
officer relative to such discharged patient.



Sec. 32.91  Purchase of services for Hansen's disease patients.

    Hansen's disease patients being treated on either an inpatient or 
outpatient basis at a hospital or clinic facility of the Service, other 
than the National Center for Hansen's Disease (Carville, Louisiana), 
may, at the sole discretion of the Secretary and subject to available 
appropriations, be provided care for the treatment of Hansen's disease 
at the expense of the Service upon closure or transfer of such hospital 
or clinic pursuant to section 987 of the Omnibus Budget Reconciliation 
Act of 1981 (Pub. L. 97-35). Payment will only be made for care arranged 
for by an authorizing official of the Service as defined in Sec. 32.1(f) 
of this part.

[46 FR 51918, Oct. 23, 1981]

           Nonbeneficiaries: Temporary Treatment in Emergency



Sec. 32.111  Conditions and extent of treatment; charges.

    (a) Persons not entitled to treatment by the Service may be provided 
temporary care and treatment at medical care facilities of the Service 
in case of emergency as an act of humanity.
    (b) Persons referred to in paragraph (a) of this section who, as 
determined by the officer in charge of the Service facility, are able to 
defray the cost of their care and treatment shall be charged for such 
care and treatment at the following rates (which shall be deemed to 
constitute the entire charge in each instance): In the case of 
hospitalization, at the current interdepartmental reciprocal per diem 
rate; and, in the case of outpatient treatment, at rates established by 
the Secretary.



PART 34--MEDICAL EXAMINATION OF ALIENS--Table of Contents




Sec.
34.1  Applicability.
34.2  Definitions.
34.3  Scope of examinations.
34.4  Medical notifications.
34.5  Postponement of medical examination.
34.6  Applicability of Foreign Quarantine Regulations.
34.7  Medical and other care; death.
34.8  Reexamination; convening of review boards; expert witnesses; 
          reports.

    Authority: 42 U.S.C. 216, 249, 252; 8 U.S.C. 1182, 1224, 1226; sec. 
601 of Pub. L. 101-649.



Sec. 34.1  Applicability.

    The provisions of this part shall apply to the medical examination 
of:
    (a) Aliens applying for a visa at an embassy or consulate of the 
United States;
    (b) Aliens arriving in the United States;
    (c) Aliens required by the INS to have a medical examination in 
connection with determination of their admissibility into the United 
States; and
    (d) Aliens applying for adjustment status.

[56 FR 25001, May 31, 1991]

[[Page 86]]



Sec. 34.2  Definitions.

    As used in this part, terms shall have the following meanings:
    (a) CDC. Centers for Disease Control, Public Health Service, U.S. 
Department of Health and Human Services.
    (b) Communicable disease of public health significance. Any of the 
following diseases:
    (1) Chancroid.
    (2) Gonorrhea.
    (3) Granuloma inguinale.
    (4) Human immunodeficiency virus (HIV) infection.
    (5) Leprosy, infectious.
    (6) Lymphogranuloma venereum.
    (7) Syphilis, infectious stage.
    (8) Tuberculosis, active.
    (c) Civil surgeon. A physician, with not less than 4 years' 
professional experience, selected by the District Director of INS to 
conduct medical examinations of aliens in the United States who are 
applying for adjustment of status to permanent residence or who are 
required by the INS to have a medical examination.
    (d) Class A medical notification. Medical notification of:
    (1) A communicable disease of public health significance;
    (2)(i) A physical or mental disorder and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others;
    (ii) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior; or
    (3) Drug abuse or addiction.
    (e) Class B medical notification. Medical notification of a physical 
or mental abnormality, disease, or disability serious in degree or 
permanent in nature amounting to a substantial departure from normal 
well-being.
    (f) Director. The Director of the Centers for Disease Control.
    (g) Drug abuse. The non-medical use of a substance listed in section 
202 of the Controlled Substances Act, as amended (21 U.S.C. 802) which 
has not necessarily resulted in physical or psychological dependence.
    (h) Drug addiction. The non-medical use of a substance listed in 
section 202 of the Controlled Substances Act, as amended (21 U.S.C. 802) 
which has resulted in physical or psychological dependence.
    (i) INS. Immigration and Naturalization Service, U.S. Department of 
Justice.
    (j) Medical examiner. A panel physician, civil surgeon, or other 
physician designated by the Director to perform medical examinations of 
aliens.
    (k) Medical hold document. A document issued to the INS by a 
quarantine inspector of the Public Health Service at a port of entry 
which defers the inspection for admission until the cause of the medical 
hold is resolved.
    (l) Medical notification. A document issued to a consular authority 
or the INS by a medical examiner, certifying the presence or absence of:
    (1) A communicable disease of public health significance;
    (2)(i) A physical or mental disorder and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others;
    (ii) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior;
    (3) Drug abuse or addiction; or
    (4) Any other physical abnormality, disease, or disability serious 
in degree or permanent in nature amounting to a substantial departure 
from normal well-being.
    (m) Medical officer. A physician of the Public Health Service 
Commissioned Corps assigned by the Director to conduct physical and 
mental examinations of aliens.
    (n) Mental disorder. A currently accepted psychiatric diagnosis, as 
defined by the Diagnostic and Statistical Manual of Mental Disorders 
published by the American Psychiatric Association, or by other 
authoritative sources.
    (o) Panel physician. A physician selected by a United States embassy 
or consulate to conduct medical examinations of aliens applying for 
visas.

[[Page 87]]

    (p) Physical disorder. A currently accepted medical diagnosis, as 
defined by the Manual of the International Classification of Diseases, 
Injuries, and Causes of Death published by the World Health 
Organization, or by other authoritative sources.

[21 FR 9829, Dec. 12, 1956, as amended at 52 FR 32543, Aug. 28, 1987; 56 
FR 25001, May 31, 1991]



Sec. 34.3  Scope of examinations.

    (a) General. In performing examinations, medical examiners shall 
consider those matters that relate to:
    (1) A communicable disease of public health significance;
    (2)(i) A physical or mental disorder and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others;
    (ii) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior;
    (3) Drug abuse or addiction; and
    (4) Any other physical abnormality, disease, or disability serious 
in degree or permanent in nature amounting to a substantial departure 
from normal well-being.

The scope of the examination shall include any laboratory or additional 
studies that are deemed necessary, either as a result of the physical 
examination or pertinent information elicited from the alien's medical 
history, for the examining physician to reach a conclusion about the 
presence or absence of a physical or mental abnormality, disease, or 
disability.
    (b) Persons subject to requirement for chest X-ray examination and 
serologic testing. (1) Except as provided in paragraph (b)(1)(v) of this 
section, a chest X-ray examination, serologic testing for syphilis and 
serologic testing for HIV of persons 15 years of age and older shall be 
required as part of the examination of:
    (i) Applicants for immigrant visas;
    (ii) Students, exchange visitors, and other applicants for a 
nonimmigrant visa who are required by a consular authority to have a 
medical examination;
    (iii) Aliens outside the United States who apply for refugee status;
    (iv) Applicants in the United States who apply for adjustment of 
status under the immigration statute and regulations;
    (v) Exceptions. Neither a chest X-ray examination nor serologic 
testing for syphilis and HIV shall be required if the alien is under the 
age of 15. Provided, a tuberculin skin test shall be required if there 
is evidence of contact with a person known to have tuberculosis or other 
reason to suspect tuberculosis, and a chest X-ray examination shall be 
required in the event of a positive tuberculin reaction, and serologic 
testing where there is reason to suspect infection with syphilis or HIV. 
Additional exceptions to the requirement for a chest X-ray examination 
may be authorized for good cause upon application approved by the 
Director.
    (2) Tuberculin skin test examination. (i) All aliens 2 years of age 
or older in the United States who apply for adjustment of status to 
permanent residents, under the immigration laws and regulations, or 
other aliens in the United States who are required by the INS to have a 
medical examination in connection with a determination of their 
admissibility, shall be required to have a tuberculin skin test. 
Exceptions to this requirement may be authorized for good cause upon 
application approved by the Director. In the event of a positive 
tuberculin reaction, a chest X-ray examination shall be required. If the 
chest radiograph is consistent with tuberculosis, the alien shall be 
referred to the local health authority for evaluation. Evidence of this 
evaluation shall be provided to the civil surgeon before a medical 
notification may be issued.
    (ii) Aliens less than 2 years old shall be required to have a 
tuberculin skin test if there is evidence of contact with a person known 
to have tuberculosis or other reason to suspect tuberculosis. In the 
event of a positive tuberculin reaction, a chest X-ray examination shall 
be required. If the chest radiograph is consistent with tuberculosis, 
the alien shall be referred to the local health authority for 
evaluation. Evidence of this evaluation shall be provided to the

[[Page 88]]

civil surgeon before a medical notification may be issued.
    (3) Sputum smear examination. All aliens subject to the chest X-ray 
examination requirement and for whom the radiograph shows an abnormality 
consistent with pulmonary tuberculosis shall be required to have a 
sputum smear examination for acid-fast bacilli.
    (4) How and where performed. All chest X-ray films used in medical 
examinations performed under the regulations in this part shall be large 
enough to encompass the entire chest (approximately 14 by 17 inches; 
35.6 x 43.2 cm.). Serologic testing for HIV shall be a sensitive and 
specific test, confirmed when positive by a test such as the Western 
blot test or an equally reliable test. For aliens examined abroad, the 
serologic testing for HIV must be completed abroad, except that the 
Attorney General after consultation with the Secretary of State and the 
Secretary of Health and Human Services may in emergency circumstances 
permit serologic testing of refugees for HIV to be completed in the 
United States.
    (5) Chest X-ray, laboratory, and treatment reports. The chest X-ray 
reading and serologic test results for syphilis and HIV shall be 
included in the medical notification. When the medical examiner's 
conclusions are based on a study of more than one chest X-ray film, the 
medical notification shall include at least a summary statement of 
findings of the earlier films, followed by a complete reading of the 
last film, and dates and details of any laboratory tests and treatment 
for tuberculosis.
    (c) Procedure for transmitting records. For aliens issued immigrant 
visas, the medical notification and chest X-ray film, if any, shall be 
placed in a separate envelope which shall be sealed and attached to the 
alien's visa in such a manner as to be readily detached at the U.S. port 
of entry. When more than one chest X-ray film is used as a basis for the 
examiner's conclusions, all films shall be included.
    (d) Failure to present records. When a determination of 
admissibility is to be made at the U.S. port of entry, a medical hold 
document shall be issued pending completion of any necessary examination 
procedures. A medical hold document may be issued for aliens who:
    (1) Are not in possession of a valid medical notification, if 
required;
    (2) Have a medical notification which is incomplete;
    (3) Have a medical notification which is not written in English;
    (4) Are suspected to have an excludable medical condition.
    (e) The Attorney General, after consultation with the Secretary of 
State and the Secretary of Health and Human Services, may in emergency 
circumstances permit the medical examination of refugees to be completed 
in the United States.
    (f) All medical examinations shall be carried out in accordance with 
such technical instructions for physicians conducting the medical 
examination of aliens as may be issued by the Director. Copies of such 
technical instructions are available upon request to the Director, 
Division of Quarantine, Mailstop E03, CDC, Atlanta GA 30333.

[56 FR 25002, May 31, 1991]



Sec. 34.4  Medical notifications.

    (a) Medical examiners shall issue medical notifications of their 
findings of the presence or absence of Class A or Class B medical 
conditions. The presence of such condition must have been clearly 
established.
    (b) Class A medical notifications. (1) The medical examiner shall 
report his/her findings to the consular officer or the INS by Class A 
medical notification which lists the specific condition for which the 
alien may be excluded, if an alien is found to have:
    (i) A communicable disease of public health significance;
    (ii)(A) A physical or mental disorder, and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others; or
    (B) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior;
    (iii) Drug abuse or addition.

[[Page 89]]


Provided, however, That a Class A medical notification of a physical or 
mental disorder, and behavior associated with that disorder that may 
pose, or has posed, a threat to the property, safety, or welfare of the 
alien or others, shall in no case be issued with respect to an alien 
having only mental shortcomings due to ignorance, or suffering only from 
a condition attributable to remediable physical causes or of a temporary 
nature, caused by a toxin, medically prescribed drug, or disease.
    (2) The medical notification shall state the nature and extent of 
the abnormality; the degree to which the alien is incapable of normal 
physical activity; and the extent to which the condition is remediable. 
The medical examiner shall indicate the likelihood, that because of the 
condition, the applicant will require extensive medical care or 
institutionalization.
    (c) Class B medical notifications. (1) If an alien is found to have 
a physical or mental abnormality, disease, or disability serious in 
degree or permanent in nature amounting to a substantial departure from 
normal well-being, the medical examiner shall report his/her findings to 
the consular or INS officer by Class B medical notification which lists 
the specific conditions found by the medical examiner. Provided, 
however, that a Class B medical notification shall in no case be issued 
with respect to an alien having only mental shortcomings due to 
ignorance, or suffering only from a condition attributable to remediable 
physical causes or of a temporary nature, caused by a toxin, medically 
prescribed drug, or disease.
    (2) The medical notification shall state the nature and extent of 
the abnormality, the degree to which the alien is incapable of normal 
physical activity, and the extent to which the condition is remediable. 
The medical examiner shall indicate the likelihood, that because of the 
condition, the applicant will require extensive medical care or 
institutionalization.
    (d) Other medical notifications. If as a result of the medical 
examination, the medical examiner does not find a Class A or Class B 
condition in an alien, the medical examiner shall so indicate on the 
medical notification form and shall report his findings to the consular 
or INS officer.

[56 FR 25003, May 31, 1991]



Sec. 34.5  Postponement of medical examination.

    Whenever, upon an examination, the medical examiner is unable to 
determine the physical or mental condition of an alien, completion of 
the medical examination shall be postponed for such observation and 
further examination of the alien as may be reasonably necessary to 
determine his/her physical or mental condition. The examination shall be 
postponed for aliens who have an acute infectious disease until the 
condition is resolved. The alien shall be referred for medical care as 
necessary.

[56 FR 25003, May 31, 1991]



Sec. 34.6  Applicability of Foreign Quarantine Regulations.

    Aliens arriving at a port of the United States shall be subject to 
the applicable provisions of 42 CFR part 71, Foreign Quarantine, with 
respect to examination and quarantine measures.

[56 FR 25003, May 31, 1991]



Sec. 34.7  Medical and other care; death.

    (a) An alien detained by or in the custody of the INS may be 
provided medical, surgical, psychiatric, or dental care by the Public 
Health Service through interagency agreements under which the INS shall 
reimburse the Public Health Service. Aliens found to be in need of 
emergency care in the course of medical examination shall be treated to 
the extent deemed practical by the attending physician and if considered 
to be in need of further care, may be referred to the INS along with the 
physician's recommendations concerning such further care.
    (b) In case of the death of an alien, the body shall be delivered to 
the consular or immigration authority concerned. If such death occurs in 
the United States, or in a territory or possession thereof, public 
burial shall be provided upon request of the INS and subject to its 
agreement to pay the

[[Page 90]]

burial expenses. Autopsies shall not be performed unless approved by the 
INS.

[56 FR 25003, May 31, 1991]



Sec. 34.8  Reexamination; convening of review boards; expert witnesses; reports.

    (a) The Director shall convene a board of medical officers to 
reexamine an alien:
    (1) Upon the request of the INS for a reexamination by such a board; 
or
    (2) Upon an appeal to the INS by an alien who, having received a 
medical examination in connection with the determination of admissiblity 
to the United States (including examination on arrival and adjustment of 
status as provided in the immigration laws and regulations) has been 
certified for a Class A condition.
    (b) For boards convened to reexamine aliens certified as:
    (1) Having a communicable disease of public health significance, the 
board shall consist of three medical officers, at least one of whom is 
experienced in the diagnosis and treatment of the communicable disease 
for which medical notification has been made, and the decision of the 
majority of the board shall prevail;
    (2)(i) Having a physical or mental disorder and behavior associated 
with the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others; or
    (ii) Having a history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior; or
    (iii) Being a drug abuser or addict;
    (3) In circumstances covered by paragraph (b)(2) of this section, 
the board shall consist of three medical officers, at least one of whom 
shall be a board certified psychiatrist, and the decision of the 
majority of the board shall prevail.
    (c) Reexamination shall include:
    (1) Review of all records submitted by the alien, other witnesses, 
or the board;
    (2) Use of any laboratory or additional studies which are deemed 
clinically necessary as a result of the physical examination or 
pertinent information elicited from the alien's medical history;
    (3) Consideration of statements regarding the alien's physical or 
mental condition made by a physician after his/her examination of the 
alien; and
    (4) An independent physical or psychiatric examination of the alien 
performed by the board, at the board's option.
    (d) An alien who is to be reexamined shall be notified of the time 
and place of his/her reexamination not less than 5 days prior thereto.
    (e) The alien, at his/her own cost and expense, may introduce as 
witnesses before the board such physicians or medical experts as the 
board may in its discretion permit; provided that the alien shall be 
permitted to introduce at least one expert medical witness. If any 
witnesses offered are not permitted by the board to testify, the record 
of the proceedings shall show the reason for the denial of permission.
    (f) Witnesses before the board shall be given a reasonable 
opportunity to examine the medical notification and other records 
involved in the reexamination and to present all relevant and material 
evidence orally or in writing until such time as the proceedings are 
declared by the board to be closed. During the course of the hearing the 
alien's attorney or representative shall be permitted to examine the 
alien and he/she, or the alien, shall be permitted to examine any 
witnesses offered in the alien's behalf and to cross-examine any 
witnesses called by the board. If the alien does not have an attorney or 
representative, the board shall assist the alien in the presentation of 
his/her case to the end that all of the material and relevant facts may 
be considered.
    (g) The findings and conclusions of the board shall be based on its 
medical examination of the alien, if any, and on the evidence presented 
and made a part of the record of its proceedings.
    (h) The board shall report its findings and conclusions to the INS, 
and shall also give prompt notice thereof to the alien if his/her 
reexamination has been based on his/her appeal. The board's report to 
the INS shall specifically affirm, modify, or reject the findings and

[[Page 91]]

conclusions of prior examining medical officers.
    (i) The board shall issue its medical notification in accordance 
with the applicable provisions of this part if it finds that an alien it 
has reexamined has a Class A or Class B condition.
    (j) If the board finds that an alien it has reexamined does not have 
a Class A or Class B condition, it shall issue its medical notification 
in accordance with the applicable provisions of this part.
    (k) After submission of its report, the board shall not be 
reconvened, nor shall a new board be convened, in connection with the 
same application for admission or for adjustment of status, except upon 
the express authorization of the Director.

[56 FR 25004, May 31, 1991]



PART 35--HOSPITAL AND STATION MANAGEMENT--Table of Contents




                           Subpart A--General

Sec.
35.1  Hospital and station rules.
35.2  Compliance with hospital rules.
35.3  Noncompliance; deprivation of privileges.
35.4  Noncompliance; discharge or transfer.
35.5  Entitlement to care after discharge or transfer by reason of 
          noncompliance.
35.6  Admissions; determination of eligibility for care.
35.7  Admissions; designation of person to be notified.
35.8  Safekeeping of money and effects; withdrawals.
35.9  Disposition of money and effects left by other than deceased 
          patients.
35.10  Destruction of effects dangerous to health.
35.11  Clinical records; confidential.
35.12  Solicitation of legal business prohibited.
35.13  Entry for negotiation of release or settlement.
35.14  Solicitation of legal business; negotiation of release or 
          settlement; assistance prohibited.
35.15  Consent to operative procedures.
35.16  Autopsies and other post-mortem operations.
35.17  Fees and charges for copying, certification, search of records 
          and related services.

                     Subpart B--Transfer of Patients

35.21  Authorization of transfer.
35.22  Attendants.

         Subpart C--Disposition of Articles Produced by Patients

35.31  Retention by patients.
35.32  Board of appraisers.
35.33  Sale; prices; deposit of proceeds.
35.34  Resale.
35.35  Unsalable articles.

      Subpart D--Disposal of Money and Effects of Deceased Patients

35.41  Inventory.
35.42  Notice upon death.
35.43  Delivery only upon filing claim; forms; procedure.
35.44  Delivery to legal representative; to other claimants if value is 
          $1,000 or less.
35.45  Disposition of effects; exceptions.
35.46  Conflicting claims.
35.47  Disposition of Government checks.
35.48  Deposit of unclaimed money; sale of unclaimed effects and deposit 
          of proceeds.
35.49  Sale of unclaimed effects; procedures.
35.50  Disposition of unsold effects.
35.51  Manner of delivery; costs, receipts.
35.52  Delivery of possession only; title unaffected.

          Subpart E--Contributions for the Benefit of Patients

35.61  Applicability.
35.62  Acceptance of contributions.
35.63  Report of and accounting for contributions.
35.64  Donors.
35.65  Acceptable personal property.
35.66  Expenditure of cash contributions.

    Authority: Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216, sec. 
321, 53 Stat. 695, as amended; 42 U.S.C. 248, unless otherwise noted.

    Source: 21 FR 9830, Dec. 12, 1956, unless otherwise noted.



                           Subpart A--General



Sec. 35.1  Hospital and station rules.

    The officer in charge of a station or hospital of the Service is 
authorized to adopt such rules and issue such instructions, not 
inconsistent with the regulations in this part and other provisions of 
law, as he deems necessary for the efficient operation of the station or 
hospital and for the proper and humane care and treatment of all 
patients therein. All general rules governing the conduct and privileges 
of patients, and of members of the public

[[Page 92]]

while on the premises, shall be posted in prominent places.



Sec. 35.2  Compliance with hospital rules.

    All patients and visitors in stations and hospitals of the Service 
are expected to comply with the rules and instructions issued under the 
authority of the officer in charge.



Sec. 35.3  Noncompliance; deprivation of privileges.

    Any patient who wilfully fails or refuses to comply with rules or 
instructions of a hospital or station or with regulations of the 
Service, may, by the direction of the officer in charge, be deprived of 
recreational or other privileges accorded patients. Any visitor who 
wilfully fails or refuses to comply with any such rules, instructions, 
or regulations may, by direction of the officer in charge, be denied 
visiting privileges.



Sec. 35.4  Noncompliance; discharge or transfer.

    (a) If the officer in charge finds, upon investigation, that a 
patient other than a leprosy patient, by willful and persistent failure 
or refusal to comply with such rules, instructions, or regulations is 
seriously impeding the course of his own care and treatment, or that of 
other patients, he may (1) discharge the patient, or (2) if the patient 
is not a voluntary patient, arrange for his transfer to the custody of 
the authority responsible for his admission to the station or hospital. 
No patient shall be discharged or transferred on account of 
noncompliance if to do so would seriously endanger his life or health, 
nor shall any patient be discharged if his failure to comply is due, in 
the opinion of the officer in charge, to a mental disease or disorder.
    (b) If the discharge or transfer of a patient is likely to endanger 
the health of persons other than the patient or officers or employees of 
the station or hospital, the officer in charge shall give advance notice 
to appropriate State, county, or municipal authorities of the discharge 
or transfer.



Sec. 35.5  Entitlement to care after discharge or transfer by reason of noncompliance.

    No person otherwise entitled to care, treatment, or hospitalization 
at Service facilities, or in other facilities at the expense of the 
Service, shall be denied such care or treatment by reason of his prior 
discharge or transfer from any such facility under the provisions of 
Sec. 35.4.



Sec. 35.6  Admissions; determination of eligibility for care.

    Except as may otherwise be provided for specific classes of patients 
by the regulations of this chapter, the officer in charge of the station 
or hospital to which application is made is authorized to determine the 
eligibility of applicants, as beneficiaries of the Service, for care and 
for treatment. Such determinations shall be subject to review by the 
chief of the division of the Service responsible for administration of 
the station or hospital concerned upon referral made by the officer in 
charge in doubtful cases or upon appeal made by an applicant who has 
been denied care or treatment.



Sec. 35.7  Admissions; designation of person to be notified.

    Every in-patient, at the time of admission to the hospital or 
station or as soon thereafter as practicable, shall be requested to 
designate a person or persons to be notified in case of emergency.



Sec. 35.8  Safekeeping of money and effects; withdrawals.

    (a) A place for the safekeeping of money and effects of patients 
shall be provided at each station or hospital, and an itemized receipt 
therefor shall be furnished to the patient and to any other person who 
places money or effects therein for the benefit of the patient.
    (b) Money and effects may be withdrawn only by or on behalf of the 
patient, by his legally appointed representative authorized to receive 
or dispose of his property (including the money and effects in the 
custody of the station or hospital), or by a person who is authorized, 
under the law of the

[[Page 93]]

State in which the station or hospital is located, to receive or dispose 
of the patient's money and effects. In any case in which the officer in 
charge has had actual notice of the appointment of a legal 
representative, withdrawals may be made only by such representative or 
in accordance with his written directions. No delivery shall be made 
under this paragraph unless (1) the person receiving the money or 
effects shall sign an itemized receipt therefor, or (2) the delivery is 
witnessed by two persons. The provisions of this paragraph do not 
prohibit withdrawals made necessary by the provisions of this part for 
the disposition of money and effects left by patients on death or on 
departure from the station or hospital, or by the provisions of 
Sec. 35.10.



Sec. 35.9  Disposition of money and effects left by other than deceased patients.

    Money and effects left on the premises by a patient shall be 
forwarded promptly to him. If because his whereabouts are unknown his 
money and effects cannot be delivered to him within 120 days after his 
departure, his money shall be deposited into the Treasury and credited 
to the account entitled ``Money and Effects of Former Patients (PHS (T) 
name of patient),'' and his effects shall be held for him for six months 
and then sold in accordance with Sec. 35.49, and the proceeds deposited 
into the Treasury and credited to the above account.



Sec. 35.10  Destruction of effects dangerous to health.

    The officer in charge shall cause to be destroyed effects brought 
into or received in the station or hospital area by patients which, in 
the judgement of such officer, are dangerous as a source of disease to 
the health or life of patients or personnel of the station or hospital 
or visitors therein and cannot otherwise be safely disposed of or 
rendered harmless by disinfection or other means. The destruction of 
effects shall be witnessed by at least one officer or employee 
designated for that purpose by the officer in charge, and appropriate 
records of the destruction shall be maintained.



Sec. 35.11  Clinical records; confidential.

    A complete clinical record shall be maintained for each patient 
admitted to a station or hospital of the Service. Such records shall be 
confidential and shall not be disclosed except as may be provided 
elsewhere in regulations of the Service.



Sec. 35.12  Solicitation of legal business prohibited.

    The solicitation, directly or indirectly, of legal business or of a 
retainer or agreement authorizing an attorney to render legal services, 
is prohibited in all stations and hospitals of the Service.



Sec. 35.13  Entry for negotiation of release or settlement.

    (a) No person shall be permitted to enter a station or hospital of 
the Service for the purpose of negotiating a settlement or obtaining a 
general or special release or statement from any patient with reference 
to any illness or personal injury for which the patient is receiving 
care or treatment, or for the purpose of conferring with him as an 
attorney or representative of an attorney with reference to such illness 
or injury, unless the patient has signified his willingness to have such 
person enter for such purpose and, in the judgment of the officer in 
charge, the physical or mental condition of the patient will not thereby 
be impaired.
    (b) Any person entering a station or hospital for a purpose 
enumerated in paragraph (a) of this section shall register in the manner 
prescribed by the officer in charge, and shall furnish for the records 
of the station or hospital the name of each patient by whom he has been 
received for such a purpose.



Sec. 35.14  Solicitation of legal business; negotiation of release or settlement; assistance prohibited.

    All employees of the Service and all persons attached in any 
capacity to a station or hospital, including patients, are forbidden to 
communicate, directly or indirectly, with any person for the purpose of 
aiding in the solicitation of legal business or in the negotiation of a 
settlement or the obtaining of a general or special release or statement 
from any patient with reference to any

[[Page 94]]

illness or personal injury for which the patient is receiving care or 
treatment therein. No patient is prohibited by this section from 
communicating on his own behalf with an attorney of his choice or with 
other persons.



Sec. 35.15  Consent to operative procedures.

    Except in emergencies when the patient is physically or mentally 
incapable of consenting and the delay required to obtain the consent of 
his natural or legal guardian would seriously endanger the patient's 
health, no operative procedure shall be undertaken unless the patient 
or, in the case of a minor or incompetent, his natural or legal guardian 
gives his consent, nor shall any major operative procedure or the 
administration of a general anaesthetic be undertaken unless such 
consent has been obtained in writing. The consent or refusal of consent 
shall be made a part of the clinical record.



Sec. 35.16  Autopsies and other post-mortem operations.

    Autopsies, or other post-mortem operations, including removal of 
tissue for transplanting, may be performed on the body of a deceased 
patient only by direction of the officer in charge and only if consented 
to in writing by a person authorized under the law of the State in which 
the station or hospital is located to permit an autopsy or such other 
post-mortem operation under the circumstances of the particular death 
involved. Restrictions or limitations imposed by the person consenting 
thereto on the extent of the autopsy or other post-mortem operation 
shall be observed. Documents embodying consent shall be made a part of 
the clinical record.

[25 FR 6331, July 6, 1960]



Sec. 35.17  Fees and charges for copying, certification, search of records and related services.

    A prescribed fee, in accordance with the schedule in paragraph (c) 
of this section, shall be collected for each of the listed services.
    (a) Application for services. Any person requesting (1) a copy of a 
clinical record, clinical abstract, or other document containing 
clinical information; or (2) a certification of a clinical record or 
document; or (3) a search of clinical records, shall make written 
application therefor to the Public Health Service facility having 
custody of the subject matter involved. Such application shall state 
specifically the particular record or document requested, and the 
purpose for which such copy or document is desired to be used. The 
application shall be accompanied by a deposit in an amount equal to the 
prescribed charge for the service rendered. Where it is not known if a 
clinical record or other document is in existence, the application shall 
be accompanied by a minimum deposit of $2.50.
    (b) Authorization for disclosure. The furnishing of copies of PHS 
records containing confidential clinical information must comply with 
the requirements of part I, title 42, Code of Federal Regulations, 
governing authorization for the disclosure of such information.
    (c) Schedule of fees.

(1) Photocopy reproduction of a clinical record or other
 document (through use of facility equipment):
  (a) Processing (searching, preparation of record and use of      $3.25
   equipment), first page.......................................
  (b) Each additional page......................................     .25
(2) Certification, per document.................................     .25
(3) Unsuccessful searching, per hour (minimum charge 1 hour)....    2.50
(4) Clinical abstracts, per request.............................    3.00
(5) Arranging commercial duplication of a clinical record, per    \1\ 0.
 request........................................................      50
(6) If the requested material is to be transmitted by registered
 mail, airmail, or special delivery mail, the postal fees
 therefor shall be added to the other fees provided above,
 unless the applicant has included proper postage or stamped
 return envelopes for this purpose.
 
\1\ The private concern which duplicates records for an applicant will
  make a separate charge therefor and will bill the applicant directly.

    (d) Waiver of fee. The prescribed fee may be waived, in the 
discretion of the medical officer in charge, under the following 
circumstances:
    (1) When the service or document is requested by another agency of 
the Federal Government for use in carrying out official Government 
business.
    (2) When a clinical record is requested for the purpose of providing 
continued medical care to a Service beneficiary by a non-Service 
physician, clinic, or hospital, in which case the record will be 
forwarded only to the physician, clinic, or hospital concerned.

[[Page 95]]

    (3) When the service or document is requested by an attorney in the 
prosecution of a Service beneficiary's personal injury claim against a 
third person, involving the concurrent assertion of a government medical 
care claim under 42 U.S.C. 2651-2653. In such case, the service or 
document requested will be furnished only upon compliance with all 
additional requirements for the release of records in third party 
recovery cases, including the proper execution of form PHS-4686, 
Agreement to Assign Claim Upon Request.
    (4) When the service or document is requested by, and furnished to, 
a Member of Congress for official use.
    (5) When the service or document is requested by, and furnished to, 
a court in lieu of the personal court appearance of an employee of the 
Public Health Service.
    (6) When the service or document is required to be furnished free in 
accordance with a Federal statute or an Executive order.
    (7) When the furnishing of the service or document requested without 
charge would be an appropriate courtesy to a foreign country or 
international organization.

(Sec. 501, 65 Stat. 290; 31 U.S.C. 483(a); sec. 215, 58 Stat. 690, as 
amended; 42 U.S.C. 216)

[32 FR 6842, May 4, 1967]



                     Subpart B--Transfer of Patients



Sec. 35.21  Authorization of transfer.

    Except as otherwise provided by law or regulation with respect to 
certain classes of patients, the officer in charge of a station or 
hospital of the Service may provide, without any cost to the patient, 
for the transfer of the patient either from such station or hospital to 
another station or hospital of the Service or to any non-Service station 
or hospital at which the patient may be received, or from any non-
Service hospital at which he is receiving care or treatment as a patient 
of the Service to a station or hospital of the Service.



Sec. 35.22  Attendants.

    Patients shall be transferred by such means and accompanied by such 
medical, nursing, or other attendants as may be necessary to protect the 
health and safety of the patient and other persons likely to come into 
contact with him, including in the case of a prisoner such guards as may 
be necessary to assure his safekeeping. A female patient requiring the 
services of attendants shall be accompanied by at least one female 
attendant. Medical or nursing attendants shall be qualified to care for 
persons suffering from the type of disease or disorder with which the 
patient is afflicted and shall be provided with equipment and medicines 
necessary for the care of the patient.



         Subpart C--Disposition of Articles Produced by Patients



Sec. 35.31  Retention by patients.

    Subject to the rules of the station or hospital, patients may be 
accorded the privilege of retaining articles produced by them in the 
course of their curative treatment with the aid of materials furnished 
by the Service. Articles not retained by patients shall be disposed of 
as provided in this subpart. The provisions of this subpart do not apply 
to the products of industrial activities established for narcotic 
addicts.



Sec. 35.32  Board of appraisers.

    The officer in charge shall appoint, from the personnel of the 
station or hospital, a board of three persons to serve at his pleasure. 
The board shall provide for the sale of articles having commercial value 
and shall keep appropriate records of such articles and their 
disposition.



Sec. 35.33  Sale; prices; deposit of proceeds.

    The board shall determine and redetermine from time to time the 
prices at which articles are to be sold, and in doing so shall consider 
the cost of materials used, reasonable handling charges, and the fair 
market value of the articles. The sale price shall be indicated on each 
article by tag or other appropriate means, and a list of articles 
offered for sale and their respective sale prices shall be posted from 
time to time in the hospital or station area. In its discretion, the 
board may offer such articles for purchase by

[[Page 96]]

other patients or by charitable organizations before offering them for 
purchase to the general public. No article shall be sold or resold to 
any officer or employee of the Service. Moneys received from the sale of 
articles shall be deposited into the Treasury to the credit of the 
appropriation from which the materials for making such articles were 
purchased.



Sec. 35.34  Resale.

    No article purchased under the provisions of this subpart shall be 
resold in the hospital or station area at a price to exceed the sale 
price fixed by the board for such article.



Sec. 35.35  Unsalable articles.

    Articles having no commercial value shall be stored, destroyed, or 
otherwise disposed of as the officer in charge may direct.



      Subpart D--Disposal of Money and Effects of Deceased Patients



Sec. 35.41  Inventory.

    Promptly after the death of a patient in a station or hospital of 
the Service, an inventory of his money and effects left therein shall be 
made by two or more officers or employees of the Service designated for 
such purpose by the officer in charge.



Sec. 35.42  Notice upon death.

    The officer in charge shall notify in writing all persons known to 
him to whom delivery of the patient's money and effects might be made 
hereunder, and, in the case of an alien patient, a consul of the country 
of his apparent nationality. Each person so notified shall be requested 
to furnish information concerning (a) the existence or whereabouts of 
any persons to whom delivery of the deceased patient's money and effects 
may be made pursuant to these provisions, and (b) the permanent 
residence or home of the deceased.



Sec. 35.43  Delivery only upon filing claim; forms; procedure.

    (a) Delivery of the money and effects of a deceased patient shall be 
made only to a person who has filed a claim therefor on a form 
prescribed by the Surgeon General.
    (b) A claimant shall furnish, in addition to the information on the 
prescribed form, such additional information as the officer in charge 
may consider necessary to establish the identity of the claimant and the 
truth of his statements.
    (c) A person filing a claim as a legal representative shall be 
required to present letters of administration or a certificate of a 
court attesting his qualification or appointment.
    (d) If a claim is made after the money, or proceeds from the sale of 
the effects, of a deceased patient have been deposited in the Treasury, 
the claim shall be referred to the General Accounting Office. If the 
claim is for checks or evidences of indebtedness of the United States 
which have been trasnsmitted to the issuing agency pursuant to 
Secs. 35.47 and 35.48, the claimant shall be referred to such agency.



Sec. 35.44  Delivery to legal representative; to other claimants if value is $1,000 or less.

    The money and effects of the deceased patient shall in all cases be 
delivered to the legal representative, if any, of his estate. If the 
value is $1,000 or less, and the officer in charge has neither notice 
nor other knowledge of the appointment or qualification of a legal 
representative, nor reason to believe that a legal representative will 
be appointed or qualified, he shall deliver all the money and effects, 
as soon as practicable after the expiration of 10 days from the sending 
of notices to one of the following in the indicated order of priority:
    (a) A person, if any, designated in writing by the patient to 
receive the same.
    (b) The patient's surviving spouse.
    (c) The patient's child or children in equal parts.
    (d) The patient's parent or parents in equal parts.
    (e) Any other person who would be entitled to receive the money and 
effects under the law of the patient's domicile: Provided, That delivery 
of such money and effects may be made immediately upon application by 
one

[[Page 97]]

of the persons specified above if the officer in charge has neither 
notice nor other knowledge that a person higher in the indicated order 
of priority exists.



Sec. 35.45  Disposition of effects; exceptions.

    Irrespective of the provisions of this subpart, the officer in 
charge may (a) release from among the effects of the deceased patient so 
much of the patient's clothing as may be necessary for use in 
preparation of his body for burial and (b) cause to be destroyed, or 
otherwise disposed of, such used toilet articles of the patient as 
appear to have no commercial or other value.



Sec. 35.46  Conflicting claims.

    In any case in which conflicting claims are filed or the officer in 
charge considers it to be in the interest of persons who may be 
ultimately entitled thereto, delivery may be withheld from all persons 
other than a duly qualified legal representative.



Sec. 35.47  Disposition of Government checks.

    Notwithstanding any other provisions of this subpart, immediately 
upon completion of the inventory, checks drawn on the Treasurer of the 
United States shall be sent by safe means to the department, agency, or 
establishment of the Government of the United States issuing such 
checks. The transmittal shall be accompanied by a statement of the 
reasons therefor and of all available information which may aid the 
issuing unit in the disposition of the check transmitted. Notice of the 
disposition of any checks, with identifying information, shall be given 
to the person or persons, if any, to which money and effects are 
delivered in accordance with Sec. 35.44.



Sec. 35.48  Deposit of unclaimed money; sale of unclaimed effects and deposit of proceeds.

    If, within 120 days after sending of notices no claim has been filed 
pursuant to the provisions of Sec. 35.43, the patient's money, 
consisting of all types of United States currency and coin, shall be 
deposited in the Treasury to the credit of the trust-fund account 
entitled ``Money and Effects of Deceased Patients, Public Health 
Service.'' If, within six months after the death of a patient, no claim 
has been filed pursuant to the provisions of Sec. 35.43, his effects 
(including foreign currency and coin but excluding Postal Savings 
Certificates and other evidences of indebtedness of the United States) 
shall be sold at public auction or by sealed bids to the highest bidder 
and the proceeds deposited to the credit of the trust-fund account 
entitled ``Money and Effects of Deceased Patients, Public Health 
Service.'' Postal Savings Certificates and other evidences of 
indebtedness of the United States shall be transmitted to the issuing 
department or agency with a statement of the occasion therefor.



Sec. 35.49  Sale of unclaimed effects; procedures.

    The following provisions shall govern the sale of effects:
    (a) Notice. Reasonable advance notice of proposed sales shall be 
posted at such prominent places in the station or hospital area as the 
officer in charge may designate. In addition, a notice shall be posted 
at the nearest post office, and notices shall be sent by mail to all 
known persons to whom delivery of money and effects of the patient may 
be made under the provisions of this subpart. The officer or employee 
who posts or sends notices of sales shall make an appropriate affidavit 
on a copy of the notice as to his action in that respect, including in 
his affidavit the names of persons to whom copies of the notices were 
mailed and the mailing dates. The copy of the notice on which the 
affidavit appears shall be retained in the files of the station or 
hospital.
    (b) Form and contents of notice. Notice of proposed sales shall be 
given on a form prescribed by the Surgeon General. The notice shall 
include: an inventory of the effects to be offered for sale; the names 
of the patients from whom the effects were received; the precise date, 
time, and place when and where the sale will be held; a statement that 
the articles will be available for inspection immediately prior to sale, 
if sold at public auction, or on a day and during the hours appointed 
for

[[Page 98]]

the inspection of articles if sold by sealed bid; a statement that the 
sale is to be held pursuant to the provisions of the regulations in this 
part, that, if the articles are to be sold by sealed bid, the right to 
reject all bids is reserved, and that, if otherwise authorized, delivery 
will be made of effects or proceeds of sales to persons filing claims 
prior to the sale of effects or prior to the transmittal of proceeds to 
the Surgeon General.
    (c) Time and place of sales. All sales shall be held at reasonable 
hours and at such places within the station or hospital area as the 
officer in charge may designate.
    (d) Who shall conduct sales. All sales shall be conducted by the 
officer in charge or by a responsible officer or employee designated by 
him.
    (e) Sale and delivery. All effects offered for sale shall be sold to 
the highest bidder and delivered to him immediately upon payment of the 
sale price in cash or by postal money order or certified check and 
execution of an appropriate receipt by the person to whom delivery is 
made.



Sec. 35.50  Disposition of unsold effects.

    The officer in charge shall dispose of effects offered for sale but 
remaining unsold in such manner as he considers to be proper, but, if 
practicable, such effects shall be used for the benefit of other 
patients of the Service.



Sec. 35.51  Manner of delivery; costs, receipts.

    (a) If a person entitled under this subpart to receive the money and 
effects of a patient is unable to take possession thereof at the station 
or hospital, they shall be sent to him at the expense of the United 
States in the most economical manner available. The records of the 
station or hospital shall show the names and addresses of persons to 
whom money or effects have been sent, the date of sending, the means 
used, an itemized list of the money or effects sent, and a statement by 
a witnessing officer or employee verifying the foregoing from his own 
observation.
    (b) If not delivered personally by an authorized officer or employee 
of the Service, money, evidences of indebtedness, and other valuable 
papers and documents shall be sent by registered mail (or other safe 
means).
    (c) Persons receiving the money and effects of a patient shall be 
required to execute an itemized receipt therefor.



Sec. 35.52  Delivery of possession only; title unaffected.

    Except for delivery of effects to purchasers at sales held in 
accordance with Sec. 35.49, delivery or deposit under this subpart of 
the money or effects, or the proceeds of a sale of the effects, of a 
deceased patient constitutes only a transfer of possession and is not 
intended to affect in any manner the title to such money, effects, or 
proceeds.



          Subpart E--Contributions for the Benefit of Patients

    Authority: Sec. 215, 58 Stat. 690, as amended, 63 Stat. 835 (42 
U.S.C. 216); sec. 321, 58 Stat. 695, as amended, 62 Stat. 1017 (42 
U.S.C. 248).

    Source: 42 FR 60742, Nov. 29, 1977, unless otherwise noted.



Sec. 35.61  Applicability.

    This subpart sets forth the policies and procedures governing the 
acceptance and administration of contributions of money or property 
intended solely for the benefit of all patients in a ward or unit or a 
particular hospital or station of the Public Health Service, excluding 
outpatient clinics. Such contributions are distinguishable from (a) 
monies or other valuables belonging to specific patients which are 
accepted and held in custody for the convenience of the patient until 
such time as he or she wishes to withdraw them, and (b) gifts to the 
United States to support Public Health Service functions under section 
501 of the Public Health Service Act or other statutory provisions, 
which may be accepted and administered only in accordance with such 
statutory provisions or other applicable laws.



Sec. 35.62  Acceptance of contributions.

    (a) The officer in charge of a hospital or station or his delegate 
may accept contributions of money or personal property which are donated 
for the

[[Page 99]]

general benefit of all patients within the hospital or station (or a 
ward or unit thereof) without further specification or conditions as to 
use. Contributions tendered subject to conditions by the donor, such as 
expenditure or use only on behalf of certain patients or for specific 
purposes, may not be accepted.
    (b) Contribution of money or property shall be accepted in writing.



Sec. 35.63  Report of and accounting for contributions.

    (a) Contributions of money accepted pursuant to Sec. 35.62 
(hereinafter referred to as ``patient fund'') will be treated 
consistently with Federal deposit rules and as supplemented with 
appropriate procedures of the facility. This regulation is not intended 
to exclude contributions for the benefit of patients from proper 
accountability and control of funds and property.
    (b) Contributions of property accepted pursuant to Sec. 35.62 shall 
be recorded and accounted for in the same manner as other property of a 
similar kind maintained in the hospital or station, but with suitable 
identification so that it can be distinguished from government-owned 
property.



Sec. 35.64  Donors.

    Authorized contributions may be accepted from patients, employees 
and other individuals, and agencies and organizations.



Sec. 35.65  Acceptable personal property.

    Contributions of personal property which may be accepted pursuant to 
Sec. 35.62 include, but are not limited to, recreational equipment, 
furniture, radios and television sets. After its useful life, any cash 
proceeds realized upon disposition of such property shall be deposited 
to the credit of the patient fund and shall be available for expenditure 
pursuant to Sec. 35.66(c).



Sec. 35.66  Expenditure of cash contributions.

    (a) Officials authorized to accept contributions shall not maintain 
control over the actual obligation or expenditure of such monies.
    (b) Only those officers or employees specifically designated in 
writing by the officer in charge for such purpose may obligate and 
expend monies from the patient fund. The names of officials so 
designated shall be provided to the relevant fiscal control office.
    (c) Subject to availability of sufficient funds, monies in the 
patient fund may be expended for materials, services or activities which 
contribute to the well-being or morale of patients, including but not 
limited to provision of reading and entertainment materials, recreation 
activities, and, in appropriate cases, necessary financial support 
(including travel expenses, meals, and lodging) of relatives, guardians, 
or friends of patients to enable such persons to be available for the 
patient's comfort and support.
    (d) Officers in charge may issue such additional instructions, not 
inconsistent with this subpart, as may be necessary to implement its 
provisions.



PART 36--INDIAN HEALTH--Table of Contents




                           Subpart A--Purpose

Sec.
36.1  Purpose of the regulations.
36.2  Administrative instructions.

 Subpart B--What Services are Available and Who is Eligible to Receive 
                                  Care?

36.10  Definitions.
36.11  Services available.
36.12  Persons to whom health services will be provided.
36.13  Authorization for contract health services.
36.14  Reconsideration and appeals.
36.15  Health Service Delivery Areas.
36.16  Beneficiary Identification Cards and verification of tribal 
          membership.

Subpart C  [Reserved]

                    Subpart D--Transition Provisions

36.31  Transition period.
36.32  Delayed implementation.
36.33  Grace period.
36.34  Care and treatment of people losing eligibility.

                   Subpart E--Preference in Employment

36.41  Definitions.
36.42  Appointment actions.
36.43  Application procedure for preference eligibility.

[[Page 100]]

   Subpart F--Abortions and Related Medical Services in Indian Health 
          Service Facilities and Indian Health Service Programs

36.51  Applicability.
36.52  Definitions.
36.53  General rule.
36.54  Life of the mother would be endangered.
36.55  Drugs and devices and termination of ectopic pregnancies.
36.56  Recordkeeping requirements.
36.57  Confidentiality.

                       Subpart G--Residual Status

36.61  Payor of last resort.

   Subpart H--Grants for Development, Construction, and Operation of 
                         Facilities and Services

36.101  Applicability.
36.102  Definitions.
36.103  Eligibility.
36.104  Application.
36.105  Project elements.
36.106  Grant award and evaluation.
36.107  Use of project funds.
36.108  [Reserved]
36.109  Availability of appropriations.
36.110  Facilities construction.
36.111  Interest.
36.112  Additional conditions.
36.113  Fair and uniform provision of services.
36.114  Applicability of other Department regulations.
36.115  Rescission of grants.
36.116  Reports.
36.117  Amendment of regulations.
36.118  Effect on existing rights.
36.119  Penalties.
36.120  Use of Indian business concerns.
36.121  Indian preference in training and employment.

      Subpart I--Contracts Under the Indian Self-Determination Act

36.201  Policy and applicability.
36.202  Effect on existing rights.
36.203  Amendment of regulations.
36.204  Definitions.

                 Contract Proposals, Review, and Appeal

36.205  Eligibility and application.
36.206  Tribal clearances--initial contracts.
36.207  Tribal clearances--renewal contracts.
36.208  Evaluation criteria.
36.209  Government property.
36.210  Submitting contract proposals.
36.211  Contract proposal approval officials.
36.212  Review.
36.213  Processing time.
36.214  Tribal appeals to proposal declinations.

                               Procurement

36.215  Applicability of regulations.
36.216  Waivers.
36.217  Fair and equal treatment of Indian people.
36.218  Types of contracts.
36.219  Term of contract.
36.220  Use of Indian business concerns.
36.221  Indian preference in training and employment.
36.222  Indemnity and insurance.
36.223  Exemption from bonds.
36.224  Construction and architect-engineering contracts.
36.225  Performance of personal services.
36.226  Advance payments.
36.227  Recordkeeping, reporting and audit.
36.228  Availability of information.
36.229  Penalties.
36.230  Contract revisions or amendments.
36.231  Retrocession of contract programs.
36.232  Contractor assistance.
36.233  Assumption and reassumption of contract programs.
36.234  Operation of retroceded or reassumed contracts.
36.235  Contract funds.
36.236  Unexpended funds under contract.
36.237  Contract funding and renegotiation.

         Subpart J--Indian Health Care Improvement Act Programs

    Subdivision J-1--Provisions of General and Special Applicability

36.301  Policy and applicability.
36.302  Definitions.
36.303  Indians applying for scholarships.
36.304  Publication of a list of allied health professions.
36.305  Additional conditions.

   Subdivision J-2 Health Professions Recruitment Program for Indians

36.310  Health professions recruitment grants.
36.311  Eligibility.
36.312  Application.
36.313  Evaluation and grant awards.
36.314  Use of funds.
36.315  Publication of list of grantees and projects.
36.316  Other HHS regulations that apply.

Subdivision J-3--Health Professions Preparatory Scholarship Program for 
                                 Indians

36.320  Preparatory scholarship grants.
36.321  Eligibility.
36.322  Application and selection.
36.323  Scholarship and tuition.
36.324  Availability of list of recipients.

           Subdivision J-4--Indian Health Scholarship Program

36.330  Indian health scholarships.

[[Page 101]]

36.331  Selection.
36.332  Service obligation.
36.333  Distribution of scholarships.
36.334  Publication of a list of recipients.

            Subdivision J-5--Continuing Education Allowances

36.340  Provision of continuing education allowances.

       Subdivision J-6--Contracts With Urban Indian Organizations

36.350  Contracts with Urban Indian organizations.
36.351  Application and selection.
36.352  Fair and uniform provision of services.
36.353  Reports and records.

               Subdivision J-7--Leases With Indian Tribes

36.360  Leases with Indian tribes.

Subdivision J-8--Health Professions Pregraduate Scholarship Program for 
                                 Indians

36.370  Pregraduate scholarship grants.
36.371  Eligibility.
36.372  Application and selection.
36.373  Scholarship and tuition.
36.374  Availability of list of recipients.

    Authority: Sec. 3, 68 Stat. 674; 42 U.S.C. 2003, 42 Stat. 208, sec. 
1, 68 Stat. 674; 25 U.S.C. 13, 42 U.S.C. 2001, unless otherwise noted.



                           Subpart A--Purpose



Sec. 36.1  Purpose of the regulations.

    These regulations establish general principles and program 
requirements for carrying out the Indian health program.

[46 FR 40692, Aug. 11, 1981. Redesignated at 52 FR 35048, Sept. 16, 
1987]



Sec. 36.2  Administrative instructions.

    The Service periodically issues administrative instructions to its 
officers and employees which are primarily found in the Indian Health 
Service Manual and the Area Office and Program Office supplements. These 
instructions are operating procedures to assist officers and employees 
in carrying out their responsibilities, and are not regulations 
establishing program requirements which are binding upon members of the 
general public.

[46 FR 40692, Aug. 11, 1981. Redesignated at 52 FR 35048, Sept. 16, 
1987]



 Subpart B--What Services are Available and Who is Eligible to Receive 
                                  Care?



Sec. 36.10  Definitions.

    As used in this subpart:
    Appropriate ordering official means, unless otherwise specified by 
contract with the health care facility or provider or by a contract with 
a tribe or tribal organization, the ordering official for the Service 
Unit in which the individual requesting contract health services or on 
whose behalf the services are requested, resides.
    Area Director means the Director of an Indian Health Service Area 
Office designated for purposes for administration of Indian Health 
Service Programs.
    Contract health services means health services provided at the 
expense of the Indian Health Service from public or private medical or 
hospital facilities other than those of the Service or those funded by 
the Service.
    Emergency means any medical condition for which immediate medical 
attention is necessary to prevent the death or serious impairment of the 
health of an individual.
    Health Service Delivery Area means a geographic area designated 
pursuant to Sec. 36.15 of this subpart.
    Indian tribe means any Indian tribe, band, nation, or other 
organized group or community, including any Alaska Native village or 
regional or village corporation as defined in or established pursuant to 
the Alaska Native Claims Settlement Act, 43 U.S.C. 1601 et. seq., which 
is recognized as eligible for the special programs and services provided 
by the United States to Indians because of their status as Indians.
    Reservation means any Federally recognized Indian tribe's 
reservation, Pueblo, or colony, including former reservations in 
Oklahoma, Alaska Native regions established pursuant to the Alaska 
Native Claims Settlement Act (43 U.S.C. 1601 et seq.), and Indian 
allotments if considered reservation land by the Bureau of Indian 
Affairs.
    Reside means living in a locality with the intent to make it a fixed 
and a permanent home. The following persons will be deemed residents of 
the Health Service Delivery Area:

[[Page 102]]

    (1) Students who are temporarily absent from the Health Service 
Delivery Area during full time attendance at programs of vocational, 
technical, or academic education including normal school breaks;
    (2) Persons who are temporarily absent from the Health Service 
Delivery Area for purposes of travel or employment (such as seasonal or 
migratory workers);
    (3) Indian children placed in foster care outside the Health Service 
Delivery Area by order of a court of competent jurisdiction and who were 
residents within the Health Service Delivery Area at the time of the 
court order.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    Service means the Indian Health Service.
    Service Unit Director means the Director of Indian Health Service 
programs for a designated geographical or tribal area of responsibility 
or the equivalent official of a contractor administering an IHS program.

[52 FR 35048, Sept. 16, 1987, as amended at 55 FR 4609, Feb. 9, 1990]



Sec. 36.11  Services available.

    (a) Type of services that may be available. Services for the Indian 
community served by the local facilities and program may include 
hospital and medical care, dental care, public health nursing and 
preventive care including immunizations, and health examination of 
special groups such as school children.
    (b) Where services are available. Available services will be 
provided at hospitals and clinics of the Service, and at contract 
facilities (including tribal facilities under contract with the 
Service).
    (c) Determination of what services are available. The Service does 
not provide the same health services in each area served. The services 
provided to any particular Indian community will depend upon the 
facilities and services available from sources other than the Service 
and the financial and personnel resources made available to the Service.
    (d) Priorities when funds, facilities, or personnel are insufficient 
to provide the indicated volume of services. Priorities for care and 
treatment, as among individuals who are within the scope of the program, 
will be determined on the basis of relative medical need and access to 
other arrangements for obtaining the necessary care.

[46 FR 40692, Aug. 11, 1981, as amended at 52 FR 35048, Sept. 16, 1987]



Sec. 36.12  Persons to whom health services will be provided.

    (a) Subject to the requirements of this subpart, the Indian Health 
Service will provide direct services at its facilities, and contract 
health services, as medically indicated, and to the extent that funds 
and resources allocated to the particular Health Service Delivery Area 
permit, to persons of Indian or Alaska Native descent who:
    (1) Are members of a federally recognized Indian tribe; and
    (2) Reside within a Health Service Delivery Area designated under 
Sec. 36.15; or
    (3) Are not members of a federally recognized Indian tribe but are 
the natural minor children (18 years old or under) of a member of a 
Federally recognized tribe and reside within a Health Service Delivery 
Area designated under Sec. 36.15.
    (b) Subject to the requirements of this subpart, the Indian Health 
Service will also provide direct services at its facilities and, except 
where otherwise provided, contract health services, as medically 
indicated and to the extent that funds and resources allocated to the 
particular Health Service Delivery Area permit, to people in the 
circumstances listed below:
    (1) To persons who meet the eligibility criteria in paragraph (a) of 
this section except for the residency requirement, who formerly resided 
within a Health Service Delivery area designated under Sec. 36.15, and 
who present themselves to any Indian Health Service or Indian Health 
Service funded facility (and to minor children of such persons if the 
children meet the eligibility criteria in paragraph (a) of this

[[Page 103]]

section except for the residency requirement). Contract health services 
may not be authorized for these individuals;
    (2) To a non-Indian woman pregnant with an eligible Indian's child 
but only during the period of her pregnancy through post-partum 
(generally about 6 weeks after delivery). In cases where the woman is 
not married to the eligible Indian under applicable state or tribal law, 
paternity must be acknowledged in writing by the Indian or determined by 
order of a court of competent jurisdiction;
    (3) To non-Indian members of an eligible Indian's household if the 
medical officer in charge determines that the health services are 
necessary to control acute infectious disease or a public health hazard; 
and
    (4) To an otherwise eligible person for up to 90 days after the 
person ceases to reside in a Health Service Delivery Area when the 
Service Unit Director has been notified of the move.
    (c) Contract health services will not be authorized when and to the 
extent that Indian Health Service or Indian Health Service funded 
facilities are available to provide the needed care. When funds are 
insufficient to provide the volume of contract health services needed by 
the service population, the Indian Health Service shall determine 
service priorities on the basis of medical need.
    (d) The Indian Health Service may provide direct services at its 
facilities on a fee-for-service basis to persons who are not 
beneficiaries under paragraphs (a) and (b) of this section under a 
number of authorities including the following:
    (1) In emergencies under section 322(b) of the Public Health Service 
Act, 42 U.S.C. 249(b), and 42 CFR 32.111 of the regulations;
    (2) To Public Health Service and other Federal beneficiaries under 
Economy Act (31 U.S.C. 1535) arrangements to the extent that providing 
services does not interfere with or restrict the provision of services 
to Indian and Alaska Native beneficiaries; and
    (3) To non-beneficiaries residing within the Health Service Delivery 
Area when approved by the tribe or tribes located on the reservation but 
only to the extent that providing services does not interfere with or 
restrict the provision of services to Indian and Alaska Native 
beneficiaries.

(Approved by the Office of Management and Budget under control number 
0915-0107)

[52 FR 35048, Sept. 16, 1987, as amended at 55 FR 4609, Feb. 9, 1990]



Sec. 36.13  Authorization for contract health services.

    (a) No payment will be made for medical care and services obtained 
from non-Service providers or in non-Service facilities unless the 
applicable requirements of paragraphs (b) and (c) below have been met 
and a purchase order for the care and services has been issued by the 
appropriate ordering official to the medical care provider.
    (b) In non-emergency cases, a sick or disabled Indian, or an 
individual or agency acting on behalf of the Indian, or the medical care 
provider shall, prior to the provision of medical care and services, 
notify the appropriate ordering official of the need for services and 
supply information that the ordering official deems necessary to 
determine the relative medical need for the services and the 
individual's eligibility. The requirement for notice prior to providing 
medical care and services under this paragraph may be waived by the 
ordering official if:
    (1) Such notice and information is provided within 72 hours after 
the beginning of treatment or admission to a health care facility; and
    (2) The ordering official determines that giving of notice prior to 
obtaining the medical care and services was impracticable or that other 
good cause exists for the failure to provide prior notice.
    (c) In emergency cases, a sick or disabled Indian, or an individual 
or agency acting on behalf of the Indian, or the medical care provider 
shall, within 72 hours after the beginning of treatment for the 
condition or after admission to a health care facility notify the 
appropriate ordering official of the fact of the admission or treatment, 
together with information necessary to determine the relative medical 
need for the services and the eligibility of the

[[Page 104]]

Indian for the services. The 72-hour period may be extended if the 
ordering official determines that notification within the prescribed 
period was impracticable or that other good cause exists for the failure 
to comply.

[43 FR 34654, Aug. 4, 1978. Redesignated at 52 FR 35048, Sept. 16, 1987]



Sec. 36.14  Reconsideration and appeals.

    (a) Any person who has applied for and been denied health services 
or eligibility by the Indian Health Service or by any contractor 
contracting to administer an Indian Health Service program or portion of 
a program, including tribes and tribal organizations contracting under 
the Indian Self-Determination Act, shall be notified of the denial in 
writing together with a statement of all the reasons for the denial. The 
notice shall advise the applicant that within 30 days from the receipt 
of the notice the applicant.
    (b) If the original decision is affirmed on reconsideration, the 
applicant shall be so notified in writing and advised that an appeal may 
be taken to the area or program director within 30 days of receipt of 
the notice of the reconsidered decision. The appeal shall be in writing 
and shall set forth the grounds supporting the appeal.
    (c) If the original or reconsidered decision is affirmed on appeal 
by the area or program director, the applicant shall be so notified in 
writing and advised that a further appeal may be taken to the Director, 
Indian Health Service, within 30 days of receipt of the notice. The 
appeal shall be in writing and shall set forth the grounds supporting 
the appeal. The decision of the Director, Indian Health Service, shall 
constitute final administrative action.

(Approved by the Office of Management and Budget under control number 
0915-0107)

[43 FR 34654, Aug. 4, 1978. Redesignated and amended at 52 FR 35048, 
35049, Sept. 16, 1987]



Sec. 36.15  Health Service Delivery Areas.

    (a) The Indian Health Service will designate and publish as a notice 
in the Federal Register specific geographic areas within the United 
States including Federal Indian reservations and areas surrounding those 
reservations as Health Service Delivery Areas.
    (b) The Indian Health Service may, after consultation with all the 
Indian tribes affected, redesignate the boundaries of any Health Service 
Delivery Area followed by publication of a notice in the Federal 
Register. Any redesignation of a Health Service Delivery area will 
include the reservation, and those areas close to the reservation 
boundaries which can reasonably be considered part of the reservation 
service area based on consideration of the following factors:
    (1) The number of persons residing in the off-reservation area who 
would be eligible under Sec. 36.12(a) (1) and (3).
    (2) The number of persons residing in the off-reservation area who 
have traditionally received health services from the Indian Health 
Service and whose eligibility for services would be affected;
    (3) The geographic proximity of the off-reservation area to the 
reservation; and
    (4) Whether the Indians residing in the off-reservation area can be 
expected to need and to use health services provided by the Indian 
Health Service given the alternate resources (health facilities and 
payment sources) available and accessible to them.
    (c) Notwithstanding paragraphs (a) and (b) of this section, the 
Indian Health Service may designate States, subdivisions of States such 
as counties or towns, or other identifiable geographic areas such as 
census divisions or zip code areas, as Health Service Delivery Areas 
where reservations are nonexistent, or so small and scattered and the 
eligible Indian population so widely dispersed that it is inappropriate 
to use reservations as the basis for defining the Health Service 
Delivery Area.
    (d) Any Indian tribal government may request a change in the 
boundaries of the Health Service Delivery Area. Such a request should be 
supported by documentation related to the factors for consideration set 
out in paragraph (b) of this section and shall include documentation of 
any consultation with or notification of other affected or nearby 
tribes. The request shall be submitted to the appropriate Area 
Director(s) who shall afford all Indian tribes affected the opportunity 
to

[[Page 105]]

express their views orally and in writing. The Area Director(s) shall 
then submit the request, including all comments, together with the 
Area's recommendation and independent findings or verification of the 
factors set out in paragraph (b) of this section, to the Indian Health 
Service Director or to the Director's designee for the Indian Health 
Service decision. The decision of the Indian Health Service Director or 
the Director's designee shall constitute final agency action on the 
tribe's request. Changes in the boundaries of Health Service Delivery 
Areas will be published in the Federal Register.

(Approved by the Office of Management and Budget under control number 
0915-0107)

[52 FR 35049, Sept. 16, 1987]



Sec. 36.16  Beneficiary Identification Cards and verification of tribal membership.

    (a) The Indian Health Service will issue Beneficiary Identification 
Cards as evidence of beneficiary status to persons who are currently 
eligible for services under Sec. 36.12(a). Persons requesting 
Beneficiary Identification Cards must submit or have on file evidence 
satisfactory to the Indian Health Service of tribal membership and 
residence within a Health Service Delivery Area. The absence of a 
Beneficiary Identification Card will not preclude an otherwise eligible 
Indian from obtaining services though it may delay the administrative 
determination that an individual is eligible for services on a no charge 
basis.
    (b) For establishing eligibility or obtaining a Beneficiary 
Identification Card, applicants must demonstrate that they are members 
of a federally recognized tribe. Membership in a federally recognized 
tribe is to be determined by the individual tribe or the Bureau of 
Indian Affairs. Therefore, the Indian Health Service will recognize two 
methods of demonstrating tribal membership:
    (1) Documentation that the applicant meets the requirements of 
tribal membership as prescribed by the charter, articles of 
incorporation, or other legal instruments or traditional processes of 
the tribe and has been officially designated a tribal member by an 
authorized tribal official or body; or
    (2) Certification of tribal enrollment or membership by the 
Secretary of the Interior acting through the Bureau of Indian Affairs.
    (c) Demonstrating membership in a federally recognized tribe is the 
responsibility of the applicant. However, the Indian Health Service may 
consult with the appropriate tribe or the Bureau of Indian Affairs on 
outstanding questions regarding an applicant's tribal membership if the 
Indian Health Service has some documentation that it believes may be 
helpful to the tribe or the Bureau of Indian Affairs in making their 
determination.

(Approved by the Office of Management and Budget under control number 
0915-0107)

[50 FR 35050, Sept. 16, 1987]

Subpart C  [Reserved]



                    Subpart D--Transition Provisions

    Source: 52 FR 35050, Sept. 16, 1987, unless otherwise noted.



Sec. 36.31  Transition period.

    (a) The transition period for full implementation of the new 
eligibility regulations consists of three parts;
    (1) A six month delayed implementation;
    (2) A six month grace period; and
    (3) A health care continuity period determined by medical factors.



Sec. 36.32  Delayed implementation.

    (a) The eligibility requirements in subparts A and B of this part 
become effective March 16, 1988.
    (b) During the six month delayed implementation period the former 
eligibility regulations will apply.



Sec. 36.33  Grace period.

    (a) Upon the effective date referred to in Sec. 36.32(a), 
individuals who would lose their eligibility under the new eligilibity 
regulations published on September 16, 1987, and who have made use of an 
Indian Health Service of Indian Health Service funded service within 
three years prior to September 16, 1987 (date of publication of the new 
eligibility regulations) shall retain

[[Page 106]]

their eligibility for a six month grace period ending September 16, 
1988. During this grace period such individual's eligibility will 
continue to be determined under the former regulations except that the 
new residency requirements established by subparts A and B must be met 
for the individual to be eligible.
    (b) All individuals who receive services during the grace period 
based on paragraph (a) of this section and whose eligibility will 
terminate on September 16, 1988, shall be notified in writing that after 
September 16, 1988 they will no longer the eligible for services as 
Indian Health Service beneficiaries. Such written notice should include 
an explanation of their appeal rights as provided in Sec. 36.14 of the 
part. These patients shall be offered assistance in locating other 
health care providers and medical assistance programs.



Sec. 36.34  Care and treatment of people losing eligibility.

    (a) Individuals who lose their eligibility on September 16, 1988, 
(end of the grace period) and on that date are actively undergoing 
treatment may still be provided services for a limited period in the 
following circumstances;
    (1) Inpatients in IHS and IHS funded facilities and those receiving 
inpatient care under contract, including contract health services, may 
continue to receive such care and necessary follow-up services at Indian 
Health Service expense until the need for hospitalization and follow-up 
services has ended as determined by the responsible Indian Health 
Service or tribal physician, all other conditions being met including 
medical priorities;
    (2) Those actively undergoing a course of outpatient treatment 
either in Indian Health Service and Indian Health Service funded 
facilities or through contract health services, termination of which 
would impair the health of the individual patient, may continue to 
receive the treatment at Indian Health Service expense for a reasonable 
length of time, until the course of treatment reaches a point where it 
may safely be terminated or the patient transferred to other providers 
as determined by the responsible Indian Health Service or tribal 
physician, all other conditions being met including medical priorities.
    (3) Those under treatment for chronic degenerative conditions may be 
provided additional treatment at Indian Health Service expense for no 
longer than 1 year beyond the end of the grace period notwithstanding 
any determination that it was otherwise safe to transfer treatment to 
other providers, all other conditions being met including medical 
priorities.
    (b) All patients receiving care under paragraph (a) of this section 
shall be notified in writing that, after discharge from care provided 
under any of the above circumstances, they will no longer be eligible 
for services as Indian Health Service beneficiaries. Such notice shall 
include an explanation of their appeal rights as provided in Sec. 36.14 
of this part. These patients shall be offered assistance in locating 
other health care providers and medical assistance programs.



                   Subpart E--Preference in Employment

    Authority: 25 U.S.C. 44, 45, 46 and 472; Pub. L. 83-568, 42 U.S.C. 
2003.



Sec. 36.41  Definitions.

    For purposes of making appointments to vacancies in all positions in 
the Indian Health Service a preference will be extended to persons of 
Indian descent who are:
    (a) Members of any recognized Indian tribe now under Federal 
jurisdiction;
    (b) Descendants of such members who were, on June 1, 1934, residing 
within the present boundaries of any Indian reservation;
    (c) All others of one-half or more Indian blood of tribes indigenous 
to the United States;
    (d) Eskimos and other aboriginal people of Alaska; or
    (e) Until January 4, 1990 or until the Osage Tribe has formally 
organized, whichever comes first, a person of at least one-quarter 
degree Indian ancestry of the Osage Tribe of Indians, whose rolls were 
closed by an act of Congress.

[43 FR 29783, July 11, 1978, as amended at 54 FR 48246, Nov. 22, 1989]

[[Page 107]]



Sec. 36.42  Appointment actions.

    (a) Preference will be afforded a person meeting any one of the 
definitions of Sec. 36.41 whether the placement in the position involves 
initial appointment, reappointment, reinstatement, transfer, 
reassignment, promotion, or any other personnel action intended to fill 
a vacancy.
    (b) Preference eligibles may be given a schedule A excepted 
appointment under 5 CFR 213.3116(b)(8). If the individuals are within 
reach on a Civil Service Register, they may be given a competitive 
appointment.

[43 FR 29783, July 11, 1978]



Sec. 36.43  Application procedure for preference eligibility.

    To be considered a preference eligible, the person must submit with 
the employment application a Bureau of Indian Affairs certification that 
the person is an Indian as defined by Sec. 36.41 except that an employee 
of the Indian Health Service who has a certificate of preference 
eligibility on file in the Official Personnel Folder is not required to 
resubmit such proof but may instead include a statement on the 
application that proof of eligibility is on file in the Official 
Personnel Folder.

[43 FR 29783, July 11, 1978]



   Subpart F--Abortions and Related Medical Services in Indian Health 
          Service Facilities and Indian Health Service Programs

    Authority: Sec. 1, 42 Stat. 208, 25 U.S.C. 13; sec. 1, 68 Stat. 674, 
42 U.S.C. 2001; sec. 3, 68 Stat. 674, 42 U.S.C. 2003.

    Source: 47 FR 4018, Jan. 27, 1982, unless otherwise noted.



Sec. 36.51  Applicability.

    This subpart is applicable to the use of Federal funds in providing 
health services to Indians in accordance with the provisions of subparts 
A, B, C, H, I and J of this part.



Sec. 36.52  Definitions.

    As used in this subpart:
    Physician means a doctor of medicine or osteopathy legally 
authorized to practice medicine and surgery at an Indian Health Service 
or tribally run facility, or by the State in which he or she practices.



Sec. 36.53  General rule.

    Federal funds may not be used to pay for or otherwise provide for 
abortions in the programs described in Sec. 36.51, except under the 
Circumstances discribed in Sec. 36.54.



Sec. 36.54  Life of the mother would be endangered.

    Federal funds are available for an abortion when a physician has 
found and so certified in writing to the appropriate tribal or other 
contracting organization, or service unit or area director, that ``on 
the basis of my professional judgement the life of the mother would be 
endangered if the fetus were carried to term.'' The certification must 
contain the name and address of the patient.



Sec. 36.55  Drugs and devices and termination of ectopic pregnancies.

    Federal funds are available for drugs or devices to prevent 
implantation of the fertilized ovum, and for medical procedures 
necessary for the termination of an ectopic pregnancy.



Sec. 36.56  Recordkeeping requirements.

    Documents required by Sec. 36.54 must be maintained for three years 
pursuant to the retention and custodial requirements for records at 45 
CFR 74.20 et seq.



Sec. 36.57  Confidentiality.

    Information which is acquired in connection with the requirements of 
this subpart may not be disclosed in a form which permits the 
identification of an individual without the individual's consent, except 
as may be necessary for the health of the individual or as may be 
necessary for the Secretary to monitor Indian Health Service program 
activities. In any event, any disclosure shall be subject to appropriate 
safeguards which will minimize the likelihood of disclosures of personal 
information in identifiable form.

[[Page 108]]



                       Subpart G--Residual Status



Sec. 36.61  Payor of last resort.

    (a) The Indian Health Service is the payor of last resort of persons 
defined as eligible for contract health services under these 
regulations, notwithstanding any State or local law or regulation to the 
contrary.
    (b) Accordingly, the Indian Health Service will not be responsible 
for or authorize payment for contract health services to the extent 
that:
    (1) The Indian is eligible for alternate resources, as defined in 
paragraph (c), or
    (2) The Indian would be eligible for alternate resources if he or 
she were to apply for them, or
    (3) The Indian would be eligible for alternate resources under State 
or local law or regulation but for the Indian's eligibility for contract 
health services, or other health services, from the Indian Health 
Service or Indian Health Service funded programs.
    (c) Alternate resources means health care resources other than those 
of the Indian Health Service. Such resources include health care 
providers and institutions, and health care programs for the payment of 
health services including but not limited to programs under title XVIII 
and XIX of the Social Security Act (i.e., Medicare, Medicaid), State or 
local health care programs and private insurance.

[55 FR 4609, Feb. 9, 1990]



   Subpart H--Grants for Development, Construction, and Operation of 
                         Facilities and Services

    Authority: Secs. 104, 107, 25 U.S.C. 450h(b), 450k; Sec. 3, Pub. L. 
83-568, 42 U.S.C. 2003.

    Source: 40 FR 53143, Nov. 14, 1975, unless otherwise noted.



Sec. 36.101  Applicability.

    The regulations of this subpart are applicable to grants awarded 
pursuant to section 104(b) of Pub. L. 93-638, 25 U.S.C. 450h(b) for (a) 
projects for development including feasibility studies, construction, 
operation, provision, or maintenance of services and facilities provided 
to Indians and, (b) for projects for planning, training, evaluation or 
other activities designed to improve the capacity of a tribal 
organization to enter into a contract or contracts pursuant to section 
103 of the Act. Such grants may include the cost of training personnel 
to perform grant related activities.



Sec. 36.102  Definitions.

    As used in this subpart:
    (a) Act means Title I of the Indian Self-Determination and Education 
Assistance Act, Pub. L. 93-638 (88 Stat. 2203).
    (b) Indian means a person who is a member of an Indian tribe.
    (c) Indian tribe means any Indian tribe, band, nation, rancheria, 
Pueblo, colony or community, including any Alaska Native Village or 
regional or village corporation as defined in or established pursuant to 
the Alaska Native Claims Settlement Act, Pub. L. 92-203 (85 Stat. 688 
which is recognized as eligible by the United States Government for the 
special programs and services provided by the United States to Indians 
because of their status as Indians.
    (d) Tribal organization means:
    (1) The recognized governing body of any Indian tribe; or
    (2) Any legally established organization of Indians which is:
    (i) Controlled, sanctioned or chartered by such governing body or 
bodies; or
    (ii) Democratically elected by the adult members of the Indian 
community to be served by such organization and which includes the 
maximum participation of Indians in all phases of its activities.
    (e) Secretary means the Secretary of the Department of Health and 
Human Services and any other officer or employee of the Department of 
Health and Human Services to whom the authority involved has been 
delegated.
    (f) Grantee means the tribe or tribal organization that receives a 
grant under section 104(b) of the Act and this subpart and assumes the 
legal and financial responsibility for the funds awarded and for the 
performance of the grant supported activity in accordance with the Act 
and these regulations.

[[Page 109]]

    (g) Indian owned economic enterprise means any commercial, 
industrial, or business activity established or organized for the 
purpose of profit which is not less than 51 percent Indian owned.



Sec. 36.103  Eligibility.

    Any Indian tribe or tribal organization is eligible to apply for a 
grant under this subpart.



Sec. 36.104  Application.

    (a) Forms for applying for grants are governed by 45 CFR part 74, 
subpart N.
    (b) In addition to such other pertinent information as the Secretary 
may require, the application for a grant under this subpart shall 
contain the following:
    (1) A description of the applicant including an indication whether 
the applicant is a Tribe or tribal organization, and if the latter:
    (i) The legal and organizational relationship of the applicant to 
the Indians in the Area to be served or effected by the project.
    (ii) A description of the current and proposed participation of 
Indians in the activities of applicant.
    (iii) Whether applicant is controlled, sanctioned or chartered by 
the governing body of the Indians to be served, and if so, evidence of 
such fact.
    (iv) If elected, a description of the election process, voting 
criteria, and extent of voter participation in the election designating 
the organization.
    (2) A narrative description of the project including its goals and 
objectives and the manner in which the proposed project is compatible 
with published Indian Health Service statements of availability of 
funds, the manner in which those goals and objectives are to be 
attained, and a work and time schedule which will be utilized to 
accomplish each goal and objective.
    (3) A description of applicant's staff, present or proposed, 
including their qualifications, academic training, responsibilities and 
functions.
    (4) A description of the manner in which the staff is or will be 
organized and supervised to carry out proposed activities.
    (5) A description of training to be provided as part of the proposed 
project.
    (6) A description of the administrative, managerial, and 
organizational arrangements and resources to be utilized to conduct the 
proposed project.
    (7) An itemized budget for the budget period (normally 12 months) 
for which support is sought and justification of the amount of grant 
funds requested.
    (8) The intended financial participation, if any, of the applicant, 
specifying the type of contributions such as cash or services, loans of 
full or part-time staff, equipment, space materials or facilities, or 
other contributions.
    (9) Where health services are to be provided, a description of the 
nature of the services to be provided and the population to be served.
    (10) A description of the Federal property, real and personal, 
equipment, facilities and personnel which applicant proposes to utilize 
and a description of the arrangements which applicant has made or will 
make to assume responsibility for the operation and management of those 
facilities.
    (c) The application shall contain assurances satisfactory to the 
Secretary that the applicant will:
    (1) Where applicant is providing services, provide such services at 
a level and range which is not less than that provided by the Indian 
Health Service or that identified by the Service after negotiation with 
the applicant, as an appropriate level, range and standard of care.
    (2) Where providing services, provide services in accordance with 
law and applicable Indian Health Service policies and regulations.
    (3) Where providing services, provide services in a fair and uniform 
manner, consistent with medical need, to all Indian people.

(Approved by the Office of Management and Budget under control number 
0915-0045)

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1853, Jan. 14, 1985]



Sec. 36.105  Project elements.

    A project supported under this subpart must:
    (a) Have sufficient, adequately trained staff in relation to the 
scope of the project.

[[Page 110]]

    (b) Maintain a mechanism for dealing with complaints regarding the 
delivery of health services or performance of project activities.
    (c) Hold confidential all information obtained by the personnel of 
the project from participants in the project related to their 
examination, care, and treatment, and shall not release such information 
without the individuals' consent except as may be required by law, as 
may be necessary to provide service to the individual, or as may be 
necessary to monitor the operations of this program or otherwise protect 
the public health. Information may be disclosed in a form which does not 
identify particular individuals.
    (d) Operate with the approval, support, and involvement of the 
tribe, tribes, or Indian communities in the area served by the local 
facility and program.
    (e) Keep in force adequate liability insurance in accordance with 
the approved application unless the Secretary, for good cause shown, has 
determined that such insurance was not obtainable or appropriate or has 
determined that such insurance may be permitted to expire or lapse. The 
insurance shall provide that prior to cancellation the Secretary must be 
notified and must further provide that for each such policy of insurance 
the carrier shall waive any right it may have to raise as a defense the 
tribe's sovereign immunity from suit but such waiver shall extend only 
to claims the amount and nature of which are within the coverage and 
limits of the policy and shall not authorize or empower the insurance 
carrier to waive or otherwise limit the tribe's sovereign immunity 
outside or beyond the coverage and limits of the policy of insurance.

    Note: This provision is excepted from application of 45 CFR 74.15 by 
section 103(c) of Pub. L. 93-638.

    (f) Provide services at a level and range which is not less than 
that provided by the Indian Health Service or that identified by the 
Service as an appropriate level, range, and standard of care.

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1854, Jan. 14, 1985]



Sec. 36.106  Grant award and evaluation.

    (a) Within the limits of funds determined by the Secretary to be 
available for such purpose, the Secretary may award grants under this 
subpart to applicants whose project will, in the judgment of the 
Secretary, best promote the purposes of the Act, and the regulations of 
this subpart, taking into account:
    (1) The apparent capability of the applicant to organize and manage 
the proposed project successfully considering, among other things the 
adequacy of staff, management systems, equipment and facilities.
    (2) The soundness of the applicant's plan for conducting the project 
and for assuring effective utilization of grant funds.
    (3) The adequacy of the budget in relation to the scope of the 
project and available funds.
    (4) The relative effectiveness of the applicant's plan, as set forth 
in the application, to carry out each of the requirements Sec. 36.105.
    (5) The compatibility of the proposed project with the published 
goals and responsibilities of the IHS in carrying out its statutory 
mission.
    (b) The Notice of Grant Awards specifies how long the Secretary 
intends to support the project period without requiring the project to 
re-compete for funds. This period, called the project period, will 
usually be for one to two years. The total project period comprises the 
original project period and any extension. Generally the grant will be 
for a one-year budget period, any subsequent award will also be a one-
year budget period. A grantee must submit a separate application for 
each subsequent year. Decisions regarding continuation awards and the 
funding level of such awards will be made after consideration of such 
factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, awards require a determination by 
the Secretary that funding is in the best interest of the Federal 
Government.
    (c) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation or

[[Page 111]]

other award with respect to any approved application or portion of an 
approved application.

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1854, Jan. 14, 1985]



Sec. 36.107  Use of project funds.

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the regulations of 
this subpart, the terms and conditions of the award and the applicable 
cost principles prescribed in subpart Q of 45 CFR part 74.
    (b) The provisions of any other Act notwithstanding, any funds made 
available to a tribal organization under grants pursuant to section 
104(b) of the Act may be used as matching shares for any other Federal 
grant programs which contribute to the purposes for which grants under 
this section are made.

    Note: This provision is excepted from application of 45 CFR 74.53 by 
section 104(c) of Pub. L. 93-638.

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1854, Jan. 14, 1985]



Sec. 36.108  [Reserved]



Sec. 36.109  Availability of appropriations.

    The Secretary will from time to time publish a notice in the Federal 
Register indicating by areas the allotment of funds and categories of 
activities for which awards may be made under this subpart. The 
Secretary may revise such allotments and categories from time to time 
and will promptly publish a notice of such revisions in the Federal 
Register.



Sec. 36.110  Facilities construction.

    In addition to other requirements of this subpart:
    (a) An applicant for a construction grant to build, renovate, 
modernize, or remodel a hospital, clinic, health station or quarters for 
housing personnel associated with such facilities, must in its 
application:
    (1) Provide its assessment of the environmental impact of the 
project as called for by section 102(2)(c) of the National Environmental 
Policy Act of 1969 (42 U.S.C. 4332(c)).
    (2) Furnish its evaluation of the project site in accordance with 
the terms and conditions of E.O. 11296, 31 FR 10663 (August 10, 1966) 
relating to the evaluation of flood hazards in locating federally owned 
or financed facilities.
    (b) The following requirements are applicable to each construction 
grant to build, renovate, modernize, or remodel a hospital, clinic, 
health station or quarters for housing personnel associated with such 
facilities.
    (1) Competitive bids. The approval of the Secretary shall be 
obtained before the project is advertised or placed on the market for 
bidding. The approval shall include a determination by the Secretary 
that the final plan and specifications conform to the minimum standards 
of construction and equipment specified in the grant award or in HHS 
documents specified in the grant award.
    (2) There will be no preference given to local contractors or 
suppliers over non-local contractors or suppliers, except as otherwise 
provided in these regulations.
    (3) Construction contracts and subcontracts under this program are 
subject to the Davis-Bacon Act (40 U.S.C. 276a et seq.). For 
requirements that grantees must observe for enforcing compliance by 
contractors and subcontractors, see the section on contract provisions 
in the procurement standards for HHS grantees made applicable by subpart 
P of 45 CFR part 74.
    (4) Minimum standards of construction and equipment. The plans and 
specifications for the project will conform to the minimum standards of 
construction and equipment specified in the grant award or in HHS 
documents specified in the grant award.
    (5) The following provision must be included in all construction 
contracts let by the grantee: ``The Secretary of the Department of 
Health and Human Services shall have access at all reasonable times to 
work wherever it is in preparation or progress, and the contractor shall 
provide proper facilities for such access and inspection.''

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1854, Jan. 14, 1985]

[[Page 112]]



Sec. 36.111  Interest.

    Tribes and Tribal organizations shall not be held accountable for 
interest earned on grant funds, pending disbursement by such 
organization.

    Note: This provision is excepted from application of 45 CFR 74.47(a) 
by section 106(b) of Pub. L. 93-638.

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1854, Jan. 14, 1985]



Sec. 36.112  Additional conditions.

    The Secretary may with respect to any grant award impose additional 
conditions prior to or at the time of any award when in his judgment 
such conditions are necessary to assure or protect advancement of the 
approved project, the interests of public health, or the conservation of 
grant funds.



Sec. 36.113  Fair and uniform provision of services.

    Services provided pursuant to a grant under this subpart shall be 
provided by the Grantee in a fair and uniform manner to all participants 
in the project consistent with their medical need, the policies and 
regulations of the Indian Health Service, and the Act.



Sec. 36.114  Applicability of other Department regulations.

    Several other regulations apply to grants under this subpart. These 
include to the extent applicable but are not limited to:

42 CFR part 50, subpart D, Public Health Service grant appeals procedure
45 CFR part 16, Procedures of the Departmental Grant Appeals Board
45 CFR part 74, Administration of grants
45 CFR part 75, Informal grant appeals procedures
45 CFR part 84, Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86, Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91, Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

    Note: To the extent they provide special benefits to Indians, grants 
under this subpart are exempted from the requirements of section 601 of 
the Civil Rights Act of 1964 [42 U.S.C. 200d], prohibiting 
discrimination on the basis of race, color or national origin, by 
regulation at 45 CFR 80.3(d) which provides, with respect to Indian 
health services, that, ``An individual shall not be deemed subjected to 
discrimination by reasons of his exclusion from the benefits of a 
program limited by Federal law to individuals of a particular race, 
color, or national origin different from his.

[50 FR 1854, Jan. 14, 1985]



Sec. 36.115  Rescission of grants.

    (a) When the Secretary determines that the performance of a grantee 
under these regulations involves (1) the violation of the rights or 
endangerment of the health, safety, or welfare of any persons, or (2) 
gross negligence or the mismanagement in the handling or use of funds 
under the grant, the Secretary will, in writing, notify the grantee of 
such determination and will request that the grantee take such 
corrective action, within such period of time, as the Secretary may 
prescribe.
    (b) When the Secretary determines that a grantee has not taken 
corrective action (as prescribed by him under paragraph (a) of this 
section) to his satisfaction, he may, after providing the grantee an 
opportunity for a hearing in accordance with paragraph (c) of this 
section, rescind the grant in whole or in part and if he deems it 
appropriate, assume or resume control or operation of the program, 
activity, or service involved.
    (c) When the Secretary has made a determination described in 
paragraph (b) of this section, he shall in writing notify the grantee of 
such determination and of the grantee's right to request a review of 
such determination (and of the determination described in paragraph (a) 
of this section) under the Public Health Service Grant Appeals Procedure 
(42 CFR part 50, subpart D). Such notification by the Secretary shall 
set forth the reasons for the determination in sufficient detail to 
enable the grantee to respond and shall inform the grantee of its 
opportunity for review under such subpart D. If the review held under 
subpart D results in a response adverse to the grantee's position, the 
grantee shall be informed of its right to have a hearing before the 
Department Grant Appeals Board, pursuant to 45 CFR part 16.

[[Page 113]]

    (d) Where the Secretary determines that a grantee's performance 
under a grant awarded under this subpart poses an immediate threat to 
the safety of any person, he may immediately rescind the grant in whole 
or in part and if he deems it appropriate, assume or resume control or 
operation of the program, activity, or service involved. Upon such 
recission he will immediately notify the grantee of such action and the 
basis or reasons therefor; and offer the grantee an opportunity for a 
hearing to be held within 10 days of such action. If the grantee 
requests such a hearing, the Secretary will designate three officers or 
employees of the Department to serve as a hearing panel. No officer or 
employee from the immediate office of the official who made the decision 
to rescind the grant under this paragraph may be designated to serve on 
the hearing panel.
    (1) The hearing shall be commenced within 10 days after the 
recission of the grant, shall be held on the record and shall afford the 
grantee the right:
    (i) To notice of the issues to be considered;
    (ii) To be represented by counsel;
    (iii) To present witnesses on grantee's behalf; and
    (iv) To cross-examine other witnesses either orally or through 
written interrogatories.
    (2) The hearing panel shall, within 25 days after the conclusion of 
the hearing, notify all parties in writing of its decision.
    (3) Such decision shall not be subject to further hearing under 42 
CFR part 50, subpart D or 45 CFR part 16.
    (e) In any case where the Secretary has rescinded a grant under 
paragraph (b) or (d) of this section, he may decline to enter into a new 
grant agreement with the grantee until such time as he is satisfied that 
the basis for the recission has been corrected. Nothing in this section 
shall be construed as contravening the Occupational Safety and Health 
Act of 1970 (84 Stat. 1590), as amended (29 U.S.C. 651).
    (f) In any case where the Secretary has rescinded a grant for the 
delivery of health services under this subpart, the grantee shall, upon 
the request of the Secretary, transfer to the Secretary all medical 
records compiled in the operation of the supported project.

    Note: This section is an exception to 45 CFR part 74, subpart M 
required by section 109 of Pub. L. 93-638.

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1855, Jan. 14, 1985]



Sec. 36.116  Reports.

    In addition to the reporting and information requirements provided 
in subpart J of 45 CFR part 74 made applicable to grants under this 
subpart by Sec. 36.114, each recipient of Federal financial assistance 
shall make such reports and information available to the Indian people 
served or represented by such recipient as and in a manner determined by 
the Secretary to be adequate.

    Note: This section is a requirement in addition to 45 CFR part 74 
and is required by section 5(c) of Pub. L. 93-638.

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1855, Jan. 14, 1985]



Sec. 36.117  Amendment of regulations.

    Before revising or amending the regulations in this subpart, the 
Secretary shall take the following actions:
    (a) Consult with Indian Tribes and national and regional Indian 
organizations to the extent practicable about the need for revision or 
amendment and consider their views in preparing the proposed revision or 
amendment.
    (b) Present the proposed revision or amendment to the Committees on 
Interior and Insular Affairs of the United States Senate and House of 
Representatives.
    (c) Publish the proposed revisions or amendments in the Federal 
Register as proposed rulemaking to provide adequate notice to receive 
comments from, all interested parties.
    (d) After consideration of all comments received, publish the 
regulations in the Federal Register in final form not less than 30 days 
before the date they are made effective.



Sec. 36.118  Effect on existing rights.

    The regulations in this part are not meant to and do not:
    (a) Affect, modify, diminish, or otherwise impair the sovereign 
immunity from suit enjoyed by an Indian tribe;

[[Page 114]]

    (b) Authorize, require or permit the termination of any existing 
trust responsibility of the United States with respect to the Indian 
people;
    (c) Permit significant reduction in services to Indian people as a 
result of this subpart.



Sec. 36.119  Penalties.

    Section 6 of Pub. L. 93-638, 25 U.S.C. 450(d) provides:

    Whoever, being an officer, director, agent, or employee of, or 
connected in any capacity with, any recipient of a contract, 
subcontract, grant, or subgrant pursuant to this Act or the Act of April 
16, 1934 (48 Stat. 596), as amended, embezzles, willfully misapplies, 
steals, or obtains by fraud any of the money, funds, assets, or property 
which are the subject of such a grant, subgrant, contract, or 
subcontract, shall be fined not more than $10,000 or imprisoned for not 
more than two years, or both, but if the amount so embezzled, 
misapplied, stolen, or obtained by fraud does not exceed $100, he shall 
be fined not more than $1,000 or imprisoned not more than one year, or 
both.



Sec. 36.120  Use of Indian business concerns.

    Grants awarded pursuant to this subpart will incorporate the 
following:
    Use of Indian business concerns.
    (a) As used in this clause, the term ``Indian organizations of an 
Indian-owned economic enterprise'' as defined in section 102(g) of this 
subpart.
    (b) The grantee agrees to give preference to qualified Indian 
business concerns in the awarding of any contracts, subcontracts or 
subgrants entered into under the grant consistent with the efficient 
performance of the grant. The grantee shall comply with any preference 
requirements regarding Indian business concerns established by the 
tribe(s) receiving services under the grant to the extent that such 
requirements are consistent with the purpose and intent of this 
paragraph.

    Note: This section is an exception to 45 CFR part 74, required by 
section 7(b) of Pub. L. 93-638.

[40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1855, Jan. 14, 1985]



Sec. 36.121  Indian preference in training and employment.

    (a) Any grant made under this subpart, or a contract or subgrant 
made under such a grant shall require that, to the greatest extent 
feasible preferences and opportunities for training and employment in 
connection with the administration of such grant, or contract or 
subgrant made under such grant, shall be given to Indians.
    (b) The grantee shall include the requirements of paragraph (a) of 
this section in all contracts and subgrants made under a grant awarded 
under this subpart.



      Subpart I--Contracts Under the Indian Self-Determination Act

    Authority: Secs. 103, 107, 25 U.S.C. 450g, 450k; sec. 3, Pub. L. 83-
568, 42 U.S.C. 2003.

    Source: 40 FR 53147, Nov. 14, 1975, unless otherwise noted.



Sec. 36.201  Policy and applicability.

    (a) Policy. (1) The Congress has recognized the obligation of the 
United States to respond to the strong expression of the Indian people 
for self-determination by assuring maximum Indian participation in the 
direction of educational as well as other Federal services to Indian 
communities so as to render such services more responsive to the needs 
and desires of those communities.
    (2) The Congress has declared its commitment to the maintenance of 
the Federal Government's unique and continuing relationship with the 
responsibilities to the Indian people through the establishment of a 
meaningful Indian self-determination policy which will permit an orderly 
transition from Federal domination of programs for and services to 
Indians to effective and meaningful participation by the Indian people 
in the planning, conduct, and administration of those programs and 
services.
    (3) It is the policy of the Secretary of the Department of Health 
and Human Services to facilitate the efforts of Indian tribes to plan, 
conduct, and administer programs, or portions thereof, which the Indian 
Health Service is authorized to administer for the benefit of Indians.
    (4) It is the policy of the Secretary to continually encourage 
Indian tribes to become increasingly knowledgeable

[[Page 115]]

about Indian Health Service programs and the opportunities Indian tribes 
have regarding them; however, it is the policy of the Indian Health 
Service to leave to Indian tribes the initiative in making requests for 
contracts and to regard self-determination as including the decision of 
an Indian tribe not to request contracts.
    (5) It is the policy of the Indian Health Service not to impose 
sanctions on Indian tribes with regard to contracting or not 
contracting; however, the special resources made available to facilitate 
the efforts of those Indian tribes which do wish to contract should be 
made known to all tribes, as should the current realities of funding and 
Federal personnel limitations.
    (6) Contracting is one of several mechanisms by which Indian tribes 
can exercise their right to plan, conduct, and administer programs or 
portions thereof which the Secretary is authorized to administer for the 
benefit of Indians. Another mechanism afforded Indian tribes is the use 
of a grant, as provided in subpart H of this part, or other resources, 
to plan the manner in which it wishes the Indian Health Service to 
operate a program or portion thereof.
    (7) The regulations in this subpart are not meant to and do not 
change the eligibility criteria which individuals must meet to be 
eligible for any program currently operated by the Indian Health 
Service.
    (b) The regulations of this subpart are applicable to contracts 
awarded pursuant to section 103 of Pub. L. 93-638, 25 U.S.C. 450g to 
carry out any or all of the functions, authorities, and responsibilities 
of the Secretary of Health and Human Services under the Act of August 5, 
1954 (68 Stat. 674), as amended, 42 U.S.C. 2001 et seq.



Sec. 36.202  Effect on existing rights.

    The regulations in this subpart are not meant to and do not:
    (a) Affect, modify, diminish, or otherwise impair the sovereign 
immunity from suit enjoyed by an Indian tribe.
    (b) Authorize, require or permit the termination of any existing 
trust responsibility of the United States with respect to the Indian 
people.
    (c) Permit significant reduction in services to Indian people as a 
result of this subpart.
    (d) Nothing in these regulations shall be construed to require a 
tribe to apply for a contract or contracts with the Secretary to carry 
out under the Indian Self-Determination Act any of the Secretary's 
functions, authorities and responsibilities under the Act of August 5, 
1954, as amended, 42 U.S.C. 2001, et seq. Such applications under these 
regulations are voluntary.
    (e) Nothing in these regulations shall be construed to preclude the 
making of contracts under any other authority of law nor to restrict 
contracts with Indian tribes or tribal organizations to contracts 
entered into under section 103 of the Act.



Sec. 36.203  Amendment of regulations.

    Before revising or amending the regulations in this subpart, the 
Secretary will take the following actions:
    (a) Consult with Indian tribes and national and regional Indian 
organizations to the extent practicable about the need for revision or 
amendment and consider their views in preparing the proposed revision or 
amendment.
    (b) Present the proposed revision or amendment to the Committees on 
Interior and Insular Affairs of the United States Senate and House of 
Representatives.
    (c) Publish the proposed revisions or amendments in the Federal 
Register as proposed rulemaking to provide adequate notice to receive 
comments from all interested parties.
    (d) After consideration of all comments received, publish the 
regulations in the Federal Register in final form not less than 60 days 
before the date they are made effective.



Sec. 36.204  Definitions.

    (a) Act means Title I of the Indian Self-Determination and Education 
Assistance Act, Pub. L. 93-638 (25 U.S.C. 450f et seq.).
    (b) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.

[[Page 116]]

    (c) Director means the Director, Indian Health Service, Health 
Services Administration, Public Health Service, Department of Health and 
Human Services (IHS) who is the official to whom the Secretary has 
delegated full responsibility and authority to implement and administer 
those aspects of the Act related to the health and well-being of the 
Indian people.
    (d) Area Director means the official in charge of an Indian Health 
Service Area, or Program Office.
    (e) Contracting Officer means the person executing the contract on 
behalf of the Government and any other officer or employee who is 
properly designated Contracting Officer; and the term includes, except 
as otherwise provided in the contract, the authorized representative of 
the Contracting Officer acting within the limits of his authority.
    (f) Indian means a person who is a member of an Indian tribe.
    (g) Indian Tribe means any Indian tribe, band, nation, rancheria, 
Pueblo, colony or community, including any Alaska Native village or 
regional or village corporation as defined in or established pursuant to 
the Alaska Native Claims Settlement Act (85 Stat. 688) which is 
recognized as eligible by the United States Government for the special 
programs and services provided by the United States to Indians because 
of their status as Indians.
    (h) Tribal organization means:
    (1) The recognized governing body of any Indian tribe; or
    (2) Any legally established organization of Indians which is:
    (i) Controlled, sanctioned or chartered by such governing body or 
bodies; or
    (ii) Democratically elected by the adult members of the Indian 
community to be served by such organization and which includes the 
maximum participation of Indians in all phases of its activities.
    (i) An Indian Owned Economic Enterprise means any commercial 
industrial, or business activity established or organized for the 
purpose of profit which is not less than 51 percent Indian owned.
    (j) An Indian Self-Determination Contract Proposal is the name of 
the document to be utilized by Indian Tribal organizations to forward to 
the Indian Health Service, their requests to enter into contracts for 
health programs or services.
    (k) Trust Resources means natural resources, land, water, minerals, 
funds, or property, asset, or claim, including any intangible right or 
interest in any of the foregoing, which is held by the United States in 
trust for any Indian tribe or any Indian individual or which is held by 
any Indian tribe or Indian individual subject to a restriction on 
alienation imposed by the United States.
    (l) Trust Responsibility means the responsibility assumed by the 
Government, by virtue of treaties, statutes and other means, legally 
associated with the role of trustee, to recognize, protect and preserve 
tribal sovereignty and to protect, manage, develop and approve 
authorized transfers of interests in trust resources held by Indian 
tribes and Indian individuals to a standard of the highest degree of 
fiduciary responsibility.
    (m) Retrocession is the voluntary return of a contracted program, or 
portion thereof, to the Indian Health Service pursuant to section 106(d) 
of the Act.
    (n) The Contract Proposal Declination Appeals Board (CPDAB) is a 
body established to review Indian Self-Determination Contract Proposals 
which have been disapproved.

                 Contract Proposals, Review, and Appeal



Sec. 36.205  Eligibility and application.

    (a) Any tribal organization upon the request of the Indian tribe to 
be served, is eligible to apply for a contract with the Secretary to 
carry out any or all of the functions, authorities and responsibilities 
of the Secretary under the Act of August 5, 1954.
    (b) All such contracts shall be based upon Indian Self-Determination 
Contract proposals which will be specific and, as a minimum, include the 
following:
    (1) Date submitted.
    (2) Full name and address of the Indian tribal organization 
submitting the proposal.

[[Page 117]]

    (3) Full name and tribe(s) which the tribal organization is 
affiliated with.
    (4) Narrative description of the functions, IHS programs, or 
portions thereof which the tribal organization wants to contract for.
    (5) Type of contract proposed (cost reimbursement, fixed price, 
etc.).
    (6) Proposed contract starting and completion dates.
    (7) Equipment and facilities needed to carry out the contract and 
how the tribal organization intends to obtain such.
    (8) Narrative indicating the tribal organization's knowledge of the 
program or function or portion thereof to be contracted for and the 
relation of such to the mission of the Indian Health Service. Where 
tribal organizations have already been involved in a contract for such 
programs, this narrative may be in the form of an updated version of the 
scope of work under that contract. In any case, the following items 
should be described in the narrative:
    (i) Experience and training of personnel performing under the 
contract;
    (ii) Familiarity with Federal Regulations and procedures involved;
    (iii) Experience in operating a similar or related tribal program;
    (iv) Extent of subcontracting contemplated and, where such 
information is available, identification of proposed subcontractors;
    (v) Identification of Federal employee transfers contemplated;
    (vi) Personnel system and key personnel;
    (vii) The work plan for carrying out the contract including the 
timetable for delivery of optimum services.
    (9) Evidence of community support for or lack of opposition to the 
contract.
    (10) Information concerning training to be given to personnel who 
will perform under the contract.
    (11) Estimate of the number of Indians to be served.
    (12) A budget, including separate cost estimates for salaries and 
wages, equipment, supplies, services, travel, subcontracts, other direct 
costs and overhead.
    (13) Justification and request for advance payments.
    (14) Names and telephone numbers of the tribal organization's 
business and technical personnel who may be contacted during the 
evaluation and negotiation process.
    (15) A description of the tribal organization including:
    (i) The legal and organizational relationship of the tribal 
organization to the Indians in the area to be served or effected by the 
contract.
    (ii) A description of the participation of Indians in all phases of 
the tribal organization.
    (iii) Whether the tribal organization is controlled, sanctioned or 
chartered by the governing body of Indians to be served, and, if so, 
evidence of such fact.
    (iv) And, if elected, a description of the election process, voting 
criteria, and extent of voter participation.
    (16) Evidence of adequate liability insurance coverage or an 
explanation of why such insurance cannot or should not be obtained. Such 
insurance shall provide that prior to cancellation the Secretary must be 
notified and must further provide that each such policy of insurance 
shall contain a provision that the insurance carrier shall waive any 
right it may have to raise as a defense the tribe's sovereign immunity 
from suit but such waiver shall extend only to claims the amount and 
nature of which are within the coverage and limits of the policy and 
shall not authorize or empower such insurance carrier to waive or 
otherwise limit the Tribe's sovereign immunity outside or beyond the 
coverage and limits of the policy of insurance.
    (17) The intended financial participation, if any, of the tribal 
organization or the tribes to be served specifying the type of 
contributions such as cash or services, loans of full or part-time 
staff, equipment, space, materials, or facilities, or other 
contributions.
    (18) Specifically include any requests for waivers to 41 CFR chapter 
1 and 3 in accordance with 36.216.
    (c) The Indian Self-Determination Contract Proposal shall be 
executed by a person or persons authorized to act on behalf of the 
tribal organization and shall be accompanied by evidence that such 
person or persons are authorized to bind the tribal organization.

[[Page 118]]

    (d) The Indian Self-Determination Contract Proposal should be 
addressed to the Area Director of the appropriate Indian Health Service 
Area. Such proposals should be submitted, in 5 copies, well in advance 
of the desired beginning of support.
    (e) Tribal organizations may obtain assistance in preparing Indian 
Self-Determination contract proposals from the IHS Area Offices. The 
Area Directors shall make any information available to the tribal 
organization which is needed in the preparation of its proposal except 
as may be exempt from disclosure by the Freedom of Information Act, 5 
U.S.C. 552(b) and the Department of Health and Human Services 
regulations thereunder, 45 CFR, part 5.



Sec. 36.206  Tribal clearances--initial contracts.

    (a) Before the IHS may enter into a contract with a tribal 
organization, it must be requested to do so by the tribe. The tribe's 
request shall be in the form of a resolution by the tribal governing 
body. If the tribal organization is applying for a contract to perform 
services benefiting more than one tribe, an authorizing resolution from 
each tribal governing body must be obtained before submitting the 
application to IHS for approval. A tribal governing body may pass a 
single resolution authorizing a tribal organization to apply for, 
negotiate, and execute more than one contract if the resolution 
specifies for each contract the same information required in paragraphs 
(b) and (c) of this section.
    (b) The resolution of the tribal governing body shall authorize the 
applicant tribal organization to apply for, negotiate and contract with 
the IHS subject to the specific terms, conditions and limitations of the 
resolution and applicable tribal laws, codes, and regulations and 
custom. The resolution shall include the date the resolution was 
approved, and signature of the person authorized to certify the accuracy 
of the information contained in the resolution.
    (c) The tribal governing body's request (resolution) should include 
the following:
    (1) When the tribal organization is the tribal governing body:
    (i) A brief statement of the contract scope.
    (ii) The tribal official authorized to negotiate the contract and 
any amendments thereto.
    (iii) The tribal official authorized to execute the contract and any 
amendments thereof.
    (iv) The expiration date of the authorities granted by the 
resolution.
    (v) The extent and procedure, if any, for review of the contract and 
any amendments thereto by the tribal governing body before execution.
    (vi) The proposed date for contract commencement.
    (vii) The proposed term of the contract.
    (2) When the tribal organization is other than the tribal governing 
body:
    (i) The name of the tribal organization.
    (ii) A brief statement of the contract scope.
    (iii) The extent and procedure, if any, for review by the tribal 
governing body of the contract and any amendments thereto prior to 
execution by the tribal organization.
    (iv) The tribal office or official to which the IHS should send 
copies of contract documents and correspondence.
    (v) The proposed term of the contract.
    (vi) The proposed date for contract commencement.
    (vii) Any limitations on authorities granted the tribal 
organization.
    (d) Any procedures specified in this section concerning the manner 
in which a tribal governing body passes a tribal resolution shall apply 
except where inconsistent with tribal constitution, law, code, 
ordinance, or custom. In such cases, the tribal law or procedures shall 
be cited in the resolution and shall take precedence.



Sec. 36.207  Tribal clearances--renewal contracts.

    The Secretary may renew a contract for the same function(s) or 
programs as

[[Page 119]]

the original contract at the written request of the tribal organization 
designated in the tribal resolution. Requests for contract renewals 
shall be made as follows:
    (a) If the original contract provided services to only one Indian 
tribe, written applications for renewal shall be sent by the tribal 
organization to the Area Office as follows:
    (1) Directly, when the tribal organization involved is the governing 
body of the tribe.
    (2) Through the governing body of the tribe for review when the 
tribal organization is not the governing body of the tribe. Submission 
shall be made to the governing body at least 75 calendar days before the 
original contract expires. The tribal organization shall promptly notify 
the IHS Area Office in writing of the date the tribal governing body 
received the application. If, within 45 calendar days after receiving 
the application, the tribal governing body does not provide the IHS Area 
Director with a formal resolution objecting to the application for 
renewal, the absence of receipt of such a resolution shall constitute 
the tribe's request for renewal of the contract.
    (b) If the original contract provided services to more than one 
Indian tribe, the tribal organization must give a copy of the written 
application for renewal to each tribal governing body at least 75 
calendar days before the original contract expires. The tribal 
organization shall promptly notify the IHS Area Office where the 
application is to be submitted in writing, of the date the tribal 
governing bodies received copies of the application. If, within 45 
calendar days after receiving copies of the application none of the 
tribal governing bodies provide the appropriate IHS Area Office with a 
formal resolution objecting to the application for renewal, the absence 
of receipt of such resolutions shall constitute the tribes' request for 
renewal of the contract. If one or more of the tribal governing bodies 
involved object to the renewal, the contract will not be made until all 
the tribal governing bodies have approved the request or the matter is 
otherwise resolved.



Sec. 36.208  Evaluation criteria.

    (a) Indian Self-Determination Contract Proposals will be evaluated 
to determine:
    (1) If the service to be rendered to Indian people by the proposed 
contract will be satisfactory;
    (2) If the proposed contract will assure that trust resources are 
protected; and
    (3) If the proposed contract will ensure proper completion and 
maintenance of the project or function involved. Failure to meet any of 
the above, may be cause for declination of the Indian Self-Determination 
Contract Proposal. However, the burden of proof to show cause for 
declination lies with the approving official.
    (b) To determine if an Indian Self-Determination Contract Proposal 
meets the above criteria, the Area Director and his staff will consider 
whether the tribal organization would be deficient in performance under 
the contract with respect to the factors listed in this paragraph.
    (1) Equipment, buildings and facilities. No higher standards with 
regard to buildings, facilities, or equipment shall be applied to tribal 
organizations than have previously been applied to IHS. The Indian 
Health Service shall make available the use of all equipment which has 
been allocated to the operation of the program by the IHS in the past, 
unless the IHS determines that the provision of such equipment will 
seriously interfere with the IHS's ability to provide services to Indian 
people in noncontracted programs. Where equipment is shared by the 
programs to be contracted and other non-contracted programs, equipment-
sharing or other suitable arrangements will be reflected in the 
contract.
    (2) Bookkeeping and accounting procedures. It must be clearly 
established by the Indian Health Service that the tribal organization 
which will undertake the contract does have an adequate accounting and 
bookkeeping system. IHS may assist the contractor in establishing an 
acceptable bookkeeping and accounting system.
    (3) Substantive knowledge of the program to be contracted. The 
tribal organization shall be presumed to have substantive knowledge of 
the program to

[[Page 120]]

be contracted if it meets one or more of the following conditions:
    (i) The tribal organization has successfully managed a similar 
program before through grant or contract for which standards have been 
established.
    (ii) The members of the tribal organization have been consumers of 
such services in the past and have developed an understanding of the 
program sufficient to enable the tribal organization to effectively 
carry out the contract operation.
    (iii) The tribal organization has made arrangements to obtain and to 
develop its knowledge of the program.
    (4) Community support. Before the IHS can enter into a contract 
there must be a request made in accordance with Sec. 36.206. The tribal 
governing body's resolution under Sec. 36.206 shall be presumed to 
demonstrate that there is community support for the proposed contract. 
Any assertion of a lack of community support by persons to be served 
under the contract, is subject to exhaustion of tribal remedies by those 
making such assertions.
    (5) Adequacy of trained personnel. The adequacy of trained personnel 
available to the tribal organization to carry out the proposed contract 
will be presumed if any of the following conditions exists:
    (i) If the tribal organization has a personnel system that 
prescribes minimum occupational qualification standards, which shall be 
not less than minimum Civil Service standards where applicable and 
procedures for the selection of personnel on the basis of such 
qualifications, and the personnel to be used under the proposed contract 
are to be employed under the personnel system.
    (ii) If there is no tribal personnel system, it will be assumed that 
the personnel to be employed under the proposed contract are adequately 
trained if the tribal organization has established position descriptions 
for key personnel to be employed under the contract and will establish 
within a reasonable time a personnel system similar to the one described 
in paragraph (c)(5)(i) of this section.
    (6) Other necessary components of contract performance. (i) The 
contractor's proposal must demonstrate the capacity to meet minimum 
health program and professional standards established by IHS for each 
major health service activity of the IHS. The Director will establish 
and make available to any prospective contractor the minimum standards 
for each major health service activity of the Indian Health Service. In 
evaluating the contractor's proposal, the IHS will take into account the 
prevailing health program and professional standards of IHS for the 
health service activity in the location concerned.
    (ii) The contractor's proposal will be evaluated to determine the 
contractor's ability to meet the Uniform Administrative Standards 
published as a Notice of Proposed Rulemaking in February 10, 1975, 40 FR 
6304.
    (iii) The ability of the contractor to carry out the contract in 
accordance with IHS policy, the applicable regulations of this part, and 
the Act.
    (iv) No other components shall be prescribed as a basis for 
declination unless such components are added to the regulations in this 
subpart by revision or amendment of regulations.
    (7) IHS officials may not decline to enter into a contract with a 
tribal organization because of any objection that would be overcome 
through the contract.



Sec. 36.209  Government property.

    (a) In carrying out a contract made under this part, the Director 
will wherever possible, permit a tribal contractor to use buildings, 
facilities, and related equipment and other personal property owned by 
the IHS within his jurisdiction. Arrangements on the use of IHS property 
shall be provided for in the contract or other agreement as appropriate. 
In determining whether real or personal property can be provided, he 
shall determine whether the IHS can provide comparable services for any 
of the uncontracted part of the program.
    (b) Requests for the use of IHS property which arise after signing 
of the contract shall be submitted to the relevant IHS official by the 
tribal organization. Such requests should be granted unless such a use 
would seriously interfere with the administration of existing IHS 
programs. The property

[[Page 121]]

must conform to the minimum standards established pursuant to the 
Occupational Safety and Health Act of 1970 (29 U.S.C. 651).



Sec. 36.210  Submitting contract proposals.

    (a) When services under the proposed contract will be provided to 
one or more tribes within the jurisdiction of a single Area Office, the 
completed contract proposal with documentation of the tribal request(s) 
and approvals of each such tribe effected shall be delivered or mailed 
to the Area Director of that Area Office.
    (b) When services will be provided to tribes within the jurisdiction 
of more than one IHS Area Office, a copy of such proposals and 
documentation shall be forwarded to each of the Area Offices affected.



Sec. 36.211  Contract proposal approval officials.

    The Director or his delegate is authorized to approve proposals for 
contract under this subpart.



Sec. 36.212  Review.

    Upon receiving a contract application, Indian Health Service will:
    (a) Notify the tribal organization in writing that the proposal has 
been received. This notice will be made within five (5) calendar days 
after receipt of the proposal.
    (b) Review the proposal for completeness and promptly request 
additional information from the tribal organization or from the 
requesting tribe which will be needed to reach a decision.
    (c) Notify Area Office subordinate activities serving the tribe(s) 
which will receive services under the contract and obtain any needed 
information and/or relevant recommendations on the contract.
    (d) Assess the contract proposal to determine if it is feasible and 
if it complies with the appropriate requirements of the Act and of the 
regulations in this subpart.
    (e) Meet with representatives of the tribal governing body and 
contract applicant to resolve any declination issues.
    (f) Whenever declination issues cannot be resolved as in paragraph 
(e) of this section, notify the tribal organization of deficiencies in 
the proposal and provide to the extent practicable technical assistance, 
as requested, to overcome such deficiencies.
    (g) Approve or disapprove the proposal after fully reviewing and 
assessing it and any additional information submitted by the tribal 
organization provided, however, that no action to disapprove shall be 
taken during the period of provision of technical assistance.
    (h) Promptly notify the tribal organization in writing of the 
decision to approve or disapprove the proposal. If the proposal is 
disapproved, the notice shall contain but need not be limited to the 
following:
    (i) Specific objections, which are based on failures to meet 
applicable program or administrative standards or fund restrictions, 
which preclude acceptance of the Indian Self-Determination Contract 
Proposal;
    (ii) Guidance to the tribe regarding the steps which need to be 
taken to overcome the stated objections;
    (iii) Identification of assistance which can practicably be made 
available to the tribe upon request to overcome the stated objections;
    (iv) Notification to the tribal organization of its right to appeal 
and to request an informal or formal hearing in accordance with 
Sec. 36.214 of this subpart.



Sec. 36.213  Processing time.

    The approving official will approve or disapprove a contract 
proposal within sixty (60) calendar days after receipt. The sixty (60) 
calendar day deadline may be extended only after obtaining the written 
consent of the tribal organization.



Sec. 36.214  Tribal appeals to proposal declinations.

    (a) On being advised that an Indian Self-Determination Contract 
Proposal has been disapproved by the appropriate approving official, and 
having been informed of the basis of such decision, the tribal 
organization may file a written appeal to the Contract Proposal 
Declination Appeals Board within thirty (30) days after receipt of the 
Declination Notice and may request an

[[Page 122]]

informal or formal hearing. The written appeal should either refute or 
overcome the objections stated as a basis for disapproval. The Contract 
Proposal Declination Appeals Board shall consider such an appeal, 
conduct any requested hearing thereon, and recommend a decision to the 
Director, Indian Health Service, or his representative whose decision 
shall be final.
    (b)(1) The tribal organization and the Indian tribe or tribes 
affected shall be notified, in writing, of the date, time, place, and 
purpose of the hearing. The hearing will be conducted within 30 calendar 
days of written request for a hearing or at such later time as may be 
agreed upon. The IHS will authorize payment of transportation costs and 
per diem to allow adequate representation of the applicant, if the 
meeting is more than 50 miles from the office of the applicant.
    (2) The hearing may be held under such rules as may be agreed upon.
    (c) If formal hearing is requested, it will be conducted within 
thirty (30) calendar days from receipt of the written request for a 
hearing or at such later time as may be agreed upon, and the notice of 
hearing shall specify in writing the date, time, place, and purpose of 
the hearing and shall afford the tribe or tribal organization the right:
    (1) To written notice of the issues to be considered;
    (2) To be represented by counsel;
    (3) To written record of the hearing;
    (4) To present and cross-examine witnesses;
    (5) To file written statements prior to the hearing;
    (6) To compel the appearance of Indian Health Service personnel or 
to take depositions of such persons at reasonable times and places.
    (d) The decision of the Director, IHS, or his representative on the 
appeals will be rendered within 15 calendar days from the date of 
receipt by the Director of the IHS of the Board's recommendation.
    (e) The Contract Proposal Declination Appeals Board shall be 
composed of 5 members appointed by the Director, Indian Health Service, 
one of whom shall be designated to serve as Chairman.

                               Procurement



Sec. 36.215  Applicability of regulations.

    Contracts with tribal organizations resulting from the submission of 
Indian Self-Determination Contract Proposals as authorized in Pub. L. 
93-638 shall be in accordance with chapters 1 and 3 of 41 CFR.



Sec. 36.216  Waivers.

    (a) The Secretary may, for good cause shown, waive for the purposes 
of a specific contract any federal contracting laws and regulations 
which he determines are not appropriate for the purposes of the contract 
involved or are inconsistent with the Act.
    (b) Requests for waivers may be initiated by tribal organizations or 
IHS contracting officers. Such requests will be forwarded to the 
Director, IHS for decision or further processing to the Secretary as 
required.
    (c) A waiver request shall set forth clearly and precisely the 
following:
    (1) The nature and basis of the needed waiver;
    (2) Identification of the procurement regulation provision from 
which the waiver is needed;
    (3) The circumstances under which the waiver would be used;
    (4) The intended effect of the waiver;
    (5) The length of time for which it can be anticipated that the 
waiver will be required;
    (6) Reasons which will contribute to complete understanding and 
support of the requested waiver;
    (7) Copies of pertinent background papers such as forms, contractor 
requests, etc.
    (d) Whenever a waiver is requested by a tribal organization and such 
request is denied, the tribal organization will be notified of the 
reasons for denial.



Sec. 36.217  Fair and equal treatment of Indian people.

    Contracts awarded to tribal organizations pursuant to the Indian 
Self-Determination Act shall incorporate the following clause:

    The Contractor agrees, consistent with medical need, to make no 
discriminatory distinctions among Indian patients or beneficiaries of 
this contract. For the purpose of

[[Page 123]]

this contract discriminatory distinctions include but are not limited to 
the following:
    (a) Denying a patient any service or benefit or availability of a 
facility;
    (b) Providing any service or benefit to a patient which is 
different, or is provided in a different manner or at a different time 
from that provided to other patients under this contract; subjecting a 
patient to segregation or separate treatment in any manner related to 
his receipt of any service; restricting a patient in any way in the 
enjoyment of any advantage or privilege enjoyed by others receiving any 
service benefit; treating a patient differently from others in 
determining whether he satisfies any admission, enrollment, quota, 
eligibility membership, or other requirements or condition which 
individuals must meet in order to be provided any service or benefit; 
the assignment of times or places for the provision of services on the 
basis of discriminatory distinctions which may be made of the patients 
to be served.



Sec. 36.218  Types of contracts.

    Cost-reimbursement type contracts provide for payment to the 
contractor of allowable costs incurred in the performance of the 
contract, to the extent prescribed in the contract: This type of 
contract establishes an estimate of total cost for the purpose of 
obligation of funds, and a monetary ceiling which the contractor may not 
exceed. Except as provided below, cost reimbursement contracts will be 
used for all contracts made pursuant to this subpart. A negotiated cost 
reimbursement contract shall contain the terms set out in Sec. 3-4.6013 
of 41 CFR.
    (a) Fixed-price contracts may be used in those instances where costs 
can be precisely established. A negotiated fixed-price contract shall 
contain the terms set out in Sec. 3-4.6014 of 41 CFR.
    (b) Cost sharing contracts may be used where the tribe contributes 
to the cost of a program and may specify a percentage of cost or fixed 
amount to be funded by the government.



Sec. 36.219  Term of contract.

    (a) The term of contracts awarded under the Acts shall normally be 
for one year except that contracts may be made for a longer term up to 
three years subject to the availability of appropriations under the 
following circumstances:
    (1) The services provided under the contract can reasonably be 
expected to be continuing in nature and, as a result, a longer contract 
term would be advantageous.
    (2) The Indian tribe or tribes to be served by the contract request 
that the term be more than one year. The tribal organization will 
indicate the desired term of the contract in the Self-Determination 
Contract Proposal.
    (b) Contracts made for a term of more than one year may be 
renegotiated annually to reflect factors which include, but need not be 
limited to, cost increases beyond the control of the tribal contractor. 
Proposed changes in the services provided under the contract which 
reflect changes in program emphasis may be considered during the annual 
renegotiation if the changes fall within the general scope of the 
contract.



Sec. 36.220  Use of Indian business concerns.

    Contracts awarded under authority of the Act shall incorporate the 
following clause, which is also set forth in 41 CFR 3-4.6013 and 3-
4.6014.

    (a) As used in this clause, the term ``Indian business concern'' 
means Indian organizations or an Indian-owned economic enterprise as 
defined in 42 CFR 36.204(i).
    (b) The contractor agrees to give preference to qualified Indian 
business concerns in the awarding of any subcontracts entered into under 
the contract consistent with the efficient performance of the contract. 
The contractor shall comply with any preference requirements regarding 
Indian business concerns established by the tribe(s) receiving services 
under the contract to the extent that such requirements are consistent 
with the purpose and intent of this paragraph.
    (c) If no Indian business concerns are available under the 
conditions in paragraph (b) above, the contractor agrees to accomplish 
the maximum amount of subcontracting, as the contractor determines is 
consistent with its efficient performance of the contract, with small 
business concerns, labor surplus area concerns or minority business 
enterprises, the definitions for which are contained in subparts 1-1.7, 
1-1.8, and 1-1.13 of the Federal Procurement Regulations. The contractor 
is not, however, required to establish a small business, labor surplus, 
or minority business subcontracting program as described in Secs. 1-
1.710-3(b), 1-1.805-3(b) and 1-1.1310-2(b), respectively of the Federal 
Procurement Regulations (41 CFR 1).

[[Page 124]]



Sec. 36.221  Indian preference in training and employment.

    Contracts awarded under authority of the Act shall incorporate the 
following clause, which is also set forth in 41 CFR 3-4.6013 and 3-
4.6014.

              Indian Preference in Training and Employment

    (a) The contractor shall give preference in employment for all work 
performed under the contract, including subcontracts thereunder, to 
qualified Indians regardless of age, religion or sex and, to the extent 
feasible consistent with the efficient performance of the contract, 
provide employment and training opportunities to Indians, regardless of 
age, religion or sex that are not fully qualified to perform under the 
contract. The contractor shall comply with any Indian preference 
requirements established by the tribe receiving services under the 
contract to the extent that such requirements are consistent with the 
purpose and intent of this paragraph.
    (b) If the contractor or any of its subcontractors is unable to fill 
its employment openings after giving full consideration to Indians as 
required in paragraph (a) above, these employment openings may then be 
filled by other than Indians under the conditions set forth in the Equal 
Opportunity clause of this contract.
    (c) The contractor agrees to include this clause or one similar 
thereto in all subcontracts issued under the contract.



Sec. 36.222  Indemnity and insurance.

    Contracts awarded under authority of the Act shall incorporate the 
following clause, which is also set forth in 41 CFR 3-4.6013 and 3-
4.6014.
    (a) The Contractor shall indemnify and save and keep harmless the 
Government against any or all loss, cost, damage, claim, expense or 
liability whatsoever, because of accident or injury to persons or 
property or others occurring in connection with any program included as 
a part of this contract, by providing where applicable, the insurance 
described below.
    (b) The Contractor shall secure, pay the premium for, and keep in 
force until the expiration of this contract, or any renewal period 
thereof, insurance as provided below. Such insurance policies shall 
specifically include a provision stating the liability assumed by the 
Contractor under this contract.
    (1) Workmen's compensation insurance as required by laws of the 
State.
    (2) Owner's, landlord's and tenant's bodily injury liability 
insurance with limits of not less than $50,000 for each person and 
$500,000 for each accident.
    (3) Property damage liability insurance with limits not less than 
$25,000 for each accident.
    (4) Automobile bodily injury liability insurance with limits of not 
less than $50,000 for each person, and $500,000 for each accident and 
property damage liability insurance with a limit of not less than $5,000 
for each accident.
    (5) Food products liability insurance with limits of not less than 
$50,000 for each person and $500,000 for each accident.
    (6) Professional malpractice insurance where medical, dental or 
other health professional services are involved.
    (7) Other liability insurance not specifically mentioned when 
required.
    (c) Each policy of insurance shall contain an endorsement providing 
that cancellation by the insurance company shall not be effective unless 
a copy of the cancellation is mailed (registered) to the Contracting 
Officer 30 days prior to the effective date of cancellation.
    (d) A certificate of each policy of insurance, and any change 
therein, shall be furnished to the Contracting Officer immediately upon 
receipt from the insurance company.
    (e) Insurance companies of the Contractor shall be satisfactory to 
the Contracting Officer. When in his opinion an insurance company is not 
satisfactory for reasons that will be stated, the Contractor shall 
provide insurance through companies that are satisfactory to the 
Contracting Officer.
    (f) Each policy of insurance shall contain a provision that the 
insurance carrier waives any rights it may have to raise as a defense 
the tribe's sovereign immunity from suit, but such waiver shall extend 
only to claims the amount and nature of which are within the coverage 
and limits of the policy of insurance. The policy shall contain no 
provision, either expressed or implied, that will serve to authorize or 
empower

[[Page 125]]

the insurance carrier to waive or otherwise limit the tribe's sovereign 
immunity outside or beyond the coverage and limits of the policy of 
insurance.



Sec. 36.223  Exemption from bonds.

    A tribal organization is not required to furnish performance and 
payment bonds before carrying out a contract under this part for the 
construction of public buildings or works as required by the Miller Act 
of August 24, 1935 (49 Stat. 793), as amended. However, the tribal 
organization shall require each of its subcontractors, other than tribal 
organizations, to furnish both performance and payment bonds as follows:
    (a) A performance bond with a surety or sureties satisfactory to the 
approving official, and in an amount he deems adequate, for the 
protection of the United States.
    (b) A payment bond with a surety or sureties satisfactory to the 
approving official for the protection of all persons supplying labor and 
material in carrying out the contract the use of each person. Whenever 
the total amount payable by the terms of the contract is not more than 
$1,000,000 the payment bond shall be one-half the total amount payable 
by the terms of the contract. Whenever the total amount payable by the 
terms of the contract is more than $1,000,000 but not more than 
$5,000,000, the payment bond shall be 40 percent of the total amount 
payable by the terms of the contract. Whenever the total amount payable 
by the terms of the contract is more than $5,000,000 the payment bond 
shall be $2,500,000.



Sec. 36.224  Construction and architect-engineering contracts.

    The special provisions, procedures, and requirements applicable to 
construction and architect-engineering service contracts are set forth 
in Sec. 3-4.6008 of 41 CFR.



Sec. 36.225  Performance of personal services.

    Any contract made under this subpart may include provisions for the 
performance of personal services which would otherwise be performed by 
Federal employees. Such services include, but are not limited to, 
performing the following functions in connection with the contract and 
applicable rules and regulations:
    (a) Determining the eligibility of applicants for assistance, 
benefits, or services.
    (b) Determining the extent or amount of assistance, benefits, or 
services to be provided.
    (c) Providing such assistance, benefits, or services.



Sec. 36.226  Advance payments.

    Contracts awarded under the authority of the Act shall incorporate 
the following clause, which is also set forth in 41 CFR 3-4.6013 and 3-
4.6014.
    (a) Amount of advance. At the request of the contractor, and subject 
to the conditions hereinafter set forth, the Government shall make an 
advance payment, or advance payments from time to time, to the 
Contractor. No advance payment shall be made (1) without the approval of 
the officer administering advance payments (hereinafter called the 
``Administering Office'' and designated in paragraph (k)(4) hereof) to 
the financial necessity therefore; (2) in an amount which together, as 
with all advance payments theretofore made, shall exceed the amount 
stated in paragraph (k)(1) of this section; and (3) without a properly 
certified invoice or invoices.
    (b) Special Bank Account. Until all advance payments made hereunder 
are liquidated and the Administering Office approves in writing the 
release of any funds due and payable to the Contractor, all advance 
payments and all other payments under the contract shall be made by 
check payable to the Contractor, and be marked for deposit only in a 
Special Bank Account with the bank designated in paragraph (k)(2) of 
this section. No part of the funds in the Special Bank Account shall be 
mingled with other funds of the contractor prior to withdrawal thereof 
from the Special Bank Account as hereinafter provided. Except as 
hereinafter provided, each withdrawal shall be made only by check of the 
Contractor countersigned on behalf of the Government by the Contracting 
Officer or such other person or persons as he may designate in writing 
(hereinafter called the ``Countersigning Agent''). Until

[[Page 126]]

otherwise determined by the Administering Office, countersignature on 
behalf of the Government will not be required.
    (c) Use of funds. The funds in the Special Bank Account may be 
withdrawn by the Contractor solely for the purposes of making payments 
for items of allowable cost or to reimburse the Contractor for such 
items of allowable cost, and for such other purposes as the 
Administering Office may approve in writing. Any interpretation required 
as to the proper use of funds shall be made in writing by the 
Administering Office.
    (d) Return of funds. The Contractor may at any time repay all or any 
part of the funds advanced hereunder. Whenever so requested in writing 
by the Administering Office, the Contractor shall repay to the 
Government such part of the unliquidated balance of advance payments as 
shall in the opinion of the Administering Office be in excess of current 
requirements, or (when added to total advance previously made and 
liquidated) in excess of the amount specified in paragraph (k)(1) of 
this section. In the event the Contractor fails to repay such part of 
the unliquidated balance of advance payments when so requested by the 
Administering Office, all or any part thereof may be withdrawn from the 
Special Bank Account by checks payable to the Treasurer of the United 
States signed solely by the Countersigning Agent and applied in 
reduction of advance payments then outstanding hereunder.
    (e) Liquidation. If not otherwise liquidated, the advance payments 
made hereunder shall be liquidated as herein provided. When the sum of 
all payments under this contract, other than advance payments, plus the 
unliquidated amount of advance payments are equal to the total estimated 
cost for the work under this contract or such lesser amount to which the 
total estimated cost under this contract may have been reduced, plus 
increases, if any, in this total estimated cost not exceeding, in the 
aggregate (including, without limitation, reimbursable costs incident to 
termination for cause and retrocession as estimated by the Contracting 
Officer), the Government shall thereafter withhold further payments to 
the Contractor and apply the amounts withheld against the Contractor's 
obligation to repay such advance payments until such advance payments 
shall have been fully liquidated. If upon completion, termination, or 
retrocession of the contract all advance payments have not been fully 
liquidated, the balances therefore shall be deducted from any sums 
otherwise due or which may become due to the Contractor from the 
Government, and any deficiency shall be paid by the Contractor to the 
Government upon demand.
    (f) Bank Agreement. Before an advance payment is made hereunder, the 
Contractor shall transmit to the Administering Office, in the form 
prescribed by such office, an Agreement in triplicate from the bank in 
which the Special Bank Account is established, clearly setting forth the 
special character of the account and the responsibilities of the bank 
thereunder. Wherever possible, such bank shall be a member bank of the 
Federal Reserve System, or an ``insured'' bank within the meaning of the 
Act creating the Federal Deposit Insurance Corporation Act of August 23, 
1935, 49 Stat. 685, as amended (12 U.S.C. 264).
    (g) Lien on Special Bank Account. The Government shall have a lien 
upon any balance in the Special Bank Account paramount to all other 
liens, which lien shall secure the repayment of any advance payments 
made hereunder.
    (h) Lien on property under contract. Any and all advance payments 
made under this contract shall be secured, when made, by a lien in favor 
of the Government, paramount to all other liens, upon the supplies or 
other things covered by this contract and on all material and other 
property acquired for or allocated to the performance of this contract, 
except to the extent that the Government by virtue of any other 
provision of this contract, or otherwise, shall have valid title to such 
supplies, materials, or other property as against other creditors of the 
Contractor. The Contractor shall identify, by marking or segregation, 
all property which is subject to a lien in favor of the Government by 
virtue of any provision of this contract in such a way as to indicate

[[Page 127]]

that it is subject to such lien and that it has been acquired for or 
allocated to the performance of this contract. If for any reason such 
supplies, materials, or other property are not identified by marking or 
segregation, the Government shall be deemed to have a lien to the extent 
of the Government's interest under this contract on any mass of property 
with which such supplies, materials, or other property are commingled. 
The Contractor shall maintain adequate accounting control over such 
property on his books and records. If at time during the progress of the 
work on the contract it becomes necessary to deliver any item or items 
and materials upon which the Government has a lien as aforesaid to a 
third person, the Contractor shall notify such third person of the lien 
herein provided and shall obtain from such third person a receipt, in 
duplicate, acknowledging, inter alia the existence of such lien. A copy 
of each receipt shall be delivered by the Contractor to the Contracting 
Officer. If this contract is terminated in whole or in part and the 
Contractor is authorized to sell or retain termination inventory 
acquired for or allocated to this contract, such sale or retention shall 
be made only if approved by the Contracting Officer, which approval 
shall constitute a release of the Government's lien hereunder to the 
extent that such termination inventory is sold or retained, and to the 
extent that the proceeds of the sale, or the credit allowed for such 
retention on the Contractor's termination claim, is applied in reduction 
of advance payments then outstanding hereunder.
    (i) Insurance. The Contractor represents and warrants that he is now 
maintaining with responsible insurance carriers, (1) insurance upon his 
own plant and equipment against fire and other hazards to the extent 
that like properties are usually insured by others operating plants and 
properties of similar character in the same general locality; (2) 
adequate insurance against liability on account of damage to persons or 
property; and (3) adequate insurance under all applicable workmen's 
compensation laws. The Contractor agrees that, until work under this 
contract has been completed and all advance payments made hereunder have 
been liquidated, he will (i) maintain such insurance; (ii) maintain 
adequate insurance upon any materials, parts, assemblies, subassemblies, 
supplies, equipment and other property acquired for or allocable to this 
contract and subject to the Government lien hereunder; and (iii) furnish 
such certificates with respect to his insurance as the Administering 
Office may from time to time require.
    (j) Prohibition against assignment. Notwithstanding any other 
provision of this contract, the Contractor shall not transfer, pledge, 
or otherwise assign this contract, or any interest therein, or any claim 
arising thereunder, to any party or parties, bank, trust company, or 
other financing institution.
    (k) Designations and determinations--(1) Amount. The amount of 
advance payments at any time outstanding hereunder shall not exceed $--
----.
    (2) Depository. The bank designated for the deposit of payments made 
hereunder shall be:
    (3) Interest charge. No interest shall be charged for advance 
payments made hereunder. The Contractor shall charge interest at the 
rate of 6 percent per annum on subadvances or down payments to 
subcontractors, and such interest will be credited to the account of the 
Government. However, interest need not be charged on subadvances on 
nonprofit subcontracts with nonprofit educational or research 
institutions for experimental, research or development work.
    (4) Administering Office. The office administering advance payments 
shall be the office designated as having responsibility for awarding the 
contract.
    (l) Other security. The terms of this contract shall be considered 
adequate security for advance payments hereunder, except that if at any 
time the administering Office deems the security furnished by the 
Contractor to be inadequate, the Contractor shall furnish such 
additional security as may be satisfactory to the Administering Office, 
to the extent that such additional security is available.

[40 FR 53147, Nov. 14, 1975; 44 FR 69933, Dec. 5, 1979]

[[Page 128]]



Sec. 36.227  Recordkeeping, reporting and audit.

    (a) The standard clauses regarding ``Accounts, Audit, and Records'' 
and ``Examination of Records'' as set forth in 41 CFR 3-4.60 apply to 
contracts awarded under the Act. Further, Recordkeeping will be in 
accordance with uniform Administrative Standards.
    (b) In addition, where Federal financial assistance is involved in 
the contract effort, the following clause, which is also set forth in 41 
CFR 3-4.60, will be incorporated as a special provision of such 
contracts:

                      Reports to the Indian People

    The contractor, as a recipient of Federal financial assistance, 
shall make reports and information available to the Indian people served 
or represented by the contractor. Such reports will reflect how the 
Federal assistance funds were utilized to the benefit of the Indian 
people served or represented as follows: (insert specific reporting 
requirements formats and method of distribution to the Indian people as 
may be prescribed in the scope of the contract and the Uniform 
Administrative Standards).

    (c) Annual reporting. (1) For each fiscal year during which a tribal 
organization receives or expends funds pursuant to a contract under this 
subpart, the tribe which requested the contract must submit a report to 
the Area Director. The report shall include, but need not be limited to, 
an accounting of the amounts and purposes for which the contract funds 
were expended and information on the conduct of the program or services 
involved. The report shall include any other information requested by 
the Area Director and shall be submitted as follows:
    (i) When the contract is with the governing body of an Indian tribe, 
the tribe shall submit the report to the Area Director.
    (ii) When the contract is with a tribal organization other than the 
governing body of the tribe, the tribe has the option of having the 
tribal organization prepare the report and submit it to the tribe for 
review and approval before the tribe submits it to the Area Director.
    (iii) When the contract benefits more than one tribe, the tribal 
organization shall prepare and submit the report to each of the tribes 
benefiting under the contract. Each tribe shall endorse the report 
before submitting it to the Area Director.
    (2) The annual report shall be submitted to the Area Director within 
60 days of the end of the fiscal year in which the contract was 
performed. However, the period for submitting the report may be extended 
if there is just cause for such extension.
    (3) In addition to the yearly reporting requirement given in 
paragraphs (a) and (b) of this section, the tribal contractor shall 
furnish other reports required by the Secretary.



Sec. 36.228  Availability of information.

    (a) Except as otherwise provided herein and so long as the release 
of information does not constitute an unwarranted invasion of personal 
privacy, a tribal contractor under this subpart shall make all reports 
and information concerning the contract available to the Indian people 
served or represented by the contractor.
    (b) A contractor shall hold confidential all information obtained by 
personnel under the contract from persons receiving services under the 
contract related to their examination, care, and treatment, and shall 
not release such information without the individual's consent except as 
may be required by law, as may be necessary to provide service to the 
individual, or as may be necessary to monitor the operations of the 
program or otherwise protect the Public Health. Information may be 
disclosed in a form which does not identify particular individuals.



Sec. 36.229  Penalties.

    Section 6 of Pub. L. 93-638, 25 U.S.C. 450(d) provides:

    Whoever, being an officer, director, agent, or employee of, or 
connected in any capacity with, any recipient of a contract or 
subcontract pursuant to this Act or the Act of April 16, 1934 (48 Stat. 
596), as amended, embezzles, willfully misapplies, steals, or obtains by 
fraud any of the money, funds, assets, or property which are the subject 
of such a contract, or subcontract, shall be fined not more than $10,000 
or imprisoned for not more than two years, or both, but if the amount so 
embezzled, willfully misapplied, stolen, or by fraud does not exceed 
$100, he shall be fined not more than $1,000 or imprisoned not more than 
one year, or both.

[[Page 129]]



Sec. 36.230  Contract revisions or amendments.

    (a) Any contract made under this subpart may be revised or amended 
as deemed necessary to carry out the purposes of the program, project, 
or function being contracted. Those changes initiated by the Government 
shall be subject to the applicable contract Change Clauses prescribed in 
41 CFR 3-4.6013 and 3-4.6014.
    (b) However, a tribal contractor may make a written request for a 
revision or amendment of a contract to the Contracting Officer. Such 
requests will be treated in the same manner as initial Self-
Determination Proposals and evaluated in accordance with the criteria 
specified in Sec. 36.208 of this subpart. If the contracting officer 
declines revision or amendment of the contract as requested, he shall 
notify the tribal organization in writing within 30 days after receiving 
the request. Thereafter, an appeal to the Contracting Officer's 
declination to amend the contract will follow the same processing and 
procedures outlined in Sec. 36.214 of this subpart.



Sec. 36.231  Retrocession of contract programs.

    (a) Whenever an Indian tribe requests retrocession for any contract 
or portion thereof entered into under this Subpart, retrocession shall 
be in accordance with the clause titled ``Retrocession'' as set forth in 
41 CFR 3-4.6013 and 3-4.6014, and shall be effective upon a date 
specified by the Contracting Officer but no later than 120 days after 
the date of the request from the tribe, except when the tribe and the 
Contracting Officer mutually agree on a later date.
    (b) Immediately after a request for retrocession, representatives of 
the tribe and the Contracting Officer shall meet and take the following 
actions:
    (1) Mutually agree on a plan for orderly transfer of 
responsibilities.
    (2) Mutually agree on a plan for inventorying materials and supplies 
on hand.
    (3) Establish an accounting of funds, current and anticipated 
obligations, and costs of operation until the retrocession date.
    (4) Identify all records relating to the contract and to the 
contracted function.
    (c) On the date of retrocession, the tribal contractor will deliver 
to the Contracting Officer all property, materials, supplies and records 
of whatever nature which have been identified as necessary for the 
continuation of the program, project or function.
    (d) Within 30 calendar days after retrocession, the tribe will 
furnish the Contracting Officer with a report including but not limited 
to an accounting of the amounts and purposes for which Federal funds 
were expended, a description and evaluation of program accomplishments, 
and reasons why retrocession was requested.
    (e) Retrocession of a contract by an Indian tribe shall be without 
prejudice to:
    (1) Any other contract to which it is a party.
    (2) Any other contracts it may request.
    (3) Any future request to contract for the programs or services 
covered by the retroceded contract.
    (f) Tribal assumption of retroceded contracts. Whenever an Indian 
tribe chooses to retrocede a contract operated by a tribal organization 
other than the tribal governing body, the tribal governing body may 
request to contract for the program. In such a case, the tribal 
governing body shall submit a contract proposal pursuant to this 
subpart.



Sec. 36.232  Contractor assistance.

    To the extent practicable, the Director, Indian Health Service, 
shall, at the request of a tribal organization, provide technical 
assistance to the contractor in attempting to resolve problems or 
deficiencies in the performance of the contract and to assist the 
contractor in taking such corrective action as may be prescribed 
pursuant to Sec. 36.233(a).



Sec. 36.233  Assumption and reassumption of contract programs.

    (a) When the Director or his delegate determines that the 
performance of a contractor under these regulations involves (1) the 
violation of the rights or endangerment of the health, safety, or

[[Page 130]]

welfare or any persons, or (2) gross negligence or the mismanagement in 
the handling or use of funds under the contract, he will, in writing, 
notify the contractor of such determination and will request that the 
contractor take such corrective action within such period of time as the 
Director or his delegate may prescribe.
    (b) When the Director or his delegate determines that a contractor 
has not taken corrective action (as prescribed by him under paragraph 
(a) of this section) to his satisfaction, he may, after the contractor 
has been provided an opportunity for a hearing in accordance with 
paragraph (c) of this section, rescind the contract in whole or in part 
and, if he deems it appropriate, assume or resume control or operation 
of the program, activity, or service involved.
    (c)(1) When the Director or his delegate has made a determination 
described in paragraph (b) of this section, he shall in writing notify 
the contractor of such determination and of the contractor's right to 
request a review of such determination and of the determination 
described in paragraph (a) of this section. Such notification by the 
Director or his delegate shall set forth the reasons for the 
determination in sufficient detail to enable the contractor to respond 
and shall inform the contractor of its right to a hearing on the record 
before a Contract Appeals Board described in paragraph (d) of this 
section. Upon the request of the contractor for a hearing, the Board, 
established pursuant to paragraph (d) of this section shall in writing 
within 10 days of the establishment notify the contractor of the time, 
place and date of the hearing which will be held not later than 45 days 
after the request for a hearing.
    (2) Where the Director or his delegate determines that a 
contractor's performance under a contract awarded under this subpart 
poses an immediate threat to the safety of any person, he may 
immediately rescind the contract in whole or in part and, if he deems it 
appropriate, assume or resume control or operation of the program, 
activity, or service involved. Upon such a decision he will immediately 
notify the contractor of such action and the basis therefor; and offer 
the contractor an opportunity for a hearing on the record before the 
Contract Appeals Board established pursuant to paragraph (d) of this 
section to be held within 10 days of each action.
    (d)(1) The Contract Appeals Board shall be composed of 3 persons 
appointed by the Director, Indian Health Service. Such persons may not 
be selected from the immediate office of any person participating in the 
determinations at issue. The Board shall afford the contractor the 
right:
    (i) To notice of the issues to be considered;
    (ii) To be represented by counsel;
    (iii) To present witnesses on contractor's behalf;
    (iv) To cross-examine other witnesses either orally or through 
written interrogatories; and
    (v) To compel the appearance of Indian Health Service personnel or 
to take depositions of such persons at reasonable times and places.
    (2) The Contracts Appeals Board shall make an initial written 
decision which shall become final with 20 days unless the Director, 
Indian Health Service or his representative modifies or reverses the 
decision. Any such decision by the Director of the Indian Health Service 
or his representative be in writing, shall be specific as to the reasons 
for such decision, and shall be considered final.
    (3) Where Board is considering issues arising under paragraph (c)(2) 
of this section, the Board shall within 25 days after the conclusion of 
the hearing, notify all parties in writing of its decision, which shall 
be considered final.
    (e) In any case where the officer has rescinded a contract under 
paragraphs (b) or (d) of this section, he may decline to enter into a 
new contract agreement with the contractor until such time as he is 
satisfied that the basis for the recission has been corrected.

Nothing in this section shall be construed as contravening the 
Occupational Safety and Health Act of 1970 (84 Stat. 1590), as amended 
(29 U.S.C. 651).



Sec. 36.234  Operation of retroceded or reassumed contracts.

    (a) The IHS shall endeavor to provide to the tribe(s) and Indians 
served by a

[[Page 131]]

retroceded or reassumed contract not less than the same quantity and 
quality of service it would have provided if there had been no contract.
    (b) The IHS shall endeavor to provide to the tribe(s) and Indians 
served by a retroceded or reassumed contract not less than the same 
quantity and quality of permanent and temporary personnel that meet the 
U.S. Civil Service qualifications, it would have provided if there has 
been no contract.
    (c) IHS officials cannot decline to accept a retroceded contract or 
to reassume a contract because they are unable to provide the quality 
and quantity of service and personnel required in paragraphs (a) and (b) 
of this section.



Sec. 36.235  Contract funds.

    The tribal organization shall be entitled to be funded for direct 
and indirect costs at a level which is not less than would have been 
provided if the IHS had operated the program or portion thereof during 
the contract period.



Sec. 36.236  Unexpended funds under contract.

    (a) If it becomes apparent during the contract term that the 
estimated amount of a contract under this subpart will be in excess of 
actual expenditures under the contract, the identified unexpended funds 
will be used to provide additional services or benefits within the scope 
or limitations of the contract.
    (b) When both the tribal organization and the IHS agree that it is 
not practicable to spend all contract funds during the contract term, to 
the extent authorized by law unexpended funds may be carried over into 
the succeeding fiscal year contract. Unexpended funds carried over into 
a succeeding fiscal year shall be added to the contract amount for that 
fiscal year.



Sec. 36.237  Contract funding and renegotiation.

    The following clause shall be included in contracts awarded under 
the Act which have a term of more than one year:

                   Contract Funding and Renegotiation

    Funds other than those appropriated during the fiscal year in which 
the contract commenced, that are included in the contract amount are 
subject to the availability of appropriations from Congress and there 
shall be no legal liability on the part of the Government in regard to 
such funds unless and until they are appropriated. Funds appropriated 
during the fiscal year in which the contract commenced that are included 
in the contract amount but not expended at the end of such fiscal year 
may be carried over and used for contract purposes in the succeeding 
fiscal year of the contracts operation or, may be used to provide 
additional services upon modifications of the contract to include such 
services therein.
    Each succeeding year of the contract may be renegotiated prior to 
the end of the then current fiscal year in order to reflect changes that 
have taken place beyond the control of the contractor since the contract 
was originally negotiated or last renegotiated as is applicable.



         Subpart J--Indian Health Care Improvement Act Programs

    Authority: Secs. 102, 103, 106, 502, 702, and 704 of Pub. L. 94-437 
(25 U.S.C. 1612, 1613, 1615, 1652, 1672 and 1674); sec. 338G of the 
Public Health Service Act, 95 Stat. 908 (42 U.S.C. 254r).

    Source: 42 FR 59646, Nov. 18, 1977, unless otherwise noted.

    Subdivision J-1--Provisions of General and Special Applicability



Sec. 36.301  Policy and applicability.

    (a) Policy. (1) It is the policy of the Secretary to encourage 
Indians to enter the health professions and to ensure the availability 
of Indian health professionals to serve Indians. The recruitment and 
scholarship programs under this subpart will contribute to this 
objective.
    (2) The regulations of this subpart are intended to be consistent 
with principles of Indian self-determination and to supplement the 
responsibilities of the Indian Health Sevice for Indian health manpower 
planning and for assisting Indian tribes and tribal organizations in the 
development of Indian manpower programs.

[[Page 132]]

    (b) Applicability. The regulations of this subpart are applicable to 
the following activities authorized by the Indian Health Care 
Improvement Act:
    (1) The award of health professions recruitment grants under section 
102 of the Act to recruit Indians into the health professions 
(Subdivision J-2);
    (2) The award of preparatory scholarship grants and pregraduate 
scholarship grants under section 103 of the Act, as amended, to Indians 
undertaking compensatory and preprofessional education (Subdivisions J-3 
and J-8);
    (3) The award of Indian Health Scholarship grants pursuant to 
section 338G of the Public Health Service Act (42 U.S.C. 254r) to Indian 
or other students in health professions schools (Subdivision J-4):
    (4) The provision of continuing education allowances to health 
professionals employed by the Service under section 106 of the Act 
(Subdivision J-5);
    (5) Contracts with urban Indian organizations under section 502 of 
the Act to establish programs in urban areas to make health services 
more accessible to the urban Indian population (Subdivision J-6); and
    (6) Leases with Indian tribes under section 704 of the Act 
(Subdivision J-7).

[42 FR 59646, Nov. 18, 1977, as amended at 49 FR 7381, Feb. 29, 1984; 50 
FR 1855, Jan. 14, 1985]



Sec. 36.302  Definitions.

    As used in this subpart: (a) Act means the Indian Health Care 
Improvement Act, Pub. L. 94-437 (25 U.S.C. 1601 et seq.).
    (b) Academic year means the traditional approximately 9 month 
September to June annual session, except for students who attend summer 
session in addition to the traditional academic year during a 12 month 
period, for whom the academic year will be considered to be of 
approximately 12 months duration.
    (c) [Reserved]
    (d) Compensatory preprofessional education means any preprofessional 
education necessary to compensate for deficiencies in an individual's 
prior education in order to enable that individual to qualify for 
enrollment in a health professions school.
    (e) Health or educational entity means an organization, agency, or 
combination thereof, which has the provision of health or educational 
programs as one of its major functions.
    (f) Health professions school means any of the schools defined in 
paragraphs (m), (n), or (o) of this section.
    (g) Hospital means general, tuberculosis, mental, and other types of 
hospitals, and related facilities such as laboratories, outpatient 
departments, extended care facilities, facilities related to programs 
for home health services, self-care units, education or training 
facilities for health professions personnel operated as an integral part 
of a hospital, and central services facilities operated in connection 
with hospitals, but does not include any hospital providing primarily 
domicillary care.
    (h) Indian or Indians means, for purposes of Subdivisions J-2, J-3, 
J-4, and J-8 of this subpart, any person who is a member of an Indian 
tribe, as defined in parargraph (i) of this section or any individual 
who (1), irrespective of whether he or she lives on or near a 
reservation, is a member of a tribe, band or other organized group 
terminated since 1940 and those recognized now or in the future by the 
State in which they reside, or who is the natural child or grandchild of 
any such member, or (2) is an Eskimo or Aleut or other Alaska Native, or 
(3) is considered by the Secretary of the Interior to be an Indian for 
any purpose, or (4) is determined to be an Indian under regulations 
promulgated by the Secretary.
    (i) Indian health organization means a nonprofit corporate body 
composed of Indians which provides for the maximum participation of all 
interested Indian groups and individuals and which has the provision of 
health programs as its principal function.
    (j) Indian tribe means any Indian tribe, band, nation, or other 
organized group or community, including any Alaska native village or 
group or regional or village corporation as defined in or established 
pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et 
seq.), which is recognized as eligible for the special programs and 
services provided by the United States

[[Page 133]]

to Indians because of their status as Indians.
    (k) Nonprofit as applied to any private entity means that no part of 
the net earnings of such entity inures or may lawfully inure to the 
benefit of any private shareholder or individual.
    (l) [Reserved]
    (m) School of allied health professions means a junior college, 
college, or university--
    (1) Which provides, or can provide, programs of education leading to 
a certificate, or to an associate or baccalaureate degree (or the 
equivalent or either), or to a higher degree for preparing personnel 
with responsibilities for supporting, complementing, or supplementing 
the professional functions of physicians, dentists, and other health 
professionals in the delivery of health care to patients or assisting 
environmental engineers and others in environmental health control and 
preventive medicine activities.
    (2) Which, if in a college or univerisity which does not include a 
teaching hospital or in a junior college, is affiliated through a 
written agreement with one or more hospitals which provide the hospital 
component of the clinical training required for completion of such 
programs of education. The written agreement shall be executed by 
individuals authorized to act for their respective institutions and to 
assume on behalf of their institution the obligations imposed by such 
agreement. The agreement shall provide:
    (i) A description of the responsibilities of the school of allied 
health professions, the responsibilities of the hospital, and their 
joint responsibilities with respect to the clinical components of such 
programs of education; and
    (ii) A description of the procedure by which the school of allied 
health professions and the hospital will coordinate the academic and 
clinical training of students in such programs of education; and
    (iii) That, with respect to the clinical component of each such 
program of education, the teaching plan and resources have been jointly 
examined and approved by the appropriate faculty of the school of allied 
health professions and the staff of the hospital.
    (3) Which is accredited or assured accreditation by a recognized 
body or bodies approved for such purpose by the Commissioner of 
Education of the Department of Health and Human Services.
    (n) School of medicine, school of dentistry, school of osteopathy, 
school of pharmacy, school of optometry, school of podiatry, school of 
veterinary medicine, and school of public health means a school which 
provides training leading, respectively, to a degree of doctor of 
medicine, a degree of doctor of dental surgery or an equivalent degree, 
a degree of doctor of osteopathy, a degree of bachelor of science in 
pharmacy or an equivalent degree, a degree of doctor of podiatry or an 
equivalent degree, and graduate degree in public health, and including 
advanced training related to such training provided by any such school, 
and is accredited or assured accreditation by a recognized body or 
bodies approved for such purpose by the Commissioner of Education of the 
Department of Health and Human Services.
    (o) School of nursing means a collegiate, associate degree, or 
diploma school of nursing, as those terms are defined below:
    (1) The term collegiate school of nursing means a department, 
division, or other administrative unit in a college or university which 
provides primarily or exclusively a program of education in professional 
nursing and allied subjects leading to the degree of bachelor of arts, 
bachelor of science, bachelor of nursing, or to an equivalent degree, or 
to a graduate degree in nursing, and including advanced training related 
to such program of education provided by such school, but only if such 
program, or such unit, college or university is accredited;
    (2) The term associated degree school of nursing means a department, 
division, or other administrative unit in a junior college, community 
college, college, or university which provides primarily or exclusively 
a two-year program of education in professional nursing and allied 
subjects leading to an associate degree in nursing or to an equivalent 
degree, but only if such program, or such unit, college or university is 
accredited;

[[Page 134]]

    (3) The term diploma school of nursing means a school affiliated 
with a hospital or university, or an independent school, which provides 
primarily or exclusively a program of education in professional nursing 
and allied subjects leading to a diploma or to equivalent indicia that 
such program has been satisfactorily completed, but only if such 
program, or such affiliated school or such hospital or university or 
such independent school is accredited.
    (4) The term accredited as used in this subsection when applied to 
any program of nurse education means a program accredited or assured 
accreditation by a recognized body or bodies, or by a State agency, 
approved for such purpose by the Commissioner of Education of the 
Department of Health and Human Services and when applied to a hospital, 
school, college, or university (or a unit thereof) means a hospital, 
school, college, or university (or a unit thereof) which is accredited 
or assured accreditation by a recognized body or bodies, or by a State 
agency, approved for such purpose by the Commissioner of Education of 
the Department of Health and Human Services.
    (p) Secretary means the Secretary of Health and Human Services and 
any other Officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (q) Service means the Indian Health Service.
    (r) State or local government means any public health or educational 
entity which is included within the definition of State or local 
government in 45 CFR 74.3 and Indian tribes or tribal organizations.
    (s) Tribal organization means the elected governing body of any 
Indian tribe or any legally established organization of Indians which is 
controlled by one or more such bodies or by a board of directors elected 
or selected by one or more such bodies (or elected by the Indian 
population to be served by such organization) and which includes the 
maximum participation of Indians in all phases of its activities.
    (t) Urban center means any city, with a population of 10,000 or more 
as determined by the United States Census Bureau, which the Secretary 
determines has a sufficient urban Indian population with unmet health 
needs to warrant assistance under title V of the Act.
    (u) Urban Indian means any individual who resides in an urban 
center, as defined in paragraph(s) of this section, and who meets one or 
more of the four criteria in paragraphs (h) (1) through (4) of this 
section.
    (v) Urban Indian organization means a nonprofit corporate body 
situated in an urban center which:
    (1) Is governed by an Indian controlled board of directors:
    (2) Has the provision of health programs as:
    (i) Its principal function, or
    (ii) One of its major functions and such health progams are 
administered by a distinct organizational unit within the organization.
    (3) Provides for the maximum participation of all interested Indian 
groups and individuals; and
    (4) Is capable of legally cooperating with other public and private 
entities for the purpose of performing the activities described in 
Sec. 36.350(a) of Subdivision J-6 of this subpart. Except, that criteria 
(2) and (3) of this subsection shall not apply to an organization 
administering an urban Indian health project under a contract with the 
Secretary prior to October 1, 1977, for the period of such contract or 
until July 1, 1978, whichever is later.

[42 FR 59646, Nov. 18, 1977, as amended at 49 FR 7381, Feb. 29, 1984; 50 
FR 1855, Jan. 14, 1985]



Sec. 36.303  Indians applying for scholarships.

    (a) For purposes of scholarship grants under Subdivisions J-3 and J-
4 of this subpart, Indian applicants must submit evidence of their 
tribal membership (or other evidence that that applicant is an Indian as 
defined in paragraph (h) of Sec. 36.302 of this subdivision) 
satisfactory to the Secretary.
    (b) Where an applicant is a member of a tribe recognized by the 
Secretary of the Interior, the applicant must submit evidence of his or 
her tribal membership, such as:
    (1) Certification of tribal enrollment by the Secretary of the 
Interior acting

[[Page 135]]

through the Bureau of Indian Affairs (BIA); or
    (2) In the absence of such BIA certification, documentation that the 
applicant meets the requirements of tribal membership as prescribed by 
the charter, articles of incorporation or other legal instrument of the 
tribe and has been officially designated a tribal member by an 
authorized tribal official; or
    (3) Other evidence of tribal membership satisfactory to the 
Secretary.
    (c) Where the applicant is a member of a tribe terminated since 1940 
or a State recognized tribe, the applicant must submit documentation 
that the applicant meets the requirements of tribal membership as 
prescribed by the charter, articles of incorporation or other legal 
instrument of the tribe and has been officially designated a tribal 
member by an authorized tribal official; or other evidence, satisfactory 
to the Secretary, that the applicant is a member of the tribe. In 
addition, if the terminated or State recognized tribe of which the 
applicant is a member is not on a list of such tribes published by the 
Secretary in the Federal Register. the applicant must submit 
documentation as may be required by the Secretary that the tribe is a 
tribe terminated since 1940 or is recognized by the State in which the 
tribe is located in accordance with the law of that State.
    (d) An applicant who is not a tribal member, but who is a natural 
child or grandchild of a tribal member as defined in paragraph (h) of 
Sec. 36.302 of this subdivision must submit evidence of such fact which 
is satisfactory to the Secretary, in addition to evidence of his or her 
parent's or grandparent's tribal membership in accordance with 
paragraphs (b) and (c) of this section.



Sec. 36.304  Publication of a list of allied health professions.

    The Secretary, acting through the Service, shall publish from time 
to time in the Federal Register a list of the allied health professions 
for consideration for the award of preparatory and Indian Health 
scholarships under subdivisions J-3 and J-4 of this Subpart, based upon 
his determination of the relative needs of Indians for additional 
service in specific allied health professions. In making that 
determination, the needs of the Service will be given priority 
consideration.



Sec. 36.305  Additional conditions.

    The Secretary may, with respect to any grant award under this 
subpart, impose additional conditions prior to or at the time of any 
award when in his judgment such conditions are necessary to assure or 
protect advancement of the approved project, the interests of the public 
health, or the conservation of grant funds.

    Note: Nondiscrimination. Grants and contracts under this subpart are 
exempted from the requirements of section 601 of the Civil Rights Act of 
1964 (42 U.S.C. 2000d), prohibiting discrimination on the basis of race, 
color or national origin, by regulation at 45 CFR 80.3(d) which 
provides, with respect to Indian Health Services, that ``An individual 
shall not be deemed subjected to discrimination by reason of his 
exclusion from the benefits of a program limited by Federal law to 
individuals of a particular race, color, or national origin different 
from his.''

[42 FR 59646, Nov. 18, 1977, as amended at 50 FR 1855, Jan. 14, 1985]

   Subdivision J-2--Health Professions Recruitment Program for Indians



Sec. 36.310  Health professions recruitment grants.

    Grants awarded under this subdivision, in accordance with section 
102 of the Act, are for the purpose of assisting in meeting the costs of 
projects to:
    (a) Identify Indians with a potential for education or training in 
the health professions and encouraging and assisting them (1) To enroll 
in schools of medicine, osteopathy, dentistry, veterinary medicine, 
optometry, podiatry, pharmacy, public health, nursing, or allied health 
professions; or (2), if they are not qualified to enroll in any such 
school, to undertake such post-secondary education or training as may be 
required to qualify them for enrollment;
    (b) Publicize existing sources of financial aid available to Indians 
enrolled in any school referred to in paragraph (a)(1) of this section 
or who are undertaking training necessary to qualify them to enroll in 
any such school; or

[[Page 136]]

    (c) Establish other programs which the Secretary determines will 
enhance and facilitate the enrollment of Indians, and the subsequent 
pursuit and completion by them of courses of study, in any school 
referred to in paragraph (a)(1) of this section.



Sec. 36.311  Eligibility.

    Any Indian tribe, tribal organization, urban Indian organization, 
Indian health organization or any public or other nonprofit private 
health or educational entity is eligible to apply for a health 
professions recruitment grant under this subdivision.



Sec. 36.312  Application.

    (a) Forms for applying for grants are governed by 45 CFR part 74, 
subpart N.\1\
---------------------------------------------------------------------------

    \1\ Applications and instructions may be obtained from the 
appropriate Indian Health Service Area or Program Office or by writing 
the Director, Indian Health Service, Room 5A-55, 5600 Fishers Lane, 
Rockville, MD 20857.
---------------------------------------------------------------------------

    (b) In addition to such other pertinent information as the Secretary 
may require, the application for a health professions recruitment grant 
shall contain the following:
    (1) A description of the legal status and organization of the 
applicant;
    (2) A description of the current and proposed participation of 
Indians (if any) in the applicant's organization.
    (3) A description of the target Indian population to be served by 
the proposed project and the relationship of the applicant to that 
population;
    (4) A narrative description of the nature, duration, purpose, need 
for and scope of the proposed project and of the manner in which the 
applicant intends to conduct the project including:
    (i) Specific measurable objectives for the proposed project;
    (ii) How the described objectives are consistent with the purposes 
of section 102 of the Act;
    (iii) The work and time schedules which will be used to accomplish 
each of the objectives;
    (iv) A description of the administrative, managerial, and 
organizational arrangements and the facilities and resources to be 
utilized to conduct the proposed project;
    (v) The name and qualifications of the project director or other 
individual responsible for the conduct of the project; the 
qualifications of the prinicipal staff carrying out the project; and a 
description of the manner in which the applicant's staff is or will be 
organized and supervised to carry out the proposed project;
    (5) An itemized budget for the budget period (normally 12 months) 
for which support is sought and justification of the amount of grant 
funds requested:
    (6) The intended financial participation, if any, of the applicant 
in the proposed project specifying the type of contributions such as 
cash or services, loans of full or part-time staff, equipment, space, 
materials or facilities or other contributions;
    (7) When the target population of a proposed project includes a 
particular Indian tribe or tribes, an official document in such form as 
is prescribed by the tribal governing body of each such tribe indicating 
that the tribe or tribes will cooperate with the applicant.
    (c) In the case of proposed projects for identification of Indians 
with a potential for education or training in the health professions, 
applications must include a method of assessing the potential of 
interested Indians for undertaking necessary education or training in 
the health professions. Proposed projects may include, but are not 
limited to, the following activities:
    (1) Identifying Indian elementary and secondary school students 
through observations, aptitude or other testing, academic performance, 
performance in special projects and activities, and other methods as may 
be designed or developed;
    (2) Identifying Indians in college or university programs, related 
employment, upward mobility programs or other areas of activity 
indicative of interest and potential;
    (3) Review of the upward mobility plans, skills, banks etc. of 
organizations employing Indians to identify individuals with appropriate 
career orientations, expression of interest, or recognized potential;
    (4) Conducting workshops, health career days, orientation projects 
or other activities to identify interested Indians at any age level;

[[Page 137]]

    (5) Performing liaison activities with Indian professional 
organizations, Indian education programs (including adult education), 
Indian school boards, Indian parent, youth recreation or community 
groups, or other Indian special interest or activity groups;
    (6) Identifying those Indians with an interest and potential who 
cannot undertake compensatory education or training in the health 
professions because of financial need.
    (d) Proposed projects designed to encourage and assist Indians to 
enroll in health professions schools; or, if not qualified to enroll, to 
undertake postsecondary education or training required to qualify them 
for enrollment may include, but are not limited to, the following 
activities:
    (1) Providing technical assistance and counseling to encourage and 
assist Indians identified as having a potential for education or 
training in the health professions--
    (i) To enroll in health professions schools.
    (ii) To undertake any post-secondary education and training required 
to qualify them to enroll in health professions schools, and
    (iii) To obtain financial aid to enable them to enroll in health 
professions schools or undertake post-secondary education or training 
required to qualify them to enroll in such schools;
    (2) Conducting programs to (i) identify factors such as deficiencies 
in basic communication, research, academic subject matter (such as 
science, mathematics, etc.), or other skills which may prevent or 
discourage Indians from enrolling in health professions schools or 
undertaking the post-secondary education or training required to qualify 
them to enroll, and (ii) provide counseling and technical assistance to 
Indians to assist them in undertaking the necessary education, training 
or other activities to overcome such factors.
    (e) Proposed projects to publicize existing kinds of financial aid 
available to Indians enrolled in health professions schools or to 
Indians undertaking training necessary to qualify them to enroll in such 
schools may include, but are not limited to, the following activities:
    (1) Collecting information on available sources of financial aid and 
disseminating such information to Indian students, Indians, recruited 
under programs assisted by grants under this subdivision and to Indian 
tribes, tribal organizations, urban Indian organizations, Indian health 
organizations and other interested groups and communities throughout the 
United States;
    (2) Providing information on available sources of financial aid 
which can be utilized by programs and counselors assisting Indians to 
obtain financial aid.
    (f) Proposed projects for establishment of other programs which will 
enhance or facilitate enrollment of Indians in health professions 
schools and the subsequent pursuit and completion by them of courses of 
study in such schools may include, but are not limited to, the following 
activities:
    (1) Compilation and dissemination of information on--
    (i) Health professions education or training programs and the 
requirements for enrollment in such programs; and
    (ii) Post-secondary education or training curricula and programs 
designed to qualify persons for enrollment in health professions 
schools;
    (2) Developing and coordinating career orientation programs in local 
schools (including high schools) and colleges and universites;
    (3) Developing programs to enable Indians to gain exposure to the 
health professions such as arranging for (i) visits to health care 
facilities and programs and meetings or seminars with health 
professionals, (ii) part-time summer or rotating employment in health 
care facilities, programs, or offices of health professionals, (iii) 
volunteer programs, or (iv) other means of providing such exposure;
    (4) Developing programs which relate tribal culture and tradition, 
including native medicine, to careers in the health professions; and
    (5) Developing programs to make Indians aware of projected health 
manpower needs, expected employment opportunities in the health 
professions, and other factors in order to orient and

[[Page 138]]

motivate Indians to pursue careers in the health professions.

[42 FR 59646, Nov. 18, 1977, as amended at 50 FR 1855, Jan. 14, 1985]



Sec. 36.313  Evaluation and grant awards.

    (a) Within the limits of funds available for such purpose, the 
Secretary, acting through the Service, may award health professions 
recruitment grants to those eligible applicants whose proposed projects 
will in his judgment best promote the purposes of section 102 of the 
Act, taking into consideration:
    (1) The potential effectiveness of the proposed project in carrying 
out such purposes;
    (2) The capability of the applicant to successfully conduct the 
project;
    (3) The accessibility of the applicant to target Indian communities 
or tribes, including evidence of past or potential cooperation between 
the applicant and such communities or tribes;
    (4) The relationship of project objectives to known or anticipated 
Indian health manpower deficiencies;
    (5) The soundness of the fiscal plan for assuring effective 
utilization of grant funds;
    (6) The completeness of the application.
    (b) Preference shall be given to applicants in the following order 
or priority: (1) Indian tribes, (2) tribal organizations, (3) urban 
Indian organizations and other Indian health organizations, and (4) 
public and other nonprofit profit private health or educational 
entities.
    (c) The Notice of Grant Awards specifies how long the Secretary 
intends to support the project period without requiring the project to 
re-compete for funds. This period, called the project period, will 
usually be for one to two years. The total project period comprises the 
original project period and any extension. Generally the grant will be 
for a one year budget period, any subsequent award will also be a one 
year budget period. A grantee must submit a separate application for 
each subsequent year. Decisions regarding continuation awards and the 
funding level of such awards will be made after consideration of such 
factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, awards require a determination by 
the Secretary that funding is in the best interest of the Federal 
Government.
    (d) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.

[42 FR 59646, Nov. 18, 1977, as amended at 50 FR 1855, Jan. 14, 1985]



Sec. 36.314  Use of funds.

    A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the regulations of 
this subpart, the terms and conditions of the award, and the applicable 
cost principles prescribed in subpart Q of 45 CFR part 74.

[50 FR 1855, Jan. 14, 1985]



Sec. 36.315  Publication of list of grantees and projects.

    The Secretary acting through the Service shall publish annually in 
the Federal Register a list of organizations receiving grants under this 
subdivision including for each grantee:
    (a) The organization's name and address;
    (b) The amount of the grant;
    (c) A summary of the project's purposes and its geographic location.



Sec. 36.316  Other HHS regulations that apply.

    Several other regulations apply to grants under this subdivision. 
These include but are not limited to:

42 CFR part 50, subpart D, Public Health Service grant appeals procedure
42 CFR part 16, Procedures of the Departmental Grant Appeals Board
45 CFR part 74, Administration of grants
45 CFR part 75, Informal grant appeals procedures
45 CFR part 84, Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86, Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance

[[Page 139]]

45 CFR part 91, Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

[50 FR 1855, Jan. 14, 1985]

Subdivision J-3--Health Professions Preparatory Scholarship Program for 
                                 Indians



Sec. 36.320  Preparatory scholarship grants.

    Scholarship grants may be awarded under this subdivision and section 
103 of the act for the period (not to exceed two academic years) 
necessary to complete a recipient's compensatory preprofessional 
education to enable the recipient to qualify for enrollment or re-
enrollment in a health professions school. Examples of individuals 
eligible for such grants are the individual who:
    (a) Has completed high school equivalency and needs compensatory 
preprofessional education to enroll in a health professions school;
    (b) Has a baccalaureate degree and needs compensatory 
preprofessional education to qualify for enrollment in a health 
professions school; or
    (c) Has been enrolled in a health professions school but is no 
longer so enrolled and needs preprofessional education to qualify for 
readmission to a health professions school.



Sec. 36.321  Eligibility.

    To be eligible for a preparatory scholarship grant under this 
subdivision an applicant must:
    (a) Be an Indian;
    (b) Have successfully completed high school education or high school 
equivalency;
    (c) Have demonstrated to the satisfaction of the Secretary the 
desire and capability to successfully complete courses of study in a 
health professions school;
    (d) Be accepted for enrollment in or be enrolled in any compensatory 
preprofessional education course or curriculum meeting the criteria in 
Sec. 36.320 of this subdivision; and
    (e) Be a citizen of the United States.



Sec. 36.322  Application and selection.

    (a) An application for a preparatory scholarship grant under this 
subdivision shall be submitted in such form and at such time as the 
Secretary acting through the Service may prescribe.\1\ However, an 
application must indicate:
---------------------------------------------------------------------------

    \1\ Applications and instructions may be obtained from the 
appropriate Indian Health Service Area or Program Office.
---------------------------------------------------------------------------

    (1) The health profession which the applicant wishes to enter, and
    (2) Whether the applicant intends to provide health services to 
Indians upon completion of health professions education or training by 
serving as described in Sec. 36.332 or otherwise as indicated on the 
application.
    (b) Within the limits of funds available for the purpose, the 
Secretary, acting through the Service, shall make scholarship grant 
awards for a period not to exceed two academic years of an individual's 
compensatory preprofessional education to eligible applicants taking 
into consideration:
    (1) Academic performance;
    (2) Work experience;
    (3) Faculty recommendations;
    (4) Stated reasons for asking for the scholarship; and
    (5) The relative needs of the Service and Indian health 
organizations for persons in specific health professions.

[42 FR 59646, Nov. 18, 1977, as amended at 49 FR 7381, Feb. 29, 1984]



Sec. 36.323  Scholarship and tuition.

    (a) Scholarship grant awards under this subdivision shall consist 
of:
    (1) A stipend of $400 per month adjusted in accordance with 
paragraph (c) of this section; and
    (2) An amount determined by the Secretary for transportation, 
tuition, fees, books, laboratory expenses, and other necessary 
educational expenses.
    (b) The portion of the scholarship for the costs of tuition and fees 
as indicated in the grant award will be paid directly to the school upon 
receipt of an invoice from the school. The stipend and remainder of the 
scholarship grant award will be paid monthly to the grantee under the 
conditions specified in the grant award.
    (c) The amount of the monthly stipend specified in paragraph (a)(1) 
of this section shall be adjusted by the

[[Page 140]]

Secretary for each academic year ending in a fiscal year beginning after 
September 30, 1978, by an amount (rounded down to the next lowest 
multiple of $1) equal to the amount of such stipend multiplied by the 
overall percentage (as set forth in the report transmitted to the 
Congress under section 5305 of title 5, United States Code) of the 
adjustment in the rates of pay under the General Schedule made effective 
in the fiscal year in which such academic year ends.

[42 FR 59646, Nov. 18, 1977, as amended at 49 FR 7381, Feb. 29, 1984]



Sec. 36.324  Availability of list of recipients.

    The Indian Health Service will provide to any persons requesting it 
a list of the recipients of scholarship grants under this subdivision, 
including the school attended and tribal affiliation of each recipient.

[49 FR 7381, Feb. 29, 1984]

           Subdivision J-4--Indian Health Scholarship Program



Sec. 36.330  Indian health scholarships.

    Indian Health Scholarships will be awarded by the Secretary pursuant 
to 338A through 339G of the Public Health Service Act, and such 
implementing regulations as may be promulgated by the Secretary except 
as set out in this subdivision for the purpose of providing scholarships 
to Indian and other students at health professions schools in order to 
obtain health professionals to serve Indians.

[42 FR 59646, Nov. 18, 1977, as amended at 50 FR 1855, Jan. 14, 1985]



Sec. 36.331  Selection.

    (a) The Secretary, acting through the Service, shall determine the 
individuals who receive Indian Health Scholarships.
    (b) Priority shall be given to applicants who are Indians.



Sec. 36.332  Service obligation.

    The service obligation provided in section 338G(b)(2) of the Public 
Health Service Act shall be met by the recipient of an Indian Health 
Scholarship by service in:
    (a) The Indian Health Service.
    (b) An urban Indian organization assisted under Subdivision J-6.
    (c) In private practice of his or her profession if, the practice 
(1) is situated in a health manpower shortage area, designated under 
section 332 of the Public Health Service Act and (2) addresses the 
health care needs of a substantial number of Indians as determined by 
the Secretary in accordance with guidelines of the Service.

[42 FR 59646, Nov. 18, 1977, as amended at 50 FR 1855, Jan. 14, 1985]



Sec. 36.333  Distribution of scholarships.

    The Secretary, acting through the Service, shall determine the 
distribution of Indian Health Scholarships among the health professions 
based upon the relative needs of Indians for additional service in 
specific health professions. In making that determination the needs of 
the Service will be given priority consideration. The following factors 
will also be considered:
    (a) The professional goals of recipients of scholarships under 
section 103 of the Indian Health Care Improvement Act; and
    (b) The professional areas of study of Indian applicants.



Sec. 36.334  Publication of a list of recipients.

    The Secretary, acting through the Service, will publish annually in 
the Federal Register a list of recipients of Indian Health Scholarships, 
including the name of each recipient, tribal affiliation if applicable, 
and school.

            Subdivision J-5--Continuing Education Allowances



Sec. 36.340  Provision of continuing education allowances.

    In order to encourage physicians, dentists and other health 
professionals to join or continue in the Service and to provide their 
services in the rural and remote areas where a significant portion of 
the Indian people reside, the Secretary, acting through the Service, may 
provide allowances to health professionals, employed in the Service in 
order to enable them to leave their duty stations for not to exceed 480 
hours of professional consultation and

[[Page 141]]

refresher training courses in any one year.

       Subdivision J-6--Contracts With Urban Indian Organizations



Sec. 36.350  Contracts with Urban Indian organizations.

    (a) The Secretary, acting through the Service, to the extent that 
funds are available for the purpose, shall contract with urban Indian 
organizations selected under Sec. 36.351 of this subdivision to carry 
out the following activities in the urban centers where such 
organizations are situated:
    (1) Determine the population of urban Indians which are or could be 
recipients of health referral or care services;
    (2) Identify all public and private health service resources within 
the urban center in which the organization is situated which are or may 
be available to urban Indians;
    (3) Assist such resources in providing service to such urban 
Indians;
    (4) Assist such urban Indians in becoming familiar with and 
utilizing such resources;
    (5) Provide basic health education to such urban Indians;
    (6) Establish and implement manpower training programs to accomplish 
the referral and education tasks set forth in paragraphs (a)(3) through 
(5) of this section;
    (7) Identify gaps between unmet health needs of urban Indians and 
the resources available to meet such needs;
    (8) Make recommendations to the Secretary and Federal, State, local, 
and other resource agencies on methods of improving health service 
programs to meet the needs of urban Indians; and
    (9) Prove or contract for health care services to urban Indians 
where local health delivery resources are not available, not accessible, 
or not acceptable to the urban Indians to be served.
    (b) Contracts with urban Indian organizations pursuant to this title 
shall be in accordance with all Federal contracting laws and regulations 
except that, in the discretion of the Secretary, such contracts may be 
negotiated without advertising and need not conform to the provisions of 
the Act of August 24, 1935 as amended, (The Miller Act, 40 U.S.C. 270a 
et seq. which is concerned with bonding requirements).
    (c) Payments under contracts may be made in advance or by way of 
reimbursement and in such installments and on such conditions as the 
Secretary deems necessary to carry out the purposes of title V of the 
Act.
    (d) Notwithstanding any provision of law to the contrary, the 
Secretary may, at the request or consent of an urban Indian 
organization, revise or amend any contract made by him with such 
organization pursuant to this subdivision as necessary to carry out the 
purposes of title V of this Act: Provided, however, that whenever an 
urban Indian organization requests retrocession of the Secretary for any 
such contract, retrocession shall become effective upon a date specified 
by the Secretary not more than one hundred and twenty days from the date 
of the request by the organization or at such later date as may be 
mutually agreed to by the Secretary and the organization.
    (e) In connection with any contract made pursuant to this 
subdivision, the Secretary may permit an urban Indian organization to 
utilize, in carrying out such contract, existing facilities owned by the 
Federal Government within his jurisdiction under such terms and 
conditions as may be agreed upon for their use and maintenance.



Sec. 36.351  Application and selection.

    (a) Proposals for contracts under this subdivision shall be 
submitted in such form and manner and at such time as the Secretary 
acting through the Service may prescribe.
    (b) The Secretary, acting through the Service shall select urban 
Indian organizations with which to contract under this subdivision whose 
proposals will in his judgment best promote the purposes of title V of 
the Act taking into consideration the following factors:
    (1) The extent of the unmet health care needs of the urban Indians 
in the urban center involved determined on the basis of the latest 
available statistics on disease incidence and prevalence, life 
expectancy, infant mortality, dental needs, housing conditions, family 
income, unemployment statistics, etc.

[[Page 142]]

    (2) The urban Indian population which is to receive assistance in 
the following order of priority:
    (i) 9,000 or more;
    (ii) 4,500 to 9,000;
    (iii) 3,000 to 4,500;
    (iv) 1,000 to 3,000;
    (v) Under 1,000.
    (3) The relative accessibility which the urban Indian population to 
be served has to health care services, in the urban center. Factors to 
be considered in determining relative accessibility include:
    (i) Cultural barriers;
    (ii) Discrimination against Indians;
    (iii) Inability to pay for health care;
    (iv) Lack of facilities which provide free care to indigent persons;
    (v) Lack of state or local health programs;
    (vi) Technical barriers created by State and local health agencies;
    (vii) Availability of transportation to health care services;
    (viii) Distance between Indian residences and the nearest health 
care facility.
    (4) The extent to which required activities under Sec. 36.350(a) of 
this subdivision would duplicate any previous or current public or 
private health services projects in the urban center funded by another 
source. Factors to be considered in determining duplication include:
    (i) Urban Indian utilization of existing health services funded by 
other sources;
    (ii) Urban Indian utilization of existing health services delivered 
by an urban Indian organization funded by other sources.
    (5) The appropriateness and likely effectiveness of the activities 
required in Sec. 36.350(a) of this subdivision in the urban center 
involved.
    (6) The capability of the applicant urban Indian organization to 
perform satisfactorily the activities required in Sec. 36.350(a) of this 
subdivision and to contract with the Secretary.
    (7) The extent of existing or likely future participation in the 
activities required in Sec. 36.350(a) of this subdivision by appropriate 
health and health related Federal, State, local, and other resource 
agencies.
    (8) Whether the city has an existing urban Indian health program.
    (9) The applicant organization's record of performance, if any, in 
regard to any of the activities required in Sec. 36.350(a) of this 
subdivision.
    (10) Letters demonstrating local support for the applicant 
organization from both the Indian and non-Indian communities in the 
urban center involved.

[42 FR 59646, Nov. 18, 1977; 42 FR 61861, Dec. 7, 1977]



Sec. 36.352  Fair and uniform provision of services.

    Contracts with urban Indian organizations under this subdivision 
shall incorporate the following clause:
    The Contractor agrees, consistent with medical need, and the 
efficient provision of medical services to make no discriminatory 
distinctions against Indian patients or beneficiaries of this contract 
which are inconsistent with the fair and uniform provision of services.



Sec. 36.353  Reports and records.

    For each fiscal year during which an urban Indian organization 
receives or expends funds pursuant to a contract under this title, such 
organization shall submit to the Secretary a report including 
information gathered pursuant to Sec. 36.350(a) (7) and (8) of this 
subdivision, information on activities conducted by the organization 
pursuant to the contract, an accounting of the amounts and purposes for 
which Federal funds were expended, and such other information as the 
Secretary may request. The reports and records of the urban Indian 
organization with respect to such contract shall be subject to audit by 
the Secretary and the Comptroller General of the United States.

               Subdivision J-7--Leases With Indian Tribes



Sec. 36.360  Leases with Indian tribes.

    (a) Any land or facilities otherwise authorized to be acquired, 
constructed, or leased to carry out the purposes of the Act may be 
leased or subleased from Indian tribes for periods not in excess of 
twenty years.

[[Page 143]]

    (b) Leases entered into pursuant to paragraph (a) shall be subject 
to the requirements of section 322 of the Economy Act (40 U.S.C. 278a), 
which limits expenditures for rent and alterations, improvements and 
repairs on leased buildings.

Subdivision J-8--Health Professions Pregraduate Scholarship Program for 
                                 Indians

    Source: 49 FR 7381, Feb. 29, 1984, unless otherwise noted.



Sec. 36.370  Pregraduate scholarship grants.

    (a) Pregraduate scholarship grants may be awarded under this 
subdivision and section 103 of the Act for the period (not to exceed 
four academic years) necessary to complete a recipient's pregraduate 
education leading to a baccalaureate degree in a premedicine, 
preoptometry, predentistry, preosteopathy, preveterinary medicine, or 
prepodiatry curriculum or equivalent.
    (b) Students enrolled in accredited health professional or allied 
health professional programs which lead to eligibility for licensure, 
certification, registration or other types of credentials required for 
the practice of a health or allied health profession are ineligible for 
scholarships under this subdivision. Examples of health professions and 
allied health professions that will not be considered for funding 
include but are not limited to: nursing, audiology, medical technology, 
dental hygiene, dental technicians, engineering, radiologic technology, 
dietitian, nutritionist, social work, health education, physical 
therapy, occupational therapy and pharmacy. Scholarships for students in 
these programs are provided under Subdivision J-4 of this subpart.



Sec. 36.371  Eligibility.

    To be eligible for a pregraduate scholarship grant under this 
subdivison an applicant must:
    (a) Be an Indian;
    (b) Have successfully completed high school education or high school 
equivalency;
    (c) Have demonstrated to the satisfaction of the Secretary the 
desire and capability to successfully complete courses of study in a 
pregraduate education program meeting the criteria in Sec. 36.370;
    (d) Be accepted for enrollment in or be enrolled in any accredited 
pregraduate education curriculum meeting the criteria in Sec. 36.370 of 
this subdivision; and
    (e) Be a citizen of the United States.



Sec. 36.372  Application and selection.

    (a) An application for a pregraduate scholarship grant under this 
subdivision shall be submitted in such form and at such time as the 
Secretary may prescribe. However, an application must indicate:
    (1) The pregraduate program in which the applicant is or wishes to 
enter, and
    (2) Whether the applicant intends to provide health services to 
Indians upon completion of health professions education or training by 
serving as described in Sec. 36.332 or otherwise as indicated on the 
application.
    (b) Within the limits of available funds, the Director, IHS, shall 
make pregraduate scholarship grant awards for a period not to exceed 
four academic years of an individual's pregraduate education to eligible 
applicants taking into consideration:
    (1) Academic performance;
    (2) Work experience;
    (3) Faculty or employer recommendation;
    (4) Stated reasons for asking for the scholarship; and
    (5) The relative needs of the IHS and Indian health organizations 
for persons in specific health professions.

(Approved by the Office of Management and Budget under control number 
0915-0080)



Sec. 36.373  Scholarship and tuition.

    (a) Scholarship grant awards under this subdivision shall consist 
of:
    (1) A stipend of $400 per month adjusted in accordance with 
paragraph (c) of this section; and
    (2) An amount determined by the Secretary for transportation, 
tuition, fees, books, laboratory expenses and other necessary 
educational expenses.

[[Page 144]]

    (b) The portion of the scholarship for the costs of tuition and fees 
as indicated in the grant award will be paid directly to the school upon 
receipt of an invoice from the school. The stipend and remainder of the 
scholarship grant award will be paid monthly to the grantee under the 
conditions specified in the grant award.
    (c) The amount of the monthly stipend specified in paragraph (a)(1) 
of this section shall be adjusted by the Secretary for each academic 
year ending in a fiscal year beginning after September 30, 1978, by an 
amount (rounded down to the next lowest multiple of $1) equal to the 
amount of such stipend multiplied by the overall percentage (as set 
forth in the report transmitted to the Congress under section 5305 of 
title 5, United States Code) of the adjustment in the rates of pay under 
the General Schedule made effective in the fiscal year in which such 
academic year ends.



Sec. 36.374  Availability of list of recipients.

    The IHS will provide to any person requesting it a list of the 
recipients of scholarship grants under this subdivision, including the 
school attended and tribal affiliation of each recipient.



PART 37--SPECIFICATIONS FOR MEDICAL EXAMINATIONS OF UNDERGROUND COAL MINERS--Table of Contents




              Subpart--Chest Roentgenographic Examinations

Sec.
37.1  Scope.
37.2  Definitions.
37.3  Chest roentgenograms required for miners.
37.4  Plans for chest roentgenographic examinations.
37.5  Approval of plans.
37.6  Chest roentgenographic examinations conducted by the Secretary.
37.7  Transfer of affected miner to less dusty area.
37.8  Roentgenographic examination at miner's expense.
37.20  Miner identification document.

    Specifications for Performing Chest Roentgenographic Examinations

37.40  General provisions.
37.41  Chest roentgenogram specifications.
37.42  Approval of roentgenographic facilities.
37.43  Protection against radiation emitted by roentgenographic 
          equipment.

  Specifications for Interpretation, Classification, and Submission of 
                          Chest Roentgenograms

37.50  Interpreting and classifying chest roentgenograms.
37.51  Proficiency in the use of systems for classifying the 
          pneumoconioses.
37.52  Method of obtaining definitive interpretations.
37.53  Notification of abnormal roentgenographic findings.
37.60  Submitting required chest roentgenograms and miner identification 
          documents.

                   Review and Availability of Records

37.70  Review of interpretations.
37.80  Availablity of records.

                           Subpart--Autopsies

37.200  Scope.
37.201  Definitions.
37.202  Payment for autopsy.
37.203  Autopsy specifications.
37.204  Procedure for obtaining payment.

    Authority: Sec. 203, 83 Stat. 763; 30 U.S.C. 843, unless otherwise 
noted.

    Source: 43 FR 33715, Aug. 1, 1978, unless otherwise noted.



              Subpart--Chest Roentgenographic Examinations



Sec. 37.1  Scope.

    The provisions of this subpart set forth the specifications for 
giving, interpreting, classifying, and submitting chest roentgenograms 
required by section 203 of the act to be given to underground coal 
miners and new miners.



Sec. 37.2  Definitions.

    Any term defined in the Federal Mine Safety and Health Act of 1977 
and not defined below shall have the meaning given it in the act. As 
used in this subpart:
    (a) Act means the Federal Mine Safety and Health Act of 1977 (30 
U.S.C. 801, et seq.).
    (b) ALOSH means the Appalachian Laboratory for Occupational Safety 
and Health, Box 4258, Morgantown, WV 26505. Although the Division of 
Respiratory Disease Studies, National Institute for Occupational Safety 
and

[[Page 145]]

Health, has programmatic responsibility for the chest roentgenographic 
examination program, the Institute's facility in Morgantown--ALOSH--is 
used throughout this subpart in referring to the administration of the 
program.
    (c) Chest roentgenogram means a single posteroanterior 
roentgenographic projection or radiograph of the chest at full 
inspiration recorded on roentgenographic film.
    (d) Convenient time and place with respect to the conduct of any 
examination under this subpart means that the examination must be given 
at a reasonable hour in the locality in which the miner resides or a 
location that is equally accessible to the miner. For example, 
examinations at the mine during, immediately preceding, or immediately 
following work and a ``no appointment'' examination at a medical 
facility in a community easily accessible to the residences of a 
majority of the miners working at the mine, shall be considered of 
equivalent convenience for purposes of this paragraph.
    (e) Institute and NIOSH mean the National Institute for Occupational 
Safety and Health Center for Disease Control, Public Health Service, 
Department of Health and Human Services.
    (f) ILO-U/C Classification means the classification of radiographs 
of the pneumoconioses devised in 1971 by an international committee of 
the International Labor Office and described in ``Medical Radiography 
and Photography,'' volume 48, No. 3, December 1972. ``ILO 
Classification'' means the classification of radiographs of the 
pneumoconioses revised in 1980 by an international committee of the 
International Labor Office and described in ``Medical Radiography and 
Photography'' volume 57, No. 1, 1981, and in ILO publication 22 (revised 
1980) from the ILO Occupational Safety and Health Series.
    (g) Miner means any individual including any coal mine construction 
worker who is working in or at any underground coal mine, but does not 
include any surface worker who does not have direct contact with 
underground coal mining or with coal processing operations.
    (h) Operator means any owner, lessee, or other person who operates, 
controls, or supervises an underground coal mine or any independent 
contractor performing services or construction at such mine.
    (i) Panel of `B' Readers means the U.S. Public Health Service 
Consultant Panel of ``B'' Readers, c/o ALOSH, P.O. Box 4258, Morgantown, 
WV 26505.
    (j) Preemployment physical examination means any medical examination 
which includes a chest roentgenographic examination given in accordance 
with the specifications of this subpart to a person not previously 
employed by the same operator or at the same mine for which that person 
is being considered for employment.
    (k) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved may be delegated.
    (l) MSHA means the Mine Safety and Health Administration, Department 
of Labor.

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7563, Mar. 1, 1984]



Sec. 37.3  Chest roentgenograms required for miners.

    (a) Voluntary examinations. Every operator shall provide to each 
miner who is employed in or at any of its underground coal mines and who 
was employed in underground coal mining prior to December 30, 1969, or 
who has completed the required examinations under Sec. 37.3(b) an 
opportunity for a chest roentgenogram in accordance with this subpart:
    (1) Following August 1, 1978 ALOSH will notify the operator of each 
underground coal mine of a period within which the operator may provide 
examinations to each miner employed at its coal mine. The period shall 
begin no sooner than the effective date of these regulations and end no 
later than a date specified by ALOSH separately for each coal mine. The 
termination date of the period will be approximately 5 years from the 
date of the first examination which was made on a miner employed by the 
operator in its coal mine under the former regulations of this subpart 
adopted July 27, 1973.

[[Page 146]]

Within the period specified by ALOSH for each mine, the operator may 
select a 6-month period within which to provide examinations in 
accordance with a plan approved under Sec. 37.5.

    Example: ALOSH finds that between July 27, 1973, and March 31, 1975, 
the first roentgenogram for a miner who was employed at mine Y and who 
was employed in underground coal mining prior to December 30, 1969, was 
made on January 1, 1974. ALOSH will notify the operator of mine Y that 
the operator may select and designate on its plan a 6-month period 
within which to offer its examinations to its miners employed at mine Y. 
The 6-month period shall be scheduled between August 1, 1978 and January 
1, 1979 (5 years after January 1, 1974).
    (2) For all future voluntary examinations, ALOSH will notify the 
operator of each underground coal mine when sufficient time has elapsed 
since the end of the previous 6-month period of examinations. ALOSH will 
specify to the operator of each mine a period within which the operator 
may provide examinations to its miners employed at its coal mine. The 
period shall begin no sooner than 3\1/2\ years and end no later than 
4\1/2\ years subsequent to the ending date of the previous 6-month 
period specified for a coal mine either by the operator on an approved 
plan or by ALOSH if the operator did not submit an approved plan. Within 
the period specified by ALOSH for each mine, the operator may select a 
6-month period within which to provide examinations in accordance with a 
plan approved under Sec. 37.5.

    Example: ALOSH finds that examinations were previously provided to 
miners employed at mine Y in a 6-month period from July 1, 1979, to 
December 31, 1979. ALOSH notifies the operator at least 3 months before 
July 1, 1983 (3\1/2\ years after December 31, 1979) that the operator 
may select and designate on its plan the next 6-month period within 
which to offer examinations to its miners employed at mine Y. The 6-
month period shall be scheduled between July 1, 1983, and July 1, 1984 
(between 3\1/2\ and 4\1/2\ years after December 31, 1979).
    (3) Within either the next or future period(s) specified by ALOSH to 
the operator for each of its coal mines, the operator of the coal mine 
may select a different 6-month period for each of its mines within which 
to offer examinations. In the event the operator does not submit an 
approved plan, ALOSH will specify a 6-month period to the operator 
within which miners shall have the opportunity for examinations.
    (b) Mandatory examinations. Every operator shall provide to each 
miner who begins working in or at a coal mine for the first time after 
December 30, 1969:
    (1) An initial chest roentgenogram as soon as possible, but in no 
event later than 6 months after commencement of employment. A 
preemployment physical examination which was made within the 6 months 
prior to the date on which the miner started to work will be considered 
as fulfilling this requirement. An initial chest roentgenogram given to 
a miner according to former regulations for this subpart prior to August 
1, 1978 will also be considered as fulfilling this requirement.
    (2) A second chest roentgenogram, in accordance with this subpart, 3 
years following the initial examination if the miner is still engaged in 
underground coal mining. A second roentgenogram given to a miner 
according to former regulations under this subpart prior to August 1, 
1978 will be considered as fulfilling this requirement.
    (3) A third chest roentgenogram 2 years following the second chest 
roentgenogram if the miner is still engaged in underground coal mining 
and if the second roentgenogram shows evidence of category 1, category 
2, category 3 simple pneumoconioses, or complicated pneumoconioses (ILO 
Classification).
    (c) ALOSH will notify the miner when he or she is due to receive the 
second or third mandatory examination under (b) of this section. 
Similarly, ALOSH will notify the coal mine operator when the miner is to 
be given a second examination. The operator will be notified concerning 
a miner's third examination only with the miner's written consent, and 
the notice to the operator shall not state the medical reason for the 
examination nor that it is the third examination in the series. If the 
miner is notified by ALOSH that the third mandatory examination is due 
and the operator is not so notified, availability of the 
roentgenographic examination under the operator's plan shall constitute 
the

[[Page 147]]

operator's compliance with the requirement to provide a third mandatory 
examination even if the miner refuses to take the examination.
    (d) The opportunity for chest roentgenograms to be available by an 
operator for purposes of this subpart shall be provided in accordance 
with a plan which has been submitted and approved in accordance with 
this subpart.
    (e) Any examinations conducted by the Secretary in the National 
Study of Coal Workers' Pneumoconiosis after January 1, 1977, but before 
August 1, 1978 shall satisfy the requirements of this section with 
respect to the specific examination given (see Sec. 37.6(d)).

[43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978, as amended at 49 
FR 7563, Mar. 1, 1984]



Sec. 37.4  Plans for chest roentgenographic examinations.

    (a) Every plan for chest roentgenographic examinations of miners 
shall be submitted on forms prescribed by the Secretary to ALOSH within 
120 calendar days after August 1, 1978. In the case of a person who 
after August 1, 1978, becomes an operator of a mine for which no plan 
has been approved, that person shall submit a plan within 60 days after 
such event occurs. A separate plan shall be submitted by the operator 
and by each construction contractor for each underground coal mine which 
has a MSHA identification number. The plan shall include:
    (1) The name, address, and telephone number of the operator(s) 
submitting the plan;
    (2) The name, MSHA identification number for respirable dust 
measurements, and address of the mine included in the plan;
    (3) The proposed beginning and ending date of the 6-month period for 
voluntary examinations (see Sec. 37.3(a)) and the estimated number of 
miners to be given or offered examinations during the 6-month period 
under the plan;
    (4) The name and location of the approved X-ray facility or 
facilities, and the approximate date(s) and time(s) of day during which 
the roentgenograms will be given to miners to enable a determination of 
whether the examinations will be conducted at a convenient time and 
place;
    (5) If a mobile facility is proposed, the plan shall provide that 
each miner be given adequate notice of the opportunity to have the 
examination and that no miner shall have to wait for an examination more 
than 1 hour before or after his or her work shift. In addition, the plan 
shall include:
    (i) The number of change houses at the mine.
    (ii) One or more alternate nonmobile approved facilities for the 
reexamination of miners and for the mandatory examination of miners when 
necessary (see Sec. 37.3(b)), or an assurance that the mobile facility 
will return to the location(s) specified in the plan as frequently as 
necessary to provide for examinations in accordance with these 
regulations.
    (iii) The name and location of each change house at which 
examinations will be given. For mines with more than one change house, 
the examinations shall be given at each change house or at a change 
house located at a convenient place for each miner.
    (6) The name and address of the ``A'' or ``B'' reader who will 
interpret and classify the chest roentgenograms.
    (7) Assurances that: (i) The operator will not solicit a physician's 
roentgenographic or other findings concerning any miner employed by the 
operator,
    (ii) Instructions have been given to the person(s) giving the 
examinations that duplicate roentgenograms or copies of roentgenograms 
will not be made and that (except as may be necessary for the purpose of 
this subpart) the physician's roentgenographic and other findings, as 
well as the occupational history information obtained from a miner 
unless obtained prior to employment in a preemployment examination, and 
disclosed prior to employment, will not be disclosed in a manner which 
will permit identification of the employee with the information about 
him, and
    (iii) The roentgenographic examinations will be made at no charge to 
the miner.
    (b) Operators may provide for alternate facilities and ``A'' or 
``B'' readers in plans submitted for approval.
    (c) The change of operators of any mine operating under a plan 
approved

[[Page 148]]

pursuant to Sec. 37.5 shall not affect the plan of the operator which 
has transferred responsibility for the mine. Every plan shall be subject 
to revision in accordance with paragraph (d) of this section.
    (d) The operator shall advise ALOSH of any change in its plan. Each 
change in an approved plan is subject to the same review and approval as 
the originally approved plan.
    (e) The operator shall promptly display in a visible location on the 
bulletin board at the mine its proposed plan or proposed change in plan 
when it is submitted to ALOSH. The proposed plan or change in plan shall 
remain posted in a visible location on the bulletin board until ALOSH 
either grants or denies approval of it at which time the approved plan 
or denial of approval shall be permanently posted. In the case of an 
operator who is a construction contractor and who does not have a 
bulletin board, the construction contractor must otherwise notify its 
employees of the examination arrangements. Upon request, the contractor 
must show ALOSH written evidence that its employees have been notified.
    (f) Upon notification from ALOSH that sufficient time has elapsed 
since the previous period of examinations, the operator will resubmit 
its plan for each of its coal mines to ALOSH for approval for the next 
period of examinations (see Sec. 37.3(a)(2)). The plan shall include the 
proposed beginning and ending dates of the next period of examinations 
and all information required by paragraph (a) of this section.

[43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978]



Sec. 37.5  Approval of plans.

    (a) Approval of plans granted prior to August 1, 1978 is no longer 
effective.
    (b) If, after review of any plan submitted pursuant to this subpart, 
the Secretary determines that the action to be taken under the plan by 
the operator meets the specifications of this subpart and will 
effectively achieve its purpose, the Secretary will approve the plan and 
notify the operator(s) submitting the plan of the approval. Approval may 
be conditioned upon such terms as the Secretary deems necessary to carry 
out the purpose of section 203 of the act.
    (c) Where the Secretary has reason to believe that he will deny 
approval of a plan he will, prior to the denial, give reasonable notice 
in writing to the operator(s) of an opportunity to amend the plan. The 
notice shall specify the ground upon which approval is proposed to be 
denied.
    (d) If a plan is denied approval, the Secretary shall advise the 
operator(s) in writing of the reasons for the denial.



Sec. 37.6  Chest roentgenographic examinations conducted by the Secretary.

    (a) The Secretary will give chest roentgenograms or make 
arrangements with an appropriate person, agency, or institution to give 
the chest roentgenograms and with ``A'' or ``B'' readers to interpret 
the roentgenograms required under this subpart in the locality where the 
miner resides, at the mine, or at a medical facility easily accessible 
to a mining community or mining communities, under the following 
circumstances:
    (1) Where, in the judgment of the Secretary, due to the lack of 
adequate medical or other necessary facilities or personnel at the mine 
or in the locality where the miner resides, the required 
roentgenographic examination cannot be given.
    (2) Where the operator has not submitted an approvable plan.
    (3) Where, after commencement of an operator's program pursuant to 
an approved plan and after notice to the operator of his failure to 
follow the approved plan and, after allowing 15 calendar days to bring 
the program into compliance, the Secretary determines and notifies the 
operator in writing that the operator's program still fails to comply 
with the approved plan.
    (b) The operator of the mine shall reimburse the Secretary or other 
person, agency, or institution as the Secretary may direct, for the cost 
of conducting each examination made in accordance with this section.
    (c) All examinations given or arranged by the Secretary will comply 
with the time requirements of Sec. 37.3. Whenever the Secretary gives or 
arranges for the examinations of miners

[[Page 149]]

at a time, a written notice of the arrangements will be sent to the 
operator who shall post the notice on the mine bulletin board.
    (d) Operators of mines selected by ALOSH to participate in the 
National Study of Coal Workers' Pneumoconiosis (an epidemiological study 
of respiratory diseases in coal miners) and who agree to cooperate will 
have all their miners afforded the opportunity to have a chest 
roentgenogram required hereunder at no cost to the operator. For future 
examinations and for mandatory examinations each participating operator 
shall submit an approvable plan.



Sec. 37.7  Transfer of affected miner to less dusty area.

    (a) Any miner who, in the judgment of the Secretary based upon the 
interpretation of one or more of the miner's chest roentgenograms, shows 
category 1 (1/0, 1/1, 1/2), category 2 (2/1, 2/2, 2/3), or category 3 
(3/2, 3/3, 3/4) simple pneumoconioses, or complicated pneumoconioses 
(ILO Classification) shall be afforded the option of transferring from 
his or her position to another position in an area of the mine where the 
concentration of respirable dust in the mine atmosphere is not more than 
1.0 mg/m3 of air, or if such level is not attainable in the 
mine, to a position in the mine where the concentration of respirable 
dust is the lowest attainable below 2.0 mg/m3 of air.
    (b) Any transfer under this section shall be in accordance with the 
procedures specified in part 90 of title 30, Code of Federal 
Regulations.

[43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978, as amended at 44 
FR 23085, Apr. 18, 1979; 49 FR 7563, Mar. 1, 1984]



Sec. 37.8  Roentgenographic examination at miner's expense.

    Any miner who wishes to obtain an examination at his or her own 
expense at an approved facility and to have submitted to NIOSH for him 
or her a complete examination may do so, provided that the examination 
is made no sooner than 6 months after the most recent examination of the 
miner submitted to ALOSH. ALOSH will provide an interpretation and 
report of the examinations made at the miner's expense in the same 
manner as if it were submitted under an operator's plan. Any change in 
the miner's transfer rights under the act which may result from this 
examination will be subject to the terms of Sec. 37.7.



Sec. 37.20  Miner identification document.

    As part of the roentgenographic examination, a miner identification 
document which includes an occupational history questionnaire shall be 
completed for each miner at the facility where the roentgenogram is made 
at the same time the chest roentgenogram required by this subpart is 
given.

    Specifications for Performing Chest Roentgenographic Examinations



Sec. 37.40  General provisions.

    (a) The chest roentgenographic examination shall be given at a 
convenient time and place.
    (b) The chest roentgenographic examination consists of the chest 
roentgenogram, and a complete Roentgenographic Interpretation Form (Form 
CDC/NIOSH (M) 2.8), and miner identification document.
    (c) A roentgenographic examination shall be made in a facility 
approved in accordance with Sec. 37.42 by or under the supervision of a 
physician who regularly makes chest roentgenograms and who has 
demonstrated ability to make chest roentgenograms of a quality to best 
ascertain the presence of pneumoconiosis.



Sec. 37.41  Chest roentgenogram specifications.

    (a) Every chest roentgenogram shall be a single posteroanterior 
projection at full inspiration on a film being no less than 14 by 17 
inches and no greater than 16 by 17 inches. The film and cassette shall 
be capable of being positioned both vertically and horizontally so that 
the chest roentgenogram will include both apices and costophrenic 
angles. If a miner is too large to permit the above requirements, then 
the projection shall include both apices with minimum loss of the 
costophrenic angle.

[[Page 150]]

    (b) Miners shall be disrobed from the waist up at the time the 
roentgenogram is given. The facility shall provide a dressing area and 
for those miners who wish to use one, the facility shall provide a clean 
gown. Facilities shall be heated to a comfortable temperature.
    (c) Roentgenograms shall be made only with a diagnostic X-ray 
machine having a rotating anode tube with a maximum of a 2 mm. source 
(focal spot).
    (d) Except as provided in paragraph (e) of this section, 
roentgenograms shall be made with units having generators which comply 
with the following: (1) The generators of existing roentgenographic 
units acquired by the examining facility prior to July 27, 1973, shall 
have a minimum rating of 200 mA at 100 kVp.; (2) generators of units 
acquired subsequent to that date shall have a minimum rating of 300 mA 
at 125 kVp.

    Note: A generator with a rating of 150 kVp. is recommended.

    (e) Roentgenograms made with battery-powered mobile or portable 
equipment shall be made with units having a minimum rating of 100 mA at 
110 kVp. at 500 Hz, or of 200 mA at 110 kVp. at 60 Hz.
    (f) Capacitor discharge and field emission units may be used if the 
model of such units is approved by ALOSH for quality, performance, and 
safety. ALOSH will consider such units for approval when listed by a 
facility seeking approval under Sec. 37.42 of this subpart.
    (g) Roentgenograms shall be given only with equipment having a beam-
limiting device which does not cause large unexposed boundaries. The 
beam limiting device shall provide rectangular collimation and shall be 
of the type described in part F of the suggested State regulations for 
the control of radiation or (for beam limiting devices manufactured 
after August 1, 1974) of the type specified in 21 CFR 1020.31. The use 
of such a device shall be discernible from an examination of the 
roentgenogram.
    (h) To insure high quality chest roentgenograms:
    (1) The maximum exposure time shall not exceed \1/20\ of a second 
except that with single phase units with a rating less than 300 mA at 
125 kVp. and subjects with chests over 28 cm. posteroanterior, the 
exposure may be increased to not more than \1/10\ of a second;
    (2) The source or focal spot to film distance shall be at least 6 
feet;
    (3) Medium speed film and medium speed intensifying screens are 
recommended. However, any film-screen combination, the rated ``speed'' 
of which is at least 100 and does not exceed 300, which produces 
roentgenograms with spatial resolution, contrast, latitude and quantum 
mottle similar to those of systems designated as ``medium speed'' may be 
employed;
    (4) Film-screen contact shall be maintained and verified at 6 month 
or shorter intervals;
    (5) Intensifying screens shall be inspected at least once a month 
and cleaned when necessary by the method recommended by the 
manufacturer;
    (6) All intensifying screens in a cassette shall be of the same type 
and made by the same manufacturer;
    (7) When using over 90 kV., a suitable grid or other means of 
reducing scattered radiation shall be used;
    (8) The geometry of the radiographic system shall insure that the 
central axis (ray) of the primary beam is perpendicular to the plane of 
the film surface and impinges on the center of the film;
    (9) A formal quality assurance program shall be established at each 
facility.
    (i) Radiographic processing:
    (1) Either automatic or manual film processing is acceptable. A 
constant time-temperature technique shall be meticulously employed for 
manual processing.
    (2) If mineral or other impurities in the processing water introduce 
difficulty in obtaining a high-quality roentgenogram, a suitable filter 
or purification system shall be used.
    (j) Before the miner is advised that the examination is concluded, 
the roentgenogram shall be processed and inspected and accepted for 
quality by the physician, or if the physician is not available, 
acceptance may be made by

[[Page 151]]

the radiologic technologist. In a case of a substandard roentgenogram, 
another shall be immediately made. All substandard roentgenograms shall 
be clearly marked as rejected and promptly sent to ALOSH for disposal.
    (k) An electric power supply shall be used which complies with the 
voltage, current, and regulation specified by the manufacturer of the 
machine.
    (l) A densitometric test object may be required on each 
roentgenogram for an objective evaluation of film quality at the 
discretion of ALOSH.
    (m) Each roentgenogram made hereunder shall be permanently and 
legibly marked with the name and address or ALOSH approval number of the 
facility at which it is made, the social security number of the miner, 
and the date of the roentgenogram. No other identifying markings shall 
be recorded on the roentgenogram.

[43 FR 33715, Aug. 1, 1978, as amended at 52 FR 7866, Mar. 13, 1987]



Sec. 37.42  Approval of roentgenographic facilities.

    (a) Approval of roentgenographic facilities given prior to January 
1, 1976, shall terminate upon August 1, 1978 unless each of the 
following conditions have been met:
    (1) The facility must verify that it still meets the requirements 
set forth in the regulations for the second round of roentgenographic 
examinations (38 FR 20076) and it has not changed equipment since it was 
approved by NIOSH.
    (2) From July 27, 1973, to January 1, 1976, the facility submitted 
to ALOSH at least 50 roentgenograms which were interpreted by one or 
more ``B'' readers not employed by the facility who found no more than 5 
percent of all the roentgenograms unreadable.
    (b) Other facilities will be eligible to participate in this program 
when they demonstrate their ability to make high quality diagnostic 
chest roentgenograms by submitting to ALOSH six or more sample chest 
roentgenograms made and processed at the applicant facility and which 
are of acceptable quality to the Panel of ``B'' readers. Applicants 
shall also submit a roentgenogram of a plastic step-wedge object 
(available on loan from ALOSH) which was made and processed at the same 
time with the same technique as the roentgenograms submitted and 
processed at the facility for which approval is sought. At least one 
chest roentgenogram and one test object roentgenogram shall have been 
made with each unit to be used hereunder. All roentgenograms shall have 
been made within 15 calendar days prior to submission and shall be 
marked to identify the facility where each roentgenogram was made, the 
X-ray machine used, and the date each was made. The chest roentgenograms 
will be returned and may be the same roentgenograms submitted pursuant 
to Sec. 37.51.

    Note: The plastic step-wedge object is described in an article by E. 
Dale Trout and John P. Kelley appearing in ``The American Journal of 
Roentgenology, Radium Therapy and Nuclear Medicine,'' Vol. 117, No. 4, 
April 1973.

    (c) Each roentgenographic facility submitting chest roentgenograms 
for approval under this section shall complete and include an X-ray 
facility document describing each X-ray unit to be used to make chest 
roentgenograms under the act. The form shall include: (1) The date of 
the last radiation safety inspection by an appropriate licensing agency 
or, if no such agency exists, by a qualified expert as defined in NCRP 
Report No. 33 (see Sec. 37.43); (2) the deficiencies found; (3) a 
statement that all the deficiencies have been corrected; and (4) the 
date of acquisition of the X-ray unit. To be acceptable, the radiation 
safety inspection shall have been made within 1 year preceding the date 
of application.
    (d) Roentgenograms submitted with applications for approval under 
this section will be evaluated by the panel of ``B'' Readers or by a 
qualified radiological physicist or consultant. Applicants will be 
advised of any reasons for denial of approval.
    (e) ALOSH or its representatives may make a physical inspection of 
the applicant's facility and any approved roentgenographic facility at 
any reasonable time to determine if the requirements of this subpart are 
being met.
    (f) ALOSH may require a facility periodically to resubmit 
roentgenograms of a plastic step-wedge object, sample roentgenograms, or 
a

[[Page 152]]

Roentgenographic Facility Document for quality control purposes. 
Approvals granted hereunder may be suspended or withdrawn by notice in 
writing when in the opinion of ALOSH the quality of roentgenograms or 
information submitted under this section warrants such action. A copy of 
a notice withdrawing approval will be sent to each operator who has 
listed the facility as its facility for giving chest roentgenograms and 
shall be displayed on the mine bulletin board adjacent to the operator's 
approved plan. The approved plan will be reevaluated by ALOSH in light 
of this change.

[43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978]



Sec. 37.43  Protection against radiation emitted by roentgenographic equipment.

    Except as otherwise specified in Sec. 37.41, roentgenographic 
equipment, its use and the facilities (including mobile facilities) in 
which such equipment is used, shall conform to applicable State and 
Federal regulations (See 21 CFR part 1000). Where no applicable 
regulations exist, roentgenographic equipment, its use and the 
facilities (including mobile facilities) in which such equipment is used 
shall conform to the recommendations of the National Council on 
Radiation Protection and Measurements in NCRP Report No. 33 ``Medical X-
ray and Gamma-Ray Protection for Energies up to 10 MeV--Equipment Design 
and Use'' (issued February 1, 1968), in NCRP Report No. 48, ``Medical 
Radiation Protection for Medical and Allied Health Personnel'' (issued 
August 1, 1976), and in NCRP Report No. 49, ``Structural Shielding 
Design and Evaluation for Medical Use of X-rays and Gamma Rays of up to 
10 MeV'' (issued September 15, 1976). These documents are hereby 
incorporated by reference and made a part of this subpart. These 
documents are available for examination at ALOSH, 944 Chestnut Ridge 
Road, Morgantown, WV 26505, and at the National Institute for 
Occupational Safety and Health, 5600 Fishers Lane, Rockville, MD 20857. 
Copies of NCRP Reports Nos. 33, 48, and 49 may be purchased for $3, 
$4.50, and $3.50 each, respectively, from NCRP Publications, P.O. Box 
30175, Washington, DC 20014.

  Specifications for Interpretation, Classification, and Submission of 
                          Chest Roentgenograms



Sec. 37.50  Interpreting and classifying chest roentgenograms.

    (a) Chest roentgenograms shall be interpreted and classified in 
accordance with the ILO Classification system and recorded on a 
Roentgenographic Interpretation Form (Form CDC/NIOSH (M)2.8).
    (b) Roentgenograms shall be interpreted and classified only by a 
physician who regularly reads chest roentgenograms and who has 
demonstrated proficiency in classifying the pneumoconioses in accordance 
with Sec. 37.51.
    (c) All interpreters, whenever interpreting chest roentgenograms 
made under the Act, shall have immediately available for reference a 
complete set of the ILO International Classification of Radiographs for 
Pneumoconioses, 1980.

    Note: This set is available from the International Labor Office, 
1750 New York Avenue, NW., Washington, DC 20006 (Phone: 202/376-2315).

    (d) In all view boxes used for making interpretations:
    (1) Fluorescent lamps shall be simultaneously replaced with new 
lamps at 6-month intervals;
    (2) All the fluorescent lamps in a panel of boxes shall have 
identical manufacturer's ratings as to intensity and color;
    (3) The glass, internal reflective surfaces, and the lamps shall be 
kept clean;
    (4) The unit shall be so situated as to minimize front surface 
glare.

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984]



Sec. 37.51  Proficiency in the use of systems for classifying the pneumoconioses.

    (a) First or ``A'' readers:
    (1) Approval as an ``A'' reader shall continue if established prior 
to (insert) effective date of these regulations).

[[Page 153]]

    (2) Physicians who desire to be ``A'' readers must demonstrate their 
proficiency in classifying the pneumoconioses by either:
    (i) Submitting to ALOSH from the physician's files six sample chest 
roentgenograms which are considered properly classified by the Panel of 
``B'' readers. The six roentgenograms shall consist of two without 
pneumoconiosis, two with simple pneumoconiosis, and two with complicated 
pneumoconiosis. The films will be returned to the physician. The 
interpretations shall be on the Roentgenographic Interpretation Form 
(Form CDC/NIOSH (M) 2.8) (These may be the same roentgenograms submitted 
pursuant to Sec. 37.42), or;
    (ii) Satisfactory completion, since June 11, 1970, of a course 
approved by ALOSH on the ILO or ILO-U/C Classification systems or the 
UICC/Cincinnati classification system. As used in this subparagraph, 
``UICC/Cincinnati classification'' means the classification of the 
pneumoconioses devised in 1968 by a Working Committee of the 
International Union Against Cancer.
    (b) Final or ``B'' readers:
    (1) Approval as a ``B'' reader established prior to October 1, 1976, 
shall hereby be terminated.
    (2) Proficiency in evaluating chest roentgenograms for 
roentgenographic quality and in the use of the ILO Classification for 
interpreting chest roentgenograms for pneumoconiosis and other diseases 
shall be demonstrated by those physicians who desire to be ``B'' readers 
by taking and passing a specially designed proficiency examination given 
on behalf of or by ALOSH at a time and place specified by ALOSH. Each 
physician must bring a complete set of the ILO standard reference 
radiographs when taking the examination. Physicians who qualify under 
this provision need not be qualified under paragraph (a) of this 
section.
    (c) Physicians who wish to participate in the program shall make 
application on an Interpreting Physician Certification Document (Form 
CDC/NIOSH (M) 2.12).

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984]



Sec. 37.52  Method of obtaining definitive interpretations.

    (a) All chest roentgenograms which are first interpreted by an ``A'' 
or ``B'' reader will be submitted by ALOSH to a ``B'' reader qualified 
as described in Sec. 37.51. If there is agreement between the two 
interpreters as defined in paragraph (b) of this section the result 
shall be considered final and reported to MSHA for transmittal to the 
miner. When in the opinion of ALOSH substantial agreement is lacking, 
ALOSH shall obtain additional interpretations from the Panel of ``B'' 
readers. If interpretations are obtained from two or more ``B'' readers, 
and if two or more are in agreement then the highest major category 
shall be reported.
    (b) Two interpreters shall be considered to be in agreement when 
they both find either stage A, B, or C complicated pneumoconiosis, or 
their findings with regard to simple pneumoconiosis are both in the same 
major category, or (with one exception noted below) are within one minor 
category (ILO Classification 12-point scale) of each other. In the last 
situation, the higher of the two interpretations shall be reported. The 
only exception to the one minor category principle is a reading sequence 
of 0/1, 1/0, or 1/0, 0/1. When such a sequence occurs, it shall not be 
considered agreement, and a third (or more) interpretation shall be 
obtained until a consensus involving two or more readings in the same 
major category is obtained.

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984; 52 
FR 7866, Mar. 13, 1987]



Sec. 37.53  Notification of abnormal roentgenographic findings.

    (a) Findings of, or findings suggesting, enlarged heart, 
tuberculosis, lung cancer, or any other significant abnormal findings 
other than pneumoconiosis shall be communicated by the first physician 
to interpret and classify the roentgenogram to the designated physician 
of the miner indicated on the miner's identifcation document. A copy of 
the communication shall be submitted to ALOSH. ALOSH will notify

[[Page 154]]

the miner to contact his or her physician when any physician who 
interprets and classifies the miner's roentgenogram reports significant 
abnormal findings other than pneumoconiosis.
    (b) In addition, when ALOSH has more than one roentgenogram of a 
miner in its files and the most recent examination was interpreted to 
show enlarged heart, tuberculosis, cancer, complicated pneumoconiosis, 
and any other significant abnormal findings, ALOSH will submit all of 
the miner's roentgenograms in its files with their respective 
interprtations to a ``B'' reader. The ``B'' reader will report any 
significant changes or progression of disease or other comments to ALOSH 
and ALOSH shall submit a copy of the report to the miner's designated 
physician.
    (c) All final findings regarding pneumoconiosis will be sent to the 
miner by MSHA in accordance with section 203 of the act (see 30 CFR part 
90). Positive findings with regard to pneumoconiosis will be reported to 
the miner's designated physician by ALOSH.
    (d) ALOSH will make every reasonable effort to process the findings 
described in paragraph (c) of this section within 60 days of receipt of 
the information described in Sec. 37.60 in a complete and acceptable 
form. The information forwarded to MSHA will be in a form intended to 
facilitate prompt dispatch of the findings to the miner. The results of 
an examination made of a miner will not be processed by ALOSH if the 
examination was made within 6 months of the date of a previous 
acceptable examination.



Sec. 37.60  Submitting required chest roentgenograms and miner identification documents.

    (a) Each chest roentgenogram required to be made under this subpart, 
together with the completed roentgenographic interpretation form and the 
completed miner identification document, shall be sumitted together for 
each miner to ALOSH within 14 calendar days after the roentgenographic 
examination is given and become the property of ALOSH.
    (b) If ALOSH deems any part submitted under paragraph (a) of this 
section inadequate, it will notify the operator of the deficiency. The 
operator shall promptly make appropriate arrangements for the necessary 
reexamination.
    (c) Failure to comply with paragraph (a) or (b) of this section 
shall be cause to revoke approval of a plan or any other approval as may 
be appropriate. An approval which has been revoked may be reinstated at 
the discretion of ALOSH after it receives satisfactory assurances and 
evidence that all deficiencies have been corrected and that effective 
controls have been instituted to prevent a recurrence.
    (d) Chest roentgenograms and other required documents shall be 
submitted only for miners. Results of preemployment physical 
examinations of persons who are not hired shall not be submitted.
    (e) If a miner refuses to participate in all phases of the 
examination prescribed in this subpart, no report need be made. If a 
miner refuses to participate in any phase of the examination prescribed 
in this subpart, all the forms shall be submitted with his or her name 
and social security account number on each. If any of the forms cannot 
be completed because of the miner's refusal, it shall be marked ``Miner 
Refuses,'' and shall be submitted. No submission shall be made, however, 
without a completed miner identification document containing the miner's 
name, address, social security number and place of employment.

                   Review and Availability of Records



Sec. 37.70  Review of interpretations.

    (a) Any miner who believes the interpretation for pneumoconiosis 
reported to him or her by MSHA is in error may file a written request 
with ALOSH that his or her roentgenogram be reevaluated. If the 
interpretation was based on agreement between an ``A'' reader and a 
``B'' reader, ALOSH will obtain one or more additional interpretations 
by ``B'' readers as necessary to obtain agreement in accord with 
Sec. 37.52(b), and MSHA shall report the results to the miner together 
with any rights which may accrue to the miner in accordance with 
Sec. 37.7. If the reported interpretation was based on agreement between 
two (or more) ``B'' readers, the reading

[[Page 155]]

will be accepted as conclusive and the miner shall be so informed by 
MSHA.
    (b) Any operator who is directed by MSHA to transfer a miner to a 
less dusty atmosphere based on the most recent examination made 
subsequent to August 1, 1978, may file a written request with ALOSH to 
review its findings. The standards set forth in paragraph (a) of this 
section apply and the operator and miner will be notified by MSHA 
whether the miner is entitled to the option to transfer.



Sec. 37.80  Availability of records.

    (a) Medical information and roentgenograms on miners will be 
released by ALOSH only with the written consent from the miner, or if 
the miner is deceased, written consent from the miner's widow, next of 
kin, or legal representative.
    (b) To the extent authorized, roentgenograms will be made available 
for examination only at ALOSH.



                           Subpart--Autopsies

    Authority: Sec. 508, 83 Stat. 803; 30 U.S.C. 957.

    Source: 36 FR 8870, May 14, 1971, unless otherwise noted.



Sec. 37.200  Scope.

    The provisions of this subpart set forth the conditions under which 
the Secretary will pay pathologists to obtain results of autopsies 
performed by them on miners.



Sec. 37.201  Definitions.

    As used in this subpart:
    (a) Secretary means the Secretary of Health and Human Services.
    (b) Miner means any individual who during his life was employed in 
any underground coal mine.
    (c) Pathologist means
    (1) A physician certified in anatomic pathology or pathology by the 
American Board of Pathology or the American Osteopathic Board of 
Pathology,
    (2) A physician who possesses qualifications which are considered 
``Board of eligible'' by the American Board of Pathology or American 
Osteopathic Board of Pathology, or
    (3) An intern, resident, or other physician in a training program in 
pathology who performs the autopsy under the supervision of a 
pathologist as defined in paragraph (c) (1) or (2) of this section.
    (d) ALFORD means the Appalachian Laboratory for Occupational 
Respiratory Diseases, Public Health Service, Department of Health and 
Human Services, Post Office Box 4257, Morgantown, WV 26505.



Sec. 37.202  Payment for autopsy.

    (a) The Secretary will pay up to $200 to any pathologist who, after 
the effective date of the regulations in this part and with legal 
consent:
    (1) Performs an autopsy on a miner in accordance with this subpart; 
and
    (2) Submits the findings and other materials to ALFORD in accordance 
with this subpart within 180 calendar days after having performed the 
autopsy; and
    (3) Receives no other specific payment, fee, or reimbursement in 
connection with the autopsy from the miner's widow, his family, his 
estate, or any other Federal agency.
    (b) The Secretary will pay to any pathologist entitled to payment 
under paragraph (a) of this section and additional $10 if the 
pathologist can obtain and submits a good quality copy or original of a 
chest roentgenogram (posteroanterior view) made of the subject of the 
autopsy within 5 years prior to his death together with a copy of any 
interpretation made.

[35 FR 13206, Aug. 19, 1970, as amended at 38 FR 16353, June 22, 1973]



Sec. 37.203  Autopsy specifications.

    (a) Every autopsy for which a claim for payment is submitted 
pursuant to this part:
    (1) Shall be performed consistent with standard autopsy procedures 
such as those, for example, set forth in the ``Autopsy Manual'' prepared 
by the Armed Forces Institute of Pathology, July 1, 1960. (Technical 
Manual No. 8-300. NAVMED P-5065, Air Force Manual No. 160-19.) Copies of 
this document may be borrowed from ALFORD.
    (2) Shall include:

[[Page 156]]

    (i) Gross and microscopic examination of the lungs, pulmonary 
pleura, and tracheobronchial lymph nodes;
    (ii) Weights of the heart and each lung (these and all other 
measurements required under this subparagraph shall be in the metric 
system);
    (iii) Circumference of each cardiac valve when opened;
    (iv) Thickness of right and left ventricles; these measurements 
shall be made perpendicular to the ventricular surface and shall not 
include trabeculations or pericardial fat. The right ventricle shall be 
measured at a point midway between the tricuspid valve and the apex, and 
the left ventricle shall be measured directly above the insertion of the 
anterior papillary muscle;
    (v) Size, number, consistency, location, description and other 
relevant details of all lesions of the lungs;
    (vi) Level of the diaphragm;
    (vii) From each type of suspected pneumoconiotic lesion, 
representative microscopic slides stained with hematoxylin eosin or 
other appropriate stain, and one formalin fixed, paraffin-impregnated 
block of tissue; a minimum of three stained slides and three blocks of 
tissue shall be submitted. When no such lesion is recognized, similar 
material shall be submitted from three separate areas of the lungs 
selected at random; a minimum of three stained slides and three formalin 
fixed, paraffin-impregnated blocks of tissue shall be submitted.
    (b) Needle biopsy techniques shall not be used.



Sec. 37.204  Procedure for obtaining payment.

    Every claim for payment under this subpart shall be submitted to 
ALFORD and shall include:
    (a) An invoice (in duplicate) on the pathologist's letterhead or 
billhead indicating the date of autopsy, the amount of the claim and a 
signed statement that the pathologist is not receiving any other 
specific compensation for the autopsy from the miner's widow, his 
surviving next-of-kin, the estate of the miner, or any other source.
    (b) Completed PHS Consent, Release and History Form (See Fig. 1). 
This form may be completed with the assistance of the pathologist, 
attending physician, family physician, or any other responsible person 
who can provide reliable information.
    (c) Report of autopsy:
    (1) The information, slides, and blocks of tissue required by this 
subpart.
    (2) Clinical abstract of terminal illness and other data that the 
pathologist determines is relevant.
    (3) Final summary, including final anatomical diagnoses, indicating 
presence or absence of simple and complicated pneumoconiosis, and 
correlation with clinical history if indicated.

                                Figure 1

              U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

       Public Health Service--National Coal Workers' Autopsy Study

 Consent, Release, and History Form Federal Coal Mine Health and Safety 
                               Act of 1969

    I, ------------------, (Name) ------------ (Relationship) of ------
------------, (Name of deceased miner) do hereby authorize the 
performance of an autopsy (------------------) (Limitation, if any, on 
autopsy) on said deceased. I understand that the report and certain 
tissues as necessary will be released to the United States Public Health 
Service and to ------------------ (Name of Physician securing autopsy)

I understand that any claims in regard to the deceased for which I may 
sign a general release of medical information will result in the release 
of the information from the Public Health Service. I further understand 
that I shall not make any payment for the autopsy.

                    Occupational and Medical History

    1. Date of Birth of Deceased ------------. (Month, Day, Year)
    2. Social Security Number of Deceased ------ ------ ------.
    3. Date and Place of Death ------------, (Month, Day, Year) --------
---------- (City, County, State).
    4. Place of Last Mining Employment:
Name of Mine____________________________________________________________
Name of Mining Company__________________________________________________
Mine Address____________________________________________________________
    5. Last Job Title at Mine of Last Employment
(e.g., Continuous Miner Operator, motorman, foreman, etc.)

[[Page 157]]

    6. Job Title of Principal Mining Occupation (that job to which miner 
devoted the most number of years)
                                                   (e.g., Same as above)
    7. Smoking History of Miner:
    (a) Did he ever smoke cigarettes? Yes
No______________________________________________________________________
    (b) If yes, for how many years?------------
Years.
    (c) If yes, how many cigarettes per day did he smoke on the 
average?----------------
                                                             (Number of)
Cigarettes per day.
    (d) Did he smoke cigarettes up until the time of his death? Yes ----
-- No ------
    (e) If no to (d), for how long before he died had he not been 
smoking cigarettes?
    8. Total Years in Surface and Underground Employment in Coal Mining, 
by State (If known) ------, (Years) ------------ (State).
    9. Total Years in Underground Coal Mining Employment, by State (If 
known) ------, (Years) ------------ (State).
_______________________________________________________________________
                                                             (Signature)
_______________________________________________________________________
                                                               (Address)
_______________________________________________________________________
                                                                  (Date)
Interviewer:____________________________________________________________



PART 38--DISASTER ASSISTANCE FOR CRISIS COUNSELING AND TRAINING--Table of Contents




Sec.
38.1  Purpose; coordination.
38.2  Definitions.
38.3  Assistance; procedures, limitations.
38.4  Contracts.
38.5  Grant assistance.
38.6  Nondiscrimination.
38.7  Nonliability.
38.8  Criminal and civil penalties.
38.9  Federal audits.

    Authority: Sec. 413, Pub. L. 93-288. The Disaster Relief Act of 
1974, 88 Stat. 157, 42 U.S.C. 5183, EO 11795, 39 FR 25939, as amended by 
EO 11910, 41 FR 15681.

    Source: 41 FR 52052, Nov. 26, 1976, unless otherwise noted.



Sec. 38.1  Purpose; coordination.

    (a) Purpose. This part establishes standards and procedures for the 
implementation of section 413 of Pub. L. 93-288, the Disaster Relief Act 
of 1974 (42 U.S.C. 5183) which authorizes the provision, either directly 
or through financial assistance to State or local agencies or private 
mental health organizations, of:
    (1) Professional counseling services to victims of a major disaster 
in order to relieve mental health problems caused or aggravated by such 
a major disaster or its aftermath; and
    (2) Training of disaster workers to provide or assist in providing 
those professional counseling services.
    (b) Coordination. The Secretary, acting through the National 
Institute of Mental Health, will, as provided in 24 CFR 2205.51, carry 
out section 413 of the Act and this part in coordination with and under 
the general policy guidance of, the Administrator of the Federal 
Disaster Assistance Administration. Contracts and grants awarded under 
this part are subject to all applicable provisions of the Act and the 
implementing regulations promulgated by the Administrator (24 CFR part 
2205).



Sec. 38.2  Definitions.

    All terms not defined herein shall have the same meaning as given 
them in the Act. As used in this part:
    (a) Act means the Disaster Relief Act of 1974 (42 U.S.C. 5121 , et 
seq.).
    (b) Administrator means the Administrator, Federal Disaster 
Assistance Administration (FDAA), Department of Housing and Urban 
Development, and any other person to whom he delegates the authority.
    (c) Contractor means any public agency or private mental health 
organization which, pursuant to this part, contracts with the Secretary 
to provide professional mental health crisis counseling services or to 
provide mental health training for disaster workers.
    (d) Crisis means the existence of any life situation resulting from 
a major disaster or its aftermath which so effects the emotional and 
mental equilibrium of a disaster victim that professional mental health 
counseling services should be provided to help preclude possible 
damaging physical or psychological effects.
    (e) Disaster workers means mental health specialists such as 
psychiatrists, psychologists, psychiatric nurses, social workers, or 
qualified agents thereof.
    (f) Federal Coordinating Officer means the person appointed by the 
Administrator to coordinate Federal assistance in a major disaster.

[[Page 158]]

    (g) Governor means the chief executive of a State.
    (h) Grantee means any public agency or private nonprofit mental 
health organization which, pursuant to this part, is awarded a grant for 
the purpose of providing professional mental health crisis counseling 
services or mental health training for disaster workers.
    (i) Major disaster means any hurricane, tornado, storm, flood, high-
water, wind-driven water, tidal wave, tsunami, earthquake, volcanic 
eruption, landslide, mudslide, snowstorm, drought, fire, explosion, or 
other catastrophe in any part of the United States which, in the 
determination of the President, causes damage of sufficient severity and 
magnitude to warrant major disaster assistance under the Act above and 
beyond emergency services by the Federal Government, to supplement the 
efforts and available resources of the States, local governments, and 
disaster relief organizations, in alleviating the damage, loss, 
hardship, or suffering caused thereby.
    (j) Regional Director means a director of a regional office of the 
Federal Disaster Assistance Administration (FDAA).
    (k) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (l) State means any of the fifty States, the District of Columbia, 
Puerto Rico, the Virgin Islands, Guam, American Samoa, the Canal Zone, 
or the Trust Territory of the Pacific Islands.
    (m) State Coordinating Officer means the person appointed by the 
Governor to act in cooperation with the appointed Federal Coordinating 
Officer.
    (n) Training means the specific instruction which may be required to 
enable disaster workers to provide professional mental health crisis 
counseling to victims of a major disaster or its aftermath.



Sec. 38.3  Assistance; procedures, limitations.

    (a) Application. In order to obtain assistance under this part, the 
Governor or his State Coordinating Officer must, not later than 60 days 
following a major disaster declaration by the President, file with the 
appropriate Regional Director a request which includes:
    (1) An estimate of the number of disaster victims who may need 
professional mental health crisis counseling services and of the number 
of disaster workers who may need training in the provision of such 
services;
    (2) Identification of the geographical areas in which the need 
exists;
    (3) An estimate of the period during which assistance under this 
part will be required and of the total funds which will be required to 
provide such assistance;
    (4) A description of the types of mental health problems caused or 
aggravated by the major disaster or its aftermath; and
    (5) Identification of the State and local agencies and private 
mental health organizations capable of providing professional mental 
health crisis counseling to disaster victims or training of disaster 
workers.
    (b) Review, approval. The Secretary, upon notification by the 
Administrator of a State request for assistance under this part, will 
conduct a review to determine the extent to which such assistance is 
needed to supplement assistance programs provided by State and local 
governments and private organizations and, on the basis of that review, 
prepare and submit a recommendation and report for consideration by the 
Administrator. Upon approval by the Administrator and his advancement of 
funds for carrying out the approved assistance, the Secretary may, 
within the limits of the funds advanced, provide the approved services 
either directly or through a grant or contract.
    (c) Eligibility for services. (1) In order to be eligible for the 
professional mental health crisis counseling services available under 
this part an individual must:
    (i) Have been located within the designated major disaster area or 
have been a resident of such area at the time of the major disaster or 
its aftermath; and

[[Page 159]]

    (ii) Have a mental health problem which was caused or aggravated by 
the major disaster or its aftermath.
    (2) Disaster workers who are available on short notice to provide 
professional mental health crisis counseling services in a major 
disaster area are eligible for training under this part.
    (d) Time limitation. Contracts and grants awarded under this part 
will not continue beyond 180 days after the first day services are 
provided pursuant to such contracts and grants, except that upon the 
recommendation of the Secretary (1) the Regional Director may extend the 
180 day period for up to 30 days or (2) the Administrator may extend the 
180 day period for more than 30 days.



Sec. 38.4  Contracts.

    (a) Eligibility. Public agencies and private mental health 
organizations which are determined by the Secretary to be capable of 
providing the professional mental health crisis counseling services or 
mental health training of disaster workers needed as a result of a major 
disaster are eligible for the award of a contract under this part.
    (b) Use of local agencies. Preference will be given to the extent 
feasible and practicable, to those agencies and organizations which are 
located or do business primarily in the area affected by the major 
disaster.
    (c) General requirements. Contracts under this part shall be entered 
into and carried out in accordance with the provisions of chapters 1 and 
3 of title 41 of the Code of Federal Regulations and all other 
applicable laws and regulations.
    (d) Payments. The Secretary shall from time to time make payments to 
the contractor of all or a portion of the contract award, either by way 
of reimbursement for expenses incurred or in advance for expenses to be 
incurred, to the extent he determines such payments are necessary to 
promote prompt initiation and advancement of the services to be provided 
under the contract. All payments not expended by the contractor within 
the period of the contract shall be returned to the Secretary.
    (e) Reports. Contractors shall submit the following reports to the 
Secretary:
    (1) Progress reports, to be submitted at the end of the first 30 
days of the contract period and every 30 days therafter;
    (2) A final report to be submitted within 60 days of the date upon 
which the contract terminates; and
    (3) Such additional reports as the Secretary may prescribe including 
those which may be required to enable the Federal Coordinating Officer 
to carry out his functions.



Sec. 38.5  Grant assistance.

    (a) Eligibility. Public agencies and private nonprofit mental health 
organizations which are determined by the Secretary to be capable of 
providing the professional mental health crisis counseling services or 
mental health training of disaster workers needed as a result of a major 
disaster are eligible for a grant award under this part.
    (b) Application. The application shall contain:
    (1) A proposed plan for the provision of the services for which 
grant assistance is requested;
    (2) A proposed budget for the expenditure of the requested grant 
funds; and
    (3) Such other pertinent information and assurances as the Secretary 
may require.
    (c) Grant awards. (1) Preference will be given, to the extent 
feasible and practicable, to those public and private nonprofit agencies 
and organizations which are located or do business primarily in the area 
affected by the major disaster.
    (2) Within the limits of the funds advanced by the Administrator, 
the amount of any grant award shall be determined on the basis of the 
Secretary's estimate of the sum necessary to carry out the grant 
purpose.
    (3) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.
    (d) Other HHS regulations that apply. Several other regulations 
apply to grants under this grant. These include, but are not limited to:


[[Page 160]]


42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of Title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

    (e) Expenditure of grant funds. Any funds granted pursuant to this 
part shall be expended solely for the purposes for which the funds were 
granted in accordance with the approved application and budget, the 
regulations of this part, the terms and the conditions of the award, and 
the applicable cost principles prescribed in subpart Q of 45 CFR part 
74.
    (f) Reports. In exceptional circumstances, a grantee may be required 
to submit special progress reports, in addition to those otherwise 
required, relating to the conduct and results of the approved grant.

[41 FR 52052, Nov. 26, 1976, as amended at 45 FR 57396, Aug. 28, 1980; 
49 FR 38109, Sept. 27, 1984]



Sec. 38.6  Nondiscrimination.

    Attention is called to the requirements of 24 CFR 2205.13 relating 
to nondiscrimination on the grounds of race. religion, sex, color, age, 
economic status, or national origin in the provision of disaster 
assistance.



Sec. 38.7  Nonliability.

    Attention is called to section 308 of the Act (42 U.S.C. 5148) which 
provides that the Federal Government shall not be liable for any claim 
based upon the exercise or performance of or the failure to exercise or 
perform a discretionary function or duty on the part of a Federal agency 
or an employee of the Federal Government in carrying out the provisions 
of the Act.



Sec. 38.8  Criminal and civil penalties.

    Attention is called to section 317 of the Act (42 U.S.C. 5157) which 
provides:

    (a) Any individual who fraudulently or willfully misstates any fact 
in connection with a request for assistance under this Act shall be 
fined not more than $10,000 or imprisoned for not more than one year or 
both for each violation.
    (b) Any individual who knowingly violates any order or regulation 
under this Act shall be subject to a civil penalty of not more than 
$5,000 for each violation.
    (c) Whoever knowingly misapplies the proceeds of a loan or other 
cash benefit obtained under any section of this Act shall be subject to 
a fine in an amount equal to one and one half times the original 
principal amount of the loan or cash benefit.



Sec. 38.9  Federal audits.

    The Secretary, the Administrator, and the Comptroller General of the 
United States, or their duly authorized representatives shall have 
access to any books, documents, papers, and records that pertain to 
Federal funds, equipment, and supplies received under this part for the 
purpose of audit and examination.

[[Page 161]]



                          SUBCHAPTER D--GRANTS





PART 50--POLICIES OF GENERAL APPLICABILITY--Table of Contents




Subpart A--Responsibility of PHS Awardee and Applicant Institutions for 
        Dealing With and Reporting Possible Misconduct in Science

Sec.
50.101  Applicability.
50.102  Definitions.
50.103  Assurance--Responsibilities of PHS Awardee and Applicant 
          Institutions.
50.104  Reporting to the OSI.
50.105  Institutional compliance.

    Subpart B--Sterilization of Persons in Federally Assisted Family 
                            Planning Projects

50.201  Applicability.
50.202  Definitions.
50.203  Sterilization of a mentally competent individual aged 21 or 
          older.
50.204  Informed consent requirement.
50.205  Consent form requirements.
50.206  Sterilization of a mentally incompetent individual or of an 
          institutionalized individual.
50.207  Sterilization by hysterectomy.
50.208  Program or project requirements.
50.209  Use of Federal financial assistance.
50.210  Review of regulation.

Appendix to Subpart B of Part 50--Required Consent Form

Subpart C--Abortions and Related Medical Services in Federally Assisted 
                  Programs of the Public Health Service

50.301  Applicability.
50.302  Definitions.
50.303  General rule.
50.304  Life of the mother would be endangered.
50.305  [Reserved]
50.306  Rape and incest.
50.307  Documentation needed by programs or projects.
50.308  Drugs and devices and termination of ectopic pregnancies.
50.309  Recordkeeping requirements.
50.310  Confidentiality.

        Subpart D--Public Health Service Grant Appeals Procedure

50.401  What is the purpose of this subpart?
50.402  To what programs do these regulations apply?
50.403  What is the policy basis for these procedures?
50.404  What disputes are covered by these procedures?
50.405  What is the structure of review committees?
50.406  What are the steps in the process?

               Subpart E--Maximum Allowable Cost for Drugs

50.501  Applicability.
50.502  Definitions.
50.503  Policy.
50.504  Allowable cost of drugs.

  Subpart F--Responsibility of Applicants for Promoting Objectivity in 
                Research for Which PHS Funding Is Sought

50.601  Purpose.
50.602  Applicability.
50.603  Definitions.
50.604  Institutional responsibility regarding conflicting interests of 
          investigators
50.605  Management of conflicting interests.
50.606  Remedies.
50.607  Other HHS regulations that apply.

    Authority: Sec. 215, Public Health Service Act, 58 Stat. 690 (42 
U.S.C. 216); Sec. 1006, Public Health Service Act, 84 Stat. 1507 (42 
U.S.C. 300a-4), unless otherwise noted.

    Source: 43 FR 52165, Nov. 8, 1978, unless otherwise noted.



Subpart A--Responsibility of PHS Awardee and Applicant Institutions for 
        Dealing With and Reporting Possible Misconduct in Science

    Authority: Sec. 493, Public Health Service Act, as amended, 99 Stat. 
874-875 (42 U.S.C. 289b); Sec. 501(f), Public Health Service Act, as 
amended, 102 Stat. 4213 (42 U.S.C. 290aa(f)).

    Source: 54 FR 32449, Aug. 8, 1989, unless otherwise noted.



Sec. 50.101  Applicability.

    This subpart applies to each entity which applies for a research, 
research-training, or research-related grant or cooperative agreement 
under the Public Health Service (PHS) Act. It requires each such entity 
to establish uniform policies and procedures for investigating and 
reporting instances of

[[Page 162]]

alleged or apparent misconduct involving research or research training, 
applications for support of research or research training, or related 
research activities that are supported with funds made available under 
the PHS Act. This subpart does not supersede and is not intended to set 
up an alternative to established procedures for resolving fiscal 
improprieties, issues concerning the ethical treatment of human or 
animal subjects, or criminal matters.



Sec. 50.102  Definitions.

    As used in this subpart:
    Act means the Public Health Service Act, as amended, (42 U.S.C. 201 
et seq.).
    Inquiry means information gathering and initial factfinding to 
determine whether an allegation or apparent instance of misconduct 
warrants an investigation.
    Institution means the public or private entity or organization 
(including federal, state, and other agencies) that is applying for 
financial assistance from the PHS, e.g., grant or cooperative 
agreements, including continuation awards, whether competing or 
noncompeting. The organization assumes legal and financial 
accountability for the awarded funds and for the performance of the 
supported activities.
    Investigation means the formal examination and evaluation of all 
relevant facts to determine if misconduct has occurred.
    Misconduct or Misconduct in Science means fabrication, 
falsification, plagiarism, or other practices that seriously deviate 
from those that are commonly accepted within the scientific community 
for proposing, conducting, or reporting research. It does not include 
honest error or honest differences in interpretations or judgments of 
data.
    OSI means the Office of Scientific Integrity, a component of the 
Office of the Director of the National Institutes for Health (NIH), 
which oversees the implementation of all PHS policies and procedures 
related to scientific misconduct; monitors the individual investigations 
into alleged or suspected scientific misconduct conducted by 
institutions that receive PHS funds for biomedical or behavioral 
research projects or programs; and conducts investigations as necessary.
    OSIR means the Office of Scientific Integrity Review, a component of 
the Office of the Assistant Secretary for Health, which is responsible 
for establishing overall PHS policies and procedures for dealing with 
misconduct in science, overseeing the activities of PHS research 
agencies to ensure that these policies and procedures are implemented, 
and reviewing all final reports of investigations to assure that any 
findings and recommendations are sufficiently documented. The OSIR also 
makes final recommendations to the Assistant Secretary for Health on 
whether any sanctions should be imposed and, if so, what they should be 
in any case where scientific misconduct has been established.
    PHS means the Public Health Service, an operating division of the 
Department of Health and Human Services (HHS). References to PHS include 
organizational units within the PHS that have delegated authority to 
award financial assistance to support scientific activities, e.g., 
Bureaus, Institutes, Divisions, Centers or Offices.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved may be delegated.



Sec. 50.103  Assurance--Responsibilities of PHS awardee and applicant institutions.

    (a) Assurances. Each institution that applies for or receives 
assistance under the Act for any project or program which involves the 
conduct of biomedical or behavioral research must have an assurance 
satisfactory to the Secretary that the applicant:
    (1) Has established an administrative process, that meets the 
requirements of this Subpart, for reviewing, investigating, and 
reporting allegations of misconduct in science in connection with PHS-
sponsored biomedical and behavioral research conducted at the applicant 
institution or sponsored by the applicant; and
    (2) Will comply with its own administrative process and the 
requirements of this Subpart.

[[Page 163]]

    (b) Annual Submission. An applicant or recipient institution shall 
make an annual submission to the OSI as follows:
    (1) The institution's assurance shall be submitted to the OSI, on a 
form prescribed by the Secretary, as soon as possible after November 8, 
1989, but no later than January 1, 1990, and updated annually therefter 
on a date specified by OSI. Copies of the form may be requested through 
the Director, OSI.
    (2) An institution shall submit, along with its annual assurance, 
such aggregate information on allegations, inquiries, and investigations 
as the Secretary may prescribe.
    (c) General Criteria. In general, an applicant institution will be 
considered to be in compliance with its assurance if it:
    (1) Establishes, keeps current, and upon request provides the OSIR, 
the OSI, and other authorized Departmental officials the policies and 
procedures required by this subpart.
    (2) Informs its scientific and administrative staff of the policies 
and procedures and the importance of compliance with those policies and 
procedures.
    (3) Takes immediate and appropriate action as soon as misconduct on 
the part of employees or persons within the organization's control is 
suspected or alleged.
    (4) Informs, in accordance with this subpart, and cooperates with 
the OSI with regard to each investigation of possible misconduct.
    (d) Inquiries, Investigations, and Reporting--Specific Requirements. 
Each applicant's policies and procedures must provide for:
    (1) Inquiring immediately into an allegation or other evidence of 
possible misconduct. An inquiry must be completed within 60 calendar 
days of its initiation unless circumstances clearly warrant a longer 
period. A written report shall be prepared that states what evidence was 
reviewed, summarizes relevant interviews, and includes the conclusions 
of the inquiry. The individual(s) against whom the allegation was made 
shall be given a copy of the report of inquiry. If they comment on that 
report, their comments may be made part of the record. If the inquiry 
takes longer than 60 days to complete, the record of the inquiry shall 
include documentation of the reasons for exceeding the 60-day period.
    (2) Protecting, to the maximum extent possible, the privacy of those 
who in good faith report apparent misconduct.
    (3) Affording the affected individual(s) confidential treatment to 
the maximum extent possible, a prompt and thorough investigation, and an 
opportunity to comment on allegations and findings of the inquiry and/or 
the investigation.
    (4) Notifying the Director, OSI, in accordance with Sec. 50.104(a) 
when, on the basis of the initial inquiry, the institution determines 
that an investigation is warranted, or prior to the decision to initiate 
an investigation if the conditions listed in Sec. 50.104(b) exist.
    (5) Notifying the OSI within 24 hours of obtaining any reasonable 
indication of possible criminal violations, so that the OSI may then 
immediately notify the Department's Office of Inspector General.
    (6) Maintaining sufficiently detailed documentation of inquiries to 
permit a later assessment of the reasons for determining that an 
investigation was not warranted, if necessary. Such records shall be 
maintained in a secure manner for a period of at least three years after 
the termination of the inquiry, and shall, upon request, be provided to 
authorized HHS personnel.
    (7) Undertaking an investigation within 30 days of the completion of 
the inquiry, if findings from that inquiry provide sufficient basis for 
conducting an investigation. The investigation normally will include 
examination of all documentation, including but not necessarily limited 
to relevant research data and proposals, publications, correspondence, 
and memoranda of telephone calls. Whenever possible, interviews should 
be conducted of all individuals involved either in making the allegation 
or against whom the allegation is made, as well as other individuals who 
might have information regarding key aspects of the allegations; 
complete summaries of these interviews should be prepared, provided to 
the interviewed party for comment

[[Page 164]]

or revision, and included as part of the investigatory file.
    (8) Securing necessary and appropriate expertise to carry out a 
thorough and authoritative evaluation of the relevant evidence in any 
inquiry or investigation.
    (9) Taking precautions against real or apparent conflicts of 
interest on the part of those involved in the inquiry or investigation.
    (10) Preparing and maintaining the documentation to substantiate the 
investigation's findings. This documentation is to be made available to 
the Director, OSI, who will decide whether that Office will either 
proceed with its own investigation or will act on the institution's 
findings.
    (11) Taking interim administrative actions, as appropriate, to 
protect Federal funds and insure that the purposes of the Federal 
financial assistance are carried out.
    (12) Keeping the OSI apprised of any developments during the course 
of the investigation which disclose facts that may affect current or 
potential Department of Health and Human Services funding for the 
individual(s) under investigation or that the PHS needs to know to 
ensure appropriate use of Federal funds and otherwise protect the public 
interest.
    (13) Undertaking diligent efforts, as appropriate, to restore the 
reputations of persons alleged to have engaged in misconduct when 
allegations are not confirmed, and also undertaking diligent efforts to 
protect the positions and reputations of those persons who, in good 
faith, make allegations.
    (14) Imposing appropriate sanctions on individuals when the 
allegation of misconduct has been substantiated.
    (15) Notifying the OSI of the final outcome of the investigation.



Sec. 50.104  Reporting to the OSI.

    (a)(1) An institution's decision to initiate an investigation must 
be reported in writing to the Director, OSI, on or before the date the 
investigation begins. At a minimum, the notification should include the 
name of the person(s) against whom the allegations have been made, the 
general nature of the allegation, and the PHS application or grant 
number(s) involved. Information provided through the notification will 
be held in confidence to the extent permitted by law, will not be 
disclosed as part of the peer review and Advisory Committee review 
processes, but may be used by the Secretary in making decisions about 
the award or continuation of funding.
    (2) An investigation should ordinarily be completed within 120 days 
of its initiation. This includes conducting the investigation, preparing 
the report of findings, making that report available for comment by the 
subjects of the investigation, and submitting the report to the OSI. If 
they can be identified, the person(s) who raised the allegation should 
be provided with those portions of the report that address their role 
and opinions in the investigation.
    (3) Institutions are expected to carry their investigations through 
to completion, and to pursue diligently all significant issues. If an 
institution plans to terminate an inquiry or investigation for any 
reason without completing all relevant requirements under 
Sec. 50.103(d), a report of such planned termination, including a 
description of the reasons for such termination, shall be made to OSI, 
which will then decide whether further investigation should be 
undertaken.
    (4) The final report submitted to the OSI must describe the policies 
and procedures under which the investigation was conducted, how and from 
whom information was obtained relevant to the investigation, the 
findings, and the basis for the findings, and include the actual text or 
an accurate summary of the views of any individual(s) found to have 
engaged in misconduct, as well as a description of any sanctions taken 
by the institution.
    (5) If the institution determines that it will not be able to 
complete the investigation in 120 days, it must submit to the OSI a 
written request for an extension and an explanation for the delay that 
includes an interim report on the progress to date and an estimate for 
the date of completion of the report and other necessary steps. Any 
consideration for an extension must balance the need for a thorough and 
rigorous

[[Page 165]]

examination of the facts versus the interests of the subject(s) of the 
investigation and the PHS in a timely resolution of the matter. If the 
request is granted, the institution must file periodic progress reports 
as requested by the OSI. If satisfactory progress is not made in the 
institution's investigation, the OSI may undertake an investigation of 
its own.
    (6) Upon receipt of the final report of investigation and supporting 
materials, the OSI will review the information in order to determine 
whether the investigation has been performed in a timely manner and with 
sufficient objectivity, thoroughness and competence. The OSI may then 
request clarification or additional information and, if necessary, 
perform its own investigation. While primary responsibility for the 
conduct of investigations and inquiries lies with the institution, the 
Department reserves the right to perform its own investigation at any 
time prior to, during, or following an institution's investigation.
    (7) In addition to sanctions that the institution may decide to 
impose, the Department also may impose sanctions of its own upon 
investigators or institutions based upon authorities it possesses or may 
possess, if such action seems appropriate.
    (b) The institution is responsible for notifying the OSI if it 
ascertains at any stage of the inquiry or investigation, that any of the 
following conditions exist:
    (1) There is an immediate health hazard involved;
    (2) There is an immediate need to protect Federal funds or 
equipment;
    (3) There is an immediate need to protect the interests of the 
person(s) making the allegations or of the individual(s) who is the 
subject of the allegations as well as his/her co-investigators and 
associates, if any;
    (4) It is probable that the alleged incident is going to be reported 
publicly.
    (5) There is a reasonable indication of possible criminal violation. 
In that instance, the institution must inform OSI within 24 hours of 
obtaining that information. OSI will immediately notify the Office of 
the Inspector General.



Sec. 50.105  Institutional compliance.

    Institutions shall foster a research environment that discourages 
misconduct in all research and that deals forthrightly with possible 
misconduct associated with research for which PHS funds have been 
provided or requested. An institution's failure to comply with its 
assurance and the requirements of this subpart may result in enforcement 
action against the institution, including loss of funding, and may lead 
to the OSI's conducting its own investigation.



    Subpart B--Sterilization of Persons in Federally Assisted Family 
                            Planning Projects



Sec. 50.201  Applicability.

    The provisions of this subpart are applicable to programs or 
projects for health services which are supported in whole or in part by 
Federal financial assistance, whether by grant or contract, administered 
by the Public Health Service.



Sec. 50.202  Definitions.

    As used in this subpart:
    Arrange for means to make arrangements (other than mere referral of 
an individual to, or the mere making of an appointment for him or her 
with, another health care provider) for the performance of a medical 
procedure on an individual by a health care provider other than the 
program or project.
    Hysterectomy means a medical procedure or operation for the purpose 
of removing the uterus.
    Institutionalized individual means an individual who is (1) 
involuntarily confined or detained, under a civil or criminal statute, 
in a correctional or rehabilitative facility, including a mental 
hospital or other facility for the care and treatment of mental illness, 
or (2) confined, under a voluntary commitment, in a mental hospital or 
other facility for the care and treatment of mental illness.
    Mentally incompetent individual means an individual who has been 
declared mentally incompetent by a Federal, State, or local court of 
competent jurisdiction for any purpose unless he or she has been 
declared competent for

[[Page 166]]

purposes which include the ability to consent to sterilization.
    Public Health Service means the Office of the Assistant Secretary 
for Health, Health Resources and Services Administration, National 
Institutes of Health, Centers for Disease Control, Alcohol, Drug Abuse 
and Mental Health Administration and all of their constituent agencies.
    The Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    Sterilization means any medical procedure, treatment, or operation 
for the purpose of rendering an individual permanently incapable of 
reproducing.

[43 FR 52165, Nov. 8, 1978, as amended at 49 FR 38109, Sept. 27, 1984]



Sec. 50.203  Sterilization of a mentally competent individual aged 21 or older.

    Programs or projects to which this subpart applies shall perform or 
arrange for the performance of sterilization of an individual only if 
the following requirements have been met:
    (a) The individual is at least 21 years old at the time consent is 
obtained.
    (b) The individual is not a mentally incompetent individual.
    (c) The individual has voluntarily given his or her informed consent 
in accordance with the procedures of Sec. 50.204 of this subpart.
    (d) At least 30 days but not more than 180 days have passed between 
the date of informed consent and the date of the sterilization, except 
in the case of premature delivery or emergency abdominal surgery. An 
individual may consent to be sterilized at the time of premature 
delivery or emergency abdominal surgery, if at least 72 hours have 
passed after he or she gave informed consent to sterilization. In the 
case of premature delivery, the informed consent must have been given at 
least 30 days before the expected date of delivery.



Sec. 50.204  Informed consent requirement.

    Informed consent does not exist unless a consent form is completed 
voluntarily and in accordance with all the requirements of this section 
and Sec. 50.205 of this subpart.
    (a) A person who obtains informed consent for a sterilization 
procedure must offer to answer any questions the individual to be 
sterilized may have concerning the procedure, provide a copy of the 
consent form, and provide orally all of the following information or 
advice to the individual who is to be sterilized:
    (1) Advice that the individual is free to withhold or withdraw 
consent to the procedure any time before the sterilization without 
affecting his or her right to future care or treatment and without loss 
or withdrawal of any federally funded program benefits to which the 
individual might be otherwise entitled:
    (2) A description of available alternative methods of family 
planning and birth control;
    (3) Advice that the sterilization procedure is considered to be 
irreversible;
    (4) A thorough explanation of the specific sterilization procedure 
to be performed;
    (5) A full description of the discomforts and risks that may 
accompany or follow the performing of the procedure, including an 
explanation of the type and possible effects of any anesthetic to be 
used;
    (6) A full description of the benefits or advantages that may be 
expected as a result of the sterilization; and
    (7) Advice that the sterilization will not be performed for at least 
30 days except under the circumstances specified in Sec. 50.203(d) of 
this subpart.
    (b) An interpreter must be provided to assist the individual to be 
sterilized if he or she does not understand the language used on the 
consent form or the language used by the person obtaining the consent.
    (c) Suitable arrangements must be made to insure that the 
information specified in paragraph (a) of this section is effectively 
communicated to any individual to be sterilized who is blind, deaf or 
otherwise handicapped.
    (d) A witness chosen by the individual to be sterilized may be 
present when consent is obtained.

[[Page 167]]

    (e) Informed consent may not be obtained while the individual to be 
sterilized is:
    (1) In labor or childbirth;
    (2) Seeking to obtain or obtaining an abortion; or
    (3) Under the influence of alcohol or other substances that affect 
the individual's state of awareness.
    (f) Any requirement of State and local law for obtaining consent, 
except one of spousal consent, must be followed.



Sec. 50.205  Consent form requirements.

    (a) Required consent form. The consent form appended to this subpart 
or another consent form approved by the Secretary must be used.
    (b) Required signatures. The consent form must be signed and dated 
by:
    (1) The individual to be sterilized; and
    (2) The interpreter, if one is provided; and
    (3) The person who obtains the consent; and
    (4) The physician who will perform the sterilization procedure.
    (c) Required certifications. (1) The person obtaining the consent 
must certify by signing the consent form that:
    (i) Before the individual to be sterilized signed the consent form, 
he or she advised the individual to be sterilized that no Federal 
benefits may be withdrawn because of the decision not to be sterilized,
    (ii) He or she explained orally the requirements for informed 
consent as set forth on the consent form, and
    (iii) To the best of his or her knowledge and belief, the individual 
to be sterilized appeared mentally competent and knowingly and 
voluntarily consented to be sterilized.
    (2) The physician performing the sterilization must certify by 
signing the consent form, that:
    (i) Shortly before the performance of the sterilization, he or she 
advised the individual to be sterilized that no Federal benefits may be 
withdrawn because of the decision not to be sterilized,
    (ii) He or she explained orally the requirements for informed 
consent as set forth on the consent form, and
    (iii) To the best of his or her knowledge and belief, the individual 
to be sterilized appeared mentally competent and knowingly and 
voluntarily consented to be sterilized. Except in the case of premature 
delivery or emergency abdominal surgery, the physician must further 
certify that at least 30 days have passed between the date of the 
individual's signature on the consent form and the date upon which the 
sterilization was performed. If premature delivery occurs or emergency 
abdominal surgery is required within the 30-day period, the physician 
must certify that the sterilization was performed less than 30 days but 
not less than 72 hours after the date of the individual's signature on 
the consent form because of premature delivery or emergency abdominal 
surgery, as applicable. In the case of premature delivery, the physician 
must also state the expected date of delivery. In the case of emergency 
abdominal surgery, the physician must describe the emergency.
    (3) If an interpreter is provided, the interpreter must certify that 
he or she translated the information and advice presented orally, read 
the consent form and explained its contents and to the best of the 
interpreter's knowledge and belief, the individual to be sterilized 
understood what the interpreter told him or her.



Sec. 50.206  Sterilization of a mentally incompetent individual or of an institutionalized individual.

    Programs or projects to which this subpart applies shall not perform 
or arrange for the performance of a sterilization of any mentally 
incompetent individual or institutionalized individual.



Sec. 50.207  Sterilization by hysterectomy.

    (a) Programs or projects to which this subpart applies shall not 
perform or arrange for the performance of any hysterectomy solely for 
the purpose of rendering an individual permanently incapable of 
reproducing or where, if there is more than one purpose to the 
procedure, the hysterectomy would not be performed but for the purpose 
of rendering the individual permanently incapable of reproducing.

[[Page 168]]

    (b) Except as provided in paragraph (c) of this section, programs or 
projects to which this subpart applies may perform or arrange for the 
performance of a hysterectomy not covered by paragraph (a) of this 
section only if:
    (1) The person who secures the authorization to perform the 
hysterectomy has informed the individual and her representative, if any, 
orally and in writing, that the hysterectomy will make her permanently 
incapable of reproducing; and
    (2) The individual or her representative, if any, has signed a 
written acknowledgment of receipt of that information.
    (c)(1) A program or project is not required to follow the procedures 
of paragraph (b) of this section if either of the following 
circumstances exists:
    (i) The individual is already sterile at the time of the 
hysterectomy.
    (ii) The individual requires a hysterectomy because of a life-
threatening emergency in which the physician determines that prior 
acknowledgment is not possible.
    (2) If the procedures of paragraph (b) of this section are not 
followed because one or more of the circumstances of paragraph (c)(1) 
exist, the physician who performs the hysterectomy must certify in 
writing:
    (i) That the woman was already sterile, stating the cause of that 
sterility; or
    (ii) That the hysterectomy was performed under a life-threatening 
emergency situation in which he or she determined prior acknowledgment 
was not possible. He or she must also include a description of the 
nature of the emergency.

[43 FR 52165, Nov. 8, 1978, as amended at 47 FR 33701, Aug. 4, 1982]



Sec. 50.208  Program or project requirements.

    (a) A program or project must, with respect to any sterilization 
procedure or hysterectomy it performs or arranges, meet all requirements 
of this subpart.
    (b) The program or project shall maintain sufficient records and 
documentation to assure compliance with these regulations, and must 
retain such data for at least 3 years.
    (c) The program or project shall submit other reports as required 
and when requested by the Secretary.



Sec. 50.209  Use of Federal financial assistance.

    (a) Federal financial assistance adminstered by the Public Health 
Service may not be used for expenditures for sterilization procedures 
unless the consent form appended to this section or another form 
approved by the Secretary is used.
    (b) A program or project shall not use Federal financial assistance 
for any sterilization or hysterectomy without first receiving 
documentation showing that the requirements of this subpart have been 
met. Documentation includes consent forms, and as applicable, either 
acknowledgments of receipt of hysterectomy information or certification 
of an exception for hysterectomies.

[43 FR 52165, Nov. 8, 1978, as amended at 47 FR 33701, Aug. 4, 1982]



Sec. 50.210  Review of regulation.

    The Secretary will request public comment on the operation of the 
provisions of this subpart not later than 3 years after their effective 
date.

         Appendix to Subpart B of Part 50--Required Consent Form

    Notice: YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT 
RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY BENEFITS PROVIDED BY 
PROGRAMS OR PROJECTS RECEIVING FEDERAL FUNDS.

                        Consent to Sterilization

    I have asked for and received information about sterilization from 
-------------- (doctor or clinic). When I first asked for the 
information, I was told that the decision to be sterilized is completely 
up to me. I was told that I could decide not to be sterilized. If I 
decide not to be sterilized, my decision will not affect my right to 
future care or treatment. I will not lose any help or benefits from 
programs receiving Federal funds, such as A.F.D.C. or medicaid that I am 
now getting or for which I may become eligible.
    I UNDERSTAND THAT THE STERILIZATION MUST BE CONSIDERED PERMANENT AND 
NOT REVERSIBLE. I HAVE DECIDED THAT I DO NOT WANT TO BECOME PREGNANT, 
BEAR CHILDREN OR FATHER CHILDREN.

[[Page 169]]

    I was told about those temporary methods of birth control that are 
available and could be provided to me which will allow me to bear or 
father a child in the future. I have rejected these alternatives and 
chosen to be sterilized.
    I understand that I will be sterilized by an operation known as a --
------------. The discomforts, risks and benefits associated with the 
operation have been explained to me. All my questions have been answered 
to my satisfaction.
    I understand that the operation will not be done until at least 30 
days after I sign this form. I understand that I can change my mind at 
any time and that my decision at any time not to be sterilized will not 
result in the withholding of any benefits or medical services provided 
by federally funded programs.
    I am at least 21 years of age and was born on -- (day), ---------- 
(month), ---- (year).
    I, --------------, hereby consent of my own free will to be 
sterilized by -------------- by a method called --------------. My 
consent expires 180 days from the date of my signature below.
    I also consent to the release of this form and other medical records 
about the operation to:
    Representatives of the Department of Health and Human Services or
    Employees of programs or projects funded by that Department but only 
for determining if Federal laws were observed.
    I have received a copy of this form.

Signature_______________________________________________________________
Date:___________________________________________________________________
(Month, day, year)

    You are requested to supply the following information, but it is not 
required:

Race and ethnicity designation (please check)

Black (not of Hispanic origin)__________________________________________
Hispanic________________________________________________________________
Asian or Pacific Islander_______________________________________________
American Indian or Alaskan native_______________________________________
White (not of Hispanic origin)__________________________________________

                         Interpreter's Statement

    If an interpreter is provided to assist the individual to be 
sterilized:
    I have translated the information and advice presented orally to the 
individual to be sterilized by the person obtaining this consent. I have 
also read him/her the consent form in -------------- language and 
explained its contents to him/her. To the best of my knowledge and 
belief he/she understood this explanation.

Interpreter_____________________________________________________________
Date____________________________________________________________________

                    State of Person Obtaining Consent

    Before -------------- (name of individual), signed the consent form, 
I explained to him/her the nature of the sterilization operation ------
--------, the fact that it is intended to be a final and irreversible 
procedure and the discomforts, risks and benefits associated with it.
    I counseled the individual to be sterilized that alternative methods 
of birth control are available which are temporary. I explained that 
sterilization is different because it is permanent.
    I informed the individual to be sterilized that his/her consent can 
be withdrawn at any time and that he/she will not lose any health 
services or any benefits provided by Federal funds.
    To the best of my knowledge and belief the individual to be 
sterilized is at least 21 years old and appears mentally competent. He/
She knowingly and voluntarily requested to be sterilized and appears to 
understand the nature and consequence of the procedure.

Signature of person obtaining consent___________________________________
Date____________________________________________________________________
Facility________________________________________________________________
Address_________________________________________________________________

                          Physician's Statement

    Shortly before I performed a sterilization operation upon ----------
---- (name of individual to be sterilized), on ---------- (date of 
sterilization), -------------- (operation), I explained to him/her the 
nature of the sterilization operation -------------- (specify type of 
operation), the fact that it is intended to be a final and irreversible 
procedure and the discomforts, risks and benefits associated with it.
    I counseled the individual to be sterilized that alternative methods 
of birth control are available which are temporary. I explained that 
sterilization is different because it is permanent.
    I informed the individual to be sterilized that his/her consent can 
be withdrawn at any time and that he/she will not lose any health 
services or benefits provided by Federal funds.
    To the best of my knowledge and belief the individual to be 
sterilized is at least 21 years old and appears mentally competent. He/
She knowingly and voluntarily requested to be sterilized and appeared to 
understand the nature and consequences of the procedure.
    (Instructions for use of alternative final paragraphs: Use the first 
paragraph below except in the case of premature delivery or emergency 
abdominal surgery where the sterilization is performed less than 30 days 
after the date of the individual's signature on the consent form. In 
those cases, the second paragraph below must be used. Cross out the 
paragraph which is not used.)

[[Page 170]]

    (1) At least 30 days have passed between the date of the 
individual's signature on this consent form and the date the 
sterilization was performed.
    (2) This sterilization was performed less than 30 days but more than 
72 hours after the date of the individual's signature on this consent 
form because of the following circumstances (check applicable box and 
fill in information requested):

{time}  Premature delivery
Individual's expected date of delivery:_________________________________
{time}  Emergency abdominal surgery:
(Describe circumstances):_______________________________________________

Physician_______________________________________________________________
Date____________________________________________________________________

[43 FR 52165, Nov. 8, 1978, as amended at 58 FR 33343, June 17, 1993]



Subpart C--Abortions and Related Medical Services in Federally Assisted 
                  Programs of the Public Health Service

    Authority: Sec. 118, Pub. L. 96-86, Oct. 12, 1979, unless otherwise 
noted.

    Source: 43 FR 4570, Feb. 2, 1978, unless otherwise noted.



Sec. 50.301  Applicability.

    The provisions of this subpart are applicable to programs or 
projects for health services which are supported in whole or in part by 
Federal financial assistance, whether by grant or contract, appropriated 
to the Department of Health and Human Services and administered by the 
Public Health Service.



Sec. 50.302  Definitions.

    As used in this subpart: (a) Law enforcement agency means an agency, 
or any part thereof, charged under applicable law with enforcement of 
the general penal statutes of the United States, or of any State or 
local jurisdiction.
    (b) Medical procedures performed upon a victim of rape or incest 
means any medical service, including an abortion, performed for the 
purpose of preventing or terminating a pregnancy arising out of an 
incident of rape or incest.
    (c) Physician means a doctor of medicine or osteopathy legally 
authorized to practice medicine and surgery by the State in which he or 
she practices.
    (d) Public health service means: (1) An agency of the United States 
or of a State or local government, that provides health or medical 
services; and
    (2) A rural health clinic, as defined under section 1(d)(aa)(2) of 
Pub. L. 95-210, 91 Stat. 1485; except that any agency or facility whose 
principal function is the performance of abortions is specifically 
excluded from this definition.



Sec. 50.303  General rule.

    Federal financial participation is not available for the performance 
of an abortion in programs or projects to which this subpart applies 
except under circumstances described in Sec. 50.304 or Sec. 50.306.

[43 FR 4570, Feb. 2, 1978, as amended at 44 FR 61598, Oct. 26, 1979]



Sec. 50.304  Life of the mother would be endangered.

    Federal financial participation is available in expenditures for an 
abortion when a physician has found, and so certified in writing to the 
program or project, that on the basis of his/her professional judgment, 
the life of the mother would be endangered if the fetus were carried to 
term. The certification must contain the name and address of the 
patient.

(Sec. 101, Pub. L. 95-205, 91 Stat. 1461, Dec. 9, 1977)

[43 FR 13868, July 21, 1978]



Sec. 50.305  [Reserved]



Sec. 50.306  Rape and incest.

    Federal financial participation is available in expenditures for 
medical procedures performed upon a victim of rape or incest if the 
program or project has received signed documentation from a law 
enforcement agency or public health service stating:
    (a) That the person upon whom the medical procedure was performed 
was reported to have been the victim of an incident of rape or incest;
    (b) The date on which the incident occurred;
    (c) The date on which the report was made, which must have been 
within 60 days of the date on which the incident occurred;

[[Page 171]]

    (d) The name and address of the victim and the name and address of 
the person making the report (if different from the victim); and
    (e) That the report included the signature of the person who 
reported the incident.

Federal financial participation is also available in expenditures for 
abortions for victims of rape or incest under the circumstances 
described in Sec. 50.304 without regard to the requirements of the 
preceding sentence.

(Sec. 101, Pub. L. 95-205, 91 Stat. 1461, Dec. 9, 1977)

[43 FR 13868, July 21, 1978, as amended at 44 FR 61598, Oct. 26, 1979]



Sec. 50.307  Documentation needed by programs or projects.

    Federal financial participation is unavailable for the performance 
of abortions or other medical procedures otherwise provided for under 
Secs. 50.304 and 50.306 if the program or project has paid without first 
having received the certifications and documentation specified in those 
sections.

[43 FR 4570, Feb. 2, 1978, as amended at 44 FR 61598, Oct. 26, 1979]



Sec. 50.308  Drugs and devices and termination of ectopic pregnancies.

    Federal financial participation is available with respect to the 
cost of drugs or devices to prevent implantation of the fertilized ovum, 
and for medical procedures necessary for the termination of an ectopic 
pregnancy.



Sec. 50.309  Recordkeeping requirements.

    Programs or projects to which this subpart applies must maintain 
copies of the certifications and documentation specified in Secs. 50.304 
and 50.306 for three years pursuant to the retention and custodial 
requirements for records at 45 CFR 74.20 et seq.

[43 FR 4570, Feb. 2, 1978, as amended at 44 FR 61598, Oct. 26, 1979]



Sec. 50.310  Confidentiality.

    Information in the records or in the possession of programs or 
projects which is acquired in connection with the requirements of this 
subpart may not be disclosed in a form which permits the identification 
of an individual without the individual's consent except as may be 
necessary for the health of the individual or as may be necessary for 
the Secretary to monitor the activities of those programs or projects. 
In any event, any disclosure shall be subject to appropriate safeguards 
which will minimize the likelihood of disclosures of personal 
information in identifiable form.



        Subpart D--Public Health Service Grant Appeals Procedure

    Authority: Sec. 215, Public Health Service Act, 58 Stat. 690 (42 
U.S.C. 216); 45 CFR 16.3(c).

    Source: 54 FR 34770, Aug. 22, 1989, unless otherwise noted.



Sec. 50.401  What is the purpose of this subpart?

    This subpart establishes an informal procedure for the resolution of 
certain postaward grant and cooperative agreement disputes within the 
agencies and offices identified in Sec. 50.402.

[63 FR 66062, Dec. 1, 1998]



Sec. 50.402  To what programs do these regulations apply?

    This subpart applies to all grant and cooperative agreement 
programs, except block grants, which are administered by the National 
Institutes of Health; the Health Resources and Services Administration; 
the Centers for Disease Control and Prevention; the Agency for Toxic 
Substances and Disease Registry; the Food and Drug Administration; and 
the Office of the Assistant Secretary for Public Health and Science. For 
purposes of this regulation, the entities are hereinafter referred to as 
``agencies.''

[63 FR 66062, Dec. 1, 1998]



Sec. 50.403  What is the policy basis for these procedures?

    The Secretary of Health and Human Services has established a 
Departmental Appeals Board for the purpose of providing a fair and 
flexible process for the appeal of written final decisions involving 
certain grant and cooperative agreement programs administered by 
constituent agencies of the Department. The regulatory provision which

[[Page 172]]

establishes the circumstances under which the Board will accept an 
appeal (45 CFR 16.3) provides, among other things, that the appellant 
must have exhausted any preliminary appeal process required by 
regulation before a formal appeal to the Departmental Board will be 
allowed. This subpart provides such an informal preliminary procedure 
for resolution of disputes in order to preclude submission of cases to 
the Departmental Appeals Board before an agency identified in 
Sec. 50.402 has had an opportunity to review decisions of its officials 
and to settle disputes with grantees.

[54 FR 34770, Aug. 22, 1989, as amended at 63 FR 66062, Dec. 1, 1998]



Sec. 50.404  What disputes are covered by these procedures?

    (a) These procedures are applicable to the following adverse 
determinations under discretionary project grants and cooperative 
agreements (both referred to in this subpart as grants) issued by the 
agencies identified at Sec. 50.402;
    (1) Termination, in whole or in part, of a grant for failure of the 
grantee to carry out its approved project in accordance with the 
applicable law and the terms and conditions of such assistance or for 
failure of the grantee otherwise to comply with any law, regulation, 
assurance, term, or condition applicable to the grant.
    (2) A determination that an expenditure not allowable under the 
grant has been charged to the grant or that the grantee has otherwise 
failed to discharge its obligation to account for grant funds.
    (3) A determination that a grant is void.
    (4) A denial of a noncompeting continuation award under the project 
period system of funding where the denial is for failure to comply with 
the terms of a previous award.
    (b) A determination subject to this subpart may not be reviewed by 
the review committee described in Sec. 50.405 unless an officer or 
employee of the agency has notified the grantee in writing of the 
adverse determination. The notification must set forth the reasons for 
the determination in sufficient detail to enable the grantee to respond 
and must inform the grantee of the opportunity for review under this 
subpart.

[54 FR 34770, Aug. 22, 1989, as amended at 63 FR 66062, Dec. 1, 1998]



Sec. 50.405  What is the structure of review committees?

    The head of the agency, or his or her designee, shall appoint review 
committees to review adverse determinations made by officials for 
programs under their jurisdiction. A minimum of three employees shall be 
appointed (one of whom shall be designated as chairperson) either on an 
ad hoc, case-by-case basis, or as regular members of review committees 
for such terms as may be designated. None of the members of the review 
committee reviewing any given appeal may be from the office of the 
responsible official whose adverse determination is being appealed 
(e.g., project officer, grants specialist, program manager, grants 
management officer).

[54 FR 34770, Aug. 22, 1989, as amended at 63 FR 66062, Dec. 1, 1998]



Sec. 50.406  What are the steps in the process?

    (a) A grantee with respect to whom an adverse determination 
described in Sec. 50.404(a) above has been made and who desires a review 
of that determination must submit a request for such review to the head 
of the appropriate agency or his or her designee no later than 30 days 
after the written notification of the determination is received, except 
that if the grantee shows good cause why an extension of time should be 
granted, the head of the appropriate agency or his or her designee may 
grant an extension of time.
    (b) The request for review must include a copy of the adverse 
determination, must identify the issue(s) in dispute, and must contain a 
full statement of the grantee's position with respect to such issue(s) 
and the pertinent facts and reasons in support of the grantee's 
position. In addition to the required written statement, the grantee 
shall provide copies of any documents supporting its claim.
    (c) When a request for review has been filed under this subpart with 
respect to an adverse determination, no action may be taken by the 
awarding

[[Page 173]]

agency pursuant to such determination until the request has been 
disposed of, except that the filing of the request shall not affect any 
authority which the agency may have to suspend assistance or otherwise 
to withhold or defer payments under the grant during proceedings under 
this subpart. This paragraph does not require the awarding agency to 
provide continuation funding during the appeal process to a grantee 
whose noncompeting continuation award has been denied.
    (d) Upon receipt of a request for review, the head of the agency or 
his or her designee will make a decision as to whether the dispute is 
reviewable under this subpart and will promptly notify the grantee and 
the office responsible for the adverse determination of this decision. 
If the head of the agency or his or her designee determines that the 
dispute is reviewable, he or she will forward the matter to the review 
committee appointed under Sec. 50.405.
    (e) The agency involved will provide the review committee appointed 
under Sec. 50.405 with copies of all relevant background materials 
(including applications(s), award(s), summary statement(s), and 
correspondence) and any additional pertinent information available. 
These materials must be tabbed and organized chronologically and 
accompanied by an indexed list identifying each document.
    (f) The grantee shall be given an opportunity to provide the review 
committee with additional statements and documentation not provided in 
the request for review described in paragraph (b) of this section. This 
additional submission, which must be organized and indexed as indicated 
under paragraph (e) of this section, should provide only material that 
is relevant to the review committee's deliberation of the issues in the 
case.
    (g) The review committee may, at its discretion, invite the grantee 
and/or the agency staff to discuss the pertinent issues with the 
committee and to submit such additional information as the committee 
deems appropriate.
    (h) Based on its review, the review committee will prepare a written 
decision to be signed by the chairperson and each of the other committee 
members. The review committee shall send the written decision with a 
transmittal letter to the grantee and shall send a copy of both to the 
official responsible for the adverse determination. If the decision is 
adverse to the grantee's position, the transmittal letter must state the 
grantee's right to appeal to the Departmental Appeals Board under 45 CFR 
part 16.

[54 FR 34770, Aug. 22, 1989, as amended at 63 FR 66063, Dec. 1, 1998]



               Subpart E--Maximum Allowable Cost for Drugs

    Authority: Sec. 215, Public Health Service Act, 58 Stat. 690 (42 
U.S.C. 216).

    Source: 40 FR 34514, Aug. 15, 1975, unless otherwise noted.



Sec. 50.501  Applicability.

    This subpart is applicable to programs or projects for health 
services which are supported in whole or in part by Federal financial 
assistance, whether by grant or contract, administered by the Public 
Health Service. It applies to Federal funds and to non-Federal funds 
which are required to be expended as a condition to receiving Federal 
funds under such programs or projects.



Sec. 50.502  Definitions.

    As used in this subpart:
    (a) Public Health Service means the Office of the Assistant 
Secretary for Health, Health Resources and Services Administration, 
National Institutes of Health, Centers for Disease Control, Alcohol, 
Drug Abuse and Mental Health Administration, Food and Drug 
Administration, and all of their constituent agencies.
    (b) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (c) Program funds means (1) Federal funds provided through grant or 
contract to support a program or project

[[Page 174]]

covered by Sec. 50.501, and (2) any non-Federal funds that are required 
as a condition of such grant or contract to be expended to carry out 
such program or project.
    (d) Provider means one who furnishes medical or pharmaceutical 
services or supplies for which program funds may be expended under any 
of the programs or projects described in Sec. 50.501.
    (e) Acquisition cost means the price generally and currently paid by 
providers for a drug marketed or sold by a particular formulator or 
labeler in the package size of drug most frequently purchased by 
providers, as determined by the Secretary on the basis of drug price 
information furnished by the Department.

[40 FR 34514, Aug. 15, 1975, as amended at 49 FR 38109, Sept. 27, 1984]



Sec. 50.503  Policy.

    It is the policy of the Secretary that program funds which are 
utilized for the acquisition of drugs be expended in the most economical 
manner feasible. In furtherance of this policy, the Secretary has 
established, in 45 CFR part 19, a procedure for determining the Maximum 
Allowable Cost for drugs which are purchased with program funds.



Sec. 50.504  Allowable cost of drugs.

    (a) The maximum amount which may be expended from program funds for 
the acquisition of any drug shall be the lowest of
    (1) The maximum allowable cost (MAC) of the drug, if any, 
established in accordance with 45 CFR part 19, plus a dispensing fee 
determined by the Secretary in accordance with paragraph (b) of this 
section, to be reasonable;
    (2) The acquisition cost of the drug plus a dispensing fee 
determined by the Secretary, in accordance with paragraph (b) of this 
section, to be reasonable; or
    (3) The provider's usual and customary charge to the public for the 
drug; Provided, That the MAC established for any drug shall not apply to 
a brand of that drug prescribed for a patient which the prescriber has 
certified, in accordance with paragraph (c) of this section, is 
medically necessary for that patient; And Provided further, That where 
compensation for drug dispensing is included in other costs allowable 
under the applicable program statute and regulations, the terms and 
conditions of the grant or contract, and the applicable cost principles 
prescribed in 45 CFR part 74, no separate dispensing fee will be 
recognized.
    (b) In determining whether a dispensing fee is reasonable, the 
Secretary will take into account:
    (1) Cost components such as overhead, professional services, and 
profits,
    (2) Payment practices of third-party payment organizations, 
including other Federal programs such as titles XVIII and XIX of the 
Social Security Act; and
    (3) Any surveys by States, universities or others of costs of 
pharmacy operations and the fees charged in the particular area.
    (c) A certification by a prescriber, pursuant to paragraph (a) of 
this section, that a brand of drug is medically necessary for a 
particular patient shall be in the prescriber's own handwriting, in such 
form and manner as the Secretary may prescribe. An example of an 
acceptable certification is the notation ``brand necessary''. A 
procedure for checking a box on a form will not constitute an acceptable 
certification.



  Subpart F--Responsibility of Applicants for Promoting Objectivity in 
                Research for Which PHS Funding Is Sought

    Authority: 42 U.S.C. 216, 289b-1, 299c-3.

    Source: 60 FR 35815, July 11, 1995; 60 FR 39076, July 31, 1995, 
unless otherwise noted.



Sec. 50.601  Purpose.

    This subpart promotes objectivity in research by establishing 
standards to ensure there is no reasonable expectation that the design, 
conduct, or reporting of research funded under PHS grants or cooperative 
agreements will be biased by any conflicting financial interest of an 
Investigator.



Sec. 50.602  Applicability.

    This subpart is applicable to each Institution that applies for PHS 
grants or cooperative agreements for research and, through the 
implementation of

[[Page 175]]

this subpart by each Institution, to each Investigator participating in 
such research (see Sec. 50.604(a)); provided, that this subpart does not 
apply to SBIR Program Phase I applications. In those few cases where an 
individual, rather than an institution, is an applicant for PHS grants 
or cooperative agreements for research, PHS Awarding Components will 
make case-by-case determinations on the steps to be taken to ensure that 
the design, conduct, and reporting of the research will not be biased by 
any conflicting financial interest of the individual.



Sec. 50.603  Definitions.

    As used in this subpart:
    HHS means the United States Department of Health and Human Services, 
and any components of the Department to which the authority involved may 
be delegated.
    Institution means any domestic or foreign, public or private, entity 
or organization (excluding a Federal agency).
    Investigator means the principal investigator and any other person 
who is responsible for the design, conduct, or reporting of research 
funded by PHS, or proposed for such funding. For purposes of the 
requirements of this subpart relating to financial interests, 
``Investigator'' includes the Investigator's spouse and dependent 
children.
    PHS means the Public Health Service, an operating division of the 
U.S. Department of Health and Human Services, and any components of the 
PHS to which the authority involved may be delegated.
    PHS Awarding Component means the organizational unit of the PHS that 
funds the research that is subject to this subpart.
    Public Health Service Act or PHS Act means the statute codified at 
42 U.S.C. 201 et seq.
    Research means a systematic investigation designed to develop or 
contribute to generalizable knowledge relating broadly to public health, 
including behavioral and social-sciences research. The term encompasses 
basic and applied research and product development. As used in this 
subpart, the term includes any such activity for which research funding 
is available from a PHS Awarding Component through a grant or 
cooperative agreement, whether authorized under the PHS Act or other 
statutory authority.
    Significant Financial Interest means anything of monetary value, 
including but not limited to, salary or other payments for services 
(e.g., consulting fees or honoraria); equity interests (e.g., stocks, 
stock options or other ownership interests); and intellectual property 
rights (e.g., patents, copyrights and royalties from such rights). The 
term does not include:
    (1) Salary, royalties, or other remuneration from the applicant 
institution;
    (2) Any ownership interests in the institution, if the institution 
is an applicant under the SBIR Program;
    (3) Income from seminars, lectures, or teaching engagements 
sponsored by public or nonprofit entities;
    (4) Income from service on advisory committees or review panels for 
public or nonprofit entities;
    (5) An equity interest that when aggregated for the Investigator and 
the Investigator's spouse and dependent children, meets both of the 
following tests: Does not exceed $10,000 in value as determined through 
reference to public prices or other reasonable measures of fair market 
value, and does not represent more than a five percent ownership 
interest in any single entity; or
    (6) Salary, royalties or other payments that when aggregated for the 
Investigator and the Investigator's spouse and dependent children over 
the next twelve months, are not expected to exceed $10,000.
    Small Business Innovation Research (SBIR) Program means the 
extramural research program for small business that is established by 
the Awarding Components of the Public Health Service and certain other 
Federal agencies under Pub. L. 97-219, the Small Business Innovation 
Development Act, as amended. For purposes of this subpart, the term SBIR 
Program includes the Small Business Technology Transfer (STTR) Program, 
which was established by Pub. L. 102-564.

[[Page 176]]



Sec. 50.604  Institutional responsibility regarding conflicting interests of investigators.

    Each Institution must:
    (a) Maintain an appropriate written, enforced policy on conflict of 
interest that complies with this subpart and inform each Investigator of 
that policy, the Investigator's reporting responsibilities, and of these 
regulations. If the Institution carries out the PHS-funded research 
through subgrantees, contractors, or collaborators, the Institution must 
take reasonable steps to ensure that Investigators working for such 
entities comply with this subpart, either by requiring those 
Investigators to comply with the Institution's policy or by requiring 
the entities to provide assurances to the Institution that will enable 
the Institution to comply with this subpart.
    (b) Designate an institutional official(s) to solicit and review 
financial disclosure statements from each Investigator who is planning 
to participate in PHS-funded research.
    (c)(1) Require that by the time an application is submitted to PHS 
each Investigator who is planning to participate in the PHS-funded 
research has submitted to the designated official(s) a listing of his/
her known Significant Financial Interests (and those of his/her spouse 
and dependent children):
    (i) That would reasonably appear to be affected by the research for 
which PHS funding is sought; and
    (ii) In entities whose financial interests would reasonably appear 
to be affected by the research.
    (2) All financial disclosures must be updated during the period of 
the award, either on an annual basis or as new reportable Significant 
Financial Interests are obtained.
    (d) Provide guidelines consistent with this subpart for the 
designated official(s) to identify conflicting interests and take such 
actions as necessary to ensure that such conflicting interests will be 
managed, reduced, or eliminated.
    (e) Maintain records of all financial disclosures and all actions 
taken by the Institution with respect to each conflicting interest for 
at least three years from the date of submission of the final 
expenditures report or, where applicable, from other dates specified in 
45 CFR 74.53(b) for different situations.
    (f) Establish adequate enforcement mechanisms and provide for 
sanctions where appropriate.
    (g) Certify, in each application for the funding to which this 
subpart applies, that:
    (1) There is an effect at that Institution a written and enforced 
administrative process to identify and manage, reduce or eliminate 
conflicting interests with respect to all research projects for which 
funding is sought from the PHS,
    (2) Prior to the Institution's expenditure of any funds under the 
award, the Institution will report to the PHS Awarding Component the 
existence of a conflicting interest (but not the nature of the interest 
or other details) found by the institution and assure that the interest 
has been managed, reduced or eliminated in accordance with this subpart; 
and, for any interest that the Institution identifies as conflicting 
subsequent to the Institution's initial report under the award, the 
report will be made and the conflicting interest managed, reduced, or 
eliminated, at least on an interim basis, within sixty days of that 
identification;
    (3) The Institution agrees to make information available, upon 
request, to the HHS regarding all conflicting interests identified by 
the Institution and how those interests have been managed, reduced, or 
eliminated to protect the research from bias; and
    (4) The Institution will otherwise comply with this subpart.



Sec. 50.605  Management of conflicting interests.

    (a) The designated official(s) must: Review all financial 
disclosures; and determine whether a conflict of interest exists and, if 
so, determine what actions should be taken by the institution to manage, 
reduce or eliminate such conflict of interest. A conflict of interest 
exists when the designated official(s) reasonably determines that a 
Significant Financial Interest could directly and significantly affect 
the design, conduct, or reporting of the PHS-

[[Page 177]]

funded research. Examples of conditions or restrictions that might be 
imposed to manage conflicts of interest include, but are not limited to:
    (1) Public disclosure of significant financial interests;
    (2) Monitoring of research by independent reviewers;
    (3) Modification of the research plan;
    (4) Disqualification from participation in all or a portion of the 
research funded by the PHS;
    (5) Divestiture of significant financial interests; or
    (6) Severance of relationships that create actual or potential 
conflicts.
    (b) In addition to the types of conflicting financial interests 
described in this paragraph that must be managed, reduced, or 
eliminated, an Institution may require the management of other 
conflicting financial interests, as the Institution deems appropriate.



Sec. 50.606  Remedies.

    (a) If the failure of an Investigator to comply with the conflict of 
interest policy of the Institution has biased the design, conduct, or 
reporting of the PHS-funded research, the Institution must promptly 
notify the PHS Awarding Component of the corrective action taken or to 
be taken. The PHS Awarding Component will consider the situation and, as 
necessary, take appropriate action, or refer the matter to the 
Institution for further action, which may include directions to the 
Institution on how to maintain appropriate objectivity in the funded 
project.
    (b) The HHS may at any time inquire into the Institutional 
procedures and actions regarding conflicting financial interests in PHS-
funded research, including a requirement for submission of, or review on 
site, all records pertinent to compliance with this subpart. To the 
extent permitted by law, HHS will maintain the confidentiality of all 
records of financial interests. On the basis of its review of records 
and/or other information that may be available, the PHS Awarding 
Component may decide that a particular conflict of interest will bias 
the objectivity of the PHS-funded research to such an extent that 
further corrective action is needed or that the Institution has not 
managed, reduced, or eliminated the conflict of interest in accordance 
with this subpart. The PHS Awarding Component may determine that 
suspension of funding under 45 CFR 74.62 is necessary until the matter 
is resolved.
    (c) In any case in which the HHS determines that a PHS-funded 
project of clinical research whose purpose is to evaluate the safety or 
effectiveness of a drug, medical device, or treatment has been designed, 
conducted, or reported by an Investigator with a conflicting interest 
that was not disclosed or managed as required by this subpart, the 
Institution must require the Investigator(s) involved to disclose the 
conflicting interest in each public presentation of the results of the 
research.



Sec. 50.607  Other HHS regulations that apply.

    Several other regulations and policies apply to this subpart.
    They include, but are not necessarily limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Uniform Administrative Requirements for Awards and 
Subawards to Institutions of Higher Education, Hospitals, Other Non-
Profit Organizations, and Commercial Organizations; and Certain Grants 
and Agreements with States, Local Governments and Indian Tribal 
Governments
45 CFR part 76--Government-wide debarment and suspension (non-
procurement)
45 CFR part 79--Program Fraud Civil Remedies
45 CFR part 92--Uniform Administrative Requirements for Grants and 
Cooperative Agreements to State and Local Governments



PART 51--REQUIREMENTS APPLICABLE TO THE PROTECTION AND ADVOCACY FOR INDIVIDUALS WITH MENTAL ILLNESS PROGRAM--Table of Contents




Sec.
51.1  Scope.
51.2  Defintitions.

                      Subpart A--Basic Requirements

51.3  Formula for determining allotments.
51.4  Grants administration requirements.
51.5  Eligibility for allotment.
51.6  Use of allotments.

[[Page 178]]

51.7  Eligibility for protection and advocacy services.
51.8  Annual reports.
51.9  [Reserved]
51.10  Remedial actions.
51.11-51.20  [Reserved]

            Subpart B--Program Administration and Priorities

51.21  Contracts for program operations.
51.22  Governing authority.
51.23  Advisory council.
51.24  Program priorities.
51.25  Grievance procedure.
51.26  Conflicts of interest.
51.27  Training.
51.28-51.30  [Reserved]

               Subpart C--Protection and Advocacy Services

51.31  Conduct of protection and advocacy activities.
51.32  Resolving disputes.
51.33-51.40  [Reserved]

        Subpart D--Access to Records, Facilities and Individuals

51.41  Access to records.
51.42  Access to Facilities and residents.
51.43  Denial of delay or access.
51.44  [Reserved]
51.45  Confidentiality of protection and advocacy system records.
51.46  Disclosing information obtained from a provider of mental health 
          services.

    Authority: 42 U.S.C. 10801, et seq.

    Source: 63 FR 53564, Oct. 15, 1997, unless otherwise noted.



Sec. 51.1  Scope.

    The provisions of this part apply to recipients of Federal 
assistance under the Protection and Advocacy for Mentally Ill 
Individuals Act of 1986, as amended.



Sec. 51.2  Definitions.

    In addition to the definitions in section 102 of the Act, as 
amended, the following definitions apply:
    Abuse means any act or failure to act by an employee of a facility 
rendering care or treatment which was performed, or which was failed to 
be performed, knowingly, recklessly, or intentionally, and which caused, 
or may have caused, injury or death to an individual with mental 
illness, and includes but is not limited to acts such as: rape or sexual 
assault; striking; the use of excessive force when placing an individual 
with mental illness in bodily restrains; the use of bodily or chemical 
restraints which is not in compliance with Federal and State laws and 
regulations; verbal, nonverbal, mental and emotional harassment; and any 
other practice which is likely to cause immediate physical or 
psychological harm or result in long-term harm if such practices 
continue.
    Act means the Protection and Advocacy for Mentally Ill Individuals 
Act of 1986, as amended, also referred to as Protection and Advocacy for 
Individuals with Mental Illness Act.
    ADD means the Administration on Developmental Disabilities within 
the Administration for Children and Families, Department of Health and 
Human Services.
    Care or Treatment means services provided to prevent, identify, 
reduce or stabilize mental illness or emotional impairment such as 
mental health screening, evaluation, counseling, biomedical, behavioral 
and psychotherapies, supportive or other adjunctive therapies, 
medication supervision, special education and rehabilitation, even if 
only ``as needed'' or under a contractual arrangement.
    Center or CMHS means the Center for Mental Health Services, a 
component of the Substance Abuse and Mental Health Services 
Administration.
    Complaint includes, but is not limited to any report or 
communication, whether formal or informal, written or oral, received by 
the P&A system, including media accounts, newspaper articles, telephone 
calls (including anonymous calls) from any source alleging abuse or 
neglect of an individual with mental illness.
    Department or HHS means the U.S. Department of Health and Human 
Services.
    Designated Official is the State official or public or private 
entity empowered by the Governor or State legislature to be accountable 
for the proper use of funds by the P&A system.
    Director means the Director of the Center for Mental Health 
Services, Substance Abuse and Mental Health Services Administration, or 
his or her designee.

[[Page 179]]

    Facility includes any public or private residential setting that 
provides overnight care accompanied by treatment services. Facilities 
include, but are not limited to the following: general and psychiatric 
hospitals, nursing homes, board and care homes, community housing, 
juvenile detention facilities, homeless shelters, and jails and prisons, 
including all general areas as well as special mental health or forensic 
units.
    Fiscal Year or FY means the Federal fiscal year (October 1-September 
30) unless otherwise specified.
    Full Investigation is based upon a complaint or a determination of 
probable cause and means the access to facilities, clients and records 
authorized under this part that is necessary for a P&A system to make a 
determination about whether an allegation of abuse or neglect is taking 
place or has taken place. Full investigations may be conducted 
independently or in cooperation with other agencies authorized to 
conduct similar investigations.
    Governor means the chief executive officer of the State, Territory 
or the District of Columbia, or his or her designee, who has been 
formally designated to act for the Governor in carrying out the 
requirements of the Act and this part.
    Individual with Mental Illness means an individual who has a 
significant mental illness or emotional impairment, as determined by a 
mental health professional qualified under the laws and regulations of 
the State and
    (1) Who is an inpatient or resident in a facility rendering care or 
treatment, even if the whereabouts of such impatient or resident is 
unknown;
    (2) Who is in the process of being admitted to a facility rendering 
care or treatment, including persons being transported to such a 
facility, or
    (3) Who is involuntarily confined in a detention facility, jail or 
prison.
    Legal Guardian, Conservator, and Legal Representative all mean an 
individual whose appointment is made and regularly reviewed by a State 
court or agency empowered under State law to appoint and review such 
officers, and having authority to consent to health/mental health care 
or treatment of an individual with mental illness. It does not include 
persons acting only as a representative payee, persons acting only to 
handle financial payments, attorneys or persons acting on behalf of an 
individual with mental illness only in individual legal matters, or 
officials responsible for the provision of health or mental health 
services to an individual with mental illness, or their designees.
    Neglect means a negligent act or omission by an individual 
responsible for providing services in a facility rendering care or 
treatment which caused or may have caused injury or death to an 
individual with mental illness or which placed an individual with mental 
illness at risk of injury or death, and includes, but is not limited to, 
acts or omissions such as failure to: establish or carry out an 
appropriate individual program or treatment plan (including a discharge 
plan); provide adequate nutrition, clothing, or health care; and the 
failure to provide a safe environment which also includes failure to 
maintain adequate numbers of appropriately trained staff.
    Private Entity means a nonprofit or for-profit corporation, 
partnership or other nongovernmental organization.
    Probable cause means reasonable grounds for belief that an 
individual with mental illness has been, or may be at significant risk 
of being subject to abuse or neglect. The individual making such 
determination may base the decision on reasonable inferences drawn from 
his or her experience or training regarding similar incidents, 
conditions or problems that are usually associated with abuse or 
neglect.
    Program means activities carried out by the P&A system and operating 
as part of a P&A system to meet the requirements of the Act.
    Public Entity means an organizational unit of a State or local 
government or a quasi-governmental entity with one or more governmental 
powers.
    System means the organization or agency designated in a State to 
administer and operate a protection and advocacy program under Part C of 
the Developmental Disabilities Assistance and Bill of Rights Act (42 
U.S.C. 6041, 6042) and thereby eligible to administer a program for 
individuals with mental illness.

[[Page 180]]



                      Subpart A--Basic Requirements



Sec. 51.3  Formula for determining allotments.

    The Secretary shall make allotments to eligible Systems from amounts 
apportioned each year under the Act on the basis of a formula prescribed 
by the Secretary in accordance with the requirements of sections 112 and 
113 of the Act (42 U.S.C. 10822 and 10823).



Sec. 51.4  Grants administration requirements.

    The following parts of titles 42 and 45 CFR apply to grants funded 
under this part.

42 CFR Part 50, Subpart D.
45 CFR Part 16--Procedures of the Departmental Grant Appeal Board.
45 CFR Part 74--Administration of Grants.
45 CFR Part 75--Informal Grant Appeals Procedures.
45 CFR Part 76--Government-wide Debarment and Suspension 
          (Nonprocurement) and Government-wide Requirements for Drug-
          Free Workplace.
45 CFR Part 80--Nondiscrimination under Programs Receiving Federal 
          Assistance through the Department of Health and Human 
          Services--Effectuation of Title VI of the Civil Rights Act of 
          1964.
45 CFR Part 81--Practice and Procedure for Hearings under Part 80 of 
          This Title.
45 CFR Part 84--Nondiscrimination on the Basis of Handicap in Programs 
          and Activities Receiving or Benefiting from Federal Financial 
          Assistance.
45 CFR Part 86--Nondiscrimination on the Basis of Sex in Education 
          Programs and Activities Receiving Federal Financial 
          Assistance.
45 CFR Part 91--Nondiscrimination on the Basis of Age in Education 
          Programs and Activities Receiving Federal Financial Assistance 
          from HHS.
45 CFR Part 92--Uniform Administrative Requirements for Grants and 
          Cooperative Agreements to State and Local Governments.
45 CFR Part 93--New Restrictions on Lobbying.
45 CFR Part 1386, subpart A.



Sec. 51.5  Eligibility for allotment.

    (a) Federal financial assistance for protection and advocacy 
activities for individuals with mental illness will be given only to a 
System that has been established under Part C of the Developmental 
Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6041, et seq.) 
and designated in accordance with 45 CFR part 1386, subpart B.
    (b) The P&A system must meet the requirements of sections 105 and 
111 of the Act (42 U.S.C. 10805 and 10821) and that P&A system must be 
operational. Each system shall submit an application at the beginning of 
each PAIMI authorization period. This application shall contain at a 
minimum the program priorities and budget for the first year of the 
authorization period and the required assurances and certifications. 
Thereafter, the system shall submit yearly updates of the budget and 
program priorities for the upcoming fiscal year through its annual 
report.
    (c) Written assurances of compliance with sections 105 and 111 of 
the Act (42 U.S.C. 10805 and 10821) and other requirements of the Act 
and this part shall be submitted by the P&A system in the format 
designated by the Director. These assurances will remain in effect for 
the period specified in the application for funds unless changes occur 
within the State which affect the functioning of the P&A system, in 
which case an amendment will be required 30 days prior to the effective 
date of the change. The P&A system shall also provide the Department the 
name of the designated official.
    (d) The Governor's written assurance that the allotments made 
available under the Act will be used to supplement and not to supplant 
the level of non-Federal funds available in the State to protect and 
advocate the rights of individuals with mental illness shall be 
submitted by the P&A system. The Governor may provide this assurance 
along with the assurances provided to ADD under 45 CFR part 1386, as 
long as it can reasonably be construed as applying to the PAIMI program. 
Any future ``supplement and not supplant'' assurance shall explicitly 
refer to the PAIMI program.



Sec. 51.6  Use of allotments.

    (a) Allotments must be used to supplement and not to supplant the 
level of non-Federal funds available in the State to protect and 
advocate the rights of individuals with mental illness.

[[Page 181]]

    (b) Allotments may not be used to support lobbying activities to 
influence proposed or pending Federal legislation or appropriations. 
This restriction does not affect the right of any P&A system, 
organization or individual to petition Congress or any other government 
body or official using other resources.
    (c) Allotments may not be used to produce or distribute written, 
audio or visual materials or publicity intended or designed to support 
or defeat any candidate for public office.
    (d) If an eligible P&A system is a public entity, that P&A system 
shall not be required by the State to obligate more than five percent of 
its annual allotment for State oversight administrative expenses under 
this grant such as costs of internal or external evaluations, monitoring 
or auditing. This restriction does not include:
    (1) Salaries, wages and benefits of program staff;
    (2) Costs associated with attending governing board or advisory 
council meetings; or
    (3) Expenses associated with the provision of training or technical 
assistance for staff, contractors, members of the governing board or 
advisory council.
    (e) No more than ten percent of each annual allotment may be used 
for providing technical assistance and training, including travel 
expenses for staff, contractors, or members of the governing board or 
advisory council as defined in Sec. 51.27.
    (f) Allotments may be used to pay the otherwise allowable costs 
incurred by a P&A system in bringing lawsuits in its own right to 
redress incidents of abuse or neglect, discrimination, and other rights 
violations impacting on individuals with mental illness and when it 
appears on behalf of named plaintiffs or a class of plaintiffs for such 
purposes.



Sec. 51.7  Eligibility for protection and advocacy services.

    In accordance with section 105(a)(1)(C) of the Act (42 U.S.C. 
10805(a)(1)(C)) and the priorities established by the P&A system 
governing authority, together with the advisory council, pursuant to 
section 105(c)(2)(B) of the Act (42 U.S.C. 10805(c)(2)(B)), allotments 
may be used:
    (a) To provide protection and advocacy services for:
    (1) Individuals with mental illness as defined in 42 U.S.C. 10802(4) 
and 10805(a), including persons who report matters which occurred while 
they were individuals with mental illness;
    (2) Persons who were individuals with mental illness who are 
residents of the State, but only with respect to matters which occur 
within 90 days after the date of the discharge of such individuals from 
a facility providing care or treatment; and
    (3) Individuals with mental illness in Federal facilities rendering 
care or treatment who request representation by the eligible P&A system. 
Representation may be requested by an individual with mental illness, or 
by a legal guardian, conservator or legal representative.
    (b) To provide representation of clients in civil commitment 
proceedings if the P&A system is acting on behalf of an eligible 
individual to obtain judicial review of his or her commitment in order 
to appeal or otherwise challenge acts or omissions which have subjected 
the individual to abuse or neglect or otherwise violated his or her 
rights. This restriction does not prevent a P&A system from representing 
clients in commitment or recommitment proceedings using other resources 
so long as this representation does not conflict with responsibilities 
under the Act.



Sec. 51.8  Annual reports.

    By January 1 of each year, a report shall be submitted, pursuant to 
section 105(a)(7) of the Act (42 U.S.C. 10805(a)(7)), to the Secretary 
which is in the format designated by the Secretary.

    Effective Date Note: At 62 FR 53564, Oct. 15, 1997, Sec. 51.8 was 
added. This section contains information collection and recordkeeping 
requirements and will not become effective until approval has been given 
by the Office of Management and Budget.

[[Page 182]]



Sec. 51.9  [Reserved]



Sec. 51.10  Remedial actions.

    Failure to submit an annual report in the designated format on time 
or to submit requested information and documentation, corrective action 
plans and ongoing implementation status reports in response to Federal 
review and monitoring activities or to satisfy any other requirement of 
the Act, this part, or other requirements, may be considered a breach of 
the terms and conditions of the grant award and may required remedial 
action, such as the suspension or termination of an active grant, 
withholding of payments or converting to a reimbursement method of 
payment. Any remedial actions shall be taken consistent with 45 CFR Part 
74 and 42 CFR Part 50, as appropriate.

    Effective Date Note: At 62 FR 53564, Oct. 15, 1997, Sec. 51.10 was 
added. This section contains information collection and recordkeeping 
requirements and will not become effective until approval has been given 
by the Office of Management and Budget.



Secs. 51.11-51.20  [Reserved]



            Subpart B--Program Administration and Priorities



Sec. 51.21  Contracts for program operations.

    (a) An eligible P&A system should work cooperatively with existing 
advocacy agencies and groups and, where appropriate, consider entering 
into contracts for protection and advocacy services with organizations 
already working on behalf of individuals with metal illness. Special 
consideration should be given to contracting for the services of groups 
run by individuals who have received or are receiving mental health 
services or by family members of such individuals.
    (b) An eligible P&A system may contract for the operation of all or 
part of its program with another public or private nonprofit 
organization with demonstrated experience in working with individuals 
with mental illness provided that:
    (1) Any organization that will operate the full program meets the 
requirements of section 104(a)(1), 105 and 111 of the Act (42 U.S.C. 
10804(a)(1), 10805 and 10821) and has the capacity to perform protection 
and advocacy activities throughout the State;
    (2) The eligible P&A system institutes oversight and monitoring 
procedures which ensure that this system will be able to meet all 
applicable terms, conditions and obligations of the Federal grant;
    (3) The eligible P&A system and the contractor organization enter 
into a written agreement that includes at least the following:
    (i) A description of the protection and advocacy services to be 
provided;
    (ii) The type of personnel, their qualifications and training;
    (iii) The methods to be used;
    (iv) A timetable for performance;
    (v) A budget;
    (vi) Assurances that the contractor will meet all applicable terms 
and conditions of the grant;
    (vii) Assurances that the contractor has adequate management and 
fiscal systems in place, including insurance coverage, if appropriate:
    (viii) Assurances that the contractor's staff is trained to provide 
advocacy services to and conduct full investigations on behalf of 
individuals with mental illness; and
    (ix) Assurances that the contractor staff is trained to work with 
family members of clients served by the P&A system where the clients 
are:
    (A) Minors;
    (B) Legally competent and choose to involve the family member; or,
    (C) Legally incompetent and the legal guardians, conservators or 
other legal representatives are family members.



Sec. 51.22  Governing authority.

    (a) Each P&A system shall have a governing authority responsible for 
its planning, designing, implementing and functioning. It shall, jointly 
with the advisory council, annually establish program priorities and 
policies.
    (b) If the P&A system is organized with a multi-member governing 
board:
    (1) Each P&A system shall establish policies and procedures for the 
selection of its governing board members and for the board evaluation of 
the P&A system director. The terms of board members shall be staggered 
and

[[Page 183]]

for 4 years except that any member appointed to fill a vacancy for an 
unexpired term shall serve for the remainder of such term. A member who 
has been appointed for a term of 4 years may not be reappointed to the 
governing board during the 2-year period beginning on the date on which 
such 4-year term expired.
    (2) The board shall be composed of members who broadly represent or 
are knowledgeable about the needs of the clients served by the P&A 
system and shall include a significant representation of individuals 
with mental illness who are, or have been eligible for services, or have 
received or are receiving mental health services, and family members, 
guardians, advocates, or authorized representatives of such individuals.
    (3) If the governing authority is organized as a private nonprofit 
entity, the chairperson of the advisory council shall be a member of the 
governing board.
    (c) Continuing efforts shall be made to include members of racial 
and ethnic minority groups as board members.
    (d) Any member of the advisory council may also serve on the 
governing board.



Sec. 51.23  Advisory council.

    (a) Each P&A system shall establish an advisory council to:
    (1) Provide independent advice and recommendations to the system.
    (2) Work jointly with the governing authority in the development of 
policies and priorities.
    (3) Submit a section of the system's annual report as required under 
Sec. 51.8.
    (b) Members of the council shall include attorneys, mental health 
professionals, individuals from the public who are knowledgeable about 
mental illness, the advocacy needs of persons with mental illness and 
have demonstrated a substantial commitment to improving mental health 
services, a provider of mental health services, individuals who have 
received or are receiving mental health services and family members of 
such individuals. Continuing efforts shall be made to include members of 
racial and ethnic minority groups on the advisory council.
    (1) At least 60 percent of the membership of the advisory council 
shall be comprised of individuals who have received or are receiving 
mental health services or who are family members of such individuals. At 
least one family member shall be a primary care giver for an individual 
who is currently a minor child or youth who is receiving or has received 
mental health services;
    (2) The council shall be chaired by an individual who has received 
or is receiving mental health services or who is a family member of such 
an individual;
    (3) The advisory council shall meet no less than three times 
annually. The terms of council members shall be staggered and for 4 
years except that any member appointed to fill a vacancy for an 
unexpired term shall serve for the remainder of such term. A member who 
has been appointed for a term of 4 years may not be reappointed to the 
council during the 2-year period beginning on the date on which such 4-
year term expired.
    (c) Each P&A system shall provide its advisory council with reports, 
materials and fiscal data to enable review of existing program policies, 
priorities and performance outcomes. Such submissions shall be made at 
least annually and shall report expenditures for the past two fiscal 
years, as well as projected expenses for the next fiscal year, 
identified by budget category (e.g., salary and wages, contract for 
services, administrative expenses) including the amount allotted for 
training of each the advisory council, governing board and staff.
    (d) Reimbursement of expenses. (1) Allotments may be used to pay for 
all or a part of the expenses incurred by members of the advisory 
council in order to participate in its activities. Expenses may include 
transportation costs, parking, meals, hotel costs, per diem expenses, 
stipends or subsistence allowances, and the cost of day care or child 
care (or its equivalent for the child's travel and subsistence expenses) 
for their dependents with mental illness or developmental disabilities.
    (2) Each P&A system shall establish its own policies and procedures 
for reimbursement of expenses of council members, taking into account 
the

[[Page 184]]

needs of individual council members, available resources, and applicable 
restrictions on use of grant funds, including the restrictions in 
Secs. 51.31(e) and 51.6(e).

    Effective Date Note: At 62 FR 53564, Oct. 15, 1997, Sec. 51.23 was 
added. This section contains information collection and recordkeeping 
requirements and will not become effective until approval has been given 
by the Office of Management and Budget.



Sec. 51.24  Program priorities.

    (a) Program priorities and policies shall be established annually by 
the governing authority, jointly with the advisory council. Priorities 
shall specify short-term program goals and objectives, with measurable 
outcomes, to implement the established priorities. In developing 
priorities, consideration shall be given to, at a minimum, case 
selection criteria, the availability of staff and monetary resources, 
and special problems and cultural barriers faced by individuals with 
mental illness who are multiply handicapped or who are members of racial 
or ethnic minorities in obtaining protection of their rights. Systemic 
and legislative activities shall also be addressed in the development 
and implementation of program priorities.
    (b) Members of the public shall be given an opportunity, on an 
annual basis, to comment on the priorities established by, and the 
activities of, the P&A system. Procedures for public comment must 
provide for notice in a format accessible to individuals with mental 
illness, including such individuals who are in residential facilities, 
to family members and representatives of such individuals and to other 
individuals with disabilities. Procedures for public comment must 
provide for receipt of comments in writing or in person.



Sec. 51.25  Grievance procedure.

    (a) The P&A system shall establish procedures to address grievances 
from:
    (1) Clients or prospective clients of the P&A system to assure that 
individuals with mental illness have full access to the services of the 
program; and
    (2) Individuals who have received or are receiving mental health 
services in the State, family members of such individuals, or 
representatives of such individuals or family members to assure that the 
eligible P&A system is operating in compliance with the Act.
    (b) At a minimum, the grievance procedures shall provide for:
    (1) An appeal to the governing authority from any final staff review 
and/or determination; in cases where the governing authority is the 
director of the P&A system, the final review and/or determination shall 
be made by a superior of the governing authority, e.g., a supervisor, or 
by an independent entity, e.g., an appointed board or committee.
    (2) Reports, at least annually, to the governing authority and the 
advisory council describing the grievances received and processed and 
their resolution;
    (3) Identification of individuals responsible for review;
    (4) A timetable to ensure prompt notification concerning the 
grievance procedure to clients, prospective clients or persons denied 
representation, and to ensure prompt resolution;
    (5) A written response to the grievant; and
    (6) Protection of client confidentiality.

    Effective Date Note: At 62 FR 53564, Oct. 15, 1997, Sec. 51.25 was 
added. This section contains information collection and recordkeeping 
requirements and will not become effective until approval has been given 
by the Office of Management and Budget.



Sec. 51.26  Conflicts of interest.

    The P&A system must develop appropriate policies and procedures to 
avoid actual or apparent conflict of interest involving clients, 
employees, contractors and subcontractors, and members of the governing 
authority and advisory council, particularly with respect to matters 
affecting client services, particular contracts and subcontracts, 
grievance review procedures, reimbursements and expenses, and the 
employment or termination of staff.



Sec. 51.27  Training.

    A P&A system shall provide training for program staff, and may also 
provide training for contractors, governing board and advisory council 
members to

[[Page 185]]

enhance the development and implementation of effective protection and 
advocacy services for individuals with mental illness, including at a 
minimum:
    (a)(1) Training of program staff to work with family members of 
clients served by the program where the individual with mental illness 
is:
    (i) A minor,
    (ii) Legally competent and chooses to involve the family member; or
    (iii) Legally incompetent and the legal guardian, conservator or 
other legal representative is a family member.
    (2) This training may be provided by individuals who have received 
or are receiving mental health services and family members of such 
individuals.
    (b) Training to enhance sensitivity to and understanding of 
individuals with mental illness who are members of racial or ethnic 
minorities and to develop strategies for outreach to those populations.
    (c) Training to conduct full investigations of abuse or neglect.



Secs. 51.28-51.30  [Reserved]



               Subpart C--Protection and Advocacy Services



Sec. 51.31  Conduct of protection and advocacy activities.

    (a) Consistent with State and Federal law and the canons of 
professional ethics, a P&A system may use any appropriate technique and 
pursue administrative, legal or other appropriate remedies to protect 
and advocate on behalf of individuals with mental illness to address 
abuse, neglect or other violations of rights.
    (b) A P&A system shall establish policies and procedures to guide 
and coordinate advocacy activities. The P&A system shall not implement a 
policy or practice restricting the remedies which may be sought on 
behalf of individuals with mental illness or compromising the authority 
of the P&A system to pursue such remedies through litigation, legal 
action or other forms of advocacy. However, this requirement does not 
prevent the P&A system from placing limitations on case or client 
acceptance criteria developed as part of the annual priorities. 
Prospective clients must be informed of any such limitations at the time 
they request service.
    (c) Wherever possible, the program should establish an ongoing 
presence in residential mental health care or treatment facilities, and 
relevant hospital units.
    (d) Program activities should be carried out in a manner which 
allows program staff to:
    (1) Interact regularly with those individuals who are current or 
potential recipients of protection and advocacy services;
    (2) Interact regularly with staff providing care or treatment;
    (3) Obtain information and review records; and
    (4) Communicate with family members, social and community service 
workers and others involved in providing care or treatment.
    (e) A P&A system may support or provide training, including related 
travel expenses, for individuals with mental illness, family members of 
such individuals, and other persons who are not program staff, 
contractors, or board or council members, to increase knowledge about 
protection and advocacy issues, to enhance leadership capabilities, or 
to promote Federal-State and intra-State cooperation on matter related 
to mental health system improvement. Decisions concerning the selection 
of individuals to receive such training shall be made in accordance with 
established policies, procedures and priorities of the P&A system.
    (f) A P&A system may monitor, evaluate and comment on the 
development and implementation of Federal, State and local laws, 
regulations, plans, budgets, levies, projects, policies and hearings 
affecting individuals with mental illness as a part of federally funded 
advocacy activities. A P&A system shall carry out systemic advocacy--
those efforts to implement changes in policies and practices of systems 
that impact persons with mental illness.
    (g) Determination of ``probable cause'' may result from P&A system 
monitoring or other activities, including observation by P&A system 
personnel, and reviews of monitoring and

[[Page 186]]

other reports prepared by others whether pertaining to individuals with 
mental illness or to general conditions affecting their health or 
safety.
    (h) A P&A which is a public P&A system shall be free from hiring 
freezes, reductions in force, prohibitions on staff travel, or other 
policies imposed by the State to the extend that such policies would 
impact program staff or activities funded with Federal dollars and would 
prevent the P&A system from carrying out its mandates under the Act.
    (i) A P&A system may exercise its authority under State law where 
the authority exceeds the authority required by the Act. However, State 
law must not diminish the required authority of the Act.



Sec. 51.32  Resolving disputes.

    (a) Each P&A system is encouraged to develop and employ techniques 
such as those involving negotiation, conciliation and mediation to 
resolve disputes early in the protection and advocacy process.
    (b) Disputes should be resolved whenever possible through 
nonadversarial process involving negotiation, mediation and 
conciliation. Consistent with State and Federal laws and canons of 
professional responsibility, family members should be involved in this 
process, as appropriate, where the individual with mental illness is:
    (1) A minor,
    (2) Legally competent and chooses to involve the family member, or
    (3) Legally incompetent and the legal guardian, conservator or other 
legal representative is a family member or the legal guardian, 
conservator or other legal representative chose to involve the family 
member.
    (c) A P&A system must exhaust in a timely manner all administrative 
remedies, where appropriate, prior to initiating legal action in a 
Federal or State court.
    (d) Paragraph (c) of this section does not apply to any legal action 
instituted to prevent or eliminate imminent serious harm to an 
individual with mental illness nor does it apply in circumstances where 
administrative procedures do not exist. If in pursing administrative 
remedies, the P&A system determines that any matter with respect to an 
individual with mental illness with mental illness with not be resolved 
within a reasonable time, the P&A system may pursue alternative 
remedies, including initiating legal action.
    (e) A P&A system shall be held to the standard of exhaustion of 
remedies provided under State and Federal law. The Act imposes no 
additional burden respecting exhaustion of remedies.



Secs. 51.33-51.40  [Reserved]



        Subpart D--Access to Records, Facilities and Individuals



Sec. 51.41  Access to records.

    (a) Access to records shall be extended promptly to all authorized 
agents of a P&A system.
    (b) A P&A system shall have access to the records of any of the 
following individuals with mental illness:
    (1) An individual who is a client of the P&A system if authorized by 
that individual or the legal guardian, conservator or other legal 
representative.
    (2) An individual, including an individual who has died or whose 
whereabouts is unknown to whom all of the following conditions apply:
    (i) The individual, due to his or her mental or physical condition, 
is unable to authorize the P&A system to have access.
    (ii) The individual does not have a legal guardian, conservator or 
other legal representative, or the individual's guardian is the State or 
one of its political subdivisions; and
    (iii) A complaint or report has been received and the P&A system has 
determined that there is probable cause to believe that the individual 
has been or may be subject to abuse or neglect.
    (3) An individual who has a legal guardian, conservator, or other 
legal representative, with respect to whom a complaint or report has 
been received by the P&A system and with respect to whom the P&A system 
has determined that there is probable cause to believe that the health 
or safety of the individual is in serious and immediate jeopardy, 
whenever all of the following conditions exists:

[[Page 187]]

    (i) The P&A system has made a good faith effort to contact the 
representative upon prompt receipt of the representative's name and 
address;
    (ii) The P&A system has made a good faith effort to offer assistance 
to the representative to resolve the situation; and
    (iii) The representative has failed or refused to act on behalf of 
the individual.

(c) Information and individual records, whether written or in another 
medium, draft or final, including handwritten notes, electronic files, 
photographs or video or audio tape records, which shall be available to 
the P&A system under the Act shall include, but not be limited to:
    (1) Information and individual records, obtained in the course of 
providing intake, assessment, evaluation, supportive and other services, 
including medical records, financial records, and reports prepared or 
received by a member of the staff of a facility or program rendering 
care or treatment. This includes records stored or maintained in 
locations other than the facility or program as long as the system has 
obtained appropriate consent consistent with section 105(a)(4) of the 
Act. The system shall request of facilities that in requesting records 
from service providers or other facilities on residents that they 
indicate in the release form the records may be subject to review by a 
system.
    (2) Reports prepared by an agency charged with investigating abuse 
neglect, or injury occurring at a facility rendering care or treatment, 
or by or for the facility itself, that describe any or all of the 
following:
    (i) Abuse, neglect, or injury occurring at the facility;
    (ii) The steps taken to investigate the incidents;
    (iii) Reports and records, including personnel records, prepared or 
maintained by the facility, in connection with such reports of 
incidents; or
    (iv) Supporting information that was relied upon in creating a 
report, including all information and records used or reviewed in 
preparing reports of abuse, neglect or injury such as records which 
describe persons who were interviewed, physical and documentary evidence 
that was reviewed, and the related investigative findings.
    (3) Discharge planning records.
    (4) Reports prepared by individuals and entities performing 
certification or licensure reviews, or by professional accreditation 
organizations, as well as related assessments prepared for the facility 
by its staff, contractors or related entities, except that nothing in 
this section is intended to preempt State law protecting records 
produced by medical care evaluation or peer review committees.
    (5) Professional, performance, building or other safety standards, 
demographic and statistical information relating to the facility.
    (d) A P&A system shall have reasonable access and authority to 
interview and examine all relevant records of any facility service 
recipient (consistent with the provisions of section 105(a)(4) of the 
Act) or employee.
    (e) A P&A system shall be permitted to inspect and copy records, 
subject to a reasonable charge to offset duplicating costs.



Sec. 51.42  Access to Facilities and residents.

    (a) Access to facilities and residents shall be extended to all 
authorized agents of a P&A system.
    (b) A P&A system shall have reasonable unaccompanied access to 
public and private facilities and programs in the State which render 
care or treatment for individuals with mental illness, and to all areas 
of the facility which are used by residents or are accessible to 
residents. The P&A system shall have reasonable unaccompanied access to 
residents at all times necessary to conduct a full investigation of an 
incident of abuse or neglect. This authority shall include the 
opportunity to interview any facility service recipient, employee, or 
other persons, including the person thought to be the victim of such 
abuse, who might be reasonably believed by the system to have knowledge 
of the incident under investigation. Such access shall be afforded, upon 
request, by the P&A system when:
    (1) An incident is reported or a complaint is made to the P&A 
system;

[[Page 188]]

    (2) The P&A system determines there is probable cause to believe 
that an incident has or may have occurred; or
    (3) The P&A system determines that there is or may be imminent 
danger of serious abuse or neglect of an individual with mental illness.
    (c) In addition to access as prescribed in paragraph (b) of this 
section, a P&A system shall have reasonable unaccompanied access to 
facilities including all area which are used by residents, are 
accessible to residents, and to programs and their residents at 
reasonable times, which at a minimum shall include normal working hours 
and visiting hours. Residents include adults or minors who have legal 
guardians or conservators. P&A activities shall be conducted so as to 
minimize interference with facility programs, respect residents' privacy 
interests, and honor a resident's request to terminate an interview. 
This access is for the purpose of:
    (1) Providing information and training on, and referral to programs 
addressing the needs of individuals with mental illness, and information 
and training about individual rights and the protection and advocacy 
services available from the P&A system, including the name, address, and 
telephone number of the P&A system.
    (2) Monitoring compliance with respect to the rights and safety of 
residents; and
    (3) Inspecting, viewing and photographing all areas of the facility 
which are used by residents or are accessible to residents.
    (d) Unaccompanied access to residents shall include the opportunity 
to meet and communicate privately with individuals regularly, both 
formally and informally, by telephone, mail and in person. Residents 
include minors or adults who have legal guardians or conservators.
    (e) The right of access specified in paragraph (c) of this section 
shall apply despite the existence of any State or local laws or 
regulations which restrict informal access to minors and adults with 
legal guardians or conservators. The system shall make very effort to 
ensure that the parents of minors or guardians of individuals in the 
care of a facility are informed that the system will be monitoring 
activities at the facility and may in the course of such monitoring have 
access to the minor or adult with a legal guardian. The system shall 
take no formal action on behalf of individuals with legal guardians or 
conservators, or initiate a formal attorney/client or advocate/client 
relationship without appropriate consent, except in emergency situations 
as described in Sec. 51.41(b)(3).
    (f) A P&A system providing representation to individuals with mental 
illness in Federal facilities shall have all the rights and authority 
accorded other representatives of residents of such facilities pursuant 
to State and Federal laws.



Sec. 51.43  Denial of delay or access.

    If a P&A system's access to facilities, programs, residents or 
records covered by the Act or this part is delayed or denied, the P&A 
system shall be provided promptly with a written statement of reasons, 
including, in the case of a denial for alleged lack of authorization, 
the name, address and telephone number of the legal guardian, 
conservator, or other legal representative of an individual with mental 
illness. Access to facilities, records or residents shall not be delayed 
or denied without the prompt provision of written statements of the 
reasons for the denial.



Sec. 51.44  [Reserved]



Sec. 51.45  Confidentiality of protection and advocacy system records.

    (a) Records maintained by the P&A system are the property of the P&A 
system which must protect them from loss, damage, tampering or use by 
unauthorized individuals. The P&A system must:
    (1) Except as provided elsewhere in this section, keep confidential 
all records and information, including information contained in any 
automated electronic database pertaining to:
    (i) Clients to the same extent as is required under Federal or State 
laws for a provider of mental health services;
    (ii) Individuals who have been provided general information or 
technical assistance on a particular matter;

[[Page 189]]

    (iii) Identity of individuals who report incidents of abuse or 
neglect or furnish information that forms the basis for a determination 
that probable cause exists; and
    (iv) Names of individuals who are residents and provide information 
for the record.
    (2) Have written policies governing access to, storage of, 
duplication and release of information from client records; and
    (3) Obtain written consent from the client, if competent, or from 
his or her legal representative, from individuals who have been provided 
general information or technical assistance on a particular matter and 
from individuals who furnish reports or information that forms the basis 
for a determination of probable cause, before releasing information to 
individuals not otherwise authorized to receive it.
    (b) Nothing in this subpart shall prevent the P&A system from. (1) 
Issuing a public report of the results of an investigation which 
maintains the confidentiality of the individuals listed in paragraph 
(a)(1) of this section or,
    (2) Reporting the results of an investigation which maintains the 
confidentiality of individual service recipients to responsible 
investigative or enforcement agencies should an investigation reveal 
information concerning the facility, its staff, or employees warranting 
possible sanctions or corrective action. this information may be 
reported to agencies responsible for facility licensing or 
accreditation, employee discipline, employee licensing or certification, 
or criminal prosecution.
    (c) For purposes of any periodic audit, report, or evaluation of the 
performance of the P&A system, the Secretary shall not require the P&A 
system to disclose the identity, or any other personally identifiable 
information, of any individual requesting assistance under a program. 
This requirement does not restrict access by the Department or other 
authorized Federal or State officials to client records or other records 
of the P&A system when deemed necessary for audit purposes and for 
monitoring P&A system compliance with applicable Federal or State laws 
and regulations. The purpose of obtaining such information is solely to 
determine that P&A systems are spending their grant funds awarded under 
the Act on serving individuals with mental illness. Officials that have 
access to such information must keep it confidential to the maximum 
extent permitted by law and regulations. If photostatic copies of 
materials are provided, then the destruction of such evidence is 
required once such reviews have been completed.
    (d) Subject to the restrictions and procedures set out in this 
section, implementing section 106 (a) and (b) of the Act (42 U.S.C. 
10806 (a) and (b)), this part does not limit access by a legal guardian, 
conservator, or other legal representative of an individual with mental 
illness, unless prohibited by State or Federal law, court order or the 
attorney-client privilege.



Sec. 51.46  Disclosing information obtained from a provider of mental health services.

    (a) Except as provided in paragraph (b) of this section, if a P&A 
system has access to records pursuant to section 105(a)(4) of the Act 
(42 U.S.C. 10805(a)(4)) which, under Federal or State law, are required 
to be maintained in a confidential manner by a provider of mental health 
services, it may not disclose information from such records to the 
individual who is the subject of the information if the mental health 
professional responsible for supervising the provision of mental health 
services to that individual has given the P&A system a written 
determination that disclosure of such information to the individual 
would be detrimental to the individual's health. The provider shall be 
responsible for giving any such written determination to the P&A system 
at the same time as access to the records containing the information is 
granted.
    (b)(1) If the disclosure of information has been denied under 
paragraph (a) of this section to an individual, the following 
individuals or the P&A system may select another mental health 
professional to review the information and to determine if disclosure of 
the information would be detrimental to the individual's health:
    (i) Such individual;

[[Page 190]]

    (ii) The legal guardian, conservator or other legal representative 
of the individual; or
    (iii) An eligible P&A system, acting on behalf of an individual:
    (A) Whose legal guardian is the State; or
    (B) Whose legal guardian, conservator, or other legal representative 
has not, within a reasonable time after the denial of access to 
information under paragraph (a), selected a mental health professional 
to review the information.
    (2) If such mental health professional determines, based on 
professional judgment, that disclosure of the information would not be 
detrimental to the health of the individual, the P&A system may disclose 
such information to the individual.
    (c) The restriction in paragraph (b) of this section does not affect 
the P&A system's access to the records.



PART 51a--PROJECT GRANTS FOR MATERNAL AND CHILD HEALTH--Table of Contents




Sec.
51a.1  To which programs does this regulation apply?
51a.2  Definitions.
51a.3  Who is eligible to apply for Federal funding?
51a.4  How is application made for Federal funding?
51a.5  What criteria will DHHS use to decide which projects to fund?
51a.6  What confidentiality requirements must be met?
51a.7  What other DHHS regulations apply?
51a.8  What other conditions apply to these grants?

    Authority: Sec. 1102 of the Social Security Act, 49 Stat. 647 (42 
U.S.C. 1302); sec. 502(a), 502(b)(1)(A), and 506(a)(3) of the Social 
Security Act, 95 Stat. 819-20 (42 U.S.C. 702(a), 702(b)(1)(A) and 
706(a)(3)).

    Source: 51 FR 7727, Mar. 5, 1986, unless otherwise noted.



Sec. 51a.1  To which programs does this regulation apply?

    The regulation in this part applies to grants, contracts, and other 
arrangements under section 502(a) and 502(b)(1)(A) of the Social 
Security Act, as amended (42 U.S.C. 702(a) and 702(b)(1)(A)), the 
Maternal and Child Health (MCH) Federal Set-Aside project grant 
programs. Section 502(a) authorizes funding for special projects of 
regional and national significance (SPRANS), research and training 
projects with respect to maternal and child health and children with 
special health care needs (including early intervention training and 
services development); genetic disease testing, counseling and 
information programs; comprehensive hemophilia diagnostic and treatment 
centers; projects for screening and follow-up of newborns for sickle 
cell anemia and other genetic disorders; and special maternal and child 
health improvement projects. Section 502(b)(1)(A) authorizes funding for 
projects termed community integrated service system (CISS) projects for 
the development and expansion of: maternal and infant health home 
visiting; projects to increase the participation of obstetricians and 
pediatricians in title V and title XIX programs; integrated maternal and 
child health service systems; maternal and child health centers 
operating under the direction of not-for-profit hospitals; rural 
maternal and child health programs; and outpatient and community-based 
services programs for children with special health care needs.

[59 FR 36706, July 19, 1994]



Sec. 51a.2  Definitions.

    Act means the Social Security Act, as amended.
    Genetic diseases means inherited disorders caused by the 
transmission of certain aberrant genes from one generation to another.
    Hemophilia means a genetically transmitted bleeding disorder 
resulting from a deficiency of a plasma clotting factor.
    Institution of higher learning means any college or university 
accredited by a regionalized body or bodies approved for such purpose by 
the Secretary of Education, and any teaching hospital which has higher 
learning among its purposes and functions and which has a formal 
affiliation with an accredited school of medicine and a full-time 
academic medical staff holding faculty status in such school of 
medicine.
    Secretary means the Secretary of Health and Human Services or his or 
her designee.

[[Page 191]]



Sec. 51a.3  Who is eligible to apply for Federal funding?

    (a) With the exception of training and research, as described in 
paragraph (b) of this section, any public or private entity, including 
an Indian tribe or tribal organization (as those terms are defined at 25 
U.S.C. 450b) is eligible to apply for federal funding under this Part.
    (b) Only public or nonprofit private institutions of higher learning 
may apply for training grants. Only public or nonprofit institutions of 
higher learning and public or private nonprofit agencies engaged in 
research or in programs relating to maternal and child health and/or 
services for children with special health care needs may apply for 
grants contracts or cooperative agreements for research in maternal and 
child health services or in services for children with special health 
care needs.

[59 FR 36706, July 19, 1994]



Sec. 51a.4  How is application made for Federal funding?

    An application for funding under the MCH Federal Set-Aside project 
grant programs must be submitted to the Secretary at such time and in 
such manner as the Secretary may prescribe. It must include a budget and 
narrative plan of the manner in which the project will meet each of the 
requirements prescribed by the Secretary. The plan must describe the 
project in sufficient detail to identify clearly the nature, need, and 
specific objectives of, and methodology for carrying out, the project.

(Approved by the Office of Management and Budget under control number 
0915-0050)

[59 FR 36706, July 19, 1994]



Sec. 51a.5  What criteria will DHHS use to decide which projects to fund?

    (a) The Secretary will determine the allocation of funds available 
under sections 502(a) and 502(b)(1)(A) of the Act for each of the 
activities described in Sec. 51a.1.
    (b) Within the limit of funds determined by the Secretary to be 
available for each of the activities described in Sec. 51a.1, the 
Secretary may award Federal funding for projects under this part to 
applicants which will, in his or her judgment, best promote the purpose 
of title V of the Social Security Act and address achievement of Healthy 
Children 2000 objectives,\1\ taking, the following factors into account:
---------------------------------------------------------------------------

    \1\ Healthy Children 2000: National Health Promotion and Disease 
Prevention Objectives Related to Mothers, Infants, Children, 
Adolescents, and Youth is a special compendium of health status goals 
and national health objectives affecting mothers, infants, children, 
adolescents, and youth originally published in Healthy People 2000 in 
September 1990. 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, DC 20402-9325, 
(telephone: 202 512-1800).
---------------------------------------------------------------------------

    (1) The extent to which the project will contribute to the 
advancement of maternal and child health and/or improvement of the 
health of children with special health care needs;
    (2) The extent to which the project is responsive to policy concerns 
applicable to MCH grants and to program objectives, requirements, 
priorities and/or review criteria for specific project categories, as 
published in program announcements or guidance materials.
    (3) The extent to which the estimated cost to the Government of the 
project is reasonable, considering the anticipated results;
    (4) The extent to which the project personnel are well qualified by 
training and/or experience for their roles in the project and the 
applicant organization has adequate facilities and personnel; and
    (5) The extent to which, insofar as practicable, the proposed 
activities, if well executed, are capable of attaining project 
objectives.
    (c) For the following types of CISS projects, preference for funding 
will be given to qualified applicants in areas with a high infant 
mortality rate (relative to the latest average infant mortality rate in 
the United States or in the State in which the area is located):
    (1) Projects for the development and expansion of maternal and 
infant health home visiting;

[[Page 192]]

    (2) Projects to increase the participation of obstetricians and 
pediatricians in title V and title XIX programs;
    (3) Integrated maternal and child health service systems;
    (4) Maternal and child health centers operating under the direction 
of not-for-profit hospitals;
    (5) Rural maternal and child health programs; and
    (6) Outpatient and community based services for children with 
special health care needs.

[59 FR 36706, July 19, 1994]



Sec. 51a.6  What confidentiality requirements must be met?

    All information as to personal facts and circumstances obtained by 
the project's staff about recipients of services shall be held 
confidential, and shall not be disclosed without the individual's 
consent except as may be otherwise required by applicable law or as may 
be necessary to provide for medical audits by the Secretary with 
appropriate safeguards for confidentiality of patient records. 
Otherwise, information may be disclosed only in summary, statistical, or 
other form which does not identify particular individuals.



Sec. 51a.7  What other DHHS regulations apply?

    (a) Several other DHHS regulations apply to awards under this part. 
These include, but are not limited to:

    42 CFR part 50--Policies of general applicability:
    subpart B--Sterilization of persons in federally assisted family 
planning projects.
    subpart C--Abortions and related medical services in federally 
assisted programs of the Public Health Service.
    subpart E--Maximum allowable cost for drugs.

    45 CFR part 76--Governmentwide debarment and suspension 
(nonprocurement) and governmentwide requirements for drug-free workplace 
(grants).
    45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Service--
Effectuation of title VI of the Civil Rights Act of 1964.
    45 CFR part 81--Practice and procedure for hearings under Part 80 of 
this title.
    45 CFR part 84--Nondiscrimination on the basis of handicap in 
programs and activities receiving or benefiting from Federal financial 
assistance.
    45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance.
    45 CFR part 91--Nondiscrimination on the basis of age in HHS 
programs or activities receiving Federal financial assistance.
    45 CFR part 93--New restrictions on lobbying.

    (b) In addition to the above regulations, the following apply to 
projects funded through grants:

    42 CFR part 50--Policies of general applicability:
    subpart D--Public Health Service grant appeals procedure.
    45 CFR part 16--Procedures of the Departmental Grant Appeals Board.
    45 CFR part 74--Administration of grants to nonprofit organizations.
    45 CFR part 75--Informal grant appeals procedures.
    45 CFR part 92--Administration of grants to State and local 
governments.

[59 FR 36707, July 19, 1994]



Sec. 51a.8  What other conditions apply to these grants?

    (a) Recipients of project grants will be required to submit such 
additional information to the Secretary on an annual basis as the 
Secretary determines, including:
    (1) the number of individuals served or trained, as appropriate 
under the project;
    (2) a copy of any evaluation conducted by the recipient; and
    (3) a list of Healthy Children 2000 objectives addressed by the 
project and data on how the project contributed toward meeting the 
objectives.
    (b) The Secretary may at the time of award of project grants under 
this Part impose additional conditions, including conditions governing 
the use of information or consent forms, when, in the Secretary's 
judgment, they are necessary to advance the approved program, the 
interest of public health, or the conservation of grant funds.

[59 FR 36707, July 19, 1994]

[[Page 193]]



PART 51b--PROJECT GRANTS FOR PREVENTIVE HEALTH SERVICES--Table of Contents




                      Subpart A--General Provisions

Sec.
51b.101  To which programs do these regulations apply?
51b.102  Definitions.
51b.103  What are the general application requirements?
51b.104  Can personnel, supplies, and related items be provided in lieu 
          of cash?
51b.105  Which other HHS regulations apply to these grants?
51b.106  What other conditions apply to these grants?
51b.107  Is participation in preventive health service programs required 
          by these regulations?

          Subpart B--Grants for Childhood Immunization Programs

51b.201  To which programs does this subpart apply?
51b.202  Definitions.
51b.203  Who is eligible for a grant under this subpart?
51b.204  What information is required in the application?
51b.205  How will grant applications be evaluated and the grants 
          awarded?
51b.206  How can grant funds be used?

Subpart C [Reserved]

         Subpart D--Grants for Venereal Disease Control Programs

51b.401  To which programs does this subpart apply?
51b.402  Definitions.
51b.403  Who is eligible for a grant under this subpart?
51b.404  What are the confidentiality requirements?
51b.405  What information is required in the application?
51b.406  How will grant applications be evaluated and the grants 
          awarded?
51b.407  How can grant funds be used?

Subpart E [Reserved]

 Subpart F--Grants for Research, Demonstrations, and Public Information 
    and Education for the Prevention and Control of Venereal Disease

51b.601  To which programs does this subpart apply?
51b.602  Who is eligible for a grant under this subpart?
51b.603  What are the confidentiality requirements?
51b.604  What information is required in the application?
51b.605  How will grant applications be evaluated and the grants 
          awarded?
51b.606  How can grant funds be used?

    Authority: Secs. 317 and 318, Public Health Service Act, 92 Stat. 
3574 and 3582 (42 U.S.C. 247b, 247c); sec. 1743 Pub. L. 97-35, 95 Stat. 
763 (31 U.S.C. 1243 note).



                      Subpart A--General Provisions

    Source: 48 FR 4473, Feb. 1, 1983, unless otherwise noted.



Sec. 51b.101  To which programs do these regulations apply?

    The regulations in this part apply to grants for preventive health 
service programs authorized under section 317 (42 U.S.C. 247b) and for 
venereal disease prevention and control programs authorized under 
section 318 (42 U.S.C. 247c) of the Act.



Sec. 51b.102  Definitions.

    As used in these regulations:
    Act means the Public Health Service Act, as amended.
    Secretary means the Secretary of Health and Human Services (HHS) or 
any other officer or employee of that Department to whom the authority 
involved has been delegated.
    State means one of the 50 States, the District of Columbia, Guam, 
the Commonwealth of Puerto Rico, the Northern Mariana Islands, the 
Virgin Islands, American Samoa, and the Trust Territory of the Pacific 
Islands.



Sec. 51b.103  What are the general application requirements?

    (a) The project application shall contain a full description of the 
program objectives, plans, and activities. With respect to programs 
authorized by section 317 of the Act only, the application shall also 
provide, as the Secretary may require:
    (1) The amount of Federal, State, and other funds obligated by the 
applicant in its latest annual accounting period for the provision of 
such program.
    (2) A description of the services provided by the applicant for this 
accounting period covered under paragraph (a)(1) of this section.

[[Page 194]]

    (3) The amount of Federal funds needed by the applicant to continue 
providing these services.
    (4) A description of any proposed changes in the provision of the 
services, reasons and priorities, and the amount of Federal funds needed 
by the applicant to make the changes.
    (b) The application shall contain evidence satisfactory to the 
Secretary that it has been submitted, as appropriate, for action to the 
planning agency designated by the Secretary under title XV of the Act 
(42 CFR parts 122 and 123). These grants are subject to the 
intergovernmental review of Federal programs of Executive Order 12372.
    (c) The application shall contain assurances that no one will be 
denied services because of inability to pay, and that the services are 
provided in a manner which preserves human dignity and maximizes 
acceptance.



Sec. 51b.104  Can personnel, supplies, and related items be provided in lieu of cash?

    The Secretary may reduce a grant by the amount of the fair market 
value of any supplies (including vaccines and other preventive agents) 
or equipment furnished a grant recipient when furnished at the request 
of the recipient. The Secretary also may reduce a grant by the amount of 
the pay, allowances, travel expenses, and any other costs in connection 
with the detail of any officer or employee of the Government to the 
recipient when the detail is at the request of the recipient. The amount 
the grant is reduced shall be available for payment by the Secretary of 
the costs incurred in furnishing the supplies or equipment or in 
detailing personnel and shall be deemed to have been paid to the 
recipient.



Sec. 51b.105  Which other HHS regulations apply to these grants?

    Several other HHS regulations apply to grants under this part. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Debarment and suspension from eligibility for financial 
assistance
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

[49 FR 38109, Sept. 27, 1984]



Sec. 51b.106  What other conditions apply to these grants?

    (a) The notice of grant award specifies how long HHS intends to 
support the project without requiring the project to recompete for 
funds. This period, called the project period, will usually be for 2 to 
5 years.
    (b) For budgetary and funding purposes, the project period is 
generally divided into 12-month intervals called budget periods. A 
grantee must submit a separate application to have the support continued 
for each subsequent budget period after the initial award. Decisions 
regarding continuation awards and the funding level of such awards will 
be made after consideration of such factors as the grantee's progress 
and management practices and the availability of funds. In all cases, 
continuation awards require a determination by HHS that continued 
funding is in the best interest of the government.
    (c) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.
    (d) Any funds granted pursuant to this subpart shall be expended 
solely for the purposes for which the funds were granted in accordance 
with the

[[Page 195]]

approved application and budget, the regulations of this part, the terms 
and conditions of the award, and the applicable cost principles 
prescribed in subpart Q of 45 CFR part 74.
    (e) The Secretary may, at the time of award, impose additional 
conditions, including conditions governing the use of information or 
consent forms, when, in the Secretary's judgment, they are necessary to 
advance the approved program, the interest of the public health, or the 
conservation of grant funds.



Sec. 51b.107  Is participation in preventive health service programs required by these regulations?

    Nothing in these regulations shall be construed to require any State 
or political subdivision to have a preventive health service program 
which would require any person who objects to treatment to be treated 
under the program.



          Subpart B--Grants for Childhood Immunization Programs

    Source: 44 FR 40501, July 11, 1979, unless otherwise noted.



Sec. 51b.201  To which programs does this subpart apply?

    The regulations in this subpart apply to the award of grants under 
section 317 of the Act for programs to immunize children against vaccine 
preventable diseases.



Sec. 51b.202  Definitions.

    As used in this subpart:
    Childhood immunization program means a preventive health service 
program to immunize children against vaccine preventable diseases 
including poliomyelitis, measles, mumps, rubella, diphtheria, pertussis, 
and tetanus.



Sec. 51b.203  Who is eligible for a grant under this subpart?

    An applicant must be a State agency or an agency of a political 
subdivision of a State which has legal responsibility for disease 
control under the laws of a State.



Sec. 51b.204  What information is required in the application?

    (a) The initial application must cover the project period, and must 
include a description of the following:
    (1) The need for grant support.
    (2) The immediate (1 year budget period) and long-range (2-5 year 
project period) objectives of the project in specific and measurable 
terms.
    (3) Current immunization programs and the additional or intensified 
activities to be carried out to meet the objectives and priorities.
    (4) The following program elements should be included and described:
    (i) A plan to assure that children begin and complete their 
immunizations on schedule, including the use of a standard immunization 
record card, a provider-based tickler system (public and private) for 
the recall of children, and a hospital-based immunization education 
program for new mothers.
    (ii) Assessment of immunization status of school enterers, children 
attending licensed day-care centers, and children under 2 years of age 
and new enrollees under age 5 served in public clinics.
    (iii) A plan for surveillance of vaccine-preventable diseases that 
includes morbidity and mortality reporting as well as field and 
laboratory investigations.
    (iv) Procedures for prompt review of the data collected from the 
morbidity surveillance system to allow for immediate response to all 
occurrence of suspected diphtheria and polio cases upon notification and 
response to suspected measles cases within 48 hours.
    (v) A system for monitoring vaccine-associated reactions including a 
mechanism for responding to persons with vaccine-related complaints.
    (vi) A plan to systematically immunize susceptible children at 
school entry through vigorous enforcement of school immunization laws.
    (5) The manner in which the applicant intends to evaluate the 
project.
    (b) An application for a continuation grant must be submitted for 
each funding period. This continuation application must include the 
following:

[[Page 196]]

    (1) A budget and justification for the grant funds requested.
    (2) A summary of the progress achieved during the previous budget 
period.
    (3) A description of any changes in the information shown in the 
project application.

[48 FR 4474, Feb. 1, 1983]



Sec. 51b.205  How will grant applications be evaluated and the grants awarded?

    (a) Within the limits of funds available, the Secretary may award a 
grant to assist in meeting part of the cost of a childhood immunization 
program. Grants will be awarded to those applicants whose projects he 
determines will best promote the purposes of section 317 of the Act. 
Before awarding a grant to a local public entity of a State, the 
Secretary will consult with the State health authority.
    (b) Priorities for funding will be based on the following factors:
    (1) The relative extent of the problems which are caused by one or 
more of the vaccine preventable diseases in the area served by the 
applicant.
    (2) The extent to which the proposed program is designed to 
eliminate or reduce the problems.
    (3) The extent to which the proposed program will increase the 
immunization rates in population groups identified as having the lowest 
immunity levels.
    (4) The extent to which the grantee will cooperate with and use 
public and nonprofit private entities and volunteers.
    (5) The extent to which a strong commitment to the objectives of the 
program is reflected in the commitment of grantee resources to the 
program.

[44 FR 40501, July 11, 1979, as amended at 48 FR 4475, Feb. 1, 1983]



Sec. 51b.206  How can grant funds be used?

    Grant funds awarded under this subpart may be used to purchase 
supplies, materials, and equipment for childhood immunization programs. 
Grant funds also may be used to pay for salaries or wages and related 
expenses for personnel directly involved in the planning, organization, 
promotion, epidemiology, surveillance, and other program activities.

Subpart C  [Reserved]



         Subpart D--Grants for Venereal Disease Control Programs

    Source: 48 FR 4475, Feb. 1, 1983, unless otherwise noted.



Sec. 51b.401  To which programs does this subpart apply?

    The regulations in this subpart apply to the award of project grants 
under section 318(c) of the Act for venereal disease prevention and 
control programs, and under section 318(b) of the Act with respect to 
public information and education activities which are integral to a 
balanced, comprehensive venereal disease control program.



Sec. 51b.402  Definitions.

    As used in this subpart:
    Venereal disease means gonorrhea, syphilis, or any other disease 
which can be sexually transmitted and which the Secretary determines is 
or may be amenable to control with assistance provided under this 
authority and which is of national significance.
    Venereal disease control program means a program designed to carry 
out activities or to provide services to systematically detect and 
prevent venereal disease as distinguished from those activities or 
services which are designed to diagnose or treat venereal disease 
patients or suspects.



Sec. 51b.403  Who is eligible for a grant under this subpart?

    An applicant must be a State agency or a political subdivision of a 
State which has legal responsibility for disease control under the laws 
of the State.



Sec. 51b.404  What are the confidentiality requirements?

    All information obtained by program personnel in connection with the 
examination, care, and treatment of an individual in this program shall 
be held confidential. It shall not be disclosed without the individual's 
consent except as may be required by the law of a

[[Page 197]]

State or political subdivision of a State or as may be necessary to 
provide services to the individual. Information may be disclosed in 
summary, statistical, or other form, or for clinical or research 
purposes, but only if the disclosure does not identify particular 
individuals.



Sec. 51b.405  What information is required in the application?

    (a) The initial application must include a description of the 
following:
    (1) The nature and extent of the venereal disease problem in the 
area.
    (2) The need for project grant support.
    (3) The immediate (1-year budget period) and long-range (2-5 year 
project period) objectives of the project in specific and measurable 
terms.
    (4) The activities to be carried out to meet the objectives. The 
following program elements must be included and described:
    (i) Venereal disease surveillance.
    (ii) Casefinding and case followup.
    (iii) Interstate epidemiologic referral and followup.
    (iv) Public venereal disease information and education.
    (v) Professional (including appropriate allied health personnel) 
venereal disease education, training, and clinical skills improvement 
activities, including efforts to assure high quality clinical services 
in public venereal disease clinics.
    (5) At the option of the applicant, special studies or 
demonstrations to evaluate or test venereal disease prevention and 
control strategies and activities.
    (6) The manner in which the applicant intends to conduct and 
evaluate the project, including a system for analysis of morbidity data 
so that control activities can be efficiently evaluated and targeted.
    (7) The diagnostic and treatment services that will be provided.
    (8) A budget and justification for the grant funds requested. Since 
public information and education activities are authorized separately 
from other control program activities, funds requested for this purpose 
must be itemized and justified separately in the narrative part of the 
application.
    (b) An application for a continuation grant must be submitted for 
each funding period. This continuation application must include the 
following:
    (1) A budget and justification for the grant funds requested.
    (2) A summary of the progress achieved during the previous budget 
period.
    (3) A description of any changes in the information shown in the 
project application.



Sec. 51b.406  How will grant applications be evaluated and the grants awarded?

    (a) Within the limits of funds available, the Secretary may award a 
grant to assist in meeting the cost of a venereal disease control 
program. Before awarding a grant to a political subdivision of a State, 
the Secretary will consult with the State health authority.
    (b) Priorities for funding will be based on the following factors:
    (1) The relative extent of the venereal disease problem in the area 
served by the applicant.
    (2) The design of the venereal disease prevention and control 
program.
    (3) The general quality of the applicant's plan of operation and 
objectives in accordance with the requirements in these regulations. 
Emphasis will be placed on determining the extent to which services are 
coordinated among health care providers in the area served and 
integrated into a cohesive plan for delivery of service to groups having 
the highest incidence of venereal disease.
    (4) The capacity of the applicant to make effective use of Federal 
funds.
    (5) The commitment of the applicant to the control of venereal 
disease as reflected in the commitment of applicant resources to the 
program.



Sec. 51b.407  How can grant funds be used?

    Grant funds awarded under this subpart may be used only for programs 
approved under section 318(c), and with respect to public information 
and education, those programs approved under section 318(b) of the Act. 
Unless specifically approved, grant funds shall not be used for 
performing diagnostic tests (other than gonorrhea screening tests),

[[Page 198]]

maintaining central registries, purchasing data processing equipment, or 
providing diagnostic and treatment facilities and services. The 
applicant must provide assurances, however, that these services will be 
available as needed as an adjunct to control program activities 
supported with grant funds. To obtain special approval for grant support 
of such activities, the grantee shall justify the exception to the 
satisfaction of the Secretary that funds for this purpose are necessary 
for the proper conduct of the program and are otherwise unavailable. 
Support of these services will generally be approved only in the 
following situations:
    (a) Special studies or demonstrations, (b) the support of 
developmental or start-up activity, or (c) the support of an essential 
service which will result in a savings to a detection or prevention 
activity supported by the grant. Unless otherwise approved, exceptions 
based on paragraphs (b) and (c) of this section are only allowed during 
one funding period. The grantee is expected to support these activities 
in subsequent funding periods.

Subpart E  [Reserved]



 Subpart F--Grants for Research, Demonstrations, and Public Information 
    and Education for the Prevention and Control of Venereal Disease

    Source: 48 FR 4476, Feb. 1, 1983, unless otherwise noted.



Sec. 51b.601  To which programs does this subpart apply?

    The regulations in this subpart apply to the award of venereal 
disease control project grants for research, demonstrations, public 
information, and education activities which can be applied to achieve 
improvements in venereal disease prevention and control under section 
318(b) of the Act.



Sec. 51b.602  Who is eligible for a grant under this subpart?

    An applicant must be a State, political subdivision of any State, or 
any other public or nonprofit private entity.



Sec. 51b.603  What are the confidentiality requirements?

    All information obtained by program personnel in connection with the 
examination, care, and treatment of an individual in this program shall 
be held confidential. It shall not be disclosed without the individual's 
consent except as may be required by the law of a State, or political 
subdivision of a State, or as may be necessary to provide services to 
the individual. Information may be disclosed in summary, statistical, or 
other form, or for clinical or research purposes, but only if the 
disclosure does not identify particular individuals.



Sec. 51b.604  What information is required in the application?

    (a) The initial application must include a description of the 
following:
    (1) The setting and circumstances for which project grant support is 
being requested, including:
    (i) The immediate and long-range objectives of the project in 
specific and measurable terms.
    (ii) The activities which will be undertaken to accomplish the 
objectives, including the timing of these activities.
    (iii) The anticipated application of findings to the national 
venereal disease control effort.
    (iv) Any other information which will support the request for grant 
assistance.
    (2) The relationship between the planned activities and the project 
objectives. The application must describe in detail how the applicant 
intends to proceed, particularly if the project is unusually complex and 
several activities are interdependent or unprecedented.
    (3) A comprehensive and realistic plan which the applicant will use 
to evaluate the project. The plan must include periodic assessment of 
any possible impact, both positive and negative, that the proposed 
project might have upon the established venereal disease control program 
in the locality or localities in which the project will be undertaken.

[[Page 199]]

    (b) An application for a continuation grant must be submitted for 
each funding period. This continuation application must include the 
following:
    (1) A budget and justification for the grant funds requested.
    (2) A summary of the progress achieved during the previous budget 
period.
    (3) A description of any changes in the information shown in the 
project application.



Sec. 51b.605  How will grant applications be evaluated and the grants awarded?

    (a) Within the limits of funds available, the Secretary may award a 
grant to assist in meeting the costs of special activities authorized 
under section 318(b) of the Act.
    (b) Grant applications will be reviewed and evaluated according to 
the following criteria:
    (1) Is there adequate evidence that the proposed project is needed 
and that the outcome has potential to directly benefit the national 
venereal disease control effort?
    (2) Are the project objectives specific, measurable, realistic, time 
phased, and related to promoting the purposes of section 318?
    (3) Is the method of operation logical and clearly related to 
project objectives, and does it describe how the applicant intends to 
proceed particularly with activities which are complex, interrelated, or 
unprecedented?
    (4) Does the method of operation include an assessment of any 
possible impact, both positive and negative, that the conduct of the 
proposed initiative might have upon the established venereal disease 
control program in the locality or localities in which the project will 
be undertaken?
    (5) Does the proposal include a comprehensive and realistic plan for 
the evaluation of the project, and specify the measures and instruments 
of measurement to be used?
    (6) Is the budget request reasonable and consistent with the 
intended use of grant funds?
    (7) If the applicant intends only to evaluate an existing disease 
prevention and control approach, are the objectives substantially 
different from those which could be met by routine program evaluation?



Sec. 51b.606  How can grant funds be used?

    (a) Grant funds may be used for the costs associated with planning, 
organizing, and conducting applied research, demonstrations, and public 
information and education programs.
    (b) Grant funds may also be used to reimburse individuals who agree 
to be participants in the applied research projects. This reimbursement, 
however, must be justified as necessary and reasonable. A schedule of 
reimbursements must be submitted with the application and approved as 
part of the program plan.
    (c) Grant funds may not be used to supplant funds supporting 
existing venereal disease control services provided by a State or 
locality.



PART 51c--GRANTS FOR COMMUNITY HEALTH SERVICES--Table of Contents




                      Subpart A--General Provisions

Sec.
51c.101  Applicability.
51c.102  Definitions.
51c.103  Eligibility.
51c.104  Application.
51c.105  Accord with health planning.
51c.106  Amount of grant.
51c.107  Use of project funds.
51c.108  Grant payments.
51c.109  Nondiscrimination.
51c.110  Confidentiality.
51c.111  Publications and copyright.
51c.112  Grantee accountability.
51c.113  Applicability of 45 CFR part 74.

 Subpart B--Grants for Planning and Developing Community Health Centers

51c.201  Applicability.
51c.202  Application.
51c.203  Project elements.
51c.204  Grant evaluation and award.

        Subpart C--Grants for Operating Community Health Centers

51c.301  Applicability.
51c.302  Application.
51c.303  Project elements.
51c.304  Governing board.
51c.305  Grant evaluation and award.

[[Page 200]]

        Subpart D--Grants for Operating Community Health Projects

51c.401  Applicability.
51c.402  Application.
51c.403  Project elements.
51c.404  Grant evaluation and award.

     Subpart E--Acquisition and Modernization of Existing Buildings

51c.501  Applicability.
51c.502  Definitions.
51c.503  Application.
51c.504  Project elements.
51c.505  Determination of cost.
51c.506  Use of grant funds.
51c.507  Facility which has previously received Federal grant.

    Authority: Sec. 330, Public Health Service Act, 89 Stat. 342, (42 
U.S.C. 254c); sec. 215, Public Health Service Act, 58 Stat. 690, (42 
U.S.C. 216).

    Source: 41 FR 53205, Dec. 3, 1976, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 51c.101  Applicability.

    The regulations of this subpart are applicable to all project grants 
authorized by section 330 of the Public Health Service Act (42 U.S.C. 
254c).



Sec. 51c.102  Definitions.

    As used in this part:
    (a) Act means the Public Health Service Act.
    (b) Catchment area means the area served by a project funded under 
section 330 of the Act.
    (c)(1) Community health center or center means an entity which, 
through its staff and supporting resources or through contracts or 
cooperative arrangements with other public or private entities, provides 
for all residents of its catchment area:
    (i) Primary health services;
    (ii) As determined by the Secretary to be appropriate for particular 
centers, supplemental health services necessary for the adequate support 
of primary health services;
    (iii) Referral to providers of supplemental health services and 
payment, as determined by the Secretary to be appropriate and feasible, 
for their provision of such services;
    (iv) Environmental health services, as determined by the Secretary 
to be appropriate for particular centers; and
    (v) Information on the availability and proper use of health 
services.
    (2) For purposes of paragraph (c)(1) of this section, the provision 
of a given service by a center will be determined by the Secretary to be 
appropriate where:
    (i) There is a need, as determined by the Secretary, for the 
provision of such service in the catchment area; and
    (ii) The provision of such service by the center is feasible, taking 
into consideration the center's projected revenues, other resources, and 
grant support under this part.
    (d) Environmental health services means the detection and 
alleviation of unhealthful conditions of the environment of the 
catchment area, such as problems associated with water supply, sewage 
treatment, solid waste disposal, rodent and parasite infestation, and 
housing conditions. For the purposes of this part, the detection and 
alleviation of unhealthful conditions of the environment includes the 
notification of and making of arrangements with appropriate Federal, 
State, or local authorities responsible for correcting such conditions.
    (e) Medically underserved population means the population of an 
urban or rural area designated by the Secretary as an area with a 
shortage of personal health services or a population group designated by 
the Secretary as having a shortage of such services. Medically 
underserved areas will be designated by the Secretary and a list of 
those designated will be published in the Federal Register from time to 
time, taking into consideration the following factors, among others:
    (1) Available health resources in relation to size of the area and 
its population, including appropriate ratios of primary care physicians 
in general or family practice, internal medicine, pediatrics, or 
obstetrics and gynecology to population;
    (2) Health indices for the population of the area, such as infant 
mortality rate;
    (3) Economic factors affecting the population's access to health 
services, such as percentage of the population

[[Page 201]]

with incomes below the poverty level; and
    (4) Demographic factors affecting the population's need and demand 
for health services, such as percentage of the population age 65 and 
over.
    (f) Nonprofit, as applied to any private agency, institution, or 
organization, means one which is a corporation or association, or is 
owned and operated by one or more corporations or associations, no part 
of the net earnings of which inures, or may lawfully inure, to the 
benefit of any private shareholder or individual.
    (g) Physician means a licensed doctor of medicine or doctor of 
osteopathy.
    (h) Primary health services means:
    (1) Diagnostic, treatment, consultative, referral, and other 
services rendered by physicians, and, where feasible, by physician's 
extenders, such as physicians' assistants, nurse clinicians, and nurse 
practitioners;
    (2) Diagnostic laboratory services and diagnostic radiologic 
services;
    (3) Preventive health services, including medical social services, 
nutritional assessment and referral, preventive health education, 
children's eye and ear examinations, prenatal and post-partum care, 
prenatal services, well child care (including periodic screening), 
immunizations, and voluntary family planning services;
    (4) Emergency medical services, including provision, through clearly 
defined arrangements, for access of users of the center to health care 
for medical emergencies during and after the center's regularly 
scheduled hours;
    (5) Transportation services as needed for adequate patient care, 
sufficient so that residents of the catchment area served by the center 
with special difficulties of access to services provided by the center 
receive such services; and
    (6) Preventive dental services provided by a licensed dentist or 
other qualified personnel, including (i) oral hygiene instruction; (ii) 
oral prophylaxis, as necessary; and (iii) topical application of 
fluorides, and the prescription of fluorides for systemic use when not 
available in the community water supply.
    (i) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (j) Supplemental health services means health services which are not 
included as primary health services and which are:
    (1) Inpatient and outpatient hospital services;
    (2) Home health services;
    (3) Extended care facility services;
    (4) Rehabilitative services (including physical and occupational 
therapy) and long-term physical medicine;
    (5) Mental health services, including services of psychiatrists, 
psychologists, and other appropriate mental health professionals;
    (6) Dental services other than those provided as primary health 
services;
    (7) Vision services, including routine eye and vision examinations 
and provision of eyeglasses, as appropriate and feasible;
    (8) Allied health services;
    (9) Pharmaceutical services, including the provision of prescription 
drugs;
    (10) Therapeutic radiologic services;
    (11) Public health services (including nutrition education and 
social services);
    (12) Ambulatory surgical services;
    (13) Health education services; and
    (14) Services, including the services of outreach workers, which 
promote and facilitate optimal use of primary health services and 
services referred to in the preceding subparagraphs of this paragraph 
and, if a substantial number of individuals in the population served by 
the center are of limited English-speaking ability, the services of 
outreach workers and other personnel fluent in the language or languages 
spoken by such individuals.



Sec. 51c.103  Eligibility.

    Any public or nonprofit private entity is eligible to apply for a 
grant under this part.



Sec. 51c.104  Application.

    (a) An application for a grant under this part shall be submitted to 
the Secretary at such time and in such form and manner as the Secretary 
may prescribe.

[[Page 202]]

    (b) The application shall contain a budget and narrative plan of the 
manner in which the applicant intends to conduct the project and carry 
out the requirements of this part. The application must describe how and 
the extent to which the project has met, or plans to meet, each of the 
requirements in subpart B (relating to grants for planning and 
developing community health centers), subpart C (relating to grants for 
the operation of community health centers), or subpart D (relating to 
grants for the operation of community health projects), as applicable. 
In addition, applications must include:
    (1) A statement of specific, measurable objectives and the methods 
to be used to assess the achievement of the objectives in specified time 
periods and at least on an annual basis.
    (2) The precise boundaries of the catchment area to be served by the 
applicant, including an identification of the medically underserved 
population or populations within the catchment area. In addition, the 
application shall include information sufficient to enable the Secretary 
to determine that the applicant's catchment area meets the following 
criteria:
    (i) The size of such area is such that the services to be provided 
by the applicant are available and accessible to the residents of the 
area promptly and as appropriate;
    (ii) The boundaries of such area conform, to the extent practicable, 
to relevant boundaries of political subdivisions, school districts, and 
areas served by Federal and State health and social service programs; 
and
    (iii) The boundaries of such area eliminate, to the extent possible, 
barriers resulting from the area's physical characteristics, its 
residential patterns, its economic and social groupings, and available 
transportation.
    (3) The results of an assessment of the need that the population 
served or proposed to be served has for the services to be provided by 
the project (or in the case of applications for planning and development 
projects, the methods to be used in assessing such need), utilizing, but 
not limited to, the factors set forth in Sec. 51c.102(e)(1)-(4).
    (4) Position descriptions for key personnel who will be utilized in 
carrying out the activities of the project and a statement indicating 
the need for the positions to be supported with grant funds to 
accomplish the objectives of the project.
    (5) Letters and other forms of evidence showing that efforts have 
been made to secure financial and professional assistance and support 
for the project within the proposed catchment area and the continuing 
involvement of the community in the development and operation of the 
project.
    (6) An assurance that an independent certified public accountant, or 
a public accountant licensed before December 31, 1970, will be engaged 
to certify that the system for the management and control of its 
financial assets will be in accord with sound financial management 
practices, including applicable Federal requirements.
    (7) A list of all services proposed to be provided by the project.
    (8) A list of services which are to be provided directly by the 
project through its own staff and resources and a description of any 
contractual or other arrangements (including copies of documents, where 
available) entered into, or planned for the provision of services.
    (9) The schedule of fees and/or payments and schedule of discounts 
for services provided by the project.
    (10) Evidence that all applicable requirements for review and/or 
approval of the application under title XV of the Act have been met.
    (11) An assurance that the project will be conducted in accordance 
with the applicable requirements of this part.
    (c) The application must be executed by an individual authorized to 
act for the applicant and to assume on behalf of the applicant the 
obligations imposed by the statute, the applicable regulations of this 
part, and any additional conditions of the grant.

(Sec. 330, Public Health Service Act, 89 Stat. 342, (42 U.S.C. 254c); 
sec. 215, Public Health Service Act, 58 Stat. 690, 67 Stat. 63 (42 
U.S.C. 216))

[41 FR 53205, Dec. 3, 1976, as amended at 48 FR 29201, June 24, 1983; 48 
FR 45558, Oct. 6, 1983]

[[Page 203]]



Sec. 51c.105  Accord with health planning.

    A grant may be made under this part only if the applicable 
requirements of title XV of the Act relating to review and approval by 
the appropriate health planning agencies have been met.



Sec. 51c.106  Amount of grant.

    (a) The amount of any award under this part will be determined by 
the Secretary on the basis of his estimate of the sum necessary for a 
designated portion of direct project costs plus an additional amount for 
indirect costs, if any, which will be calculated by the Secretary 
either:
    (1) On the basis of the estimate of the actual indirect costs 
reasonably related to the project; or
    (2) On the basis of a percentage of all, or a portion of, the 
estimated direct costs of the project when there are reasonable 
assurances that the use of such percentage will not exceed the 
approximate actual indirect costs. Such award may include an estimated 
provisional amount for indirect costs or for designated direct costs 
(such as fringe benefit rates) subject to upward (within the limits of 
available funds) as well as downward adjustments to actual costs when 
the amount properly expended by the grantee for provisional items has 
been determined by the Secretary: Provided, however, That no grant shall 
be made for an amount in excess of the total cost found necessary by the 
Secretary to carry out the project.
    (i) In determining the percentage of project costs to be borne by 
the grantee, factors which the Secretary will take into consideration 
will include the following:
    (A) The ability of the grantee to finance its share of project costs 
from non-Federal sources;
    (B) The need in the area served by the project for the services to 
be provided; and
    (C) The extent to which the project will provide services in an 
innovative manner which the Secretary desires to stimulate in the 
interest of developing more effective health service delivery systems on 
a regional or national basis.
    (ii) At any time after approval of an application under this part, 
the Secretary may retroactively agree to a percentage of project costs 
to be borne by the grantee lower than that determined pursuant to 
paragraph (a)(2)(i) of this section where he finds that changed 
circumstances justify a smaller contribution.
    (iii) In determining the grantee's share of project costs, costs 
borne by Federal grant funds, or costs used to match other Federal 
grants, may not be included except as otherwise provided by law or 
regulations.
    (b) All grant awards shall be in writing, and shall set forth the 
amount of funds granted and the period for which support is recommended.
    (c) Neither the approval of any project nor any grant award shall 
commit or obligate the United States in any way to make any additional, 
supplemental, continuation, or other award with respect to any approved 
project or portion thereof. For continuation support, grantees must make 
separate application.



Sec. 51c.107  Use of project funds.

    (a) Any funds granted pursuant to this part, as well as other funds 
to be used in performance of the approved project, may be expended 
solely for carrying out the approved project in accordance with section 
330 of the Act, the applicable regulations of this part, the terms and 
conditions of the award, and the applicable cost principles prescribed 
in subpart Q of 45 CFR part 74.
    (b) Project funds awarded under this part may be used for, but need 
not be limited to, the following:
    (1) The costs of acquiring and modernizing existing buildings 
(including the costs of amortizing the principal of, and paying interest 
on, loans), but only in accordance with subpart E of this part and as 
approved in the grant award;
    (2) The costs of obtaining technical assistance to develop and 
improve the management capability of the project, but only as approved 
by the Secretary;
    (3) The reimbursement of members of the grantee's governing board, 
if any, for reasonable expenses actually incurred by reason of their 
participation in board activities;

[[Page 204]]

    (4) The reimbursement of governing board members for wages lost by 
reason of participation in the activities of such board if the member is 
from a family with an annual family income below $10,000 or if the 
member is a single person with an annual income below $7,000;
    (5) The cost of delivering health services, including services 
rendered on a prepaid capitation basis, to residents of the project's 
catchment area within the following limitations: grant funds may be used 
to pay the full cost of project services to individuals and families 
with annual incomes at or below those set forth in the most recent ``CSA 
Income Poverty Guidelines'' (45 CFR 1060.2) issued by the Community 
Services Administration; and to pay the portion of the cost of services 
provided in accordance with the schedule of discounts which, under such 
schedule, is uncompensated; Provided, That (i) charges will be made to 
such individuals and families in accordance with Sec. 51c.303(f) of 
subpart C; (ii) reasonable effort shall be made to collect such charges 
under a billing and collections system; and (iii) the charge to grant 
funds shall exclude any amounts collected pursuant to paragraph 
(b)(5)(ii) of this section;
    (6) The cost of insurance for medical emergency and out-of-area 
coverage;
    (7) The cost of providing to the staff of the project training 
related to the provision of health services provided or to be provided 
by the project, and, to the staff and governing board, if any, training 
related to the management of an ambulatory care facility, consistent 
with the applicable requirements of 45 CFR part 74; and
    (8) The cost of developing and maintaining a reserve fund where 
required by State law for prepaid health care plans.
    (c) Prior approval by the Secretary of revisions of the budget and 
project plan is required whenever there is to be a significant change in 
the scope or nature of project activities.



Sec. 51c.108  Grant payments.

    The Secretary shall from time to time make payments to a grantee of 
all or a portion of any grant award, either in advance or by way of 
reimbursement for expenses incurred or to be incurred, to the extent he 
determines such payments necessary to promote prompt initiation and 
advancement of the approved project.



Sec. 51c.109  Nondiscrimination.

    (a) Attention is called to the requirements of title VI of the Civil 
Rights Act of 1964 (78 Stat. 252, (42 U.S.C. 2000d et seq.)) and in 
particular section 601 of such Act which provides that no person in the 
United States shall on the grounds of race, color, or national origin be 
excluded from participation, in be denied the benefits of, or be 
subjected to discrimination under any program or activity receiving 
Federal Financial assistance. A regulation implementing such title VI, 
which applies to grants made under this part, has been issued by the 
Secretary of Health and Human Services with the approval of the 
President (45 CFR part 80). In addition, no person shall, on the grounds 
of age, sex, creed, or marital status (unless otherwise medically 
indicated), be excluded from participation in, be denied the benefits 
of, or be subjected to discrimination under any program or activity so 
receiving Federal financial assistance.
    (b) Attention is called to the requirements of section 504 of the 
Rehabilitation Act of 1973, as amended, which provides that no otherwise 
qualified handicapped individual in the United States shall, solely by 
reason of his handicap, be excluded from participation in, be denied the 
benefits of, or be subjected to discrimination under any program or 
activity receiving Federal financial assistance.



Sec. 51c.110  Confidentiality.

    All information as to personal facts and circumstances obtained by 
the project staff about recipients of services shall be held 
confidential, and shall not be divulged without the individual's consent 
except as may be required by law or as may be necessary to provide 
service to the individual or to provide for medical audits by the 
Secretary or his designee with appropriate safeguards for 
confidentiality of patient records. Otherwise, information may be 
disclosed only in summary, statistical, or other form which

[[Page 205]]

does not identify particular individuals.



Sec. 51c.111  Publications and copyright.

    Except as may otherwise be provided under the terms and conditions 
of the award, the grantee may copyright without prior approval any 
publications, films, or similar materials developed or resulting from a 
project supported by a grant under this part, subject, however, to a 
royalty-free, nonexclusive, and irrevocable license or right in the 
Government to reproduce, translate, publish, use, disseminate, and 
dispose of such materials and to authorize others to do so.



Sec. 51c.112  Grantee accountability.

    (a) Accounting for grant award payments. All payments made by the 
Secretary shall be recorded by the grantee in accounting records 
separate from the records of all other funds, including funds derived 
from other grant awards. With respect to each approved project, the 
grantee shall account for the sum total of all amounts paid as well as 
other funds and in-kind contributions by presenting or otherwise making 
available evidence satisfactory to the Secretary of expenditure for 
direct and indirect costs meeting the requirements of this part: 
Provided, however, That when the amount awarded for indirect costs was 
based on a predetermined fixed-percentage of estimated direct costs, the 
amount allowed for indirect costs shall be computed on the basis of such 
predetermined fixed-percentage rates applied to the total, or a selected 
element thereof, of the reimbursable direct costs incurred.
    (b) Accounting for interest earned on grant funds. Pursuant to 
section 203 of the Intergovernmental Cooperation Act of 1968 (42 U.S.C. 
4213), a State will not be held accountable for interest earned on grant 
funds, pending their disbursement for grant purposes. A State, as 
defined in section 102 of the Intergovernmental Cooperation Act, means 
any one of the several States, the District of Columbia, Puerto Rico, 
any territory or possession of the United States, or any agency or 
instrumentality of a State, but does not include the government of the 
political subdivisions of the State. All grantees other than a State, as 
defined, must return all interest earned on grant funds to the Federal 
Government.
    (c) Grant closeout--(1) Date of final accounting. A grantee shall 
render, with respect to each approved project, a full account, as 
provided herein, as of the date of the termination of grant support. The 
Secretary may require other special and periodic accounting.
    (2) Final settlement. There shall be payable to the Federal 
Government as final settlement with respect to each approved project the 
total sum of:
    (i) Any amount not accounted for pursuant to paragraph (a) of this 
section;
    (ii) Any credits for earned interest pursuant to paragraph (b) of 
this section;
    (iii) Any other amounts due pursuant to subparts F, M, and O of 45 
CFR part 74.



Sec. 51c.113  Applicability of 45 CFR part 74.

    The provisions of 45 CFR part 74, establishing uniform 
administrative requirements and cost principles, shall apply to all 
grants under this part to State and local governments as those terms are 
defined in subpart A of that part 74. The relevant provisions of the 
following subparts of part 74 shall also apply to grants to all other 
grantee organizations under this part:

                             45 CFR Part 74

Subpart
A  General.
B  Cash depositories.
C  Bonding and insurance.
D  Retention and custodial requirements for records.
F  Grant-related income.
G  Matching and cost sharing.
K  Grant payment requirements.
L  Budget revision procedures.
M  Grant closeout, suspension, and termination.
O  Property.
Q  Cost principles.



 Subpart B--Grants for Planning and Developing Community Health Centers



Sec. 51c.201  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart

[[Page 206]]

A of this part, are applicable to grants awarded pursuant to section 
330(c) of the Act for projects for planning and developing community 
health centers which will serve medically underserved populations.



Sec. 51c.202  Application.

    To be approved by the Secretary under this subpart, an application 
for a grant must, in addition to meeting the requirements of 
Sec. 51c.104 of subpart A, contain information sufficient to enable the 
Secretary to determine that the project for which the grant is sought 
will meet the requirements of Sec. 51c.203.



Sec. 51c.203  Project elements.

    A project for the planning and developing of a community health 
center supported under this subpart must:
    (a) Prepare an assessment of the need of the population proposed to 
be served by the community health center for the services set forth in 
Sec. 51c.102(c)(1) of subpart A, with special attention to the need of 
the medically underserved population for such services. Such assessment 
of need shall, at a minimum, consider the factors listed in 
Sec. 51c.102(e)(1)-(4).
    (b) Design a community health center program for such population, 
based on such assessment, which indicates in detail how the proposed 
community health center will fulfill the needs identified in the 
assessment prepared pursuant to paragraph (a) of this section and how it 
will meet the requirements contained in subpart C of this part.
    (c) Develop a plan for the implementation of the program designed 
pursuant to paragraph (b) of this section. Such implementation plan 
shall provide for the time-phased recruitment and training of the 
personnel essential for the operation of a community health center and 
the gradual assumption of operational status of the project so that the 
project will, in the judgment of the Secretary, meet the requirements 
contained in subpart C of this part as of the end of the project period.
    (d) Implement the plan developed pursuant to paragraph (c) of this 
section in accordance with such paragraph.
    (e) Make efforts to secure, within the proposed catchment area of 
such center to the extent possible, financial and professional 
assistance and support for the project.
    (f) Initiate and encourage continuing community involvement in the 
development and operation of the project.
    (g) Establish standards and qualifications for personnel (including 
the project director).
    (h) Utilize, to the maximum extent feasible, other Federal, State, 
local, and private resources available for support of the project, prior 
to use of project funds under this subpart.



Sec. 51c.204  Grant evaluation and award.

    (a) Within the limits of funds determined by the Secretary to be 
available for such purpose, the Secretary may award grants under this 
subpart to applicants therefor which will, in his judgment, best promote 
the purposes of section 330(c) of the Act and the applicable regulations 
of this part, taking into account:
    (1) The degree to which the proposed project satisfactorily provides 
for the elements set forth in Sec. 51c.203;
    (2) The relative need of the population to be served for the 
services to be provided;
    (3) The administrative and management capability of the applicant;
    (4) The potential of the project for development of new and 
effective methods for health services delivery and management;
    (5) The soundness of the fiscal plan for assuring effective 
utilization of grant funds and maximizing non-grant revenue;
    (6) The extent to which community resources will be utilized in the 
project;
    (7) The extent to which grants approved under this part will provide 
for an appropriate distribution of resources throughout the country, 
taking into consideration the following factors;
    (i) The urban-rural area to be served;
    (ii) The nature of the organization applying; and
    (iii) The organizational structure for delivery of services;

[[Page 207]]

    (8) Whether the project's catchment area is exclusive of the area 
served by a community health center;
    (9) The degree to which the applicant intends to integrate services 
supported by a grant under this subpart with health services provided 
under other Federally assisted health services or reimbursement programs 
or projects.
    (b) The Secretary may:
    (1) Make no more than two grants under this subpart for the same 
project.
    (2) Make a grant under this subpart to an entity which has been 
awarded one or more grants under section 330(d)(1)(A) and/or section 
330(d)(1)(B) of the Act only if the grant under this subpart is for a 
new project.



        Subpart C--Grants for Operating Community Health Centers



Sec. 51c.301  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart A, are applicable to grants awarded pursuant to section 
330(d)(1)(A) of the Act for the costs of operation of community health 
centers which serve medically underserved populations.



Sec. 51c.302  Application.

    To be approved by the Secretary under this subpart, an application 
for a grant must, in addition to meeting the requirements of 
Sec. 51c.104 of subpart A,
    (a) Be submitted by an entity which may be a co-applicant which the 
Secretary determines is a community health center, and
    (b) Contain information sufficient to enable the Secretary to 
determine that the center will meet the requirements of Sec. 51c.103.

[41 FR 53205, Dec. 3, 1976, as amended at 42 FR 60418, Nov. 25, 1977]



Sec. 51c.303  Project elements.

    A community health center supported under this subpart must:
    (a) Provide the health services of the center so that such services 
are available and accessible promptly, as appropriate, and in a manner 
which will assure continuity of service to the residents of the center's 
catchment area.
    (b) Implement a system for maintaining the confidentiality of 
patient records in accordance with the requirements of Sec. 51c.110 of 
subpart A.
    (c) Have an ongoing quality assurance program which provides for the 
following:
    (1) Organizational arrangements, including a focus of 
responsibility, to support the quality assurance program and the 
provision of high quality patient care;
    (2) Periodic assessment of the appropriateness of the utilization of 
services and the quality of services provided or proposed to be provided 
to individuals served by the center. Such assessments shall:
    (i) Be conducted by physicians or by other licensed health 
professionals under the supervision of physicians;
    (ii) Be based on the systematic collection and evaluation of patient 
records; and
    (iii) Identify and document the necessity for change in the 
provision of services by the center and result in the institution of 
such change, where indicated.
    (d) Develop management and control systems which are in accordance 
with sound financial management procedures, including the provision for 
an audit on an annual basis (unless waived for cause by the Secretary) 
by an independent certified public accountant or a public accountant 
licensed prior to December 31, 1970, to determine, at a minimum, the 
fiscal integrity of grant financial transactions and reports, and 
compliance with the regulations of this part and the terms and 
conditions of the grant.
    (e) Where the cost of care and services furnished by or through the 
project is to be reimbursed under title XIX or title XX of the Social 
Security Act, obtain or make every reasonable effort to obtain a written 
agreement with the title XIX or title XX State agency for such 
reimbursement.
    (f) Have prepared a schedule of fees or payments for the provision 
of its services designed to cover its reasonable costs of operation and 
a corresponding schedule of discounts adjusted on the basis of the 
patient's ability to pay. Provided, That such schedule of discounts 
shall provide for a full discount

[[Page 208]]

to individuals and families with annual incomes at or below those set 
forth in the most recent CSA Proverty Income Guidelines (45 CFR 1060.2) 
and for no discount to individuals and families with annual incomes 
greater than twice those set forth in such Guidelines, except that 
nominal fees for services may be collected from individuals with annual 
incomes at or below such levels where imposition of such fees is 
consistent with project goals.
    (g) Make every reasonable effort, including the establishment of 
systems for eligibility determination, billing, and collection, to:
    (1) Collect reimbursement for its costs in providing health services 
to persons who are entitled to insurance benefits under title XVIII of 
the Social Security Act, to medical assistance under a State plan 
approved under title XIX of such Act, to social services and family 
planning under title XX of such Act, or to assistance for medical 
expenses under any other public assistance program, grant program, or 
private health insurance or benefit program on the basis of the schedule 
of fees prepared pursuant to paragraph (f) of this section without 
application of any discounts, and
    (2) Secure from patients payments for services in accordance with 
the schedule of fees and discounts required by paragraph (f) of this 
section.
    (h) Have a governing board which meets the requirements of 
Sec. 51c.304.
    (i) Have developed an overall plan and budget for the center that:
    (1) Provides for an annual operating budget and a three-year 
financial management plan which include all anticipated income and 
expenses related to items which would, under generally accepted 
accounting principles, be considered income and expense items;
    (2) Provides for a capital expenditures plan for at least a three-
year period (including the year to which the operating budget described 
in paragraph (i)(1) of this section is applicable) which includes and 
identifies in detail the anticipated sources of financing for, and the 
objective of, each anticipated expenditure in excess of $100,000 related 
to the acquisition of land, the improvement of land, buildings, and 
equipment and the replacement, modernization and expansion of buildings 
and equipment which would, under generally accepted accounting 
principles, be considered capital items;
    (3) Provides for plan review and updating at least annually; and
    (4) Is prepared under the direction of the governing board, by a 
committee consisting of representatives of the governing board, and 
administrative staff, and the medical staff, if any, of the center.
    (j) Establish basic statistical data, cost accounting, management 
information, and reporting or monitoring systems which shall enable the 
center to provide such statistics and other information as the Secretary 
may reasonably require relating to the center's costs of operation, 
patterns of utilization of services, and the availability, 
accessibility, and acceptability of its services and to make such 
reports to the Secretary in a timely manner with such frequency as the 
Secretary may reasonably require.
    (k) Review its catchment area annually to insure that the criteria 
set out in Sec. 51c.104(b)(2) of subpart A are met and, where such 
criteria are not met, revise its catchment area, with the approval of 
the Secretary, to conform to such criteria to the extent feasible.
    (l) In the case of a center which serves a population including a 
substantial proportion of individuals of limited English-speaking 
ability, have developed a plan and made arrangements responsive to the 
needs of such populations for providing services to the extent 
practicable in the language and cultural context most appropriate to 
such individuals, and have identified an individual on its staff who is 
fluent in both that language and in English and whose responsibilities 
include providing guidance to such individuals and to appropriate staff 
members with respect to cultural sensitivities and bridging linguistic 
and cultural differences. If more than one non-English language is 
spoken by such group or groups, an individual or individuals fluent in 
those languages and English shall be so identified.
    (m) Be operated in a manner calculated to preserve human dignity and 
to maximize acceptability and effective utilization of services.

[[Page 209]]

    (n) To the extent possible, coordinate and integrate project 
activities with the activities of other Federally funded, as well as 
State and local, health services delivery projects and programs serving 
the same population.
    (o) Establish means for evaluating progress toward the achievement 
of the specific objectives of the project.
    (p) Provide sufficient staff, qualified by training and experience, 
to carry out the activities of the center.
    (q) Assure that facilities utilized in the performance of the 
project meet applicable fire and life safety codes.
    (r) Utilize, to the maximum extent feasible, other Federal, State, 
and local, and private resources available for support of the project, 
prior to use of project funds under this part.
    (s) Provide for community participation through, for example, 
contributions of cash or services, loans of full-or part-time staff, 
equipment, space, materials, or facilities.
    (t) Where the center will provide services through contract or other 
cooperative arrangements with other providers of services, establish 
rates and methods of payment for health care. Such payments must be made 
pursuant to agreements, with a schedule of rates and payment procedures 
maintained by the project. The project must be prepared to substantiate 
that such rates are reasonable and necessary.
    (u) Operate in a manner such that no person shall be denied service 
by reason of his inability to pay therefor: Provided, however, That a 
charge for the provision of services will be made to the extent that a 
third party (including a Government agency) is authorized or is under 
legal obligation to pay such charges.
    (v) In addition to the above, projects which are supported with 
grant funds for the operation of a prepaid health care plan also must 
provide:
    (1) A marketing and enrollment plan, including market analysis, 
marketing strategy, and enrollment growth projections.
    (2) A plan that provides for funding on a capitation basis of such 
portion of the residents of the catchment area of the center, as the 
Secretary shall determine.
    (3) An assurance that services shall be available to all residents 
of the catchment area without regard to method of payment or health 
status.



Sec. 51c.304  Governing board.

    A governing board for the center shall be established by an 
applicant as follows:
    (a) Size. The board shall consist of at least 9 but not more than 25 
members, except that this requirement may be waived by the Secretary for 
good cause shown.
    (b) Composition. (1) A majority of the board members shall be 
individuals who are or will be served by the center and who, as a group, 
represent the individuals being or to be served in terms of demographic 
factors, such as race, ethnicity, sex.
    (2) No more than one-half of the remaining members of the board may 
be individuals who derive more than 10 percent of their annual income 
from the health care industry.
    (3) The remaining members of the board shall be representative of 
the community in which the center's catchment area is located and shall 
be selected for their expertise in community affairs, local government, 
finance and banking, legal affairs, trade unions, and other commercial 
and industrial concerns, or social service agencies within the 
community.
    (4) No member of the board shall be an employee of the center, or 
spouse or child, parent, brother or sister by blood or marriage of such 
an employee. The project director may be a non-voting, ex-officio member 
of the board.
    (c) Selection of members. The method of selection of all governing 
board members shall be prescribed in the by-laws or other internal 
governing rules of the center. Such by-laws or other rules must specify 
a process of selection of individuals on the governing board who 
represent the population served or to be served by the center so that 
such individuals, as a group, are representative of such population. 
Such process of selection in the by-laws or other rules is subject to 
approval by the Secretary.
    (d) Functions and responsibilities. (1) The governing board for the 
center

[[Page 210]]

shall have authority for the establishment of policy in the conduct of 
the center.
    (2) The governing board shall hold regularly scheduled meetings, at 
least once each month, for which minutes shall be kept.
    (3) The governing board shall have specific responsibility for:
    (i) Approval for the selection and dismissal of a project director 
or chief executive officer of the center;
    (ii) Establishing personnel policies and procedures, including 
selection and dismissal procedures, salary and benefit scales, employee 
grievance procedures, and equal opportunity practices;
    (iii) Adopting policy for financial management practices, including 
a system to assure accountability for center resources, approval of the 
annual project budget, center priorities, eligibility for services 
including criteria for partial payment schedules, and long-range 
financial planning;
    (iv) Evaluating center activities including services utilization 
patterns, productivity of the center, patient satisfaction, achievement 
of project objectives, and development of a process for hearing and 
resolving patient grievances;
    (v) Assuring that the center is operated in compliance with 
applicable Federal, State, and local laws and regulations; and
    (vi) Adopting health care policies including scope and availability 
of services, location and hours of services, and quality-of-care audit 
procedures.



Sec. 51c.305  Grant evaluation and award.

    Within the limits of funds determined by the Secretary to be 
available for such purpose, the Secretary may award grants under this 
subpart to applicants therefor which will, in his judgment, best promote 
the purposes of section 330(d)(1)(A) of the Act and the applicable 
regulations of this part, taking into consideration;
    (a) The extent to which the project would provide for the elements 
set forth in Sec. 51c.303;
    (b) The relative need of the population to be served for the 
services to be provided;
    (c) The potential of the center for the development of new and 
effective methods for health services delivery and management;
    (d) The soundness of the fiscal plan for assuring effective 
utilization of grant funds and maximizing non-grant revenue;
    (e) The administrative and management capability of the applicant;
    (f) The extent to which grants approved under this part will provide 
for an appropriate distribution of resources throughout the country, 
taking into consideration the following factors:
    (1) The urban-rural area to be served;
    (2) The nature of the organization applying;
    (3) The organizational structure for delivery of services;
    (g) The number of users of the center and the level of utilization 
of services in previous operational periods, if any;
    (h) Whether the center's catchment area is exclusive of the area 
served by another center;
    (i) The degree to which the applicant intends to integrate services 
supported by a grant under this subpart with health services provided 
under other Federally assisted health services or reimbursement programs 
or projects;
    (j) The extent to which community resources will be utilized by the 
project;
    (k) The extent to which the center will provide preventive health 
services so as to maintain and improve the health status of the 
population served; and
    (l) The extent to which center operations will emphasize direct 
health services, efficiency of operations and sound financial 
management.



        Subpart D--Grants for Operating Community Health Projects



Sec. 51c.401  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart A are applicable to grants awarded pursuant to section 
330(d)(1)(B) of the Act for the costs of operation of projects which 
provide health services to medically underserved populations.



Sec. 51c.402  Application.

    To be approved by the Secretary under this subpart, an application 
for a

[[Page 211]]

grant must, in addition to meeting the requirements of Sec. 51c.104 of 
subpart A, contain information sufficient to enable the Secretary to 
determine that the project for which the grant is sought will meet the 
requirements of Sec. 51c.403 of this subpart.



Sec. 51c.403  Project elements.

    A project for the operation of a community health project supported 
under this subpart must:
    (a) Meet all of the requirements of Sec. 51c.303 of this part except 
for paragraph (h).
    (b) Provide those services enumerated in Sec. 51c.102(c)(1) of this 
part which the Secretary determines to be feasible and desirable and 
which are specified in the grant award.
    (c) Establish a governing board meeting the requirements of 
Sec. 51c.304 by the end of the period of support under section 
330(d)(1)(B) of the Act and this subpart.



Sec. 51c.404  Grant evaluation and award.

    (a) Within the limits of funds determined by the Secretary to be 
available for such purpose, the Secretary may award grants under this 
subpart to applicants therefor which will, in his judgment, best promote 
the purposes of section 330(d)(1)(B) of the Act and the applicable 
regulations of this part,
    (1) Where the project meets the requirements of Sec. 51c.403(a); and
    (2) Taking into consideration the following:
    (i) The degree to which the project would provide the services 
enumerated in Sec. 51c.102(c)(1) and the feasibility of its providing 
all of such enumerated services by the end of the period of support 
under section 330(d)(1)(B) of the Act and this subpart;
    (ii) Whether the project will have a governing board meeting the 
requirements of Sec. 51c.304 by the end of the period of support under 
section 330(d)(1)(B) of the Act and this subpart;
    (iii) The degree to which the applicant intends to integrate 
services supported by a grant under this subpart with health services 
provided under other Federally assisted health service or reimbursement 
programs or projects;
    (iv) The need of the population to be served for the services to be 
provided;
    (v) The potential of the project for the development of new and 
effective methods for health services delivery and management;
    (vi) The soundness of the fiscal plan for assuring effective 
utilization of grant funds and maximizing non-grant revenue;
    (vii) The administrative and management capacity of the applicant; 
and
    (viii) The extent to which community resources will be utilized in 
the project.
    (b) The Secretary may:
    (1) Make no more than two grants for the same entity under section 
330(d)(1)(B) of the Act;
    (2) Not make any grant under section 330(d)(1)(B) to an entity 
which, for the same project, has been awarded more than one grant under 
section 330(c) of the Act;
    (3) Not make a grant under section 330(d)(1)(B) to an entity which 
has been awarded a grant under section 330(d)(1)(A) of the Act.



     Subpart E--Acquisition and Modernization of Existing Buildings



Sec. 51c.501  Applicability.

    The regulations of this subpart, in addition to the regulations of 
the other applicable subparts of this part, are applicable to grants 
under section 330 of the Act for project costs which include the cost of 
acquisition and/or modernization of existing buildings (including the 
cost of amortizing the principal of, and paying the interest on, loans), 
except that, these regulations are not applicable to grants for project 
costs which include the costs of modernization of existing buildings if 
those costs can otherwise be supported under subparts B, C, or D of this 
part.

[43 FR 5352, Feb. 7, 1978]



Sec. 51c.502  Definitions.

    (a) Equipment means nonexpendable personal property as defined in 45 
CFR 74.132.
    (b) Existing building means a completed or substantially completed 
structure, and may include the realty on which it is or is to be 
located.

[[Page 212]]

    (c) Modernization means the alteration, repair, remodeling and/or 
renovation of a building (including the initial equipment thereof and 
improvements to the building's site) which, when completed, will render 
the building suitable for use by the project for which the grant is 
made.

[43 FR 5352, Feb. 7, 1978]



Sec. 51c.503  Application.

    (a) General requirements. An application for a grant under this part 
for a project under subparts B, C, or D which includes the acquisition 
and/or modernization of an existing building must include the following:
    (1) A legal description of the site and a drawing showing the 
location of the building;
    (2) A description of the architectural, structural, and other 
pertinent characteristics of the building sufficient to show that it is 
or that it will be, after alteration and renovation or after 
modernization, suitable for use by the project;
    (3) A detailed estimate of the cost of the proposed acquisition and/
or modernization;
    (4) A description of, and copies of any relevant documents 
concerning, any existing or proposed financing arrangements for the 
acquisition and/or modernization;
    (5) The proposed schedule for acquisition and/or modernization and 
occupancy;
    (6) An assessment of the environmental impact of the proposed 
acquisition and/or modernization as called for by section 102(2)(c) of 
the National Environmental Policy Act of 1969 (42 U.S.C. 4332(c)) and 
such information as may be necessary to comply with the National 
Historic Preservation Act of 1966 (16 U.S.C. 470(f));
    (7) Reasonable assurances that--
    (i) The applicant has or will obtain a fee simple or such other 
estate or interest in the site, including necessary easements and 
rights-of-way, sufficient to assure for a period of not less than 20 
years (in the case of interim facilities, for the period constituting 
the estimated useful life of such facilities) undisturbed use and 
possession for the purpose of the operation of the project;
    (ii) The building will be used for the purposes for which the grant 
is made;
    (iii) The building complies, or after alteration and renovation or 
after modernization will comply, with applicable State and local codes 
and with:
    (A) ``American National Standard Specifications for Making Buildings 
and Facilities Accessible to, and Usable by, the Physically 
Handicapped'' Number ANSI A117.1-1961 (R 1971), as modified by other 
standards prescribed by the Secretary or the Administrator of the 
General Services Administration. The applicant shall be responsible for 
conducting inspections to insure compliance with the specifications;
    (B) The applicable standards set forth in Life Safety Code 1973, 
NFPA No. 101, which is hereby incorporated by reference and made a part 
hereof. Copies of such document are available for examination at the 
Department's and Regional Offices' Information Centers listed in 45 CFR 
5.31 and may also be obtained from the National Fire Protection 
Association, 470 Atlantic Avenue, Boston, MA 02210 for $3.00 per copy.
    (iv) In the case of a public applicant with an approved project 
which involves the displacement of persons or businesses on or after 
January 2, 1971, whose real property has or will be taken, the applicant 
will comply with the provisions of the Uniform Relocation Assistance and 
Real Property Acquisition Policies Act of 1970 (Pub. L. 91-646) and the 
applicable regulations issued thereunder (45 CFR part 15);
    (v) Sufficient funds will be available to meet any portion of the 
cost of acquiring and/or modernizing the building not borne by the grant 
under this part;
    (vi) Sufficient funds will be available after acquisition and/or 
modernization of the building for effective use of the building for the 
purposes of the project;
    (vii) The applicable requirements of the Flood Disaster Protection 
Act of 1973 have been met;
    (8) Such other information as the Secretary may reasonably require.
    (b) Requirement for acquisition grants. Except for a grant solely 
for amortization of principal and payment of interest on an existing 
loan, an application for a grant for a project which includes

[[Page 213]]

the acquisition of an existing building must include, in addition to the 
requirements of paragraph (a) of this section, evidence satisfactory to 
the Secretary that the applicant has explored other alternatives to the 
proposed acquisition (such as leasing facilities or acquiring other 
facilities in the project's catchment area) and that the proposed 
acquisition constitutes the soundest alternative from a financial and 
program standpoint.
    (c) Requirements for modernization grants. In addition to the 
requirements of paragraph (a) of this section, an application for a 
grant for a project which includes modernization of an existing building 
must include the following:
    (1) Plans and specifications for the proposed modernization which 
conform to the standards specified in Sec. 51c.503(a)(7)(iii);
    (2) Reasonable assurance that any laborer or mechanic employed by 
any contractor or subcontractor in the performance of work on the 
modernization project will be paid wages at rates not less than those 
prevailing on similar work in the locality as determined by the 
Secretary of Labor under the Davis-Bacon Act (40 U.S.C. 276a et seq.) 
and will receive compensation at a rate not less than one and one-half 
times his basic rate of pay for all hours worked in any workweek in 
excess of 8 hours in any calendar day; and
    (3) Copies of any construction and materials contracts already 
entered into for the proposed modernization.

[41 FR 57000, Dec. 30, 1976, as amended at 43 FR 5352, Feb. 7, 1978]



Sec. 51c.504  Project elements.

    (a) General requirements. A grantee which has received a grant under 
section 330 of the Act for a project which includes the acquisition and/
or modernization of an existing building must:
    (1) Assurances. Comply with the assurances provided pursuant to this 
subpart.
    (2) Approval of estimated cost. Not enter into any contract for the 
acquisition and/or modernization funded under this subpart where the 
cost of such acquisition and/or modernization exceeds the estimates in 
the application, without the prior approval of the Secretary.
    (3) Non-default. Make every effort to prevent any default on any 
loan secured by the building and, in the event of a default, promptly 
notify the Secretary of the default and make every effort on a timely 
basis to cure the default.
    (b) Requirements for acquisition grants. In addition to the 
requirements of paragraph (a) of this section, a grantee which has 
received a grant under section 330 of the Act for a project which 
includes the acquisition of an existing building must:
    (1) Bona-fide sale. Acquire or, in the case of a grant solely for 
amortization of principal and payment of interest on an existing loan, 
have acquired the existing building pursuant to a bona-fide sale 
involving an actual cost to the applicant and resulting in additional or 
improved facilities for the purposes of the project.
    (2) Standards of construction and equipment. Except in the case of a 
grant solely for amortization of principal and payment of interest on an 
existing loan, obtain a determination by the Secretary that the facility 
conforms (or upon completion of any necessary alteration and renovation 
or modernization will conform) to the standards set forth in 
Sec. 51c.503(a)(7)(iii) of this subpart before entering into a final or 
unconditional contract for the acquisition. Where the Secretary finds 
that exceptions to or modifications of any such standards would be 
consistent with the purposes of the Act and of the program, he may 
authorize such exceptions or modifications.
    (3) Financing. Where the grantee will obtain a loan secured by the 
building in order to acquire the building, obtain such financing at the 
lowest current rate prevailing in the area for comparable loans on 
comparable facilities.
    (c) Requirements for modernization grants. In addition to the 
requirements of paragraph (a) of this section, a grantee which has 
received a grant under section 330 of the Act for a project which 
includes the modernization of an existing building must:
    (1) Costs in excess of approved costs. Finance all costs in excess 
of the estimated costs approved in the application and submit to the 
Secretary for

[[Page 214]]

prior approval any changes that substantially alter the scope of the 
function, utilities, or safety of the facility.
    (2) Competitive bids. (i) Obtain the approval of the Secretary 
before the project is advertised or placed on the market for bidding; 
such approval must include a determination by the Secretary that the 
final plans and specifications conform to the standards set forth in 
Sec. 51c.503(a)(7)(iii) of these regulations.
    (ii) Except as otherwise provided by State or local law, contract 
for construction (including the purchase and installation of built-in 
equipment) on a lump sum fixed-price basis, and award contracts on the 
basis of competitive bidding obtained by public advertising with award 
of the contracts to the lowest responsive and responsible bidders. The 
provision for exceptions based on State and local law shall not be 
invoked to give local contractors or suppliers a percentage preference 
over non-local contractors bidding for the same contract. Such practices 
are precluded by this paragraph.
    (3) Construction contracts. (i) Include the following conditions and 
provisions in all construction contracts for the modernization project:
    (A) The provisions set forth in ``DHHS Requirements for Federally 
Assisted Construction Contracts Regarding Labor Standards and Equal 
Employment Opportunities,'' Form DHHS 514 (rev. 7/76) (issued by the 
Office of Grants Administration Policy, U.S. Department of Health and 
Human Services) pertaining to the Davis-Bacon Act, the Contract Work 
Hours Standards Act, and the Copeland Act (Anti-Kickback) Regulations, 
except in the case of contracts in the amount of $2,000 or less; and 
pertaining to Executive Order 11246, 30 FR 12319 (September 24, 1965), 
as amended, relating to nondiscrimination in construction contract 
employment, except in the case of contracts in the amount of $10,000 or 
less;
    (B) That the contractor shall furnish performance and payment bonds 
each of which shall be in the full amount of the contract price, and 
shall maintain, during the life of the contract, adequate fire, 
workmen's compensation, public liability, and property damage insurance: 
Provided, however, That in the case of a State or local unit of 
government which enters into a construction contract of less than 
$100,000, State or local provisions with respect to performance and 
payment bonds shall be deemed to meet the requirements of this 
paragraph; and
    (C) That the Secretary shall have access at all reasonable times to 
work wherever it is in preparation or progress, and the contractor shall 
provide proper facilities for such access and inspection.
    (ii) Executive Order 11246. Comply with the applicable requirements 
of Executive Order 11246, 30 FR 12319 (September 24, 1965) as amended, 
relating to nondiscrimination in construction contract employment, and 
the applicable rules, regulations, and procedures prescribed pursuant 
thereto.
    (4) Modernization supervision. Provide and maintain competent and 
adequate architectural or engineering supervision and inspection at the 
modernization site to insure that the completed work conforms with the 
plans and specifications.
    (5) Completion responsibility. Complete the modernization in 
accordance with the grant application and the approved plans and 
specifications.
    (6) Progress reports. Furnish progress reports and such other 
information concerning the modernization as the Secretary may require.
    (d) The Secretary may at any time approve exceptions to the 
provisions of this section where he finds that such exceptions are not 
inconsistent with section 330 of the Act, other requirements of law, or 
the purposes of the program.

[41 FR 57000, Dec. 30, 1976, as amended at 43 FR 5352, Feb. 7, 1978]



Sec. 51c.505  Determination of cost.

    The cost of acquisition and/or modernization of existing buildings 
for which funds may be granted under this part will be determined by the 
Secretary, utilizing such documentation submitted by the applicant as 
the Secretary may prescribe (including the reports of such real estate 
appraisers as the Secretary may approve) and other relevant factors, 
taking into consideration only that portion of the existing

[[Page 215]]

building necessary for the operation of the approved project.

[41 FR 5700, Dec. 30, 1976]



Sec. 51c.506  Use of grant funds.

    Grant funds may be used to amortize the principal of or pay interest 
on a loan or mortgage on an existing building acquired under this part, 
including a building purchased by a grantee prior to the promulgation of 
this part, but only if the building is being used for the purposes of 
section 330 and complies with the applicable provisions of this subpart 
and only to the extent the Secretary finds such principal amounts and 
interest rates to be reasonable.

[41 FR 5700, Dec. 30, 1976]



Sec. 51c.507  Facility which has previously received Federal grant.

    No grant for the acquisition of a facility which has previously 
received a Federal grant for construction, acquisition, or equipment 
shall serve either to reduce or restrict the liability of the applicant 
or any other transferor or transferee from any obligation of 
accountability imposed by the Federal Government by reason of such prior 
grant.

[41 FR 5700, Dec. 30, 1976]

                       PARTS 51d--51g  [RESERVED]



PART 52--GRANTS FOR RESEARCH PROJECTS--Table of Contents




Sec.
52.1  To which programs do these regulations apply?
52.2  Definitions.
52.3  Who is eligible to apply for a grant?
52.4  How to apply for a grant.
52.5  Evaluation and disposition of applications.
52.6  Grant awards.
52.7  Use of funds; changes.
52.8  Other HHS regulations and policies that apply.
52.9  Additional conditions.

    Authority: 42 U.S.C. 216.



Sec. 52.1  To which programs do these regulations apply?

    (a) General. The regulations of this party apply to all health-
related research project grants administered by the PHS or its 
components, except for grants for health services research, 
demonstration, and evaluation projects administered by the Agency for 
Health Care Policy and Research. These regulations do not apply to 
research grants that are not for the support of an identified research 
project (sometimes referred to as general research support grants), 
grants for the construction or operation of research facilities, grants 
for prevention or educational programs, demonstration grants, 
traineeships, training grants, or to the support of research training 
under the National Research Service Awards program.
    (b) Specific programs covered. From time to time the Secretary will 
publish a list of the research project grant programs covered by this 
part. The list is for informational purposes only and is not intended to 
restrict the statement of applicability in paragraph (a) of this 
section. In addition, information on particular research project grant 
programs, including applications and instructions, may be obtained from 
the component of the PHS that administers the program.

[61 FR 55105, Oct. 24, 1996.]



Sec. 52.2  Definitions.

    As used in this part:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.).
    Grantee means the institution, organization, individual or other 
person designated in the grant award document as the responsible legal 
entity to whom a grant is awarded under this part. The term shall also 
mean the recipient of a cooperative agreement awarded under this part.
    HHS means the Department of Health and Human Services.
    Principal investigator means a single individual designated by the 
grantee in the grant application and approved by the Secretary, who is 
responsible for the scientific and technical direction of the project.
    Project means the particular activity for which funding is sought 
under this part as described in the application for grant award.
    Public Health Service and PHS means the operating division of the 
Department that consists of the Agency for

[[Page 216]]

Health Care Policy and Research, the Centers for Disease Control and 
Prevention, the Food and Drug Administration, the Health Resources and 
Services Administration, the Indian Health Service, the National 
Institutes of Health, the Office of the Assistant Secretary for Health, 
the Substance Abuse and Mental Health Administration, and the Agency for 
Toxic Substances and Disease Registry.
    Research means a systematic investigation, study or experiment 
designed to contribute to general knowledge relating broadly to public 
health by establishing, discovering, developing, elucidating or 
confirming information about, or the underlying mechanisms relating to, 
the biological functions, diseases, or related matters to be studied.
    Secretary means the Secretary of HHS and any other officer or 
employee of the HHS to whom the authority involved may be delegated.

[61 FR 55105, Oct. 24, 1996]



Sec. 52.3  Who is eligible to apply for a grant?

    (a) Persons eligible. Any individual, corporation, public or private 
institution or agency, or other legal entity shall be eligible for a 
grant award, except:
    (1) An individual or entity which is otherwise ineligible for an 
award under applicable law or regulation;
    (2) Federal agencies or institutions, unless specifically authorized 
by law to receive the grant; or
    (3) Individuals, corporations, institutions, agencies, and other 
entities during the period they are debarred or suspended from 
eligibility for Federal financial assistance (see 45 CFR part 76).
    (b) Permissible activities within research projects. Any project 
found by the Secretary to be a research project within the meaning of 
this part shall be eligible for a grant award. Eligible projects may 
consist of laboratory, clinical, population, field, statistical, basic, 
applied or other types of investigations, studies or experiments, or 
combinations thereof, and may either be limited to one, or a particular 
aspect of a problem or subject, or may consist of two or more related 
problems or subjects for concurrent or consecutive investigation and 
involving multiple disciplines, facilities and resources.
    (c) Preferences. In the award of grants for international research 
relating to the development and evaluation of vaccines and treatments 
for AIDS under section 2315 of the Act, preference shall be given to:
    (1) Activities conducted by, or in cooperation with, the World 
Health Organization, and
    (2) With respect to activities in the Western Hemisphere, activities 
conducted by, or in cooperation with, the Pan American Health 
Organization or the World Health Organization.

[61 FR 55105, Oct. 24, 1996]



Sec. 52.4  How to apply for a grant.

    Each institution interested in applying for a grant under this part 
must submit an application at such time and in such form and manner as 
the Secretary may prescribe.

[61 FR 55105, Oct. 24, 1996]



Sec. 52.5  Evaluation and disposition of applications.

    (a) Evaluation. All applications filed in accordance with Sec. 52.4 
shall be evaluated by the Secretary through such officers and employees 
and such experts or consultants engaged for this purpose as the 
Secretary determines are specially qualified in the areas of research 
involved in the project, including review by an appropriate National 
Advisory Council or other body as may be required by law. The 
Secretary's evaluation shall take into account among other pertinent 
factors the scientific merit and significance of the project, the 
competency of the proposed staff in relation to the type of research 
involved, the feasibility of the project, the likelihood of its 
producing meaningful results, the proposed project period, and the 
adequacy of the applicant's resources available for the project and the 
amount of grant funds necessary for completion, and in the case of 
applications for support of research in emergency medical services, 
special consideration shall be given to applications for grants for 
research relating to the delivery of emergency medical services in rural 
areas.

[[Page 217]]

    (b) Disposition. On the basis of the Secretary's evaluation of an 
application in accordance with paragraph (a) of this section and subject 
to approvals, recommendations or consultations by the appropriate 
National Advisory Council or other body as may be required by law, the 
Secretary will (1) approve, (2) defer because of either lack of funds or 
a need for further evaluation, or (3) disapprove support of the proposed 
project in whole or in part. With respect to approved projects, the 
Secretary will determine the project period (subject to extension as 
provided in Sec. 52.7(c)) during which the project may be supported. Any 
deferral and disapproval of an application will not preclude its 
reconsideration or a reapplication.

[45 FR 12240, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980]



Sec. 52.6  Grant awards.

    (a) Within the limits of funds available for that purpose, the 
Secretary will award a grant to those applicants whose approved projects 
will in the Secretary's judgment best promote the purposes of the 
statute authorizing the grant and the regulations of this part. The date 
specified by the Secretary as the beginning of the project period shall 
be no later than 9 months following the date of any initial or new award 
statement unless the Secretary finds that because of the nature of a 
project or the grantee's particular circumstances earlier assurance of 
grant support is required to initiate the project. Any funds granted 
under this part shall be expended solely for the purposes for which the 
funds were granted in accordance with the approved application and 
budget, the regulations of this part, the terms and conditions of the 
award and the applicable cost principles prescribed in subpart Q of 45 
CFR part 74.
    (b) Evaluation of unapproved drug treatments for AIDS. Grants under 
section 2314 of the Act to support research relating to the evaluation 
of drug treatments for AIDS not approved by the Commissioner of Food and 
Drugs, shall be subject to appropriate scientific and ethical guidelines 
established by the Secretary for each project, pursuant to section 
2314(c) of the Act. In order to receive a grant, the applicant must 
agree to comply with those guidelines.
    (c) Notice of grant award. (1) The notice of grant award specifies 
how long HHS intends to support the project without requiring the 
project to recompete for funds. This period, called the project period, 
will usually be for 1-5 years.
    (2) Generally, the grant will initially be for one year and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit an application at the time and in the form and 
manner as the Secretary may prescribe to have support continued for each 
subsequent year.
    (3) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.
    (d) Multiple or concurrent awards. Whenever a research project 
involves a number of different but related problems, activities or 
disciplines which require evaluation by different groups, or whenever 
support for a project could be more effectively administered by separate 
handling of separate aspects of the project, the Secretary may evaluate, 
approve and make awards pursuant to two or more concurrent applications, 
each dealing with one or more specified aspects of the project.
    (e) Unobligated balances. The Secretary may permit unobligated grant 
funds remaining in the grant account at the close of a budget period to 
be carried forward for obligation during a subsequent budget period, 
provided a continuation award is made for that period and the 
Secretary's written approval is obtained.
    (f) Award for continuation of project under new grantee. The 
Secretary, upon application in accordance with the provisions of 
Sec. 52.4 and without further action by a Council or other body, may 
make a grant to any institution or other person eligible under Sec. 52.3 
for continuation of a currently supported project for which a grant was 
previously made to another institution or person, provided the Secretary 
finds

[[Page 218]]

that the change in the conduct of the project is consonant with the 
previous evaluation and approval of the project under Sec. 52.5.

[45 FR 12240, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980; 61 FR 55105, 
Oct. 24, 1996]



Sec. 52.7  Use of funds; changes.

    (a) Delegation of fiscal responsibility. The grantee may not in 
whole or in part delegate or transfer to another person responsibility 
for the use or expenditure of grant funds.
    (b) Changes in project. The permissible changes by the principal 
investigator in the approved project shall be limited to changes in 
methodology, approach or other aspects of the project to expedite 
achievement of the project's research objectives, including changes that 
grow out of the approved project and serve the best scientific strategy. 
If the grantee and the principal investigator are uncertain whether a 
change complies with this provision, the question must be referred to 
the Secretary for a final determination.
    (c) Changes in project period. The project period determined 
pursuant to Sec. 52.5(b) may be extended by the Secretary, with or 
without additional grant support, for such an additional period as the 
Secretary determines may be required to complete, or fulfill the 
purposes of, the approved project.

[45 FR 12240, Feb. 25, 1980]



Sec. 52.8  Other HHS regulations and policies that apply.

    Several other HHS policies and regulations apply to grants under 
this part. These include, but are not necessarily limited to:


37 CFR part 401--Rights to inventions made by nonprofit organizations 
and small business firms under government grants, contracts, and 
cooperative agreements

42 CFR part 50, subpart A--Responsibility of PHS awardee and applicant 
institutions for dealing with and reporting possible misconduct in 
science

42 CFR part 50, subpart D--Public Health Service grant appeals procedure

42 CFR part 50, subpart F--Responsibility of applicants for promoting 
objectively in research for which PHS funding is sought

45 CFR part 16--Procedures of the Departmental Grant Appeals Board

45 CFR part 46--Protection of human subjects

45 CFR part 74--Administration of grants

45 CFR part 75--Informal grant appeals procedures

45 CFR part 76--Governmentwide debarment and suspension (nonprocurement) 
and governmentwide requirements for drug-free workplace (grants)

45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services--
effectuation of title VI of the Civil Rights Act of 1964

45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title

45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving Federal financial assistance

45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance

45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

45 CFR part 92--Uniform administrative requirements for grants and 
cooperative agreements to State and local governments

45 CFR part 93--New restrictions on lobbying

59 FR 14508 (March 28, 1994)--NIH Guidelines on the Inclusion of Women 
and Minorities as Subjects in Clinical Research.

    Note: This policy is subject to changes, and interested persons 
should contact the Office of Research on Women's Health, NIH, Room 201, 
Building 1, MSC 0161, BETHESDA, MD 20892-0161 (301-402-1770; not a toll-
free number) to obtain references to the current version and any 
amendments.]


59 FR 34496 (July 5, 1994)--NIH Guidelines for Research Involving 
Recombinant DNA Molecules.

    Note: This policy is subject to changes, and interested persons 
should contact the Office of Recombinant DNA Activities, NIH,

[[Page 219]]

Suite 323, 6000 Executive Boulevard, MSC 7010, Bethesda, MD 20892-7010 
(301-496-9838; not a toll-free number) to obtain references to the 
current version and any amendments.]

    ``PHS Grants Policy Statement,'' DHHS Publication No. (OASH) 94-
50,000 (Rev.) April 1, 1994.

    Note: This policy is subject to changes, and interested persons 
should contact the Grants Policy Branch, OASH, Room 17A45, Parklawn 
Building, 5600 Fishers Lane, Rockville, MD 20857 (301-443-1874; not a 
toll-free number) to obtain references to the current version and any 
amendments.]

    ``Public Health Service Policy on Humane Care and Use of Laboratory 
Animals,'' Office for Protection from Research Risks, NIH (Revised 
September 1986).

    Note: This policy is subject to changes, and interested persons 
should contact the Office for Protection from Research Risks, NIH, Suite 
3B01, 6100 Executive Boulevard, MSC 7507, Rockville, MD 20852-7507 (301-
496-7005; not a toll-free number) to obtain references to the current 
version and any amendments.]

[61 FR 55106 Oct. 24, 1996]



Sec. 52.9  Additional conditions.

    The Secretary may with respect to any grant award or class of awards 
impose additional conditions prior to or at the time of any award when 
in the Secretary's judgment such conditions are necessary to assure or 
protect advancement of the approved project, the interests of the public 
health, or the conservation of grant funds.

[45 FR 12240, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980]



PART 52a--NATIONAL INSTITUTES OF HEALTH CENTER GRANTS--Table of Contents




Sec.
52a.1  To which programs do these regulations apply?
52a.2  Definitions.
52a.3  Who is eligible to apply?
52a.4  What information must each application contain?
52a.5  How will NIH evaluate applications?
52a.6  Information about grant awards.
52a.7  For what purposes may a grantee spend grant funds?
52a.8  Other HHS regulations and policies that apply.
52a.9  Additional conditions.

    Authority: 42 U.S.C. 216, 285a-3, 285a-6(c)(1)(E), 285a-7(c)(1)(G), 
285b-4, 285c-5, 285d-6, 285e-2, 285e-3, 285f-1, 285g-5, 285g-7, 285m-3, 
285n-2, 285o-2, 300cc-16.

    Source: 57 FR 61006, Dec. 23, 1992, unless otherwise noted.



Sec. 52a.1  To which programs do these regulations apply?

    (a) The regulations of this part apply to grants by the National 
Institutes of Health and its organizational components to support the 
planning, establishment, strengthening or expansion, and operation of 
research and demonstration and/or multipurpose centers in the health 
fields described in this paragraph. Specifically, these regulations 
apply to national cancer research and demonstration centers (including 
payments for construction, but not including the acquisition of land), 
as authorized by section 414 of the Act; national cancer research and 
demonstration centers with respect to breast cancer, as authorized by 
section 417 of the Act; national cancer research and demonstration 
centers with respect to prostate cancer, as authorized by section 417A 
of the Act; national research and demonstration centers for heart, blood 
vessel, lung, and blood diseases, sickle cell anemia, blood resources 
and pediatric cardiovascular diseases (including payments for 
construction, but not including the acquisition of land), as authorized 
by section 422 of the Act; research and training centers in diabetes 
mellitus and related endocrine and metabolic diseases (including 
digestive, kidney, and urologic diseases), and research and training 
centers regarding nutritional disorders, including obesity, as 
authorized by section 431 of the Act; multipurpose arthritis and 
musculoskeletal diseases centers (including payments for alteration, 
remodeling, improvement, expansion, and repair of existing buildings, 
and the provision of equipment necessary to make them suitable for use 
as a center, but not construction), as authorized by Section 441 of the 
Act; Alzheimer's disease centers, as authorized by section 445 of the 
Act; Claude D. Pepper Older Americans Independence Centers, as 
authorized by section 445A of the Act; research centers regarding 
chronic fatigue syndrome, as authorized by section 447 of

[[Page 220]]

the Act; research centers with respect to contraception and infertility, 
as authorized by section 452A of the Act; child health research centers, 
as authorized by section 452C of the Act; multipurpose deafness and 
other communication disorders centers (including payments for 
alteration, remodeling, improvement, expansion, and repair of existing 
buildings, and the provision of equipment necessary to make them 
suitable for use as a center, but not construction), as authorized by 
section 464C of the Act; national alcohol research centers, as 
authorized by section 464J of the Act; national drug abuse research 
centers, as authorized by section 464N of the Act; and centers for 
acquired immunodeficiency syndrome research (including payments for 
renovation and leasing of existing buildings, and the provision of 
equipment necessary to make them suitable for use as a center, but not 
construction), as authorized by section 2316 of the Act.
    (b) This part does not apply to:
    (1) Grants for construction (see 42 CFR part 52b), except as noted 
in paragraph (a) of this section;
    (2) Grants covered by 42 CFR part 52 (grants for research projects); 
or
    (3) Grants for general research support under section 301(a)(3) of 
the Act (42 U.S.C. 241(a)(3)).
    (c) This part also applies to cooperative agreements made to support 
the centers specified in paragraph (a) of this section. When a reference 
is made in this part to ``grants,'' the reference shall include 
``cooperative agreements.''

[61 FR 55108, Oct. 24, 1996]



Sec. 52a.2  Definitions.

    As used in this part:
    Act means the Public Health Services Act, as amended (42 U.S.C. 201 
et seq.).
    Center means:
    (1) For purposes of grants authorized by section 414 of the Act, an 
agency or institution which provides for planning and conducting basic 
and clinical research into, training in, and demonstration of advanced 
diagnostic, control, prevention and treatment methods for cancer;
    (2) For purposes of grants authorized by section 417 of the Act, an 
agency or institution which provides for planning and conducting basic, 
clinical, epidemiological, psychosocial, prevention and treatment 
research and related activities on breast cancer;
    (3) For purposes of grants authorized by section 417A of the Act, an 
agency or institution which provides for planning and conducting basic, 
clinical, epidemiological, psychosocial, prevention and control, 
treatment, research, and related activities on prostate cancer;
    (4) For purposes of grants authorized by section 422 of the Act, an 
agency or institution which provides for planning and basic and clinical 
research into, training in, and demonstration of, management of blood 
resources and advanced diagnostic, prevention, and treatment methods 
(including emergency services) for heart, blood vessel, lung, or blood 
diseases including sickle cell anemia;
    (5) For purposes of grants authorized by section 431 of the Act, a 
single institution or a consortium of cooperating institutions which 
conducts research, training, information programs, epidemiological 
studies, data collection activities and development of model programs 
in: diabetes mellitus and related endocrine and metabolic diseases; 
kidney and urologic diseases; or nutritional disorders, including 
obesity;
    (6) For purposes of grants authorized by section 441 of the Act, a 
single institution or a consortium of cooperating institutions which 
conducts basic and clinical research into arthritis and musculoskeletal 
diseases and orthopedic procedures, and provides training and 
information programs for health professionals and the general public;
    (7) For purposes of grants authorized by section 445 of the Act, an 
entity (including a university medical center) which conducts basic and 
clinical research (including multidisciplinary research) into, training 
in, and demonstration of advanced diagnostic, prevention, and treatment 
methods for Alzheimer's disease;
    (8) For purposes of grants authorized by section 445A of the Act, an 
entity which conducts research into the aging processes and into the 
diagnosis and treatment of diseases, disorders, and

[[Page 221]]

complications related to aging, including menopause, which includes 
research on the treatments, and on medical devices and other medical 
interventions regarding these diseases, disorders, and complications 
that can assist individuals in avoiding institutionalization and 
prolonged hospitalization and in otherwise increasing the independence 
of the individuals;
    (9) For purposes of grants authorized by section 447 of the Act, a 
single institution or consortium of cooperating institutions which 
conducts basic and clinical research on chronic fatigue syndrome;
    (10) For purposes of grants authorized by section 452A of the Act, a 
single institution or consortium of cooperating institutions which 
conducts clinical and other applied research, training programs, 
continuing education programs, and information programs with respect to 
methods of contraception and infertility;
    (11) For purposes of grants authorized by section 452C of the Act, 
an agency or institution which conducts research with respect to child 
health, and gives priority to the expeditious transfer of advances from 
basic science to clinical applications and improving the care of infants 
and children;
    (12) For purposes of grants authorized by section 464C of the Act, a 
single institution or a consortium of cooperating institutions which 
conducts basic and clinical research into, training in, information and 
continuing education programs for health professionals and the general 
public about, and demonstration of, advanced diagnostic, prevention, and 
treatment methods for disorders of hearing and other communication 
processes and complications resulting from these disorders;
    (13) For purposes of grants authorized by section 464J of the Act, 
an entity engaged in long-term interdisciplinary research relating to 
alcoholism and other alcohol problems;
    (14) For purposes of grants authorized by section 464N of the Act, 
an entity for interdisciplinary research relating to drug abuse and 
other biomedical, behavioral, and social issues related to drug abuse; 
or
    (15) For purposes of grants authorized by section 2316 of the Act, 
an entity for basic and clinical research into, and training in, 
advanced diagnostic, prevention, and treatment methods for acquired 
immunodeficiency syndrome.
    (16) As provided in the section of the Act authorizing the 
particular program or on the determination of the Director, a center may 
include the facilities of a single institution or a consortium of 
cooperating institutions and, if practical, may be part of an equitable 
geographical distribution of centers with proven research capabilities.
    Director means the Director of NIH or the organizational component 
authorized to award grants to support centers under this part.
    Grant(s) means, unless the context otherwise requires, an award of 
funds to support a center authorized under Sec. 52a.1. The term includes 
cooperative agreement(s).
    NIH means the National Institutes of Health and its organizational 
components that award grants.
    Nonprofit as applied to any agency or institution means an agency or 
institution which is a corporation or an association, no part of the net 
earnings of which inures or may lawfully inure to the benefit of any 
private shareholder or individual.
    Project period means the period of time, from one to five years, 
specified in the notice of grant award that the NIH or the awarding 
component intends to support a proposed center without requiring the 
center to recompete for funds.

[57 FR 61006, Dec. 23, 1992, as amended at 61 FR 55108, Oct. 24, 1996]



Sec. 52a.3  Who is eligible to apply?

    (a) Any public or private nonprofit agency, institution, or 
consortium of agencies is eligible to apply for a grant under sections 
414, 417, 417A, 422, 445, 445A, 447, 452A, and 2316 of the Act.
    (b) Any public or private nonprofit or for-profit agency, 
institution, or consortium of agencies is eligible to apply for a grant 
under sections 431, 441, 452C, 464C, 464J, and 464N of the Act.
    (c) Any applicant under this part must be located in a State, the 
District of Columbia, Puerto Rico, the Virgin

[[Page 222]]

Islands, the Canal Zone, Guam, American Samoa, or the successor States 
of the Trust Territory of the Pacific Islands (the Federated States of 
Micronesia, the Republic of the Marshall Islands, and the Republic of 
Palau).

[57 FR 61006, Dec. 23, 1992, as amended at 61 FR 55109, Oct. 24, 1996]



Sec. 52a.4  What information must each application contain?

    Each application under this part must include detailed information 
as to the following:
    (a) The personnel, facilities, and other resources available to the 
applicant with which to initiate and maintain the proposed center grants 
program;
    (b) Any research, training, demonstration, or information 
dissemination activities in which the applicant is currently engaged; 
the sources of funding for these activities; and the relevance of these 
activities to the proposed center grants program;
    (c) Proposed research, training, demonstration, and information 
dissemination activities;
    (d) The proposed organizational structure of the center and the 
relationship of the proposed center to the applicant organization(s);
    (e) The names and qualifications of the center director and key 
staff members who would be responsible for conducting the proposed 
activities;
    (f) Proposed methods for monitoring and evaluating individual 
activities and the overall center program;
    (g) Proposed methods for coordinating the center's activities, where 
appropriate, with similar efforts by other public and private 
organizations;
    (h) The availability of any community resources necessary to carry 
out proposed activities; and
    (i) Efforts to be made to generate and collect income from sources 
other than NIH to be used to further the purposes of the center program. 
NIH encourages these efforts. Income may include, but is not limited to, 
that generated from the sale or rental of products or services produced 
by grant-supported activities, such as laboratory tests, computer time, 
and payments received from patients or third parties, where appropriate 
(the disposition of grant-related income is governed by 45 CFR 74.40 
through 74.47 and 45 CFR 92.25);
    (j) The proposed budget for the center and a justification for the 
amount of the grant funds requested; and
    (k) Any other information that the Director of the awarding 
institute may request.

[Approved under OMB Control Number 0925-0001]



Sec. 52a.5  How will NIH evaluate applications?

    (a) NIH considers the following in evaluating Center grant 
applications:
    (1) The scientific and technical merit of the proposed program;
    (2) The qualifications and experience of the center director and 
other key personnel;
    (3) The statutory and program purposes to be accomplished;
    (4) The extent to which the various components of the proposed 
program would be coordinated into one multi-disciplinary effort within 
the center;
    (5) The extent to which the center's activities would be coordinated 
with similar efforts by other organizations;
    (6) The administrative and managerial capability of the applicant;
    (7) The reasonableness of the proposed budget in relation to the 
proposed program; and
    (8) Other factors which the awarding institute, center, or division 
considers appropriate in light of its particular statutory mission.
    (b) Where required by statute or NIH policy, applications are 
reviewed by appropriate national advisory councils or boards before 
awards are made. NIH grants may be awarded generally only after approval 
recommendations from both appropriate scientific peer review groups and 
national advisory councils or boards.



Sec. 52a.6  Information about grant awards.

    (a) The notice of grant award specifies how long NIH intends to 
support the project without requiring the project to recompete for 
funds. This period, called the project period, will usually be for 1-5 
years.
    (b) Generally, the grant will initially be for one year, and 
subsequent continuation awards will also be for one

[[Page 223]]

year at a time. A grantee must submit a separate application to have the 
support continued for each subsequent year. Decisions regarding 
continuation awards and the funding level of such awards will be made 
after consideration of such factors as the grantee's progress and 
management practices, and the availability of funds. In all cases, 
continuation awards require a determination by the NIH that continued 
funding is in the best interest of the Federal Government.
    (c) Neither the approval of any application, nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.

[Approved under OMB Control Number 0925-0001]



Sec. 52a.7  For what purposes may a grantee spend grant funds?

    A grantee shall spend funds it receives under this part solely in 
accordance with the approved application and budget, the authorizing 
legislation, the regulations of this part, the terms and conditions of 
the award, and the applicable cost principles prescribed in 45 CFR 
74.27.

[61 FR 55109, Oct. 24, 1996]



Sec. 52a.8  Other HHS regulations and policies that apply.

    Several other regulations and policies apply to this part. These 
include, but are not necessarily limited to:

42 CFR part 50, Subpart A--Responsibilities of PHS awardee and applicant 
institutions for dealing with and reporting possible misconduct in 
science
42 CFR part 50, Subpart D-- Public Health Service grant appeals 
procedures
42 CFR part 50, subpart F--Responsibility of applicants for promoting 
objectivity in research for which PHS funding is sought
45 CFR part 16-- Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Uniform administrative requirements for awards and 
subawards to institutions of higher education, hospitals, other 
nonprofit organizations, and commercial organizations; and certain 
grants and agreements with states, local governments and Indian tribal 
governments
45 CFR part 75-- Informal grant appeals procedures
45 CFR part 76-- Governmentwide debarment and suspension 
(nonprocurement) and governmentwide requirements for drug-free workplace 
(grants)
45 CFR part 80-- Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services--
Effectuation of Title VI of the Civil Rights Act of 1964
45 CFR part 81-- Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84-- Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86-- Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91-- Nondiscrimination on the basis of age in HHS programs 
or activities receiving Federal financial assistance
45 CFR part 92-- Uniform administrative requirements for grants and 
cooperative agreements to State and local governments
45 CFR part 93-- New restrictions on lobbying
59 FR 14508 (March 28,1994)--NIH Guidelines on the Inclusion of Women 
and Minorities as Subjects in Clinical Research.

     [Note: This policy is subject to change, and interested persons 
should contact the Office of Research on Women's Health, NIH, Room 201, 
MSC 0161, BETHESDA, MD 20892-0601 (301-402-1770; not a toll-free number) 
to obtain references to the current version and any amendments.]

59 FR 34496 (July 5,1994)--NIH Guidelines for Research Involving 
Recombinant DNA Molecules.

     [Note: This policy is subject to change, and interested persons 
should contact the Office of Recombinant DNA Activities, NIH, Suite 323, 
6000 Executive Boulevard, MSA 7010, BETHESDA, MD 20892-7010 (301-496-
9838; not a toll-free number) to obtain references to the current 
version and any amendments.]

Public Health Service Policy on Humane Care and Use of Laboratory 
Animals, Office for Protection from Research Risks, NIH (Revised 
September 1986).

    [Note: This policy is subject to change, and interested persons 
should contact the Office for Protection from Research Risks, NIH, Suite 
3B01, 6100 Executive Boulevard, MSC 7507, Bethesda, MD 20892-7507 (301-
496- 7005; not a toll-free number) to obtain references to the current 
version and any amendments.]

[57 FR 61006, Dec. 23, 1992, as amended at 61 FR 55109, Oct. 24, 1996]

[[Page 224]]



Sec. 52a.9  Additional conditions.

    The Director may, with respect to any grant award, impose additional 
conditions prior to or at the time of any award when in the Director's 
judgment the conditions are necessary to assure the carrying out of the 
purposes of the award, the interests of the public health, or the 
conservation of grant funds.

[61 FR 55110, Oct. 24, 1996]



PART 52b--NATIONAL CANCER INSTITUTE CONSTRUCTION GRANTS--Table of Contents




Sec.
52b.1  Applicability.
52b.2  Definitions.
52b.3  Eligibility.
52b.4  Application.
52b.5  Evaluation.
52b.6  Other HHS regulations that apply.
52b.7  Rate of Federal financial participation.
52b.8  Terms and conditions.
52b.9  Acquisition of facilities.
52b.10  Additional conditions.
52b.11  Minimum standards of construction and equipment.

    Authority: Sec. 215, 58 Stat. 690, as amended (42 U.S.C. 216); sec. 
406(b), 92 Stat. 3428 (42 U.S.C. 286a); sec. 404(b)(9), 92 Stat. 3427 
(42 U.S.C. 285).

    Source: 45 FR 12243, Feb. 25, 1980, unless otherwise noted.



Sec. 52b.1  Applicability.

    The provisions of this part apply to award of grants under section 
406(b) of the Public Health Service Act for the construction of centers 
for clinical research, training and demonstration of advanced diagnostic 
and treatment methods relating to cancer, and to the award of grants 
under section 404(b)(9) for construction of basic research laboratory 
facilities.



Sec. 52b.2  Definitions.

    (a) Act means the Public Health Service Act, as amended.
    (b) Director means the Director of the National Cancer Institute and 
any officer or employee of the National Cancer Institute to whom the 
authority involved may be delegated.
    (c) Construction grant means a grant of funds for construction 
pursuant to sections 406(b) and 404(b)(9) of the Act, and in accordance 
with these regulations.
    (d) Construction includes the construction of new buildings; 
acquisition of land or existing buildings provided such acquisition 
occurs after the filing of the application; the expansion, remodeling, 
and alteration of existing buildings provided the cost of such 
expansion, remodeling, and alteration is not less than $75,000; and the 
initial equipment of any such buildings; but excludes the cost of off-
site improvements.



Sec. 52b.3  Eligibility.

    In order to be eligible for a construction grant under section 
406(b) or section 404(b)(9) of the Act, the applicant must be:
    (a) A public or private nonprofit agency or institution; and
    (b) Located in a State, the District of Columbia, the Commonwealth 
of Puerto Rico, the Virgin Islands, the Canal Zone, American Samoa, the 
Trust Territory of the Pacific Islands, or Guam.



Sec. 52b.4  Application.

    (a) Submittal. Applications for construction grants under section 
406(b) or section 404(b)(9) of the Act, including both detailed 
narrative descriptions and detailed estimates of the cost of the 
respective projects, shall be made on an authorized form.
    (b) Environmental impact. Each applicant shall furnish its analysis 
of the environmental impact of the proposed construction taking into 
account the consideration set forth in the National Environmental Policy 
Act, Pub. L. 91-190 ((42 U.S.C. 4321 et seq.), 83 Stat. 852).
    (c) Flood hazards. Each applicant shall furnish its assessment of 
the project site in light of the considerations set forth in Executive 
Order 11296, 31 FR 10663 (August 10, 1966) concerning the evaluation of 
flood hazards in locating Federally supported facilities.
    (d) Review by State and local comprehensive health planning agency. 
In the case of a project for the construction of a facility intended, at 
least in part, for the provision of health services, the applicant shall 
provide an opportunity for comment and approval with respect to such 
project to (1) the

[[Page 225]]

State agency administering or supervising the administration of the 
State plan approved under section 314(a) of the Act, and (2) the public 
or nonprofit private agency or organization responsible for the plan or 
plans referred to in section 314(b) of the Act and covering the area in 
which such project is to be located or if there is no such agency, such 
other public or nonprofit private agency or organization (if any) as 
performs, as determined in accordance with criteria of the Director, 
similar functions.

(Sec. 215, Public Health Service Act, 58 Stat. 690, 67 Stat. 631 (42 
U.S.C. 216); sec. 406(b), Public Health Service Act, 92 Stat. 3428 (42 
U.S.C. 286a); sec. 404(b)(9), Public Health Service Act, 92 Stat. 3427 
(42 U.S.C. 285))

[45 FR 12243, Feb. 25, 1980, as amended at 48 FR 29201, June 24, 1983; 
48 FR 45558, Oct. 6, 1983]



Sec. 52b.5  Evaluation.

    In approving applications for construction grants under this part, 
the Director shall take into account, among other factors, the 
following:
    (a) The relevance of the program for which construction is proposed 
to the objectives and priorities of the National Cancer Program (42 
U.S.C. 286a),
    (b) The scientific merits of the program for which construction is 
proposed,
    (c) The scientific or professional standing or reputation of the 
agency or institution and of its existing or proposed officers and 
research staff,
    (d) The availability, by affiliation or other association, of other 
scientific or health personnel and facilities to the extent necessary to 
carry out effectively the contemplated program, including the adequacy 
of an acceptable biohazard control and containment program where 
warranted,
    (e) The need to accomplish appropriate geographical distribution of 
facilities, and
    (f) The financial need of the applicant.



Sec. 52b.6  Other HHS regulations that apply.

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

[49 FR 38110, Sept. 27, 1984]



Sec. 52b.7  Rate of Federal financial participation.

    (a) The amount of a construction grant may not exceed 75 percent of 
the necessary allowable cost of construction as determined by the 
Director, except that in situations where the Director finds good cause 
for waiving requirements, for example, in order to achieve sufficient 
geographical distribution of facilities, the amount of the construction 
grant may exceed 75 percent of the necessary allowable cost of 
construction.
    (b) Subject to paragraph (a) of this section, the Director shall set 
the actual rate of Federal financial participation in the necessary 
allowable cost of construction taking into consideration the most 
effective use of available Federal funds to further the purposes of 
section 406(b) or section 404(b)(9).



Sec. 52b.8  Terms and conditions.

    In addition to any other requirement imposed by law or determined by 
the Director to be reasonably necessary with respect to any particular 
grant to fulfill the purposes thereof, each construction grant shall be 
subject to the condition that the applicant provide certain evidences, 
supported by such documentation as the Director may reasonably require. 
The Director may for good cause shown approve exceptions to these 
conditions and evidences

[[Page 226]]

where the Director finds that such exceptions are not inconsistent with 
the Act and the purposes of the program:
    (a) Title. That the applicant has a fee simple or such other estate 
or interest in the site, including necessary easements and rights-of-way 
sufficient to assure for the estimated useful life of the facility, as 
determined by the Director, undisturbed use and possession for the 
purpose of the construction and operation of the facility.
    (b) Plans and specifications. That approval by the Director of the 
final working drawings and specifications will be obtained before the 
project is advertised or placed on the market for bidding and that such 
approval shall include a determination by the Director that the final 
plans and specifications conform to the minimum standards of 
construction and equipment as set forth in Sec. 52b.11 of this part.
    (c) Relocation assistance. That in the case of a public applicant 
with an approved project which involves the displacement of persons or 
businesses on or after January 4, 1971, the applicant will comply with 
the provisions of the Uniform Relocation Assistance and Real Property 
Acquisition Policies Act of 1970 ((42 U.S.C. 4601 et seq.), 84 Stat. 
1984) and the applicable regulations issued thereunder (45 CFR part 15).
    (d) Approval of changes in estimated cost. That the applicant will 
not enter into any construction contract or contracts for the project or 
a part thereof, the cost of which is in excess of the estimated cost 
approved in the application for that portion of the work covered by the 
plans and specifications, without the prior approval of the Director.
    (e) Completion responsibility. That the applicant will construct the 
project, or cause it to be constructed, to final completion in 
accordance with the grant application and approved plans and 
specifications.
    (f) Construction inspection. That the applicant will provide and 
maintain competent and adequate architectural or engineering inspection 
at the construction site to insure that the completed work conforms with 
the approved plans and specifications.
    (g) Non-Federal share. That sufficient funds will be available to 
meet the non-Federal share of the cost of constructing the facility.
    (h) Funds for operation. That sufficient funds will be available 
when construction is completed for effective use of the facility for the 
purposes for which it is being constructed.
    (i) Inspection. That the Director and the Director's representatives 
shall have access at all reasonable times to work whereever it is in 
preparation or progress, and the contractor shall provide proper 
facilities for such access and inspection.
    (j) Accessibility to handicapped. That, the facility shall be 
designed to comply with the Federal Accessibility Standard (41 CFR 
subpart 101-19.6) as modified by other standards prescribed by the 
Director or the Administrator of General Services. The applicant will be 
responsible for conducting inspections to insure compliance with these 
specifications by the contractor.
    (k) Minimum standards of construction and equipment. That the plans 
and specifications for the project will conform to the minimum standards 
of construction and equipment as set forth in Sec. 52b.11 of this part.

[45 FR 12243, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980]



Sec. 52b.9  Acquisition of facilities.

    In addition to the other requirements of this part, the following 
provisions are applicable to the acquisition of existing facilities.
    (a) Minimum standards of construction and equipment. A determination 
by the Director that the facility conforms (or upon completion of any 
necessary construction will conform) to the minimum standards of 
construction and equipment as set forth in Sec. 52b.11 of this part, 
shall be obtained before entering into a final or unconditional contract 
for such acquisition. Where the Director finds that exceptions to or 
modification of any such minimum standards of construction and equipment 
would be consistent with the purposes of section 406(b) or section 
404(b)(9) of the Act, the Director may authorize such exceptions or 
modifications;

[[Page 227]]

    (b) Estimated cost of acquisition and remodeling: Suitability of 
facility. Each application for a project involving the acquisition of 
existing facilities shall include in the detailed estimates of the cost 
of the project, the cost of acquiring such facilities, and any cost of 
remodeling, renovating or altering such facilities to serve the purposes 
for which they are acquired. Such application shall demonstrate to the 
satisfaction of the Director that the architectural, structural and 
other pertinent features of the facility, as modified by any proposed 
expansion, remodeling, renovation, or alteration, will be clearly 
suitable for the purposes of section 406(b) or section 404(b)(9) of the 
Act, and, to the extent of the costs in which Federal participation is 
requested, are not in excess of what is necessary for the services 
proposed to be provided in such facilities;
    (c) Bona fide sale. Federal participation in the acquisition of 
existing facilities is on condition that such acquisition constitutes a 
bona fide sale involving an actual cost to the applicant and will result 
in additional or improved facilities for purposes of section 406(b) or 
section 404(b)(9) of the Act; and
    (d) Facility which has previously received Federal grant. No grant 
for the acquisition of a facility which has previously received a 
Federal grant for construction, acquisition, or equipment shall serve 
either to reduce or restrict the liability of the applicant or any other 
transferor or transferee from any obligation of accountability imposed 
by the Federal Government by reason of such prior grant.

[45 FR 12243, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980]



Sec. 52b.10  Additional conditions.

    The Director may with respect to any grant award impose additional 
conditions consistent with these regulations prior to or at the time of 
any award when in the Director's judgment such conditions are necessary 
to assure or protect advancement of the approved project, the interests 
of the National Cancer Program, or the conservation of grant funds.



Sec. 52b.11  Minimum standards of construction and equipment.

    The standards set forth in this section have been determined by the 
Director to constitute minimum requirements for construction and 
equipment, including remodeling, renovation, or alteration of existing 
buildings, and shall apply to all projects for which Federal assistance 
is requested under section 406(b) or section 404(b)(9) of the Act. In 
accordance with 5 U.S.C. 552(a)(1), the publications to which reference 
is made in this section, unless otherwise indicated, are hereby 
incorporated by reference and made a part hereof. These documents are 
available for inspection at the Department and Regional Offices' 
Information Centers listed in 45 CFR 5.31 and copies of such documents 
may be purchased as specified. The Director may for good cause shown 
approve plans and specifications which contain deviations from the 
requirements prescribed, if the Director is satisfied that the purposes 
of such requirements have been fulfilled. In addition to these 
requirements, it is recognized that each project will have to meet the 
requirements of State and/or local codes and ordinances relating to 
construction.
    (a) General. The structural design, construction, and fire safety 
provisions of all project facilities shall comply with the standards of 
the Uniform Building Code (available from International Conference of 
Building Officials, 5360 South Workman Road, Whittier, CA 90601) or with 
applicable State or local codes and ordinances, whichever is more 
restrictive.
    (b) Mechanical. All installations of fuel burning equipment, steam, 
heating, air conditioning and ventilation, plumbing and other piping 
systems, incinerators, and boilers shall comply with the following 
standards:
    (1) Handbook of Fundamentals: American Society of Heating, 
Refrigerating and Air Conditioning Engineers (ASHRAE), United Engineer 
Center, 345 East 47th Street, New York, NY 10017.
    (2) National Standard Plumbing Code: National Association of 
Plumbing-Heating-Cooling Contractors, 1016 20th Street NW., Washington, 
DC 20036.

[[Page 228]]

    (3) Standard for Non-Flammable Medical Gas Systems, 1973, NFPA 
Bulletin No. 56F, National Fire Protection Association, 470 Atlantic 
Avenue, Boston, MA 02110.
    (4) Standard for Medical-Surgical Vacuum Systems in Hospitals, 
Pamphlet P-2.1: Compressed Gas Association (CGA), 500 Fifth Avenue, New 
York, NY 10036.
    (c) Fire and safety. The fire-resistant design criteria for the 
facility will be governed by the criteria necessary for that portion of 
the facility which is subject to the most severe usage. Remodeled 
structures shall be upgraded, in total, unless it is feasible to isolate 
the improved portion of the building with fire walls and fire doors. 
Fire-resistant design shall be in accordance with the standards of Life 
Safety Code, NFPA No. 101, 1973, National Fire Protection Association, 
470 Atlantic Avenue, Boston, MA 02110.
    (d) Emergency electrical service. Fire alarm systems and other 
electrical service shall conform to the standards as specified in Life 
Safety Code, NFPA No. 101, 1973, National Fire Protection Association, 
470 Atlantic Avenue, Boston, MA 02110.
    (e) Electrical. All electrical installations and equipment shall be 
in accordance with State and local codes and applicable sections of 
National Electric Code, NFPA Bulletin No. 70, 1971, National Fire 
Protection Association, 470 Atlantic Avenue Boston, MA 02110.
    (f) Radiation protection. All areas in which X-ray, gamma-ray, beta-
ray producing and similar equipment is located shall be protected from 
radiation in accordance with the standards which are in the Handbook 
Reports No. 33 and 34: National Council on Radiation Protection (NCRP), 
P.O. Box 30175, Washington, DC 20008.
    (g) Earthquake. All facilities shall be designed and constructed in 
accordance with the standards specified in the Uniform Building Code, 
1973, International Conference of Building Officials, 5360 South Workman 
Mill Road, Whittier, CA 90601, unless more restrictive State and local 
codes govern.
    (h) Zoning. State and local codes shall apply.

[45 FR 12243, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980]



PART 52c--MINORITY BIOMEDICAL RESEARCH SUPPORT PROGRAM--Table of Contents




Sec.
52c.1  Applicability.
52c.2  Definitions.
52c.3  Eligibility.
52c.4  Application.
52c.5  Grant awards.
52c.6  Expenditure of grant funds.
52c.7  Other HHS regulations that apply.
52c.8  Additional conditions.

    Authority: 42 U.S.C. 216, 241(a)(3).

    Source: 45 FR 12246, Feb. 25, 1980, unless otherwise noted.



Sec. 52c.1  Applicability.

    The regulations in this part apply to grants (under the Minority 
Biomedical Research Support Program) awarded in accordance with section 
301(a)(3) of the Public Health Service (PHS) Act (42 U.S.C. 241(a)(3)) 
to increase the numbers of ethnic minority faculty, students, and 
investigators engaged in biomedical research, and to broaden the 
opportunities for participation in biomedical research of ethnic 
minority faculty, students, and investigators, by providing general 
support for biomedical research programs at eligible institutions.

[58 FR 61030, Nov. 19, 1993]



Sec. 52c.2  Definitions.

    As used in this part:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.).
    Ethnic minorities includes but is not limited to such groups as 
Black Americans, Hispanic Americans, Asian/Pacific Islanders, and 
American Indians/Native Alaskans (Native Americans).
    HHS means the Department of Health and Human Services.
    Nonprofit as applied to any institution means an institution which 
is a corporation or association no part of the net earnings of which 
inures or may lawfully inure to the benefit of any private shareholder 
or individual.
    Program director means a single individual, designated in the grant 
application, who is scientifically trained and has research experience 
and who is responsible for the overall execution of the program 
supported under this part at the grantee institution.

[[Page 229]]

    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.

[58 FR 61030, Nov. 19, 1993]



Sec. 52c.3  Eligibility.

    To be eligible for a grant under this Program, an applicant must be:
    (a) One of the following:
    (1) A public or private nonprofit university, four year college, or 
other institution offering undergraduate, graduate, or health 
professional degrees, with a traditionally high (more than 50 percent) 
minority student enrollment;
    (2) A public or private nonprofit two year college with a 
traditionally high (more than 50 percent) minority student enrollment;
    (3) A public or private nonprofit university, four year college, or 
other institution offering undergraduate, graduate, or health 
professional degrees, with a student enrollment a significant proportion 
(but not necessarily more than 50 percent) of which is derived from 
ethnic minorities, provided the Secretary determines that said 
institution has a demonstrated commitment to the special encouragement 
of and assistance to ethnic minority faculty, students, and 
investigators; or
    (4) An Indian tribe which has a recognized governing body which 
performs substantial governmental functions, or an Alaska Regional 
Corporation as defined in the Alaska Native Claims Settlement Act (43 
U.S.C. 1601 et seq.), and
    (b) Located in a State, the District of Columbia, Puerto Rico, the 
Virgin Islands, the Canal Zone, Guam, American Samoa, or the successor 
States of the Trust Territory of the Pacific Islands (the Federated 
States of Micronesia, the Republic of the Marshall Islands, and the 
Republic of Palau).

[45 FR 12246, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980; 58 FR 61030, 
Nov. 19, 1993]



Sec. 52c.4  Application.

    An institution interested in applying for a grant under this part 
must submit an application at the time and in the form and manner that 
the Secretary may prescribe.

[58 FR 61030, Nov. 19, 1993]



Sec. 52c.5  Grant awards.

    (a) Within the limits of funds available, and upon such 
recommendation as may be required by law, the Secretary shall award 
grants to those applications with proposed biomedical research programs 
which will, in the Secretary's judgment, best promote the purposes of 
this part, taking into consideration among other pertinent factors:
    (1) The benefits that can be expected to accrue to the national 
effort in biomedical research and in increasing the pool of biomedical 
researchers;
    (2) The institution's capability, from a scientific and technical 
standpoint, to engage in biomedical research;
    (3) The benefits that can be expected to accrue to the institution 
and its students;
    (4) The administrative and managerial capability and competence of 
the applicant;
    (5) The availability of the facilities and resources (including 
where necessary collaborative arrangements with other institutions) to 
engage in biomedical research;
    (6) The applicant's relative need for funding; and
    (7) The overall significance of the proposal in terms of numbers of 
ethnic minority persons benefited thereby.
    (b) The notice of grant award specifies how long HHS intends to 
support the project without requiring the project to recompete for 
funds. This period, called the project period, will usually be for 1-5 
years.
    (c) Generally the grant will initially be for one year and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit a separate application to have the support continued 
for each subsequent year. Decisions regarding continuation awards and 
the funding level of such awards will be made after consideration of 
such factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, continuation awards require a 
determination by HHS that continued

[[Page 230]]

funding is in the best interest of the government.
    (d) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.

[45 FR 12246, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980; 58 FR 61030, 
Nov. 19, 1993]



Sec. 52c.6  Expenditure of grant funds.

    (a) Any funds granted pursuant to this part shall be expended solely 
for the purposes for which the funds were granted in accordance with the 
approved application and budget, the regulations of this part, the terms 
and conditions of the award, and the applicable cost principles 
prescribed by subpart Q of 45 CFR part 74.
    (b) The Secretary may permit unobligated grant funds remaining in 
the grant account at the close of a budget period to be carried forward 
for obligation during a subsequent budget period, provided a 
continuation award is made for that period and the Secretary's written 
approval is obtained. The amount of any subsequent award will take into 
consideration unobligated grant funds remaining in the grant account.

[45 FR 12246, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980; 45 FR 68392, 
Oct. 15, 1980]



Sec. 52c.7  Other HHS regulations that apply.

    Several other regulations and policies apply to grants under this 
part. These include, but are not necessarily limited to:

37 CFR part 401--Rights to inventions made by nonprofit organizations 
and small business firms under government grants, contracts, and 
cooperative agreements
42 CFR part 50, subpart A--Responsibilities of PHS awardee and applicant 
institutions for dealing with and reporting possible misconduct in 
science
42 CFR part 50, subpart D--Public Health Service grant appeals 
procedures
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide debarment and suspension (nonprocurement) 
and governmentwide requirements for drug-free workplace (grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
Effectuation of Title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs 
and activities receiving Federal financial assistance
45 CFR part 92--Uniform administrative requirements for grants and 
cooperative agreements to State and local governments
45 CFR part 93--New restrictions on lobbying
51 FR 16958, or successor--NIH Guidelines for Research Involving 
Recombinant DNA Molecules
``Public Health Service Policy on Humane Care and Use of Laboratory 
Animals,'' Office for Protection from Research Risks, NIH (Revised 
September 1986), or successor

[58 FR 61030, Nov. 19, 1993]



Sec. 52c.8  Additional conditions.

    The Secretary may with respect to any grant award impose additional 
conditions prior to or at the time of any award when in the Secretary's 
judgment those conditions are necessary to assure or protect advancement 
of the approved program, the interests of the public health, or the 
conservation of grant funds.



PART 52d--NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM--Table of Contents




Sec.
52d.1  Applicability.
52d.2  Definitions.
52d.3  Eligibility.
52d.4  Application.
52d.5  Program requirements.

[[Page 231]]

52d.6  Grant awards.
52d.7  Expenditure of grant funds.
52d.8  Other HHS regulations that apply.
52d.9  Additional conditions.

    Authority: Sec. 215, 58 Stat. 690, as amended, 63 Stat. 835 (42 
U.S.C. 216); sec. 404(a)(4), 92 Stat. 3426 (42 U.S.C. 285).

    Source: 45 FR 12247, Feb. 25, 1980, unless otherwise noted.



Sec. 52d.1  Applicability.

    The regulations in this part apply to grants under the Clinical 
Cancer Education Program authorized by section 404(a)(4) of the Public 
Health Service Act, to encourage planning and development of 
multidisciplinary educational programs aimed at achieving optimal care 
of cancer patients and to enable students in the health professions to 
acquire basic knowledge of neoplastic disease and the preventive 
measures and diagnostic and therapeutic skills necessary to the 
provision of such care.



Sec. 52d.2  Definitions.

    (a) Act means the Public Health Service Act, as amended.
    (b) Director, NCI, means the Director of the National Cancer 
Institute and any other officer or employee of said Institute to whom 
the authority involved has been delegated.
    (c) [Reserved]
    (d) Board means the National Cancer Advisory Board established by 
section 407 of the Act (42 U.S.C. 286b).
    (e) Affiliated teaching hospital means a hospital which, although 
not owned by such school, has a written agreement with a school of 
medicine, osteopathy, dentistry, or public health eligible for 
assistance under this part, providing for effective control by the 
school of the teaching in the hospital.
    (f) Specialized cancer institute means an institution which has as 
its primary mission the diagnosis, prevention, or treatment of cancer.

[45 FR 12247, Feb. 25, 1980; 45 FR 20096, Mar. 27, 1980, as amended at 
47 FR 53012, Nov. 24, 1982]



Sec. 52d.3  Eligibility.

    To be eligible for a grant under this part, an applicant must be:
    (a) A public or private school of medicine, osteopathy, dentistry, 
or public health, affiliated teaching hospital, or specialized cancer 
institute; and
    (b) Located in a State, the District of Columbia, Puerto Rico, the 
Virgin Islands, the Canal Zone, Guam, American Samoa, or the Trust 
Territory of the Pacific Islands.

[45 FR 12247, Feb. 25, 1980, as amended at 47 FR 53012, Nov. 24, 1982]



Sec. 52d.4  Application.

    (a) Application for a grant under this subpart shall be made on an 
authorized form.\1\ Applicants shall submit completed forms, on or 
before the dates the Director, NCI, may prescribe.
---------------------------------------------------------------------------

    1  Applications and instructions are available from the 
Division of Cancer Research Resources and Centers, Education Branch, 
Westwood Building, 5333 Westbard Avenue, Bethesda, MD 20205.
---------------------------------------------------------------------------

    (b) [Reserved]
    (c) In addition to any other pertinent information that the 
Director, NCI, may require, each application shall set forth in detail:
    (1) A program plan defining the objectives of the proposed program 
and the means by which these objectives would be achieved, including 
descriptions of:
    (i) The general educational level (e.g., pre-doctoral, post-
doctoral) of the students to be involved in the program;
    (ii) The proposed course of study and its relation to the diagnosis, 
prevention, control, and treatment of cancer;
    (iii) The clinical experiences to be provided to the students;
    (iv) Multidisciplinary aspects of the program;
    (v) The particular schools or branches within the institution which 
would have responsibility for individual aspects of the program; and
    (vi) The teaching mechanisms to be employed, including specific 
discussion of those techniques which would be innovative.
    (2) The availability of personnel, facilities, and resources needed 
to carry out the program;
    (3) The names, qualifications, and proposed duties of the program 
director and any staff members who would be responsible for the program, 
including a description of those duties which would actually be carried 
out by the program director and those which would be shared with or 
assigned to others;

[[Page 232]]

    (4) The names and qualifications of proposed members of a cancer 
education committee which would be established by the applicant to 
advise it on the planning, organization, operation and evaluation of the 
program and the specific duties which would be assigned to said 
committee;
    (5) Insofar as necessary, cooperative arrangements with other 
schools, hospitals, and institutions which would participate in the 
program;
    (6) The proposed project period, a detailed budget for the first 
budget period including a list of other anticipated sources of support 
and anticipated total needs for each of the succeeding budget periods of 
the requested project period, and a justification for the amount of 
grant funds requested;
    (7) Proposed methods for monitoring and evaluating the program; and
    (8) A description of how the education and training effort will be 
sustained upon expiration of the award.

[45 FR 12247, Feb. 25, 1980, as amended at 47 FR 53012, Nov. 24, 1982]



Sec. 52d.5  Program requirements.

    (a) If the program is to be offered at the graduate level, it must 
be multidisciplinary in scope involving at least two or more clinical or 
preclinical sciences relating to cancer;
    (b) The cancer education committee provided for in the approved 
application must meet at least four times per year, and must be chaired 
by the program director.



Sec. 52d.6  Grant awards.

    (a) Within the limits of funds available, after consultation with 
the Board, the Director, NCI, may award grants to applicants with 
proposed programs which in the NCI Director's judgment best promote the 
purposes of this part, taking into consideration among other pertinent 
factors:
    (1) The relevance of the proposed program to the objectives of this 
part;
    (2) The extent to which the program would involve innovative 
teaching techniques;
    (3) The availability of adequate staff, facilities, and resources 
(including where necessary cooperative arrangements with other 
institutions or hospitals) to carry out the program;
    (4) The qualifications and experience of the program director;
    (5) The authority of the program director to ensure that the program 
is planned with multidisciplinary input and that multidisciplinary 
aspects of the program are carried out;
    (6) The extent to which the cancer education committee is broadly 
representative of the disciplines concerned with cancer care and 
teaching and is allowed to participate in the planning, organization, 
operation, and evaluation of the program;
    (7) If the program is to be offered at the pre-doctoral level, the 
extent to which its objectives are designed to aid students:
    (i) To acquire a basic understanding of fundamental principles of 
cancer biology, epidemiology, detection, diagnosis, prevention, 
treatment and control;
    (ii) To interest students in learning more about cancer; and
    (iii) To develop an appreciation of the need for a comprehensive 
multidisciplinary approach to the care of cancer patients;
    (8) The administrative and managerial capability of the applicant;
    (9) The reasonableness of the proposed budget in relation to the 
proposed program;
    (10) The adequacy of the methods for monitoring and evaluating the 
program on a continuing basis; and
    (11) The degree to which the application adequately provides for the 
requirements set forth in Sec. 52d.5.
    (b) The notice of grant award specifies how long HHS intends to 
support the program without requiring the program to recompete for 
funds. This period, called the project period, will usually be for 1-5 
years.
    (c) Generally, the grant will initially be for one year and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit a separate application to have the support continued 
for each subsequent year. Decisions regarding continuation awards and 
the funding level of such awards will be made after consideration of 
such factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, continuation awards require a

[[Page 233]]

determination by HHS that continued funding is in the best interest of 
the government.
    (d) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.



Sec. 52d.7  Expenditure of grant funds.

    (a) Any funds granted pursuant to this part shall be expended solely 
for the purposes for which the funds were granted in accordance with the 
approved application and budget, the regulations of this part, the terms 
and conditions of the awards, and the applicable cost principles 
prescribed by subpart Q of 45 CFR part 74, except that grant funds may 
not be used for costs incurred in connection with activities which, 
prior to the grant, were part of the grantee's standard curriculum.
    (b) The Director, NCI, may permit unobligated grant funds remaining 
in the grant account at the close of a budget period to be carried 
forward for obligation during a subsequent budget period, provided a 
continuation award is made for that period and the NCI Director's 
written approval is obtained. The amount of any subsequent award will 
take into consideration unobligated grant funds remaining in the grant 
account.



Sec. 52d.8  Other HHS regulations that apply.

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

[49 FR 38111, Sept. 27, 1984]



Sec. 52d.9  Additional conditions.

    The Director, NCI, may with respect to any grant award impose 
additional conditions prior to or at the time of any award when in the 
NCI Director's judgment those conditions are necessary to assure or 
protect advancement of the approved program, the interests of the public 
health, or the conservation of grant funds.



PART 52e--NATIONAL HEART, LUNG, AND BLOOD INSTITUTE GRANTS FOR PREVENTION AND CONTROL PROJECTS--Table of Contents




Sec.
52e.1  To what programs do these regulations apply?
52e.2  Definitions.
52e.3  Who is eligible to apply?
52e.4  How to apply.
52e.5  What are the project requirements?
52e.6  How will NIH evaluate applications?
52e.7  What are the terms and conditions of awards?
52e.8  Other HHS regulations and policies that apply.
52e.9  Additional conditions.

    Authority: 42 U.S.C. 216, 285b-1.

    Source: 45 FR 12249, Feb. 25, 1980, unless otherwise noted.



Sec. 52e.1  To what programs do these regulations apply?

    (a) This part applies to grants under section 419 of the Act (42 
U.S.C. 285b-1) for projects to:
    (1) Demonstrate and evaluate the effectiveness of new techniques or 
procedures for the prevention and control of heart, blood vessel, lung, 
and blood diseases, with special consideration given to the prevention 
and control of these diseases in children, and in populations that are 
at increased risk with respect to such diseases;

[[Page 234]]

    (2) Develop and evaluate methods of educating health practitioners 
concerning the prevention and control of these diseases; and
    (3) Develop and evaluate methods of educating the public concerning 
the prevention and control of these diseases.
    (b) For purposes of this part, prevention and control projects shall 
include community-based and population-based programs carried out in 
cooperation with other Federal agencies, with public health agencies of 
State or local governments, with nonprofit private entities that are 
community-based health agencies, or with other appropriate public or 
nonprofit private entities.

[45 FR 12249, Feb. 25, 1980; 45 FR 20097, Mar. 27, 1980, as amended at 
58 FR 54298, Oct. 21, 1993; 59 FR 59372, Nov. 17, 1994]



Sec. 52e.2  Definitions.

    As used in this part:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.)
    Council means the National Heart, Lung, and Blood Advisory Council, 
established under section 406 of the Act (42 U.S.C. 284a).
    Director means the Director of the National Heart, Lung, and Blood 
Institute and any official to whom the authority involved may be 
delegated.
    Emergency medical services means the services utilized in responding 
to the perceived individual need for immediate medical care in order to 
prevent loss of life or aggravation of physiological or psychological 
illness or injury.
    HHS means the Department of Health and Human Services.
    National program means the National Heart, Blood Vessel, Lung, and 
Blood Diseases and Blood Resources Program referred to in section 421 of 
the Act (42 U.S.C. 285b-3).
    Nonprofit as applied to any agency or institution means an agency or 
institution which is a corporation or an association, no part of the net 
earnings of which inures or may lawfully inure to the benefit of any 
private shareholder or individual.
    PHS means the Public Health Service.

[58 FR 54298, Oct. 21, 1993]



Sec. 52e.3  Who is eligible to apply?

    To be eligible for a grant under this part, an applicant must be a 
public or nonprofit private agency or institution.

[45 FR 12249, Feb. 25, 1980, as amended at 58 FR 54298, Oct. 21, 1993]



Sec. 52e.4  How to apply.

    (a) Application for a grant under this subpart shall be made on an 
authorized form.2Applicants shall submit completed forms on 
or before the dates the Director may prescribe.
---------------------------------------------------------------------------

    2 Applications and instructions are available from the 
Division of Extramural Affairs, National Heart, Lung, and Blood 
Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, 
MD 20205.
---------------------------------------------------------------------------

    (b) Each private institution which does not already have on file 
with the National Institutes of Health evidence of nonprofit status, 
must submit with its application acceptable proof of such status.
    (c) In addition to any other pertinent information that the Director 
may require each application shall set forth in detail:
    (1) The nature and purpose of the proposed project and the methods 
to be employed in carrying it out;
    (2) The relevance of the proposed project to the National Program;
    (3) The defined population to participate in the proposed project 
and the rationale for its selection;
    (4) With respect to applications relating to projects covered by 
Sec. 52e.1(a)(1), prior research findings on which the proposed project 
is based;
    (5) The personnel, facilities, and other resources, including 
community resources, available to carry out the proposed project;
    (6) Current activities of the applicant involving prevention or 
control of heart, blood vessel, lung, and blood diseases, the sources of 
funding for such activities, and the anticipated relationship of these 
activities to the proposed project;
    (7) The names and qualifications of the project director and key 
staff members who would be responsible for conducting the proposed 
project;
    (8) Proposed methods for monitoring and evaluating the project; and

[[Page 235]]

    (9) The proposed project period; a detailed budget for the first 
budget period, including a list of other anticipated sources of support 
and anticipated total needs for each of the succeeding budget periods of 
the requested project period; and a justification for the amount of 
grant funds requested.

[45 FR 12249, Feb. 25, 1980, as amended at 58 FR 54298, Oct. 21, 1993]



Sec. 52e.5  What are the project requirements?

    (a) An approvable application must demonstrate to the satisfaction 
of the Director that:
    (1) With respect to applications relating to projects covered by 
Sec. 52e.1(a)(1), the techniques or procedures to be demonstrated and 
evaluated have been found safe and effective in the research setting 
and, based upon research findings, appear to have the potential for 
general applicability to the prevention, diagnosis, or treatment of 
heart, blood vessel, lung, or blood diseases;
    (2) With respect to applications relating to projects covered by 
Sec. 52e.1(a)(2) and Sec. 52e.1(a)(3), the project will include 
development and evaluation of one or more methods for educating health 
practitioners or the public concerning advances in the prevention, 
diagnosis, or treatment of such diseases; and
    (3) The nature of the project is such that its completion may be 
anticipated within the project period, or such other period as may be 
specified in the application.
    (b) The project must, in the judgment of the Director, be necessary 
for cooperation by the National Heart, Lung, and Blood Institute with 
one or more other Federal Health agencies, State, local or regional 
public health agencies, or nonprofit private health agencies in the 
diagnosis, prevention, or treatment of heart, blood vessel, lung or 
blood diseases.

[45 FR 12249, Feb. 25, 1980, as amended at 58 FR 54298 and 54299, Oct. 
21, 1993]



Sec. 52e.6  How will NIH evaluate applications?

    (a) Within the limits of funds available, after consultation with 
the Council, the Director may award grants to applicants with proposed 
projects which in the Director's judgment will best promote the purposes 
of section 419 of the Act, taking into consideration among other 
pertinent factors:
    (1) The scientific and technical merit of the proposed project;
    (2) The significance of the project in relation to the goals of the 
National Program;
    (3) Whether the project appropriately emphasizes the prevention, 
diagnosis, or treatment of heart, blood vessel, lung, or blood diseases 
of children;
    (4) The qualifications and experience of the project director and 
other key personnel;
    (5) The administrative and managerial capability and fiscal 
responsibility of the applicant;
    (6) The reasonableness of the proposed budget in relation to the 
proposed project;
    (7) The adequacy of the methods proposed for monitoring and 
evaluating the proposed project; and
    (8) The degree to which the application adequately provides for the 
requirements set forth in Secs. 52e.5(a) and 52e.5(b).
    (b) The notice of grant award specifies how long HHS intends to 
support the project without requiring the project to recompete for 
funds. This period, called the project period, will usually be for 1-5 
years.
    (c) Generally, the grant will initially be for one year and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit a separate application to have the support continued 
for each subsequent year. Decisions regarding continuation awards and 
the funding level of such awards will be made after consideration of 
such factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, continuation awards require a 
determination by HHS that continued funding is in the best interest of 
the government.
    (d) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.

[[Page 236]]

    (e) Any funds granted under this part shall be expended solely for 
the purposes for which the funds were granted in accordance with the 
approved application and budget, the regulations of this part, the 
terms, and conditions of the award, and the applicable cost principles 
prescribed in subpart Q of 45 CFR part 74.

[45 FR 12249, Feb. 25, 1980, as amended at 58 FR 54298, Oct. 21, 1993]



Sec. 52e.7  What are the terms and conditions of awards?

    (a) Any funds granted pursuant to this part shall be expended solely 
for the purposes for which the funds were granted in accordance with the 
approved application and budget, the regulations of this part, the terms 
and conditions of the award, and the applicable cost principles 
prescribed by subpart Q of 45 CFR part 74.
    (b) The Director may permit unobligated grant funds remaining in the 
grant account at the close of a budget period to be carried forward for 
obligation during a subsequent budget period, provided a continuation 
award is made for that period and the NHLBI Director's written approval 
is obtained. The amount of any subsequent award will take into 
consideration unobligated grant funds remaining in the grant account.

[45 FR 12249, Feb. 25, 1980, as amended at 58 FR 54298 and 54299, Oct. 
21, 1993]



Sec. 52e.8  Other HHS regulations and policies that apply.

    Several other regulations apply to grants under this part. These 
include but are not necessarily limited to:

42 CFR part 50, subpart A--Responsibility of PHS awardee and applicant 
institutions for dealing with and reporting possible misconduct in 
science
42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide debarment and suspension (nonprocurement) 
and governmentwide requirements for drug-free workplace (grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services--
Effectuation of Title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 92--Uniform administrative requirements for grants and 
cooperative agreements to State and local governments
45 CFR part 93--New restrictions on lobbying
51 FR 16958 or successor--NIH Guidelines for Research Involving 
Recombinant DNA Molecules
``Public Health Service Policy on Humane Care and Use of Laboratory 
Animals,'' Office for Protection from Research Risks, NIH (Revised 
September 1986), or successor
59 FR 14508 (as republished March 28, 1994), as may be amended, or its 
successor--NIH Guidelines on the Inclusion of Women and Minorities as 
Subjects in Clinical Research.

[58 FR 54298, Oct. 21, 1993, as amended at 59 FR 59372, Nov. 17, 1994]



Sec. 52e.9  Additional conditions.

    The Director, may with respect to any grant award impose additional 
conditions prior to or at the time of any award when in the Director's 
judgment those conditions are necessary to assure or protect advancement 
of the approved project, the interests of the public health, or the 
conservation of grant funds.

[45 FR 12249, Feb. 25, 1980, as amended at 58 FR 54299, Oct. 21, 1993]



PART 52h--SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT CONTRACT PROJECTS--Table of Contents




Sec.
52h.1  Applicability.
52h.2  Definitions.
52h.3  Establishment and operation of peer review groups.

[[Page 237]]

52h.4  Composition of peer review groups.
52h.5  Conflict of interest.
52h.6  Availability of information.
52h.7  Grants; matters to be reviewed.
52h.8  Grants; review criteria.
52h.9  Unsolicited contract proposals; matters to be reviewed.
52h.10  Contract projects involving solicited contract proposals; 
          matters to be reviewed.
52h.11  Contract projects and proposals; review criteria.
52h.12  Applicability of other regulations.

    Authority: Sec. 215, 58 Stat. 690, as amended (42 U.S.C. 216); sec. 
475, 88 Stat. 360, 89 Stat. 351 (42 U.S.C. 289l-4); sec. 955(a), Pub. L. 
97-35, 95 Stat. 590 (42 U.S.C. 300z-7(e)).

    Source: 43 FR 7862, Feb. 24, 1978, unless otherwise noted.



Sec. 52h.1  Applicability.

    The regulations in this part apply to:
    (a) Applications for grants for biomedical and behavioral research, 
under the Act to the National Institutes of Health; the Alcohol, Drug 
Abuse, and Mental Health Administration; or any of their components; or 
the Division of Nursing, Bureau of Health Professions, Health Resources 
and Services Administration. These regulations do not apply to 
applications for:
    (1) Continuation funding for budget periods within an approved 
project period;
    (2) Supplemental funding to meet increased administrative costs 
within a project period; or
    (3) Construction grants.
    (b) Biomedical and behavorial research and development contract 
projects administered by the National Institutes of Health; the Alcohol, 
Drug Abuse, and Mental Health Administration; or any of their 
components; or the Division of Nursing, Bureau of Health Professions, 
Health Resources and Services Administration.
    (c) Applications for grants and contracts under section 2008 of the 
Act.

(Sec. 215, 58 Stat. 690, as amended (42 U.S.C. 216); sec. 475, 88 Stat. 
360, 89 Stat. 351, 92 Stat. 3436 (42 U.S.C. 289l-4))

[45 FR 35328, May 27, 1980, as amended at 47 FR 50261, Nov. 5, 1982; 49 
FR 38111, Sept. 27, 1984]



Sec. 52h.2  Definitions.

    As used in this part:
    (a) Act means the Public Health Service Act, as amended.
    (b) Project period has the same meaning as in 42 CFR part 52.
    (c) Budget period means the interval of time (usually 12 months) 
into which the project period is divided for budgetary and reporting 
purposes.
    (d) Awarding official means the Secretary of Health and Human 
Services and any other officer or employee of the Department of Health 
and Human Services to whom the authority involved has been delegated; 
Except that, where the Act specifically authorizes another official to 
make awards in connection with a particular program, the ``awarding 
official'' shall mean said other official and any other officer or 
employee of the Department of Health and Human Services to whom the 
authority involved has been delegated.
    (e) Peer review group means a group of experts qualified by training 
and experience in particular scientific or technical fields to give 
expert advice, in accordance with the provisions of this part, on the 
scientific and technical merit of grant applications or contract 
projects in those fields.
    (f) Research means systematic study directed toward new or fuller 
knowledge and understanding of the subject studied.
    (g) Development means the systematic use of knowledge and 
understanding gained from research, directed toward creating useful 
materials, devices, systems, or methods.
    (h) Research and development contract project means an identified, 
circumscribed activity, involving a single contract or two or more 
similar, related, or interdependent contracts, intended and designed to 
acquire new or fuller knowledge and understanding of a subject and/or to 
use such knowledge and understanding to develop useful materials, 
devices, systems, or methods. The terms include (but are not limited to) 
development and utilization of resources, testing, demonstrations, 
clinical trials, preparation of reports, and production of experimental 
or test models necessary or incidental to a research and/or development 
activity, but exclude quantity production and routine product testing 
and quality control.

[[Page 238]]

    (i) Project concept means the basic purpose, scope, and objectives 
of the project.
    (j) Project approach means the methodology to be followed and the 
resources needed in carrying out the project.
    (k) Contract proposal means a written offer to enter into a 
contract, submitted to an awarding official by an individual or non-
Federal organization, and including as a minimum a description of the 
nature, purpose, duration, and cost of the project and the methods, 
personnel, and facilities to be utilized in carrying it out.
    (l) Solicited contract proposal has the same meaning as in 41 CFR 3-
1.353(b)(2).
    (m) Unsolicited contract proposal has the same meaning as in 41 CFR 
3-4.5201.
    (n) Request for proposals means a Government solicitation to 
prospective offerors, under procedures for negotiated contracts, to 
submit a proposal to fulfill specific agency requirements based on terms 
and conditions defined in the request for proposals. The request for 
proposals contains information sufficient to enable all offerors to 
prepare competitive proposals, and is as complete as possible with 
respect to: Nature of work to be performed; descriptions and 
specifications of items to be delivered; performance schedule; special 
requirements clauses, or other circumstances affecting the contract; 
format for cost proposals; and evaluation criteria by which the 
proposals will be evaluated.



Sec. 52h.3  Establishment and operation of peer review groups.

    (a) To the extent applicable, the Federal Advisory Committee Act (5 
U.S.C. App. I), Department of Health and Human Services (45 CFR part 
11), implementing regulations and chapter 9 of the Department of Health 
and Human Services General Administration Manual 1 will 
govern the establishment and operation of peer review groups, including 
that meetings shall be open to the public except as determined by the 
Secretary.
---------------------------------------------------------------------------

    1  The Department of Health and Human Services General 
Administration Manual is available for public inspection and copying at 
the Department's and Regional Offices' information centers listed in 45 
CFR 5.31 and may be purchased from the Superintendent of Documents, U.S. 
Printing Office, Washington, DC 20402.
---------------------------------------------------------------------------

    (b) Subject to Sec. 52h.5 and paragraph (a) of this section, the 
Director of the National Institutes of Health, the Administrator of the 
Alcohol, Drug Abuse and Mental Health Administration, and the 
Administrator of the Health Resources and Services Administration will 
adopt procedures for the conduct of reviews and the formulation of 
recommendations under Secs. 52h.7, 52h.9 and 52h.10 within their 
respective agencies.

(Sec. 215, 58 Stat. 690, as amended (42 U.S.C. 216); sec. 475, 88 Stat. 
360, 89 Stat. 351, 92 Stat. 3436 (42 U.S.C. 289l-4))

[43 FR 7862, Feb. 24, 1978, as amended at 45 FR 35328, May 27, 1980; 49 
FR 38111, Sept. 27, 1984]



Sec. 52h.4  Composition of peer review groups.

    (a) To the extent applicable, the selection and appointment of 
members of peer review groups and their terms of service will be 
governed by Chapter 9 of the Department of Health and Human Services 
General Administration Manual.\1\
    (b) Subject to paragraph (a) of this section, members will be 
selected based upon their training and experience in relevant scientific 
or technical fields, taking into account, among other factors:
    (1) The level of formal scientific or technical education completed 
or experience acquired by the individual;
    (2) The extent to which the individual has engaged in relevant 
research, the capacities (e.g., principal investigator, assistant) in 
which the individual has done so, and the quality of such research;
    (3) Recognition as reflected by awards and other honors received 
from scientific and professional organizations outside the Department of 
Health and Human Services; and
    (4) The need for the group to have included within its membership 
experts from various areas of specialization within relevant scientific 
or technical fields.
    (c) Not more than one-fourth of the members of any peer review group 
to which these regulations are applicable

[[Page 239]]

may be officers or employees of the United States. For purposes of the 
preceding sentence, membership on such groups does not make an 
individual an officer or employee of the United States.



Sec. 52h.5  Conflict of interest.

    (a) Members of peer review groups covered by this part are subject 
to relevant provisions in title 18 of the United States Code, relating 
to criminal activity, the Department of Health and Human Services 
Standards of Conduct (45 CFR part 73), and Executive Order 11222, as 
amended.
    (b) In addition to any restrictions imposed under paragraph (a) of 
this section:
    (1) No member of a peer review group may participate in or be 
present during any review by said group of a grant application, contract 
project, or contract proposal in which, to the member's knowledge, any 
of the following has a financial interest: (i) The member or his or her 
spouse, parent, child, or partner, (ii) any organization in which the 
member or his or her spouse, parent, child, or partner is serving as an 
officer, director, trustee, partner, or employee, or is otherwise 
similarly associated, or (iii) any organization with which the member or 
his or her spouse, parent, child, or partner is negotiating or has any 
arrangement concerning prospective employment or other similar 
association.
    (2) In the event any member of a peer review group or his or her 
spouse, parent, child, or partner is currently or expected to be the 
principal investigator or member of the staff responsible for carrying 
out any research or development activities contemplated as part of a 
grant application, contract project, or contract proposal, that group is 
disqualified and the review will be conducted by another group with the 
expertise to do so. If there is no other group with the requisite 
expertise, the review will be conducted by an ad hoc group no more than 
50 percent of whose members may be from the disqualified group. The 
composition of any such ad hoc group will be determined in accordance 
with Sec. 52h.4(b) and Sec. 52h.4(c) of this part and, to the extent 
feasible, Sec. 52h.4(a) of this part.
    (3) Where a member of a peer review group participates in or is 
present during:
    (i) Development or review of a project approach or request for 
proposals by said group or
    (ii) Review by said group under Sec. 52h.10(b) or Sec. 52h.10(c), 
i.e. after the issuance of a request for proposals, no contract may 
thereafter be awarded as the result of such development or review to 
said member, his or her spouse, parent, child, or partner or any 
organization in which the member, his or her spouse, parent, child, or 
partner was serving as officer, director, trustee, partner, or employee 
at the time of such development or review or with which the member, his 
or her spouse, parent, child, or partner was negotiating or had any 
arrangement concerning prospective employment at said time.
    (4) No member of a peer review group may participate in any review 
under this part of a specific grant application or contract project for 
which the member has had or is expected to have any other responsibility 
or involvement (whether preaward or postaward) as an officer or employee 
of the United States.
    (c) Where permissible under the statutes, standards, and order cited 
in paragraph (a) of this section, the Director of the National 
Institutes of Health, the Administrator of the Alcohol, Drug Abuse, and 
Mental Health Administration, the Administrator of the Health Resources 
and Services Administration, or their designees may waive the 
requirements in paragraph (b) of this section if he or she determines 
that there is no other practical means for securing appropriate expert 
advice on a particular grant application, contract project, or contract 
proposal.

(Sec. 215, 58 Stat. 690, as amended (42 U.S.C. 216); sec. 475, 88 Stat. 
360, 89 Stat. 315, 92 Stat. 3436 (42 U.S.C. 289l-4))

[43 FR 7862, Feb. 24, 1978, as amended at 45 FR 35328, May 27, 1980; 49 
FR 38111, Sept. 27, 1984]

[[Page 240]]



Sec. 52h.6  Availability of information.

    Transcripts, minutes, and other documents made available to or 
prepared for or by a peer review group will be available for public 
inspection and copying to the extent provided in the Freedom of 
Information Act (5 U.S.C. 552), the Federal Advisory Committee Act (5 
U.S.C. App. I), the Privacy Act (5 U.S.C. 552a), and implementing 
Department of Health and Human Services regulations (45 CFR parts 5, 
5b).



Sec. 52h.7  Grants; matters to be reviewed.

    (a) No awarding official will make a grant based upon an application 
covered by this part unless the application has been reviewed by a peer 
review group in accordance with the provisions of this part and said 
group has made recommendations concerning the scientific merit of such 
application. In addition, where under applicable law an awarding 
official is required to secure the approval or advice of a national 
advisory council or board concerning an application, said application 
will not be considered by the council or board unless it has been 
reviewed by a peer review group in accordance with the provisions of 
this part and said group has made recommendations concerning the 
scientific merit of the application except where the council or board is 
the peer review group.
    (b) Except to the extent otherwise provided for by law, such 
recommendations are advisory only and not binding on the awarding 
official or national advisory council or board.



Sec. 52h.8  Grants; review criteria.

    In carrying out its review under Sec. 52h.7, the peer review group 
will take into account, among other factors:
    (a) The significance and originality from a scientific or technical 
standpoint of the goals of the proposed research;
    (b) The adequacy of the methodology proposed to carry out the 
research;
    (c) The qualifications and experience of the principal investigator 
and proposed staff;
    (d) The reasonable availability of resources necessary to the 
research;
    (e) The reasonableness of the proposed budget and duration in 
relation to the proposed research; and
    (f) Where an application involves activities which could have an 
adverse effect upon humans, animals, or the environment, the adequacy of 
the proposed means for protecting against or minimizing such effects.



Sec. 52h.9  Unsolicited contract proposals; matters to be reviewed.

    (a) No awarding official will award a contract based upon an 
unsolicited contract proposal covered by this part unless the proposal 
has been reviewed by a peer review group in accordance with the 
provisions of this part (pursuant to procedures set forth in 41 CFR 
subpart 3-4.52) and said group has made recommendations concerning the 
scientific merit of such proposal.
    (b) Except to the extent otherwise provided for by law, such 
recommendations are advisory only and not binding on the awarding 
official.



Sec. 52h.10  Contract projects involving solicited contract proposals; matters to be reviewed.

    (a) Subject to paragraph (b) of this section, no awarding official 
will issue a request for contract proposals with respect to a contract 
project involving solicited contract proposals unless the project 
concept has been reviewed by a peer review group in accordance with the 
provisions of this part and said group has made recommendations 
concerning the scientific merit of said concept. Where in the judgment 
of the awarding official the project approach has been sufficiently well 
defined by the time the review required by the preceding sentence is 
conducted, this review and the resulting recommendations shall include 
the project approach as well.
    (b) The awarding official may waive the requirements of paragraph 
(a) of this section for peer review before issuing a request for 
contract proposals if he determines that the accomplishments of 
essential program objectives would otherwise be placed in jeopardy and 
any further delay would clearly not be in the best interest of the 
Government. The awarding official shall specify in writing the grounds 
on which this determination is based. Under such circumstances, the 
awarding official will not award a contract based on

[[Page 241]]

the request for contract proposals unless the proposals received in 
response to the request have been reviewed by a peer review group and 
that group has made recommendations concerning the scientific merit of 
the project concept and of the approaches outlined in the proposals. The 
request for proposals will indicate that the project concept has not 
been reviewed by a peer review group and that no award will be made 
until such review is conducted and recommendations made based on such 
review.
    (c) The Director of the National Institutes of Health, the 
Administrator of the Alcohol, Drug Abuse and Mental Health 
Administration, the Administrator of the Health Resources and Service 
Administration, or their designees may identify individual contracts or 
classes of contracts which may not be awarded unless all pertinent 
contract proposals have been reviewed by a peer review group in 
accordance with the provisions of this part and that group has made 
recommendations concerning the scientific merit of the proposals.
    (d) Except to the extent otherwise provided for by law, such 
recommendations are advisory only and not binding on the awarding 
official.

(Sec. 215, Public Health Service Act, 58 Stat. 690, as amended (42 
U.S.C. 216); sec. 475, Public Health Service Act, 88 Stat. 360, 89 Stat. 
351, 92 Stat. 3436 (42 U.S.C. 2891-4); sec. 955(a), Pub. L. 97-35, 95 
Stat. 590 (42 U.S.C. 300z-7(e)))

[43 FR 7862, Feb. 24, 1978, as amended at 45 FR 35328, May 27, 1980; 49 
FR 38111, Sept. 27, 1984]



Sec. 52h.11  Contract projects and proposals; review criteria.

    (a) In carrying out its review of a project concept under 
Sec. 52h.10(a) or Sec. 52h.10(b), the peer review group will take into 
account, among other factors:
    (1) The significance from a scientific or technical standpoint of 
the goals of the proposed research or development activity;
    (2) The availability of the technology and other resources necessary 
to achieve these goals;
    (3) The extent to which there are identified, practical uses for the 
anticipated results of the activity; and
    (4) Where the review includes the project approach, the adequacy of 
the methodology to be utilized in carrying out the activity.
    (b) In carrying out its review of unsolicited contract proposals 
under Sec. 52h.9, the peer review group will take into account, among 
other factors, those criteria in Sec. 52h.8 which are relevant to the 
particular proposals.
    (c) In carrying out its review of solicited contract proposals under 
Sec. 52h.10(c) the peer review group will evaluate each proposal in 
accordance with the criteria set forth in the request for proposals.



Sec. 52h.12  Applicability of other regulations.

    The regulations in this part are in addition to, and do not 
supersede other regulations concerning grant applications, contract 
projects, or contract proposals appearing elsewhere in this title, title 
41, or title 45 of the Code of Federal Regulations.



PART 53--GRANTS, LOANS AND LOAN GUARANTEES FOR CONSTRUCTION AND MODERNIZATION OF HOSPITALS AND MEDICAL FACILITIES--Table of Contents




Subparts A-K  [Reserved]

   Subpart L--Services for Persons Unable to Pay; Community Service; 
                            Nondiscrimination

Sec.
53.111  Services for persons unable to pay.
53.112  Nondiscrimination.
53.113  Community service.

Subpart M  [Reserved]

               Subpart N--Loan Guarantees and Direct Loans

53.154  Waiver of right of recovery.
53.155  Modification of loans.
53.156  Fees for modification requests.

    Authority: Secs. 215, 603, 609, 621, 623, Public Health Service Act 
as amended, 58 Stat. 690, 78 Stat. 451 and 456, 84 Stat. 344 and 346 (42 
U.S.C. 216, 291c, 291i, 291j-1 and 291j-3; 31 U.S.C. 9701).

Subparts A-K  [Reserved]

[[Page 242]]



   Subpart L--Services for Persons Unable to Pay; Community Service; 
                           Nondiscrimination.



Sec. 53.111  Services for persons unable to pay.

    (a) Applicability. The provisions of this section apply to every 
applicant which heretofore has given or hereafter will give an assurance 
that it will make available a reasonable volume of services to persons 
unable to pay therefor but shall not apply to an applicant (1) for more 
than 20 years after the completion of construction of any facility with 
respect to which funds have been paid under section 606 of the Act or 
(2) beyond the period during which any amount of a direct loan made 
under sections 610 or 623 of the Act, or any amount of a loan with 
respect to which a loan guarantee and interest subsidy has been provided 
under sections 623 and 624 of the Act remains unpaid.
    (b) Definitions. As used in this section:
    (1) The term facility includes hospitals, facilities for long-term 
care, outpatient facilities, rehabilitation facilities, and public 
health centers;
    (2) The term applicant means an applicant for, or recipient of, a 
grant, a loan guarantee or a loan under the Act;
    (3) Fiscal year means the fiscal year of the applicant;
    (4) The term operating costs means the actual operating costs of the 
applicant for a fiscal year as determined in accordance with cost 
determination principles and requirements under title XVIII of the 
Social Security Act (42 U.S.C. 1395): Provided, That such ``operating 
costs'' shall be determined for the applicant's entire facility and for 
all patients regardless of the source of payment for such care: And 
provided further, That in determining such operating costs there shall 
be deducted the amount of all actual or estimated reimbursements, as 
applicable, for services received or to be received pursuant to title 
XVIII and XIX of the Social Security Act (42 U.S.C. 1395 and 1936);
    (5) The term reasonable cost means the cost of providing services to 
a specific patient determined in accordance with the cost determination 
principles and requirements under title XVIII of the Social Security Act 
(42 U.S.C. 1395) and subpart D of the regulations thereunder (20 CFR 
part 405,1part 401 et seq.);
---------------------------------------------------------------------------

    1 Redesignated as 42 CFR part 405 at 42 FR 52826, Sept. 
30, 1977.
---------------------------------------------------------------------------

    (6) The term uncompensated services means services which are made 
available to persons unable to pay therefor without charge or at a 
charge which is less than the reasonable cost of such services. The 
level of such services is measured by the difference between the amount 
charged such persons for such services and the reasonable cost thereof;
    (7) Reasonable volume of services to persons unable to pay therefor 
means a level of uncompensated services which meets a need for such 
services in the area served by an applicant and which is within the 
financial ability of such applicant to provide.
    (c) Assurance. (1) Before an application under this part is 
recommended by a State agency to the Secretary for approval, the State 
agency shall obtain an assurance from the applicant that there will be 
made available in the facility or portion thereof to be constructed or 
modernized a reasonable volume of services to persons unable to pay 
therefor. The requirement of an assurance from an applicant shall be 
waived if the applicant demonstrates to the satisfaction of the State 
agency, subject to subsequent approval by the Secretary, that such a 
requirement is not feasible from a financial viewpoint.
    (2) Prior to recommending that such requirement be waived, the State 
agency shall publish in a newspaper of general circulation in the area 
served by the applicant a notice of the request for such waiver and 
invite public comment thereon, allowing not less than 30 days therefor. 
All comments received shall be available for public inspection, and 
shall be considered by the State agency in arriving at its 
recommendation. Notice of the determination on the request for waiver 
shall be given to all interested persons and to the public before the 
approval of the Secretary is sought.
    (d) Presumptive compliance guideline. An applicant which, for a 
fiscal year, (1) budgets for the support of, and

[[Page 243]]

makes available on request, uncompensated services at a level not less 
than the lesser of 3 percent of operating costs or 10 percent of all 
Federal assistance provided to or on behalf of the applicant under the 
Act, or (2) certifies that it will not exclude any person from admission 
on the ground that such person is unable to pay for needed services and 
that it will make available to each person so admitted services provided 
by the facility without charge or at a charge below reasonable cost 
which does not exceed any such person's ability to pay therefor as 
determined in accordance with criteria established pursuant to paragraph 
(g), shall be deemed in presumptive compliance with its assurance. In 
the case of a loan guarantee with interest subsidy or a direct loan 
guarantee be sold by the Secretary with an interest subsidy, the amount 
of Federal assistance shall include the total amount of the interest 
subsidy which the Secretary is, or will be, obligated to pay over the 
full life of the loan, as well as any other payments which the Secretary 
makes on behalf of the applicant in connection with the loan guarantee 
or the direct loan which has been sold.
    (e) Compliance reports. (1) Each applicant shall, not later than 120 
days after the end of a fiscal year, unless a longer period is approved 
by the State agency for good cause shown, file with the State agency a 
copy of its annual statement for such year as required by section 646 of 
the Act and Sec. 53.128(q), which shall set forth its operating costs.
    (2) With respect to each fiscal year for which a level of 
uncompensated services has been established in accordance with this 
section, the annual statement shall also set forth the amount of 
uncompensated services provided in such year.
    (i) The provision of a level of uncompensated services in such year 
which equals or exceeds the level established pursuant to paragraph (h) 
of this section for such year shall constitute compliance with the 
assurance.
    (ii) If the level of services provided was less than the level of 
uncompensated services established pursuant to paragraph (h) of this 
section, the applicant shall submit with such statement: A justification 
therefor, showing that the provision of such lower level of 
uncompensated services was reasonable under the circumstances; and a 
description of the steps it proposes to take to assure the availability 
and utilization of the level of uncompensated services to be established 
for the current fiscal year, which shall include an affirmative action 
plan, utilizing press releases or other appropriate means as the 
facility may desire to bring to the attention of the public the 
availability of such uncompensated services and the conditions of 
eligibility therefor.
    (3) Each applicant shall file with its annual statement a copy of 
that portion of its adopted budget for the current fiscal year relating 
to the support of uncompensated services in such year. Such budget for 
uncompensated services shall be based on the operating costs of the 
applicant for the preceding fiscal year and shall give due cognizance to 
probable increases in operating costs. Except in the case of a 
certification pursuant to paragraph (d)(2) of this section, if the 
budget statement does not conform to the presumptive compliance 
guideline, the applicant shall submit with its statement.
    (i) A justification therefor, showing that such lower level of 
uncompensated services is reasonable under the circumstances, and
    (ii) A plan to increase such uncompensated services to meet the 
presumptive compliance guideline or such other level of uncompensated 
services as may have been established or as it requests the State agency 
to establish in accordance with paragraph (h) of this section.
    (4) The applicant shall also submit such additional reports related 
to compliance with its assurance as the State agency may reasonably 
require.
    (5) Pending the establishment of a level of uncompensated services 
for any fiscal year pursuant to paragraph (h) of this section, the 
applicant shall, in such fiscal year, provide a level of services which 
is the higher of
    (i) The level established for the preceding fiscal year (or if no 
such level has been established for such prior year, the level of 
services provided in such year) or

[[Page 244]]

    (ii) The level proposed in its adopted budget for the current fiscal 
year.
    (f) Qualifying services. (1) In determining the amount of 
uncompensated services provided by an applicant, there shall be included 
only those services provided to an individual with respect to whom the 
applicant has made a written determination prior to the provision of 
such services that such individual is unable to pay therefor under the 
criteria established pursuant to 42 CFR 53.111(g), except that:
    (i) Such determination may be made after the provision of such 
services in the case of services provided on an emergency basis: 
Provided, That when billing is made for such service, such billing must 
be accompanied by substantially the information required in the posted 
notice under paragraph (i) of this section; and
    (ii) Such determination may be made after the provision of such 
services in the case of a change in circumstances as a result of the 
illness or injury occasioning such services (e.g., the patient's 
financial condition has changed due to a loss of wages resulting from 
the illness) or in case of insurance coverage or other resources being 
less than anticipated or the costs of services being greater than 
anticipated. Further, in all cases where such determination was not made 
prior to the provision of services, such services may not be included as 
uncompensated services if any collection effort has been made other than 
the rendering of bills permissible in the above exceptions: Provided, 
That such a determination may be made at any time if the determination 
was hindered or delayed by reason of erroneous or incomplete information 
furnished by or in behalf of the patient.
    (2) There shall be excluded from the computation of uncompensated 
services:
    (i) Any amount which the applicant has received, or is entitled to 
receive, from a third party insurer or under a governmental program; and
    (ii) The reasonable cost of any services for which payment in whole 
or in part would be available under a governmental program (e.g., 
Medicare and Medicaid) in which the applicant, although eligible to do 
so, does not participate, but only to the extent of such otherwise 
available payment.
    (g) Persons unable to pay for services. (1) The State agency shall 
set forth in its State plan, subject to approval by the Secretary, 
criteria for identifying persons unable to pay for services, which shall 
include persons who are otherwise self-supporting but unable to pay the 
full charge for needed services. Such criteria shall be based on the 
following or similar factors:
    (i) The health and medical care insurance coverage, personal or 
family income, the size of the patient's family, and other financial 
obligations and resources of the patient or the family in relation to 
the reasonable cost of the services;
    (ii) Generally recognized standards of need such as:
    (a) The State standard for the medically needy as determined for the 
purposes of the Aid for Families with Dependent Children program;
    (b) The current Social Security Administration poverty income level;
    (c) The current Office of Economic Opportunity Income Poverty 
Guidelines applicable in the area; or
    (iii) Any other equivalent measures which are found by the Secretary 
to provide a reasonable basis for determining an individual's ability to 
pay for medical and hospital services.
    (2) A copy of such criteria shall be provided by the applicant, upon 
request, to any patient or former patient of the applicant and to any 
person seeking services from the applicant.
    (3) The State agency shall provide a copy of such criteria to any 
person requesting it.
    (h) Level of uncompensated services. (1) The State agency shall set 
forth in its State plan procedures for the determination for each 
applicant of the level of uncompensated services which constitutes a 
reasonable volume of services to persons unable to pay therefor provided 
that in no event shall the level of uncompensated services established 
under this section exceed the presumptive compliance guideline.
    (2) The State agency shall for the purpose of making such 
determination, review, and evaluate the annual statement, the budget and 
the related documents submitted by each applicant

[[Page 245]]

pursuant to paragraph (e) of this section, by applying the following 
criteria:
    (i) The financial status of the applicant, taking account of income 
from all sources, and its financial ability to provide uncompensated 
services;
    (ii) The nature and quantity of services provided by the applicant;
    (iii) The need within the area served by the applicant for the 
provision, without charge or at charge which is less than reasonable 
cost, for services of the nature provided or to be provided by the 
applicant; and
    (iv) The extent and nature of joint or cooperative programs with 
other facilities for the provision of uncompensated services, and the 
extent and nature of outreach services directed to the needs of 
underserved areas.
    (3) In accordance with its findings made after such review and 
evaluation, the State agency shall, within 60 days after receipt of the 
annual statement and related documents required by paragraph (e) of this 
section, for each fiscal year of an applicant which begins following the 
expiration of 90 days after the effective date of this regulation:
    (i) Establish a level of uncompensated services for each applicant 
which may be equal to or less than the presumptive compliance guideline: 
Provided, That if the State agency determines, in accordance with 
paragraph (h)(2) of this section, that (a) there is a need in the area 
served by an applicant for a level of uncompensated services greater 
than the level proposed in the applicant's budget statement, and (b) the 
applicant is financially able to provide such greater level of 
uncompensated services, the State agency shall establish such greater 
level as the level applicable to the applicant; and
    (ii) Accept or modify a plan submitted pursuant to paragraph (e) of 
this section.
    (4) The State agency shall notify the applicant in writing of the 
level of uncompensated services which it has established for the 
applicant for the fiscal year. At the time of notifying the applicant, 
the State agency shall also publish as a public notice in a newspaper of 
general circulation within the community served by the applicant the 
rate that has been established and a statement that the documents upon 
which the agency based its determination are available for public 
inspection at a location and time prescribed. In the case of the 
establishment by the State agency of a rate which is less than the 
presumptive compliance guideline, such notice shall also include a 
statement that persons wishing to object to the rate established may do 
so by writing to the State agency within 20 days after publication of 
the notice: Provided, That the applicant may object to any level 
established which is greater than the level proposed in the applicant's 
budget statement.
    (5) In accordance with the provisions of paragraph (h)(4) of this 
section, the applicant or any person or persons residing or located 
within the area served by the applicant, or any organization on behalf 
of such person or persons, may submit to the State agency within 20 days 
of the publication and sending of the notice objections to the rate 
established by the State agency for the applicant. Such objections may 
be supported in writing by factual information and argument. The State 
agency shall give public notice of receipt of the objections and shall 
make the objections and their supporting documents available for public 
inspection and comment. It may, if it believes that determination of the 
objections will be assisted by oral evidence or by oral argument, set a 
public hearing on the objections and shall give notice of such hearing 
to all interested parties and to the public. The State agency shall 
within 60 days of the expiration of the period within which objections 
may be filed, rule upon the objections in writing, stating its reason 
for sustaining or overruling them, in whole or in part, and establishing 
finally the rate of uncompensated services either the same as, above, or 
below the rate previously established, as may best accord with all of 
the evidence on file with or heard by the State agency. Notice of the 
final determination shall be mailed to all parties who filed objections 
or who participated in the proceedings leading to the redetermination.

[[Page 246]]

    (6) Within 20 days of receipt of written notice of the final 
determination of a State agency after ruling on objections to the rate 
established by the State agency, the applicant or any other interested 
person or organization may submit to the Secretary a written request for 
review of the State agency determination. Such review shall be made upon 
the record of the State agency determination which shall be sustained if 
supported by substantial evidence and is not otherwise arbitrary or 
capricious. If the Secretary or his designee determines that the rate 
established by the State agency is unsupported by the evidence in the 
record or is otherwise arbitrary or capricious, the Secretary or his 
designee shall, upon the basis of the record or upon other evidence or 
information which is before him or which he may obtain, establish a 
level of uncompensated services which he determines, in accordance with 
the criteria set out in paragraph (h)(2) of this section, is 
appropriate.
    (7) The level of uncompensated services established for an applicant 
under this section for any fiscal year shall constitute a reasonable 
volume of services to persons unable to pay therefor with respect to 
such applicant for such fiscal year.
    (i) Posted notice. The applicant shall post notice (which shall be 
multilingual where the applicant serves a multilingual community), in 
substantially the following form, in appropriate areas within the 
facility (admissions, office, emergency department and business office) 
for the purpose of informing patients or potential patients that 
criteria for eligibility and applications are available upon request:

                    Notice of Hill-Burton Obligation

    This hospital (or other facility) is required by law to give a a 
reasonable amount of service at no cost or less than full cost to people 
who cannot pay. If you think that you are eligible for these services, 
please contact our business office (give office location) and ask for 
assistance. If you are not satisfied with the results, you may contact 
(the State Hill-Burton agency with address).
    Provided, That an applicant which has selected a presumptive 
compliance guideline under paragraph (d)(1) of this section may, at its 
option, either (1) add to such notice language stating that the 
facility's obligation is limited to a specified dollar volume of 
uncompensated services and that if the facility has, during a specified 
period (e.g., year, quarter, month), already provided a volume of 
uncompensated services sufficient to satisfy such obligation, any person 
inquiring about such services will be given a written statement to that 
effect which shall also state when additional uncompensated services 
will be available; or (2) post an additional notice stating that the 
facility's obligation has been satisfied for the current period and 
stating when additional uncompensated services will be available.

    (j) Evaluation and enforcement. The State plan shall provide for 
evaluation and enforcement of the assurance in accordance with the 
following requirements:
    (1) The State agency shall,
    (i) At least annually, perform evaluations of the amount of the 
various services provided in each facility with respect to which Federal 
assistance has been provided under the Act, to determine whether such 
assurance is being complied with; and
    (ii) Establish procedures for the investigation of complaints that 
such assurance is not being complied with.
    (2) Evaluation pursuant to paragraph (j)(1) of this section shall be 
based on the annual budget of each facility for uncompensated services 
and on financial statements of such facilities filed pursuant to section 
646 of the Act and Sec. 53.128(q), and on such other information, 
including reports of investigations and hearing decisions, as the State 
agency deems relevant and material.
    (3) The State plan shall provide for adequate methods of enforcement 
of the assurance, including effective sanctions to be applied against 
any facility which fails to comply with such assurance. Such sanctions 
may include, but need not be limited to, license revocation, termination 
of State assistance, and court action.
    (k) Reports. (1) The State agency shall, not less often than 
annually, report in writing to the Secretary its evaluation of each 
facility's compliance with the assurance, the disposition of each 
complaint received by the State agency, proposed remedial action with 
respect to each facility found by

[[Page 247]]

the State agency to be not in compliance with the assurance, and the 
status of such remedial action.
    (2) In addition, the State agency shall promptly report to the 
Regional Attorney and Regional Health Director of the Department of 
Health and Human Services the institution of any legal action against a 
facility or the State agency involving compliance with the assurance.

[37 FR 14721, July 22, 1972, as amended at 38 FR 16354, June 22, 1973; 
40 FR 46203, Oct. 6, 1975]



Sec. 53.112  Nondiscrimination.

    (a) Before an application is recommended by a State agency to the 
Secretary for approval, the State agency shall obtain an assurance from 
the applicant that all portions and services of the entire facility for 
the construction or modernization of which, or in connection with which, 
aid under the Act is sought will be made available without 
discrimination on account of creed and no professionally qualified 
person will be discriminated against on account of creed with respect to 
the privilege of professional practice in the facility.
    (b) Each construction contract is subject to the condition that the 
applicant shall comply with the requirements of Executive Order 11246, 
September 24, 1965 (30 FR 12319), relating to nondiscrimination in 
construction contract employment, and the applicable rules, regulations, 
and procedures prescribed pursuant thereto.
    (c) Attention is called to the requirement of title VI of the Civil 
Rights Act of 1964 (42 U.S.C. 2000d; 78 Stat. 252) which provides that 
no person in the United States shall, on the ground of race, color, or 
national origin be excluded from participation in, be denied the 
benefits of, or be subjected to discrimination under any program or 
activity receiving Federal financial assistance. A regulation 
implementing such title VI, applicable to assistance under this part for 
construction and modernization of hospitals and medical facilities, has 
been issued by the Secretary of Health and Human Services with the 
approval of the President (45 CFR part 80).

[37 FR 182, Jan. 6, 1972, as amended at 39 FR 31767, Aug. 30, 1974]



Sec. 53.113  Community service.

    (a) Applicability. The provisions of this section apply to every 
applicant which heretofore has given or hereafter will give a community 
service assurance.
    (b) Definitions. As used in this section:
    (1) The term community service assurance means an assurance required 
by regulations promulgated pursuant to section 603(e)(1) of the Act or 
the predecessor of that section (section 622(f), Public Health Service 
Act, enacted by Pub. L. 79-725, 60 Stat. 1041).
    (2) The term facility has the same meaning as is given it in 
Sec. 53.111(b)(1).
    (3) The term applicant has the same meaning as is given it in 
Sec. 53.111(b)(2).
    (4) The term fiscal year has the same meaning as is given it in 
Sec. 53.111(b)(3).
    (c) Assurance. Before an application under this part is recommended 
by a State agency to the Secretary for approval, the State agency shall 
obtain an assurance from the applicant that the facility will furnish a 
community service.
    (d) Compliance. In order to comply with its community service 
assurance an applicant must:
    (1)(i) Make the services it furnishes available to the general 
public, or
    (ii) Limit the availability of such services only on the basis of 
age, medical indigency, or type or kind of medical or mental disability, 
or
    (iii) If the facility constitutes a medical or nursing care unit of 
a home or other institution, make such home or other institution 
available in accordance with paragraph (d)(1) (i) or (ii) of this 
section; and
    (2)(i) Make arrangements, if eligible to do so, for reimbursement 
for services with:
    (A) Those principal State and local governmental third-party payors 
which provide reimbursement for services that is not less than the 
actual cost of such services as determined in accordance with accepted 
cost accounting principles; and

[[Page 248]]

    (B) Those Federal governmental third-party programs, such as 
Medicare and Medicaid, to the extent that the applicant is entitled to 
reimbursement at reasonable cost under a formula established in 
accordance with applicable Federal law.
    (ii) Take such additional steps as may be necessary to ensure that 
admission to and services of the facility will be available to 
beneficiaries of the governmental programs specified in paragraph 
(d)(2)(i) of this section without discrimination (or preference) on 
account of their being such beneficiaries.
    (e) Reports. The annual statement required by section 646 of the Act 
and Sec. 53.128(q), a copy of which must be submitted to the State 
agency in accordance with the requirements of Sec. 53.111(e)(1), shall 
set forth the amount of the reimbursement received pursuant to each 
arrangement with a principal governmental third-party payor.
    (f) Evaluation and enforcement. The State plan shall provide for 
evaluation and enforcement of the community service assurance in 
accordance with the following requirements:
    (1) The State agency shall,
    (i) At least annually, evaluate the compliance of facilities with 
such assurance; and
    (ii) Establish procedures for the investigation of complaints that 
such assurance is not being complied with.
    (2) The State plan shall provide for adequate methods of enforcement 
of the assurance, including effective sanctions to be applied against 
any facility which fails to comply with such assurance. Such sanctions 
may include, but need not be limited to, license revocation, termination 
of State assistance and court action.
    (g) Reports. (1) The State agency shall, not less often than 
annually, report in writing to the Secretary its general evaluation of 
facilities' compliance with the assurance, the disposition of each 
complaint received by the State agency, proposed remedial action with 
respect to each facility found by the State agency to be not in 
compliance with the assurance, and the status of such remedial action.
    (2) In addition, the State agency shall promptly report to the 
Regional Attorney and Regional Health Director of the Department of 
Health and Human Services the institution of any legal action against a 
facility or the State agency involving compliance with the assurance.

[39 FR 31767, Aug. 30, 1974, as amended at 42 FR 16780, Mar. 30, 1977]

Subpart M  [Reserved]



               Subpart N--Loan Guarantees and Direct Loans



Sec. 53.154  Waiver of right of recovery.

    In determining whether there is good cause for waiver of any right 
of recovery which he may have against a nonprofit private agency by 
reason of any payments made pursuant to a loan guarantee, or against a 
public agency by reason of the failure of such agency to make payments 
of principal and interest on a direct loan to such agency, the Secretary 
shall take into consideration the extent to which:
    (a) The facility with respect to which the loan guarantee or direct 
loan was made will continue to be devoted by the applicant or other 
owner to use for the purpose for which it was constructed or another 
public or nonprofit purpose which will promote the purposes of the Act;
    (b) There are reasonable assurances that for the remainder of the 
repayment period of the loan other public or non-profit facilities not 
previously utilized for the purpose for which the facility was 
constructed will be so utilized and are substantially equivalent in 
nature and extent for such purposes; and
    (c) Such recovery would seriously curtail the provision of medical 
services to persons in need of such services in the area.

[37 FR 182, Jan. 6, 1972]



Sec. 53.155  Modification of loans.

    No official of the Department of Health and Human Services will 
approve any proposal to modify the terms of a loan guaranteed under 
title VI of the Public Health Service Act (42 U.S.C. 291 et seq.) and 
this subpart which would permit the use of the guaranteed loan (or the 
guarantee) as

[[Page 249]]

collateral for an issue of tax-exempt securities.

[48 FR 42984, Sept. 21, 1983]



Sec. 53.156  Fees for modification requests.

    (a) Fees will be charged for the processing of requests for parity, 
and for major and minor modifications of the terms of documents 
evidencing and securing direct and guaranteed loans. In accordance with 
the requirements of the User Charge Statute, 31 U.S.C. 9701(b), the 
Secretary determines the amount of the application fee that must be 
submitted with each type of modification.
    (1) As used in this section, a request for parity allows new debt to 
share lien position (i.e. collateral) with an existing Hill-Burton loan.
    (2) As used in this section, a major modification is any 
modification involving the release of $100,000 or more of collateral; a 
corporate restructuring that involves a transfer of assets; master 
indenture requests; modifications to a sinking fund; defeasance requests 
and requests for additional secured indebtedness; and any, other 
modification that involves a comparably significant use of Department 
resources.
    (3) As used in this section, a minor modification is any 
modification involving the release of less than $100,000 of collateral; 
an easement; and any other modification that involves a comparable use 
of Department resources.
    (b) A request for modification is to be accompanied by a certified 
check or money order in the amount of the appropriate fee, payable to 
the U.S. Treasury. The fees for modification requests submitted on or 
after October 28, 1986 are as follows:
    (1) $1,500 for a minor modification,
    (2) $4,500 for a major modification, and
    (3) $5,500 for a request for parity.
    (c) A submitter may withdraw its request for modification within 10 
business days following its receipt and receive a refund of the fee.
    (d) If the Secretary determines that a change in the amount of a fee 
is appropriate, the Department will issue a notice of proposed 
rulemaking in the Federal Register to announce the proposed amount.

[51 FR 39376, Oct. 28, 1986]



PART 55a--PROGRAM GRANTS FOR BLACK LUNG CLINICS--Table of Contents




                      Subpart A--General Provisions

Sec.
55a.101  Definitions.
55a.102  Who is eligible to apply for a Black Lung clinics grant?
55a.103  What criteria has HHS established for deciding which grant 
          application to fund?
55a.104  What confidentiality requirements must be met?
55a.105  How must grantees carry out their projects?
55a.106  Provision for waiver by the Secretary.
55a.107  What other regulations apply?

                       Subpart B--Grants to States

55a.201  What is required for a State application?

             Subpart C--Grants to Entities Other Than States

55a.301  What is required for an application from an entity other than a 
          State?

    Authority: Sec. 427(a), Federal Mine Safety and Health Act of 1977, 
92 Stat. 100 (30 U.S.C. 937(a)).

    Source: 50 FR 7913, Feb. 27, 1985, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 55a.101  Definitions.

    Act, as used in this part, means the Federal Mine Safety and Health 
Act of 1977, as amended (30 U.S.C. 801 et seq.).
    Secretary means the Secretary of Health and Human Services and any 
other officer or empolyee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    Miner or coal miner means any individual who works or has worked in 
or around a coal mine or coal preparation facility in the extraction or 
preparation of coal. The term also includes an individual who works or 
has worked in coal mine construction or transportation in or around a 
coal mine, to the

[[Page 250]]

extent that the individual was exposed to coal dust as a result of 
employment.



Sec. 55a.102  Who is eligible to apply for a Black Lung clinics grant?

    Any State or public or private entity may apply for a grant under 
this part.



Sec. 55a.103  What criteria has HHS established for deciding which grant application to fund?

    (a) The Secretary will give preference to a State, which meets the 
requirements of this part and applies for a grant under this part, over 
other applicants in that State.
    (b) Within the limits of funds available for these purposes the 
Secretary may award grants to assist in the carrying out of those 
programs which will in the Secretary's judgment best promote the 
purposes of section 427(a) of the Act, taking into account;
    (1) The number of miners to be served and their needs; and
    (2) The quality and breadth of services to be provided.



Sec. 55a.104  What confidentiality requirements must be met?

    All information as to personal facts and circumstances obtained by 
the grantee's staff about recipients of services shall be held 
confidential and shall not be disclosed without the individual's consent 
except as may be required by law or as may be necessary to provide 
service to the individual or to provide for audits with appropriate 
safeguards for confidentiality of patient records. Otherwise, 
information may be disclosed only in summary, statistical, or other form 
which does not identify particular individuals.



Sec. 55a.105  How must grantees carrry out their projects?

    Grantees must carry out their projects in accordance with their 
applications and the provisions of this part.



Sec. 55a.106  Provision for waiver by the Secretary.

    The Secretary may, for good cause shown, waive provisions of these 
regulations.



Sec. 55a.107  What other regulations apply?

    Other regulations which apply to the Black Lung Clinics Program 
include, but are not limited to, the following:

42 CFR part 50, subpart D--Public Health Service grant appeals 
procedure;
42 CFR part 50, subpart E--Maximum allowable cost for drugs;
45 CFR part 16--Procedures of the Departmental Grant Appeals Board;
45 CFR part 19--Limitations on payment or reimbursement for drugs;
45 CFR part 74--Administration of grants;
45 CFR part 75--Informal grant appeals procedures;
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964;
45 CFR part 81--Practice and procedure for hearings under part 80;
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial 
assistance; and
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance.



                       Subpart B--Grants to States



Sec. 55a.201  What is required for a State application?

    An approvable State application must contain assurances that the 
State will:
    (a) Provide the following services for active and inactive miners in 
the State:
    (1) Primary care;
    (2) Patient and family education and counseling;
    (3) Outreach;
    (4) Patient care coordination, including individual patient care 
plans for all patients;
    (5) Antismoking advice; and
    (6) Other symptomatic treatments.
    (b) Provide medical services in consultation with a physician with 
special training or experience in the diagnosis and treatment of 
respiratory diseases.
    (c) Meet all criteria for approval and designation by the Department 
of Labor under 20 CFR part 725 to perform disability examination and 
provide treatment under the Act.

[[Page 251]]

    (d) Use grant funds under this part to supplement and not supplant 
existing services of the State.
    (e) Provide the services described above for those miners previously 
served by a Black Lung Clinic in the State for which grant support 
expires during the funding period of the State's grant.
    (f) Provide services described above regardless of a person's 
ability to pay.
    (g) Audit its expenditures from amounts received under this part in 
accordance with the provisions of Attachment P, Audit Requirements, of 
Office of Management and Budget Circular A-102, Uniform Requirements for 
Assistance to State and Local Governments, as adopted for the Department 
of Health and Human Services by 45 CFR part 74.

(Approved by the Office of Management and Budget under control number 
0915-0081)

[50 FR 7913, Feb. 27, 1985, as amended at 50 FR 53156, Dec. 30, 1985]



             Subpart C--Grants to Entities Other Than States



Sec. 55a.301  What is required for an application from an entity other than a State?

    An approvable application must contain the following:
    (a) A plan for the provision of the services required by 
Sec. 55a.201(a), consistent with the requirements of Sec. 55a.201 (b) 
and (c). The plan must also contain at least the following elements:
    (1) A description of the target population to whom services are to 
be provided, including a statement of the need for services;
    (2) An assurance that charges shall be made for services rendered as 
follows:
    (i) A schedule shall be maintained listing fees or payments for the 
provision of services, designed to cover reasonable costs of operations;
    (ii) A schedule of discounts adjusted on the basis of a patient's 
ability to pay shall be maintained. The schedule of discounts must 
provide for a full discount to individuals and families with annual 
incomes at or below the poverty line established in accordance with 
section 673(2) of the Community Services Block Grant Act (42 U.S.C. 
9902(2)), (except that nominal fees for service may be requested, but 
not required, from individuals and families with annual incomes at or 
below the poverty line). No discounts shall be provided to individuals 
and families with annual incomes greater than twice the poverty line; 
and
    (iii) Where third-party payors (including Government Agencies) are 
authorized or under a legal obligation to pay all or a portion of such 
charges, all services covered by that reimbursement plan will be billed 
and every reasonable effort will be made to obtain payment.
    (b) An assurance that no person will be denied services because of 
inability to pay.
    (c) An assurance that grant funds received under this part will be 
used to supplement and not supplant existing services of the grantee.

(Approved by the Office of Management and Budget under control number 
0915-0081)

[50 FR 7913, Feb. 27, 1985, as amended at 50 FR 53156, Dec. 30, 1985]



PART 56--GRANTS FOR MIGRANT HEALTH SERVICES--Table of Contents




                      Subpart A--General Provisions

Sec.
56.101  Applicability.
56.102  Definitions.
56.103  Eligibility.
56.104  Application.
56.105  Accord with health planning.
56.106  Amount of grant.
56.107  Priorities for grants.
56.108  Use of grant funds.
56.109  Grant payments.
56.110  Nondiscrimination.
56.111  Confidentiality.
56.112  Publications and copyright.
56.113  Grantee accountability.
56.114  Applicability of 45 CFR part 74.

  Subpart B--Grants for Planning and Developing Migrant Health Centers

56.201  Applicability.
56.202  Application.
56.203  Project elements.
56.204  Grant evaluation and award.

[[Page 252]]

         Subpart C--Grants for Operating Migrant Health Centers

56.301  Applicability.
56.302  Application.
56.303  Project elements.
56.304  Governing board.
56.305  Grant evaluation and award.

         Subpart D--Grants for Operating Migrant Health Entities

56.401  Applicability.
56.402  Application.
56.403  Project elements.
56.404  Grant evaluation and award.

  Subpart E--Grants for Planning and Developing Migrant Health Programs

56.501  Applicability.
56.502  Application.
56.503  Project elements.
56.504  Grant evaluation and award.

         Subpart F--Grants for Operating Migrant Health Programs

56.601  Applicability.
56.602  Application.
56.603  Project elements.
56.604  Grant evaluation and award.

               Subpart G--Grants for Technical Assistance

56.701  Applicability.
56.702  Application.
56.703  Project elements.
56.704  Grant evaluation and award.

     Subpart H--Acquisition and Modernization of Existing Buildings

56.801  Applicability of 42 CFR part 51c, subpart E.

    Authority: Secs. 215, 319, Public Health Service Act (42 U.S.C. 216, 
247d).

    Source: 42 FR 60406, Nov. 25, 1977, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 56.101  Applicability.

    The regulations of this subpart are applicable to all grants 
authorized by section 319 of the Public Health Service Act (42 U.S.C. 
247d).



Sec. 56.102  Definitions.

    As used in this part:
    (a) Act means the Public Health Service Act (42 U.S.C. 201 et seq.), 
as amended.
    (b)(1) Agriculture means farming in all its branches, including--
    (i) Cultivation and tillage of the soil;
    (ii) The production, cultivation, growing, and harvesting of any 
commodity grown on, in, or as an adjunct to or part of a commodity grown 
in, or on, the land; and
    (iii) Any practice (including preparation and processing for market 
and delivery to storage or to market or to carriers for transportation 
to market) performed by a farmer or on a farm incident to or in 
conjunction with an activity described in subsection (ii).
    (c) Catchment area means the geographic area served by a project 
funded under section 319 of the Act.
    (d) Environmental health services means the detection and 
alleviation of unhealthful conditions of the environment of the persons 
served by the project, such as problems associated with water supply, 
sewage treatment, solid waste disposal, rodent and parasite infestation, 
field sanitation, and housing conditions and the treatment of medical 
conditions arising therefrom. For the purposes of this part, the 
detection and alleviation of unhealthful conditions of the environment 
includes the notification of appropriate Federal, State, or local 
authorities responsible for correcting such conditions and the making of 
arrangements therefor with such authorities.
    (e) Health professionals means professionals (such as physicians, 
dentists, nurses, podiatrists, optometrists, and physicians' extenders) 
who are engaged in the delivery of health services and who meet all 
applicable Federal or State requirements to provide their professional 
services.
    (f) High impact area means a catchment area which has not less than 
6,000 migratory agricultural workers, seasonal agricultural workers, and 
members of the families of such workers residing within its boundaries 
for more than two months in the most recent calendar year for which 
statistical data acceptable to the Secretary is available.
    (g)(1) Migrant health center means an entity which either through 
its staff and supporting resources or through contracts or cooperative 
arrangements

[[Page 253]]

with other public or private entities provides for migratory 
agricultural workers, seasonal agricultural workers, and the members of 
the families of such workers, within its catchment area:
    (i) Primary health services;
    (ii) As determined by the Secretary to be appropriate for particular 
centers, supplemental health services necessary for the adequate support 
of primary health services;
    (iii) Referral to providers of supplemental health services and 
payment, as determined by the Secretary to be appropriate and feasible, 
for the provision of such services;
    (iv) Environmental health services, as determined by the Secretary 
to be appropriate for particular centers;
    (v) As determined by the Secretary to be appropriate for particular 
centers, infectious and parasitic disease screening and control 
services;
    (vi) As determined by the Secretary to be appropriate for particular 
centers, accident prevention programs, including prevention of excessive 
exposure to pesticides through, but not limited to, notification of 
appropriate Federal, State or local authorities of hazardous conditions 
due to pesticide use; and
    (vii) Information on the availability and proper use of health 
services.
    (2) For purposes of paragraph (g)(1) of this section, the provision 
of a given service by a center will be determined by the Secretary to be 
appropriate where
    (i) There is a need, as determined by the Secretary, for the 
provision of such service to individuals described in paragraph (g)(1) 
of this section in the catchment area; and
    (ii) The provision of such service by the center is feasible, taking 
into consideration the center's projected revenues, other resources, and 
grant support under this part.
    (h) Migratory agricultural worker means an individual whose 
principal employment is in agriculture on a seasonal basis, who has been 
so employed within the last 24 months, and who establishes for the 
purpose of such employment a temporary place of abode;
    (i) Nonprofit, as applied to any private agency, institution, or 
organization, means one which is a corporation or association, or is 
owned and operated by one or more corporations or associations, no part 
of the net earnings of which inures, or may lawfully inure, to the 
benefit of any private shareholder or individual.
    (j) Physician means a licensed doctor of medicine or doctor of 
osteopathy.
    (k) Primary care means preventive, diagnostic, treatment, 
consultant, referral, and other services rendered by physicians 
(including, as appropriate, physicians' extenders), routine associated 
laboratory services and diagnostic radiologic services, and emergency 
health services.
    (l) Primary health services means:
    (1) Diagnostic, treatment, consultative referral, and other services 
rendered by physicians and, where feasible, by physicians' extenders, 
such as physicians' assistants, nurse clinicians, and nurse 
practitioners;
    (2) Diagnostic laboratory services and diagnostic radiologic 
services;
    (3) Preventive health services, including children's eye and ear 
examinations, prenatal and post-partum care, perinatal services, well 
child care (including periodic screening), immunizations, and voluntary 
family planning services;
    (4) Emergency medical services, including provision, through clearly 
defined arrangements, for access of users of the center to health care 
for medical and dental emergencies during and after the center's 
regularly scheduled hours;
    (5) Transportation services as needed for adequate patient care, 
sufficient so that residents of the catchment area served by the center 
with special difficulties of access to services provided by the center 
receive such services; and
    (6) Preventive dental services provided by a licensed dentist or 
other qualified personnel, including--
    (i) Oral hygiene instruction;
    (ii) Oral prophylaxis, as necessary; and
    (iii) Topical application of fluorides, and the prescription of 
fluorides for systemic use when not available in the community water 
supply.
    (m) Seasonal agricultural worker means an individual whose principal

[[Page 254]]

employment is in agriculture on a seasonal basis and who is not a 
migratory agricultural worker.
    (n) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (o) Supplemental health services means health services which are not 
included as primary health services and which are:
    (1) Inpatient and outpatient hospital services;
    (2) Home health services;
    (3) Extended care facility services;
    (4) Rehabilitative services (including physical and occupational 
therapy) and long-term physical medicine;
    (5) Mental health services, including services of psychiatrists, 
psychologists, and other appropriate mental health professionals;
    (6) Dental services other than those provided as primary health 
services;
    (7) Vision services, including routine eye and vision examinations 
and provision of eyeglasses, as appropriate and feasible;
    (8) Allied health services;
    (9) Pharmaceutical services, including the provision of prescription 
drugs;
    (10) Therapeutic radiologic services;
    (11) Ambulatory surgical services;
    (12) Public health services (including nutrition education and 
social services);
    (13) Health education services; and
    (14) Services including the services of outreach workers, which 
promote and facilitate optimal use of primary health services and 
services referred to in the preceding subparagraphs of this paragraph 
and, if a substantial number of individuals in the population served by 
the center are of limited English-speaking ability, the services of 
outreach workers and other personnel fluent in the language or languages 
spoken by such individuals.



Sec. 56.103  Eligibility.

    Any public or nonprofit private entity is eligible to apply for a 
grant under this part.



Sec. 56.104  Application.

    (a) An application for a grant under this part shall be submitted to 
the Secretary at such time and in such form and manner as the Secretary 
may prescribe.
    (b) The application shall contain a budget and narrative plan of the 
manner in which the applicant intends to conduct the project and carry 
out the requirements of this part. The application must describe how and 
the extent to which the project has met, or plans to meet, each of the 
requirements in subpart B (relating to grants for planning and 
development of migrant health centers), subpart C (relating to grants 
for the operation of migrant health centers), subpart D (relating to 
grants for the operation of migrant health entities), subpart E 
(relating to grants for planning and developing migrant health 
programs), subpart F (relating to grants for the operation of migrant 
health programs), or subpart G (relating to grants for technical 
assistance), as applicable. In addition, applications must include:
    (1) A statement of specific, measurable objectives and the methods 
to be used to assess the achievement of the objectives in specified time 
periods and at least on an annual basis.
    (2) The precise boundaries of the catchment area to be served by the 
applicant. In addition, the application shall include information 
sufficient to enable the Secretary to determine that the applicant's 
catchment area meets the following criteria:
    (i) The size of such area is such that the services to be provided 
by the applicant are available and accessible to the residents of the 
area promptly and as appropriate;
    (ii) The boundaries of such area conform, to the extent practicable, 
to relevant boundaries of political subdivisions, school districts, and 
areas served by Federal and State health and social service programs; 
and
    (iii) The boundaries of such area eliminate, to the extent possible, 
barriers resulting from the area's physical characteristics, its 
residential patterns, its economic and social groupings, and available 
transportation.

[[Page 255]]

    (3)(i) The number of migratory agricultural workers and members of 
their families, and seasonal agricultural workers and members of their 
families which resided in the project's catchment area in the most 
recent calendar year for which statistical data acceptable to the 
Secretary is available; and
    (ii) The approximate period or periods of residence of all groups of 
migratory agricultural workers and their families counted under 
paragraph (b)(3)(i) of this section.
    (4) The results of an assessment of the need that the population to 
be served has for the services to be provided by the project (or in the 
case of applications for planning and development projects, the methods 
to be used in assessing such need), taking into consideration the 
following factors:
    (i) Available health resources in relation to size of the catchment 
area and population of migratory and seasonal agricultural workers and 
their families in such area, including appropriate ratios of primary 
care physicians in general or family practice, internal medicine, 
pediatrics, or obstetrics and gynecology, to such population;
    (ii) Health indices for such population, such as infant mortality 
rate;
    (iii) Economic factors affecting such population's use of health 
services, such as percentage of such population with incomes below the 
poverty level;
    (iv) Demographic factors affecting such population's need and demand 
for health services, such as percentage of such population age 65 and 
over; and
    (v) Special factors of access resulting from the conditions of 
employment of such workers (including working hours, housing, and 
sanitation).
    (5) Position descriptions for personnel who will be utilized in 
carrying out the activities of the project and a statement indicating 
the need for the positions to be supported with grant funds to 
accomplish the objectives of the project.
    (6) Letters and other forms of evidence showing that efforts have 
been made to secure financial and professional assistance and support 
for the project within the proposed catchment area and the continuing 
involvement of the community in the development and operation of the 
project.
    (7) An assurance that an independent certified public accountant 
will be engaged to certify that the project's system for the management 
and control of its finances will be in accord with sound financial 
management practices, including applicable Federal requirements.
    (8) A list of all services proposed to be provided by the project.
    (9) A list of services which are to be provided directly by the 
project through its own staff and resources and a description of any 
contractual or other arrangements (including copies of documents, where 
available) entered into, or planned for the provision of services.
    (10) The schedule of fees and/or payments and schedule of discounts 
for services provided by the project.
    (11) If the applicant provides services to populations other than 
migratory and seasonal agricultural workers and their families, 
identification of such populations.

    Note: Funds granted under this part and non-Federal funds required 
to be expended by the project as a condition of any such grant may not 
be used to provide services to individuals who are not migratory or 
seasonal agricultural workers or members of the families of such 
workers.

    (12) Evidence that all applicable requirements for review and/or 
approval of the application under title XV of the Act have been met.
    (13) An assurance that the project will be conducted in accordance 
with the applicable requirements of this part.
    (c) The application must be executed by an individual authorized to 
act for the applicant and to assume on behalf of the applicant the 
obligations imposed by the statute, the applicable regulations of this 
part, and any additional conditions of the grant.

(Sec. 215, Public Health Service Act, 58 Stat. 690, 67 Stat. 631 (42 
U.S.C. 216); sec. 329, Public Health Service Act, 95 Stat. 569 (42 
U.S.C. 254b)).

[42 FR 60406, Nov. 25, 1977, as amended at 48 FR 29202, June 24, 1983; 
48 FR 45559, Oct. 6, 1983]

[[Page 256]]



Sec. 56.105  Accord with health planning.

    A grant may be made under this part only if the applicable 
requirements of title XV of the Act relating to review and approval by 
the appropriate health planning agencies have been met.



Sec. 56.106  Amount of grant.

    (a) The amount of any award under this part will be determined by 
the Secretary on the basis of his estimate of the sum necessary for a 
designated portion of direct project costs plus an additional amount for 
indirect costs, if any, which will be calculated by the Secretary 
either:
    (1) On the basis of the estimate of the actual indirect costs 
reasonably related to the project; or
    (2) On the basis of a percentage of all, or a portion of, the 
estimated direct costs of the project when there are reasonable 
assurances that the use of such percentage will not exceed the 
approximate actual indirect costs. Such award may include an estimated 
provisional amount for indirect costs or for designated direct costs 
(such as fringe benefit rates) subject to upward (within the limits of 
available funds) as well as downward adjustments to actual costs when 
the amount properly expended by the grantee for provisional items has 
been determined by the Secretary: Provided, however, That no grant shall 
be made for an amount in excess of the total costs found necessary by 
the Secretary to carry out the project.
    (i) In determining the percentage of project costs to be borne by 
the grantee, factors which the Secretary will take into consideration 
will include the following:
    (A) The ability of the grantee to finance its share of project costs 
from non-Federal sources;
    (B) The need in the area served by the project for the services to 
be provided; and
    (C) The extent to which the project will provide services in an 
innovative manner which the Secretary desires to stimulate in the 
interest of developing more effective health service delivery systems on 
a regional or national basis.
    (ii) At any time after approval of an application under this part, 
the Secretary may retroactively agree to a percentage of project costs 
to be borne by the grantee lower than that determined pursuant to 
paragraph (a)(2)(i) of this section where he finds that changed 
circumstances justify a smaller contribution.
    (iii) In determining the grantee's share of project costs, costs 
borne by Federal grant funds, or costs used to match other Federal 
grants, may not be included except as otherwise provided by law or 
regulations.
    (b) All grant awards shall be in writing, and shall set forth the 
amount of funds granted and the period for which support is recommended.
    (c) Neither the approval of any project nor any grant award, shall 
commit or obligate the United States in any way to make any additional, 
supplemental, continuation, or other award with respect to any approved 
project or portion thereof. For continuation support, grantees must make 
separate application.



Sec. 56.107  Priorities for grants.

    (a) Grants under sections 319(c) (1)(A), 319(d)(1)(A), 319(d)(1)(B) 
of the Act and subparts B, C, and D of this part shall be made in 
accordance with the following priorities:
    (1) Highest priority will be given to approvable applications which 
propose to serve catchment areas in which 6,000 or more migratory 
agricultural workers and members of their families reside for more than 
two months in the calendar year.
    (2) Second priority will be given to approvable applications which 
propose to serve catchment areas in which fewer than 6,000 but more than 
1,000 migratory agricultural workers and members of their families 
reside for more than two months in the applicable calendar year.
    (3) Third priority will be given to approvable applications which 
propose to serve catchment areas in which migratory agricultural workers 
and members of their families reside but in which fewer than 1,000 such 
persons reside for more than two months in the applicable calendar year.
    (4) Fourth priority will be given to approvable applications which 
propose

[[Page 257]]

to serve catchment areas in which migratory agricultural workers and 
members of their families reside in the applicable calendar year but in 
which no such persons reside for more than two months in such year.
    (5) Fifth priority will be given to approvable applications which 
propose to serve catchment areas in which no migratory agricultural 
workers or members of their families reside for any period in the 
applicable calendar year but in which 6,000 or more seasonal 
agricultural workers and the members of their families reside.
    (6) Lowest priority will be given to approvable applications which 
propose to serve catchment areas in which no migratory agricultural 
workers or members of their families reside for any period in the 
applicable calendar year and in which fewer than 6,000 seasonal 
agricultural workers and the members of their families reside.
    (b) Grants under sections 319(c) (1)(B) and 319(d)(1)(C) of the Act 
and subparts E and F of this part will be made in accordance with 
priorities set forth in paragraphs (a)(2) through (a)(6) of this 
section, in the order set forth.
    (c) For the purposes of this section, the applicable calendar year 
will be the calendar year for which data is provided in accordance with 
Sec. 56.104(b)(3) of this subpart.



Sec. 56.108  Use of grant funds.

    (a) Any funds granted pursuant to this part, as well as other funds 
to be used in performance of the approved project, may be expended 
solely for carrying out the approved project in accordance with section 
319 of the Act, the applicable regulations of this part, the terms and 
conditions of the award, and the applicable cost principles prescribed 
in subpart Q of 45 CFR part 74.
    (b) Project funds awarded under this part may be used for, but need 
not be limited to, the following:
    (1) The costs of acquiring and modernizing existing buildings 
(including the costs of amortizing the principal of, and paying interest 
on, loans), but only in accordance with subpart H of this part and as 
approved in the grant award;
    (2) The costs of obtaining technical assistance to develop and 
improve the management or service capability of the project but only as 
approved by the Secretary;
    (3) To reimburse members of the grantee's governing board 
established pursuant to Sec. 56.304 of subpart C, or advisory council 
established pursuant to Sec. 56.603(q) of subpart F, if any, for 
reasonable expenses actually incurred by reason of their participation 
in the activities of such board or council;
    (4) To reimburse such governing board or advisory council members 
who are individuals eligible to be served by the project for wages lost 
by reason of participation in the activities of such board or council;
    (5) The cost of delivering health services to migratory agricultural 
workers, seasonal agricultural workers and the members of their families 
within the project's catchment area, within the following limitations: 
grant funds may be used to pay the full cost of project services to such 
individuals and families with annual incomes at or below those set forth 
in the most recent ``CSA Income Poverty Guidelines'' (45 CFR 1060.2) 
issued by the Community Services Administration, and to pay the portion 
of the cost of services provided in accordance with the schedule of 
discounts which, under such schedule, is uncompensated; Provided, That
    (i) Charges will be made to such individuals and families in 
accordance with Sec. 56.303(f) of subpart C or Sec. 56.603(e) of subpart 
F, as applicable;
    (ii) Reasonable effort shall be made to collect such charges under a 
billing and collections system; and
    (iii) The charge to grant funds shall exclude any amounts collected 
pursuant to paragraph (b)(5)(ii) of this section;
    (6) The cost of insurance for medical emergency and out-of-area 
coverage; and
    (7) The cost of providing to the staff and governing board, if any, 
of the project training related to the management of an ambulatory care 
facility, and to the staff of a project funded under subpart C, D, or F 
of this part, training related to the provision of primary, supplemental 
and environmental health services provided or to be provided by the 
project, consistent with

[[Page 258]]

the applicable requirements of 45 CFR part 74.
    (c) Prior approval by the Secretary of revisions of the budget and 
project plan is required whenever there is to be a significant change in 
the scope or nature of project activities.



Sec. 56.109  Grant payments.

    The Secretary shall from time to time make payments to a grantee of 
all or a portion of any grant award, either in advance or by way of 
reimbursement for expenses incurred or to be incurred, to the extent he 
determines such payments necessary to promote prompt initiation and 
advancement of the approved project.



Sec. 56.110  Nondiscrimination.

    (a) Attention is called to the requirements of title VI of the Civil 
Rights Act of 1964 (78 Stat. 252, 42 U.S.C. 2000d et seq.) and in 
particular section 601 of such Act which provides that no person in the 
United States shall on the grounds of race, color, or national origin be 
excluded from participation in, be denied the benefits of, or be 
subjected to discrimination under any program or activity receiving 
Federal financial assistance. A regulation implementing such title VI, 
which applies to grants made under this part, has been issued by the 
Secretary of Health and Human Services with the approval of the 
President (45 CFR part 80). In addition, no person shall, on the grounds 
of age, sex, creed, or marital status (unless otherwise medically 
indicated), be excluded from participation in, be denied the benefits 
of, or be subjected to discrimination under any program or activity so 
receiving Federal financial assistance.
    (b) Attention is called to the requirements of section 504 of the 
Rehabilitation Act of 1973, as amended, which provides that no otherwise 
qualified handicapped individual in the United States shall, solely by 
reason of his handicap, be excluded from participation in, be denied the 
benefits of, or be subjected to discrimination under any program or 
activity receiving Federal financial assistance.



Sec. 56.111  Confidentiality.

    All information as to personal facts and circumstances obtained by 
the project staff about recipients of services shall be held 
confidential and shall not be divulged without the individual's consent 
except as may be required by law or as may be necessary to provide 
service to the individual or to provide for medical audits by the 
Secretary or his designee with appropriate safeguards for 
confidentiality of patient records. Otherwise, information may be 
disclosed only in summary, statistical, or other form which does not 
identify particular individuals.



Sec. 56.112  Publications and copyright.

    Except as may otherwise be provided under the terms and conditions 
of the award, the grantee may copyright without prior approval any 
publications, films, or similar materials developed or resulting from a 
project supported by a grant under this part, subject, however, to a 
royalty-free, non-exclusive, and irrevocable license or right in the 
Government to reproduce, translate, publish, use, disseminate, and 
dispose of such materials and to authorize others to do so.



Sec. 56.113  Grantee accountability.

    (a) Accounting for grant award payments. All payments made by the 
Secretary shall be recorded by the grantee in accounting records 
separate from the records of all other funds, including funds derived 
from other grant awards. With respect to each approved project, the 
grantee shall account for the sum total of all amounts paid as well as 
other funds and in-kind contributions by presenting or otherwise making 
available evidence satisfactory to the Secretary of expenditures for 
direct and indirect costs meeting the requirements of this part: 
Provided, however, That when the amount awarded for indirect costs was 
based on a predetermined fixed-percentage of estimated direct costs, the 
amount allowed for indirect costs shall be computed on the basis of such 
predetermined fixed-percentage rates applied to the total, or a selected 
element thereof, of the reimbursable direct costs incurred.
    (b) Accounting for interest earned on grant funds. Pursuant to 
section 203 of

[[Page 259]]

the Intergovernmental Cooperation Act of 1968 (42 U.S.C. 4213), a State 
will not be held accountable for interest earned on grant funds, pending 
their disbursement for grant purposes. A State, as defined in section 
102 of the Intergovernmental Cooperation Act, means any one of the 
several States, the District of Columbia, Puerto Rico, any territory or 
possession of the United States, or any agency or instrumentality of a 
State, but does not include the government of the political subdivisions 
of the State. All grantees other than a State, as so defined, must 
return all interest earned on grant funds to the Federal Government.
    (c) Grant closeout--(1) Date of final accounting. A grantee shall 
render, with respect to each approved project, a full account, as 
provided herein, as of the date of the termination of grant support. The 
Secretary may require other special and periodic accounting.
    (2) Final settlement. There shall be payable to the Federal 
Government as final settlement with respect to each approved project, 
the sum of:
    (i) Any amount not accounted for pursuant to paragraph (a) of this 
section;
    (ii) Any credits for earned interest pursuant to paragraph (b) of 
this section;
    (iii) Any other amounts due pursuant to subparts F, M, and O of 45 
CFR part 74.

Such total sum shall constitute a debt owed by the grantee to the 
Federal Government and shall be recovered from the grantee or its 
successors or assignees by setoff or other action as provided by law.



Sec. 56.114  Applicability of 45 CFR part 74.

    The provisions of 45 CFR part 74, establishing uniform 
administrative requirements and cost principles, shall apply to all 
grants under this part to States and local governments as those terms 
are defined in subpart A of that part 74. The relevant provisions of the 
following subparts of part 74 shall also apply to grants to all other 
grantee organizations under this part:

                             45 CFR Part 74

Subpart
A  General.
B  Cash depositories.
C  Bonding and insurance.
D  Retention and custodial requirements for records.
F  Grant-related income.
G  Matching and cost sharing.
K  Grant payment requirements.
L  Budget revision procedures.
M  Grant closeout, suspension, and termination.
O  Property.
Q  Cost principles.



  Subpart B--Grants for Planning and Developing Migrant Health Centers



Sec. 56.201  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart A of this part, are applicable to grants awarded pursuant to 
section 319(c)(1)(A) of the Act for projects for planning and developing 
migrant health centers in high impact areas.



Sec. 56.202  Application.

    To be approved by the Secretary under this subpart, an application 
for a grant must, in addition to meeting the requirements of Sec. 56.104 
of subpart A of this part, contain information sufficient to enable the 
Secretary to determine that the project for which the grant is sought 
will meet the requirements of this part.



Sec. 56.203  Project elements.

    A project for planning and developing a migrant health center 
supported under this subpart must:
    (a) Determine (by survey or other appropriate means) the approximate 
number of (1) migratory agricultural workers and the members of their 
families, and (2) seasonal agricultural workers and the members of their 
families, within the proposed catchment area in the calendar year in 
which the grant is made and the period of time these workers and their 
families reside in the catchment area during such year.
    (b) Prepare an assessment of the need of the population proposed to 
be served by the migrant health center for the

[[Page 260]]

services set forth in Sec. 56.102(g)(1) of subpart A of this part. This 
assessment of need must, at a minimum, include the factors listed in 
Sec. 56.104(b)(3) (i)-(iv).
    (c) Design a migrant health center program for such population, 
based on the assessment prepared pursuant to paragraph (b) of this 
section which indicates in detail how the proposed center will fulfill 
the needs identified in that assessment and meet the requirements of 
subpart C of this part.
    (d) Develop a plan for the implementation of the program designed 
pursuant to paragraph (c) of this section. This implementation plan must 
provide for the time-phased recruitment and training of the personnel 
essential for the operation of a migrant health center and the gradual 
assumption of operational status of the project so that the project 
will, in the judgment of the Secretary, meet the requirements contained 
in subpart C of this part by the end of the project period.
    (e) Implement the plan developed pursuant to paragraph (d) of this 
section in accordance with such paragraph.
    (f) Make efforts to secure within the proposed catchment area of 
such center, to the extent possible, financial and professional 
assistance and support for the project.
    (g) Initiate and encourage continuing community involvement in the 
development and operation of the project through, for example, 
contributions or loans of cash, services, equipment, full-or part-time 
staff, space, materials, or facilities.
    (h) Provide for sufficient staff, qualified by training and 
experience, to carry out the project and establish standards and 
qualifications for personnel (including the project director).
    (i) Utilize, to the maximum extent feasible, other Federal, State, 
local, and private resources available for support of the project, prior 
to use of project funds under this subpart.
    (j) Provide the means for evaluating the project's progress in 
achievement of its specific objectives, and submit such progress reports 
on the project as the Secretary may from time to time request.



Sec. 56.204  Grant evaluation and award.

    (a) Within the limits of funds determined by the Secretary to be 
available for such purpose, the Secretary may award grants under this 
subpart to applicants therefor which, in his judgment, will provide 
needed health services in a catchment area which will not be served by 
another project funded under this part and meet the applicable 
requirements of section 319(c)(1)(A) of the Act and this part, in 
accordance with priorities established pursuant to section 319(b) of the 
Act and Sec. 56.107 of subpart A of this part; Provided, That in the 
case of applicants which propose to serve substantially the same 
catchment areas or where available funds are insufficient to fund all 
approvable applications within a priority category specified in 
Sec. 56.107,
    (1) Priority shall be given to applications submitted by community-
based organizations which are representative of the population to be 
served by the project. For purposes of this paragraph, an applicant 
shall be deemed to be such an organization if it provides a formal 
mechanism (such as membership on the organization's governing body or 
membership on an advisory body) which gives migratory seasonal 
agricultural workers and their families significant involvement in the 
formulation of the organization's policies; and
    (2) Where all such applicants are community-based organizations 
representative of the population to be served by the project, the 
Secretary shall award the grant to the applicants which will, in his 
judgment, best promote the purposes of section 319(c)(1)(A) of the Act 
and the applicable regulations of this part, taking into account with 
respect to each application:
    (i) The degree to which the proposed project satisfactorily provides 
for the elements set forth in Sec. 56.203;
    (ii) The administrative and management capability of the applicant;
    (iii) The extent to which community resources will be utilized in 
the project; and
    (iv) The degree to which the applicant intends to integrate services 
supported by a grant under this part with health services provided under 
other

[[Page 261]]

federally assisted health services or reimbursement programs or 
projects.
    (b) The Secretary shall award no more than two grants under this 
subpart for the same project.



         Subpart C--Grants for Operating Migrant Health Centers



Sec. 56.301  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart A of this part, are applicable to grants awarded pursuant to 
section 319(d)(1)(A) of the Act for the costs of operation of migrant 
health centers in high impact areas.



Sec. 56.302  Application.

    To be approved by the Secretary under this subpart, an application 
for a grant must, in addition to meeting the requirements of Sec. 56.104 
of subpart A of this part,
    (a) Be submitted by an entity (which may be a co-applicant) which 
the Secretary determines is a migrant health center, and
    (b) Contain information sufficient to enable the Secretary to 
determine that the center will meet the requirements of this part.



Sec. 56.303  Project elements.

    A migrant health center supported under this subpart must:
    (a) Provide the health services of the center so that such services 
are available and accessible promptly, as appropriate, and in a manner 
which will assure continuity of service to the migratory and seasonal 
agricultural workers and their families within the center's catchment 
area.
    (b) Implement a system for maintaining the confidentiality of 
patient records in accordance with the requirements of Sec. 56.111 of 
subpart A of this part.
    (c) Have an ongoing quality assurance program which provides for the 
following:
    (1) Organizational arrangements, including a focus of 
responsibility, to support the quality assurance program and the 
provision of high quality patient care;
    (2) Periodic assessment of the appropriateness of the utilization of 
services and the quality of services provided or proposed to be provided 
by the center, and by other providers through contract or other 
cooperative arrangement with the center. Such assessments must:
    (i) Be conducted by physicians or by other appropriate health 
professionals under the supervision of physicians or, as appropriate, by 
health professionals who are peers of the health professionals who 
provided the services;
    (ii) Be based on the systematic collection and evaluation of patient 
records; and
    (iii) Identify and document the necessity for change in the 
provision of services by the center and result in the institution of 
such change, where indicated.
    (d) Develop management and control systems which are in accordance 
with sound financial management procedures, including the provision for 
an audit (1) conducted in accordance with the ``Guide for Audits of 
Migrant Health Grants'' of the DHHS Audit Agency, and (2) conducted with 
reasonable frequency, usually annually but not less frequently than 
every two years (unless waived for cause by the Secretary), to be made 
by qualified individuals who are sufficiently independent of those who 
authorize the expenditure of Federal funds to produce unbiased opinions, 
conclusions, or judgments, and to determine, at a minimum, the fiscal 
integrity of grant financial transactions and reports, and compliance 
with the applicable regulations of this part and the terms and 
conditions of the grant.
    (e) Where the cost of care and services furnished by or through the 
center is to be reimbursed under title XIX or title XX of the Social 
Security Act, obtain or make every reasonable effort to obtain a written 
agreement with the title XIX or title XX State agency for such 
reimbursement.
    (f) Have prepared a schedule of fees or payments for the provision 
of its services designed to cover its reasonable costs of operation and 
a corresponding schedule of discounts adjusted on the basis of the 
patient's ability to pay. The schedule of discounts must provide for a 
full discount to individuals and families with annual incomes at or

[[Page 262]]

below those set forth in the most recent CSA Poverty Income Guidelines 
(42 CFR 1060.2) (except that nominal fees for service may be collected 
from such individuals and families) and for no discount to individuals 
and families with annual incomes greater than twice those set forth in 
such Guidelines.
    (g) Make every reasonable effort, including the establishment of 
systems for eligibility determination, billing, and collection, to
    (1) Collect reimbursement for its costs in providing health services 
to persons who are entitled to insurance benefits under title XVIII of 
the Social Security Act, to medical assistance under a State plan 
approved under title XIX of such Act, to social services and family 
planning under title XX of such Act, or to assistance for medical 
expenses under any other public assistance program, grant program, or 
private health insurance or benefit program on the basis of the schedule 
of fees prepared pursuant to paragraph (f) of this section without 
application of any discounts, and
    (2) Secure from patients payments for services in accordance with 
the schedule of fees and discounts required by paragraph (f) of this 
section.
    (h) Have a governing board which meets the requirements of 
Sec. 56.304.
    (i) Have developed an overall plan and budget for the center that:
    (1) Provides for an annual operating budget and a three-year 
financial management plan which includes all anticipated income and 
expenses related to items which would, under generally accepted 
accounting principles, be considered income and expense items;
    (2) Provides for a capital expenditure plan for at least a three-
year period (including the year to which the operating budget described 
in paragraph (h)(i)(1) is applicable) which includes and identifies in 
detail the anticipated sources of financing for, and the objective of, 
each anticipated expenditure in excess of $100,000 related to the 
acquisition of land, the improvement of land, buildings, and equipment 
and the replacement, modernization and expansion of buildings and 
equipment which would, under generally accepted accounting principles, 
be considered capital items;
    (3) Provides for plan review and updating at least annually; and
    (4) Is prepared under the direction of the governing board by a 
committee consisting of representatives of the governing board, the 
administrative staff, and the medical staff, if any, of the center.
    (j) Establish basic statistical data, cost accounting, management 
information, and reporting or monitoring systems which will enable the 
center to provide such statistics and other information as the Secretary 
may reasonably require relating to the center's costs of operation, 
patterns of utilization of services, and the availability, 
accessibility, and acceptability of its services, and to make such 
reports to the Secretary in a timely manner with such frequency as the 
Secretary may reasonably require.
    (k) Review its catchment area annually to insure that the criteria 
set out in Sec. 56.104(b)(2) are met and, if criteria are not met, 
revise its catchment area, with the approval of the Secretary, to 
conform with such criteria to the extent feasible.
    (l) In the case of a center which serves a population including a 
substantial proportion of individuals of limited English-speaking 
ability, have developed a plan and made arrangements responsive to the 
needs of such populations for providing services to the extent 
practicable in the language and cultural context most appropriate to 
such individuals, and have identified an individual on its staff who is 
fluent in both that language and in English and whose responsibilities 
include providing guidance to such individuals and to appropriate staff 
members with respect to cultural sensitivities and bridging linguistic 
and cultural differences. If more than one non-English language is 
spoken by such group or groups, an individual or individuals fluent in 
those languages and English must be so identified.
    (m) Be operated in a manner calculated to preserve human dignity and 
to maximize acceptability and effective utilization of services.
    (n) To the extent possible, coordinate and integrate project 
activities with

[[Page 263]]

the activities of other federally funded, as well as State and local, 
health services delivery projects and programs serving the same 
population.
    (o) Establish means for evaluating progress toward the achievement 
of the specific objectives of the project.
    (p) Provide sufficient staff, qualified by training and experience, 
to carry out the activities of the center.
    (q) Assure that facilities utilized in the performance of the 
project meet applicable fire and life safety codes.
    (r) Utilize, to the maximum extent feasible, other Federal, State 
and local, and private resources available for support of the project, 
prior to use of project funds under this part.
    (s) Provide for community participation through, for example, 
contributions of cash or services, loans of full- or part-time staff, 
equipment, space, materials, or facilities.
    (t) Where the center will provide services through contract or other 
cooperative arrangements with other providers of services, the center 
must:
    (1) Enter into the contract or arrangement only if the provider of 
services will provide the services in a timely manner and make the 
services accessible and acceptable to the population to be served;
    (2) Make payment for services so provided only pursuant to 
agreements with the providers in accordance with a schedule of rates and 
payment procedures established and maintained by the center. The center 
must be prepared to substantiate that such rates are reasonable and 
necessary;
    (3) Directly provide at least primary care unless the center has 
made arrangements for the provision of primary care which include 
transfer of all medical and financial information relating to such care 
to the center; and
    (4) Enter into contracts or arrangements for the provision of 
primary health services only if alternative resources are reasonably 
available to provide these services in the event of termination of such 
arrangements.
    (u) Operate in a manner such that no migratory or seasonal 
agricultural worker or member of their family will be denied service by 
reason of his or her inability to pay therefor. Provided, however, That 
a charge for the provision of services will be made to the extent that a 
third party (including a Government agency) is authorized or is under 
legal obligation to pay such charges.



Sec. 56.304  Governing board.

    The governing board of the center must meet the following 
requirements:
    (a) Size. The board must consist of at least 9 but not more than 25 
members except that this provision may be waived by the Secretary for 
good cause shown.
    (b) Composition. (1) A majority of the board members must be 
migratory and seasonal agricultural workers and members of their 
families who are or will be served by the center and who, as a group, 
represent the individuals being or to be served in terms of demographic 
factors, such as race, ethnicity, and sex.
    (2) No more than two-thirds of the remaining members of the board 
may be individuals who derive more than 10 percent of their annual 
income from the health care industry.
    (3) The remaining members of the board must be representatives of 
the community in which the center's catchment area is located and shall 
be selected for their expertise in relevant subject areas, such as 
community affairs, local government, finance and banking, legal affairs, 
trade unions, and other commercial and industrial concerns, or social 
services within the community.
    (4) No member of the board shall be an employee of the center, or 
spouse or child, parent, brother or sister by blood of marriage of such 
an employee. The project director may be a nonvoting, ex-officio member 
of the board.
    (c) Selection of members. The method of selection must be prescribed 
in the by-laws or other internal governing rules of the center. Such by-
laws or other rules must specify a process of selection of individuals 
on the governing board who represent the population served or to be 
served by the center so that such individuals, as a group, are 
representative of such population. Such process of selection in the by-
laws or other rules is subject to approval by the Secretary.

[[Page 264]]

    (d) Functions and responsibilities. (1) The governing board shall 
have authority for the establishment of policy in the conduct of the 
center.
    (2) The governing board shall hold regularly scheduled meetings, at 
least once each month, except for periods of the year, as specified in 
the bylaws, during which monthly meetings are not practical due to 
migration out of the catchment area.
    (3) Minutes must be kept for all regularly scheduled meetings of the 
board.
    (4) The governing board shall have specific responsibility for:
    (i) Approval of the selection and dismissal of the project director 
or chief executive officer of the center;
    (ii) Establishing personnel policies and procedures, including 
selection and dismissal procedures, salary and benefit scales;
    (iii) The development of bylaws which specify the responsibility of 
the board and principal operating officials of the centers;
    (iv) Adopting policy for financial management practices, including a 
system to assure accountability for center resources, approval of the 
annual project budget, center priorities, eligibility for services, 
including criteria for partial payment schedules, and long-range 
financial planning;
    (v) Evaluating center activities, including services utilization 
patterns, productivity of the center, patient satisfaction, achievement 
of project objectives, and development of a process for hearing and 
resolving patient grievances;
    (vi) Assuring that the center is operated in compliance with 
applicable Federal, State, and local laws and regulations; and
    (vii) Adopting health care policies including scope and availability 
of services, location and hours of services, and quality assurance 
procedures.



Sec. 56.305  Grant evaluation and award.

    (a) Within the limits of funds determined by the Secretary to be 
available for such purpose, the Secretary may award grants under this 
subpart to applicants therefor which, in his judgment, will provide 
needed health services in a catchment area which will not be served by 
another project funded under this part and meet the applicable 
requirements of section 319(d)(1)(A) of the Act and this part, in 
accordance with priorities established pursuant to section 319(b) of the 
Act and Sec. 56.107 of subpart A of this part: Provided, That in the 
case of applicants which propose to serve substantially the same 
catchment area or where available funds are insufficient to fund all 
approvable applications within a priority category specified in 
Sec. 56.107, the Secretary will award grants to the applicants which, in 
his judgment, will best promote the purpose of section 319(d)(1)(A) of 
the Act and the applicable regulations of this part, taking into account 
with respect to each application:
    (1) The extent to which the project would provide for the elements 
set forth in Sec. 56.303;
    (2) The capability of the applicant to provide quality health care 
services;
    (3) The soundness of the financial management plan for assuring 
effective utilization of grant funds and maximizing non-grant revenue;
    (4) The administrative and management capability of the applicant;
    (5) The capability of the applicant to provide primary health 
services directly. In evaluating the relative capability of the 
applicant to provide such services directly, the Secretary shall take 
into consideration whether the direct provision of such services is 
inappropriate because:
    (i) Provision of such services through contract or other arrangement 
would be more cost-effective;
    (ii) Provision of such services directly would unnecessarily 
duplicate existing resources; or
    (iii) Provision of such services other than directly would enhance 
the accessibility or acceptability of such services to the population to 
be served.
    (6) The degree to which the applicant intends to integrate services 
supported by a grant under this part with health services provided under 
other federally assisted health services or reimbursement programs or 
projects;
    (7) The extent that community resources will be utilized by the 
project; and
    (8) Consistent with the other requirements of this part, the degree 
to which

[[Page 265]]

and the manner in which the applicant provides specific health services 
which the Secretary has, through publication of a notice in the Federal 
Register, established as services which should receive emphasis by 
applicants.



         Subpart D--Grants for Operating Migrant Health Entities



Sec. 56.401  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart A of this part, are applicable to grants awarded pursuant to 
section 319(d)(1)(B) of the Act for the costs of operation of entities 
which intend to become migrant health centers and which provide health 
services to migratory agricultural workers, seasonal agricultural 
workers, and the members of their families in high impact areas.



Sec. 56.402  Application.

    To be approved by the Secretary under this subpart, an application 
for a grant must, in addition to meeting the requirements of Sec. 56.104 
of subpart A of this part,
    (a) Be submitted by an entity which the Secretary determines intends 
to become a migrant health center but which will not, at the time of the 
grant award, meet one or more of the requirements of paragraphs (a) 
through (l) of Sec. 56.303 of subpart C of this part; and
    (b) Contain information sufficient to enable the Secretary to 
determine that the project for which the grant is sought will meet the 
requirements of this part. Such information must include a plan which 
identifies which requirements of Sec. 56.303 will not be met at the time 
of grant award and provides a timetable for and a detailed statement of 
the means to be employed in meeting those requirements.



Sec. 56.403  Project elements.

    A project for the operation of a migrant health entity supported 
under this subpart must:
    (a) Meet all of the requirements of Sec. 56.303 of this part, 
Provided, That the project will not be required to meet the requirements 
of paragraphs (c), (h), (i), or (n) of such section if the Secretary 
finds that meeting any such requirement is not feasible or practical at 
the time of grant award.
    (b) Provide those services enumerated in Sec. 56.102(g)(1) of 
subpart A of this part which are specified in the grant award.
    (c) Meet the requirements of Sec. 56.303 of subpart C of this part 
by the end of the period of support under section 319(d)(1)(B) of the 
Act and this subpart, in accordance with the plan submitted under 
Sec. 56.402(b) of this subpart.



Sec. 56.404  Grant evaluation and award.

    (a) Within the limits of funds determined by the Secretary to be 
available for such purposes, the Secretary may award grants under this 
subpart to applicants therefor which, in his judgment, will provide 
needed health services in a catchment area not served by another project 
funded under this part and meet the applicable requirements of section 
319(d)(1)(B) of the Act and this part, in accordance with the priorities 
established pursuant to section 319(b) of the Act and Sec. 56.107 of 
subpart A of this part; Provided, That in the case of applicants which 
propose to serve substantially the same catchment area or where 
available funds are insufficient to fund all approvable applications 
within a priority category specified in Sec. 56.107, the Secretary will 
award the grant to the applicants which, in his judgment, will best 
promote the purposes of section 319(d)(1)(B) of the Act and the 
applicable regulations of this part, taking into account with respect to 
each application:
    (1) The degree to which the project would provide the services 
enumerated in Sec. 56.102(g)(1) and the feasibility of its providing all 
of such enumerated services by the end of the period of support under 
section 319(d)(1)(B) of the Act and this subpart;
    (2) The degree to which the applicant intends to integrate services 
supported by a grant under this subpart with health services provided 
under other federally assisted health service or reimbursement programs 
or projects;
    (3) The capability of the project to provide quality health care 
services;
    (4) The administrative and management capability of the applicant; 
and

[[Page 266]]

    (5) The capability of the applicant to provide primary health 
services directly. In evaluating the relative capability of the 
applicant to provide such services directly, the Secretary shall take 
into consideration whether the direct provision of services is 
inappropriate because:
    (i) Provision of such services through contract or other arrangement 
would be more cost-effective;
    (ii) Provision of such services directly would unnecessarily 
duplicate existing resources; or
    (iii) Provision of the services other than directly would enhance 
the accessibility or acceptability of the services to the population 
served.
    (6) The extent to which community resources will be utilized by the 
project; and
    (7) Consistent with the other requirements of this part, the degree 
to which and the manner in which the applicant provides specific health 
services which the Secretary has, through publication of a notice in the 
Federal Register, established as services which should receive emphasis 
by applicants.
    (b) The Secretary shall:
    (1) Make no more than two grants for the same entity under section 
319(d)(1)(B) of the Act;
    (2) Not make any grant under section 319(d)(1)(B) to an entity 
which, for the same project, has been awarded more than one grant under 
section 319(c) of the Act;
    (3) Not make a grant under section 319(d)(1)(B) to an entity which 
has been awarded a grant under section 319(d)(1)(A) of the Act.



  Subpart E--Grants for Planning and Developing Migrant Health Programs



Sec. 56.501  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart A of this part, are applicable to grants awarded pursuant to 
section 319(c)(1)(B) of the Act for projects to plan and develop migrant 
health programs to provide health services to migratory agricultural 
workers, seasonal agricultural workers and the members of their families 
in areas in which no migrant health center exists and in which not more 
than 6,000 migratory agricultural workers and their families reside for 
more than two months.



Sec. 56.502  Application.

    To be approved by the Secretary under this subpart, an application 
for a grant must, in addition to meeting the requirements of Sec. 56.104 
of subpart A of this part,
    (a) Be submitted for a project within a catchment area which
    (1) Is not served, in whole or in part, by a migrant health center, 
and
    (2) Has not more than 6,000 migratory agricultural workers and 
members of their families residing therein for more than 2 months per 
year; and
    (b) Contain information sufficient to enable the Secretary to 
determine that the project for which the grant is sought will meet the 
requirements of this part.



Sec. 56.503  Project elements.

    A project for the planning and development of a migrant health 
program supported under this subpart must:
    (a) Determine (by survey or other appropriate means) the approximate 
number of
    (1) Migratory agricultural workers and the members of their 
families, and
    (2) Seasonal agricultural workers and the members of their families 
within the project's catchment area in the calendar year in which the 
grant is made and the period of time these workers and their families 
reside in the catchment area during such year.
    (b) Prepare an assessment of need of the population proposed to be 
served by the migrant health program for the services set forth in 
Sec. 56.603(a) of subpart F of this part. This assessment of need must, 
at a minimum, consider the factors listed in Sec. 56.104(b)(3) (i)-(iv).
    (c) Design a migrant health program for such population, based on 
such assessment, which indicates in detail how the proposed program will 
fulfill the needs identified in that assessment and meet the 
requirements of subpart F of this part.
    (d) Develop a plan for the implementation of the program designed 
pursuant to paragraph (c) of this section. The implementation plan must 
provide for the time-phased recruitment and

[[Page 267]]

training of the personnel essential for the operation of a migrant 
health program and the gradual assumption of operational status of the 
project so that the project will, in the judgment of the Secretary, meet 
the requirements of subpart F of this part as of the end of the project 
period.
    (e) Implement the plan developed pursuant to paragraph (d) of this 
section in accordance with such paragraph.
    (f) Make efforts to secure within the proposed catchment area of 
such project, to the extent possible, financial and professional 
assistance and support for the project.
    (g) Initiate and encourage continuing community involvement in the 
development and operation of the project through, for example, 
contributions or loans of cash, services, equipment, full- or part-time 
staff, space, materials, or facilities.
    (h) Provide for sufficient staff, qualified by training and 
experience, to carry out the project and establish standards and 
qualifications for personnel (including the project director).
    (i) Utilize, to the maximum extent feasible, other Federal, State, 
local, and private resources available for support of the project, prior 
to use of project funds under this subpart.
    (j) Provide for the means of evaluating the project's progress in 
achievement of its specific objectives and submission of such progress 
reports on the project as the Secretary may from time to time request.



Sec. 56.504  Grant evaluation and award.

    (a) Within the limits of funds determined by the Secretary to be 
available for such purpose, the Secretary may award grants under this 
subpart to applicants therefor which, in his judgment, will provide 
needed health services in a catchment area not served by another project 
funded under this part and meet the applicable requirements of section 
319(c)(1)(B) of the Act and this part, in accordance with priorities 
established pursuant to section 319(b) of the Act and Sec. 56.107 of 
subpart A of this part; Provided, That in the case of applicants which 
propose to serve substantially the same catchment areas or where 
available funds are insufficient to fund all approvable applications 
within a priority category specified in Sec. 56.107,
    (1) Priority shall be given to applications submitted by community-
based organizations which are representative of the population to be 
served by the project. For purposes of this paragraph, an applicant 
shall be deemed to be such an organization if it provides a formal 
mechanism (such as membership on the organization's governing body or 
membership on an advisory body) which gives migratory and seasonal 
agricultural workers and their families significant involvement in the 
formulation of the organization's policies; and
    (2) Where all such applicants are community-based organizations 
representative of the population to be served by the project, the 
Secretary shall award the grant to the applicants which will, in his 
judgment, best promote the purposes of section 319(c)(1)(B) of the Act 
and the applicable regulations of this part, taking into account with 
respect to each application:
    (i) The degree to which the proposed project satisfactorily provides 
for the elements set forth in Sec. 56.203;
    (ii) The administrative and management capability of the applicant;
    (iii) The extent to which community resources will be utilized in 
the project; and
    (iv) The degree to which the applicant intends to integrate services 
supported by a grant under this part with health services provided under 
other federally assisted health services or reimbursement programs or 
projects.
    (b) The Secretary shall award no more than one grant under this 
subpart for the same project.



         Subpart F--Grants for Operating Migrant Health Programs



Sec. 56.601  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart A of this part, are applicable to grants awarded pursuant to 
section 319(d)(1)(C) of the Act for projects for operating programs to 
provide health services to migratory agricultural workers, seasonal 
agricultural workers and the members of their families in

[[Page 268]]

areas in which no migrant health center exists and in which not more 
than 6,000 migratory agricultural workers and their families reside for 
more than two months.



Sec. 56.602  Application.

    To be approved by the Secretary under this subpart, an application 
for a grant must, in addition to meeting the requirements of Sec. 56.104 
of subpart A of this part,
    (a) Be submitted for a project with a catchment area which
    (1) Is not served, in whole or in part, by a migrant health center, 
and
    (2) Has not more than 6,000 migratory agricultural workers and the 
members of their families residing therein for more than two months per 
year; and
    (b) Contain information sufficient to enable the Secretary to 
determine that the project for which the grant is sought will meet the 
requirements of this part.



Sec. 56.603  Project elements.

    A project for operating a migrant health program supported under 
this subpart must:
    (a) Provide to migratory and seasonal agricultural workers and the 
members of their families in its catchment area one or more of the 
following groups of services so that such services are available and 
accessible promptly as appropriate, and in a manner which will assure 
continuity of care, as approved by the Secretary and set forth 
(including specific services to be provided) in the grant award:
    (1) Emergency health care, including diagnostic and treatment 
services in an ambulatory health care setting or hospital and dental 
services for the alleviation of acute pain and suffering for medical 
emergencies, when provision of such services is necessary to avoid 
jeopardizing the patient's condition until appropriate services from 
other providers can reasonably be obtained;
    (2) Primary care;
    (3) Arrangements with existing health care facilities to furnish 
primary health services (other than primary care);
    (4) Other services set forth in Sec. 56.102(g)(1) which are needed 
to improve the health of such individuals.
    (b) Implement a system for maintaining the confidentiality of 
patient records in accordance with the requirement of Sec. 56.111 of 
subpart A of this part.
    (c) Develop management and control systems which are in accordance 
with sound financial management procedures, including the provision for 
an audit conducted in accordance with the DHHS Audit Agency Guide for 
Audits of Migrant Health Grants, as amended, on at least an annual basis 
(unless waived for cause by the Secretary), by an independent certified 
public accountant or public accountant licensed before December 31, 
1970, to determine, at a minimum, the fiscal integrity of grant 
financial transactions and reports and compliance with the regulations 
of this part and the terms and conditions of the grant.
    (d) When the cost of care and services furnished by or through the 
project is to be reimbursed under title XIX or title XX of the Social 
Security Act, obtain or make every reasonable effort to obtain a written 
agreement with the title XIX or title XX State agency for such 
reimbursement.
    (e) Have prepared a schedule of fees or payments for the provision 
of its services designed to cover its reasonable costs of operation and 
a corresponding schedule of discounts adjusted on the basis of the 
patient's ability to pay. The schedule of discounts must provide for a 
full discount to individuals and families with annual incomes at or 
below those set forth in the most recent CSA Poverty Income Guidelines 
(42 CFR 1060.2) (except that nominal fees for service may be collected 
from individuals and families with annual incomes at or below such 
levels if imposition of such fees is consistent with project goals) and 
for no discount to individuals and families with annual incomes greater 
than twice those set forth in the Guidelines.
    (f) Make every reasonable effort, including the establishment of 
systems for eligibility determination, billing, and collection, to
    (1) Collect reimbursement for its costs in providing health services 
to persons who are entitled to insurance benefits under title XVIII of 
the Social Security Act, to medical assistance

[[Page 269]]

under a State plan approved under title XIX of such Act, to social 
services and family planning under title XX of such Act, or to 
assistance for medical expenses under any other public assistance 
program, grant program, or private health insurance or benefit program 
on the basis of the schedule of fees prepared pursuant to paragraph (e) 
of this section without application of any discounts, and
    (2) Secure from patients payments for services in accordance with 
the schedule of fees and discounts required by paragraph (e) of this 
section.
    (g) Develop an overall financial management plan and an operating 
budget for the project which include and identify, in accordance with 
generally accepted accounting principles, all anticipated current income 
and expense items and capital income and expense items, if any.
    (h) Establish basic statistical data, cost accounting, management 
information, and reporting or monitoring systems which will meet the 
project's management needs and shall enable the project to provide such 
statistics and other information as the Secretary may reasonably require 
relating to the project's costs of operation, patterns of utilization of 
services, and the availability, accessibility, and acceptability of its 
services, and to make such reports to the Secretary in a timely manner 
with such frequency as the Secretary may reasonably require.
    (i) Review its catchment area annually to insure that the criteria 
set out in Sec. 56.104(b)(2) are met and, where such criteria are not 
met, revise its catchment area, with the approval of the Secretary, to 
conform with such criteria to the extent feasible.
    (j) In the case of a project which serves a population including a 
substantial proportion of individuals of limited English-speaking 
ability, have a plan and made arrangements responsive to the needs of 
these populations for providing services to the extent practicable in 
the language and cultural context most appropriate to such individuals, 
and have identified an individual on its staff who is fluent in both 
that language and in English and whose responsibilities include 
providing guidance to such individuals and to appropriate staff members 
with respect to cultural sensitivities and bridging linguistic and 
cultural differences. If more than one non-English language is spoken by 
such group or groups, an individual or individuals fluent in those 
languages and English must be so identified.
    (k) Be operated in a manner calculated to preserve human dignity and 
to maximize acceptability and effective utilization of services.
    (l) To the extent possible, coordinate and integrate project 
activities with the activities of other federally funded, as well as 
State and local, health services delivery projects and programs serving 
the same population.
    (m) Establish means for evaluating progress toward the achievement 
of the specific objectives of the project.
    (n) Provide sufficient staff, qualified by training and experience, 
to carry out the activities of the project.
    (o) Assure that facilities utilized in the performance of the 
project meet applicable fire and life safety codes.
    (p) Utilize, to the maximum extent feasible, other Federal, State 
and local, and private resources available for support of the project, 
prior to use of project funds under this part.
    (q) Provide for community participation through, for example, 
contributions of cash or services, loans of full- or part-time staff, 
equipment, space, materials, or facilities, and, to the extent feasible, 
establishment of an advisory council to advise with respect to the 
overall management of the project including services to be provided, the 
manner of their provision, and appointment of personnel. The membership 
of such advisory council shall be representative of the population to be 
served in terms of appropriate demographic characteristics, such as 
race, sex, and ethnicity.
    (r) Where the project will provide services through contract or 
other cooperative arrangements with other providers of services, the 
project must
    (1) Enter into any such contract or arrangement only if the provider 
of services will provide the services in a timely manner and make the 
services accessible and acceptable to the population to be served; and

[[Page 270]]

    (2) Make payment for services so provided in accordance with a 
schedule of rates and payment procedures established and maintained by 
the project. The project must be prepared to substantiate that such 
rates are reasonable and necessary.
    (s) Operate in a manner such that no migratory or seasonal 
agricultural worker or member of their families will be denied service 
by reason of his or her inability to pay therefor. Provided, however, 
That a charge for the provision of services will be made to the extent 
that a third party (including a Government agency) is authorized or is 
under legal obligation to pay such charges.
    (t) Have an ongoing quality assurance program as described in 
Sec. 56.303(c) except as the Secretary finds that such a program would 
not be feasible.



Sec. 56.604  Grant evaluation and award.

    (a) Within the limit of funds determined by the Secretary to be 
available the Secretary may award grants under this subpart to 
applicants therefor which will, in his judgment, provide needed health 
services in a catchment area which will not be served by another project 
funded under this part and meet the applicable requirements of section 
319(d)(1)(C) of the Act and this subpart, in accordance with priorities 
established pursuant to section 319(b) of the Act and Sec. 56.107 of 
subpart A of this part; Provided, That in the case of applicants which 
propose to serve substantially the same catchment areas or where 
available funds are insufficient to fund all approvable applications 
within a priority category specified in Sec. 56.107,
    (1) Priority shall be given to applications submitted by community-
based organizations which are representative of the population to be 
served by the project. For purposes of this paragraph, an applicant 
shall be deemed to be such an organization if it provides a formal 
mechanism (such as membership on the organization's governing body or 
membership on an advisory body) which gives migratory seasonal 
agricultural workers and their families significant involvement in the 
formulation of the organization's policies; and
    (2) Where all such applicants are community-based organizations 
representative of the population to be served by the project, the 
Secretary shall award the grant to the applicants which will, in his 
judgment, best promote the purposes of section 319(d)(1)(C) of the Act 
and the applicable regulations of this part, taking into account with 
respect to each application:
    (i) The degree to which the proposed project satisfactorily provides 
for the elements set forth in Sec. 56.203;
    (ii) The administrative and management capability of the applicant;
    (iii) The extent to which community resources will be utilized in 
the project; and
    (iv) The degree to which the applicant intends to integrate services 
supported by a grant under this part with health services provided under 
other federally assisted health services or reimbursement programs or 
projects.



               Subpart G--Grants for Technical Assistance



Sec. 56.701  Applicability.

    The regulations of this subpart, in addition to the regulations of 
subpart A of this part except as otherwise set forth herein, are 
applicable to grants awarded pursuant to section 319(g) of the Act for 
the provision of technical and other non-financial assistance to 
grantees under sections 319(c)(1)(A), 319(d)(1)(A) and 319(d)(1)(B) of 
the Act.



Sec. 56.702  Application.

    To be approved by the Secretary under this subpart, an application 
for a grant must meet the requirements of Secs. 56.104(a), 56.104(b) 
(1), (4), (7), (10), and (11), and 56.104(c) of subpart A of this part.



Sec. 56.703  Project elements.

    A project for the provision of technical assistance to migrant 
health centers and entities which intend to become migrant health 
centers which is supported under this subpart must:
    (a) Provide to such centers and entities as are specified in the 
grant award, such technical and other nonfinancial assistance (such as 
fiscal and program management assistance or training of

[[Page 271]]

the staff of such center or entity in such management) as may be 
specified in the grant award. Such technical or other nonfinancial 
assistance shall be designed to assist such centers and entities in:
    (1) Developing plans for becoming migrant centers; and/or
    (2) Meeting the requirements of sections 319(f)(2) of the Act.
    (b) Provide such assistance through its own staff or resources.
    (c) Where the project will provide training to the staff of a center 
or entity in management or the provision of health services, provide 
such training consistent, as applicable, with Sec. 56.108(b)(7).
    (d) Maintain such records and make such reports on the expenditure 
of funds under this subpart and provision of such assistance as the 
Secretary may require.



Sec. 56.704  Grant evaluation and award.

    Within the limits of funds determined by the Secretary to be 
available for such purpose, the Secretary may award grants under this 
subpart to applicants therefor which will, in his judgment, best promote 
the purposes of section 319(g) of the Act and applicable regulations of 
this part, taking into consideration:
    (a) The cost-effectiveness of the application; and
    (b) The number of centers and entities to be served by the 
applicant.



     Subpart H--Acquisition and Modernization of Existing Buildings



Sec. 56.801  Applicability of 42 CFR part 51c, subpart E.

    The provisions of 42 CFR part 51c, subpart E, establishing 
requirements for the acquisition and modernization of existing 
buildings, shall apply to all grants under section 319 of the Act for 
project costs which include the cost of acquisition and/or modernization 
of existing buildings (including the cost of amortizing the principal 
of, and paying the interest on, loans); except that, for purposes of 
this subpart, references within subpart E to part 51c, or to subparts of 
part 51c, shall be deemed to be references to part 56, or to the 
appropriate subparts of part 56, and references to section 330 of the 
Act shall be deemed to be references to section 319 of the Act.

[43 FR 5353, Feb. 7, 1978]



PART 57--GRANTS FOR CONSTRUCTION OF TEACHING FACILITIES, EDUCATIONAL IMPROVEMENTS, SCHOLARSHIPS AND STUDENT LOANS--Table of Contents




Subparts A-B  [Reserved]

               Subpart C--Health Professions Student Loans

57.201  Applicability.
57.202  Definitions.
57.203  Application by school.
57.204  Payment of Federal capital contributions and reallocation of 
          funds remitted to the Secretary.
57.205  Health professions student loan funds.
57.206  Eligibility and selection of health professions student loan 
          applicants.
57.207  Maximum amount of health professions student loans.
57.208  Health professions student loan promissory note and disclosure 
          requirements.
57.209  Payment of health professions student loans.
57.210  Repayment and collection of health professions student loans.
57.211  Cancellation of health professions student loans for disability 
          or death.
57.212  [Reserved]
57.213  Continuation of provisions for cancellation of loans made prior 
          to November 18, 1971.
57.213a  Loan cancellation reimbursement.
57.214  Repayment of loans made after November 17, 1971, for failure to 
          complete a program of study.
57.215  Records, reports, inspection, and audit.
57.216  What additional Department regulations apply to schools?
57.216a  Performance standard.
57.217  Additional conditions.
57.218  Noncompliance.

                    Subpart D--Nursing Student Loans

57.301  Applicability.
57.302  Definitions.
57.303  Application by school.
57.304  Payment of Federal capital contributions and reallocation of 
          funds remitted to the Secretary.
57.305  Nursing student loan funds.
57.306  Eligibility and selection of nursing student loan applicants.

[[Page 272]]

57.307  Maximum amount of nursing student loans.
57.308  Nursing student loan promissory note.
57.309  Payment of nursing student loans.
57.310  Repayment and collection of nursing student loans.
57.311  Cancellation of nursing student loans for disability or death.
57.312  Repayment of loans for service in a shortage area.
57.313  Loan cancellation for full-time employment as a registered 
          nurse.
57.313a  Loan cancellation reimbursement.
57.314  Repayment of loans made after November 17, 1971, for failure to 
          complete a program of study.
57.315  Records, reports, inspection, and audit.
57.316  What additional Department regulations apply to schools?
57.316a  Performance standard.
57.317  Additional conditions.
57.318  Noncompliance.

     Subpart E--Grants for Construction of Nurse Training Facilities

57.409  Good cause for other use of completed facility.

          Subpart F--Grants for Nurse Anesthetist Traineeships

57.501  To what programs do these regulations apply?
57.502  Definitions.
57.503  Who is eligible to apply for a grant?
57.504  How will applications be evaluated?
57.505  How long does grant support last?
57.506  How is the amount of the award determined?
57.507  For what purposes may grant funds be spent?
57.508  What financial support is available to trainees?
57.509  Who is eligible for financial assistance as a trainee?
57.510  What are the requirements for traineeships and the appointment 
          of trainees?
57.511  Duration of traineeships.
57.512  Termination of traineeships.
57.513  What additional Department regulations apply to grantees?
57.514  Additional conditions.

Subpart G  [Reserved]

       Subpart H--Grants for Physician Assistant Training Programs

57.701  Applicability.
57.702  Definitions.
57.703  Eligibility.
57.704  Application.
57.705  Project requirements.
57.706  Evaluation of applications.
57.707  Grant award.
57.708  Grant payments.
57.709  Purposes for which grant funds must be spent.
57.710  What additional Department regulations apply to grantees?
57.711  What other audit and inspection requirements apply to grantees?
57.712  Additional conditions.

      Subpart I--Programs for the Training of Physician Assistants

57.801  Purpose and scope.
57.802  Definitions.
57.803  Requirements.

Subparts J-K  [Reserved]

 Subpart L--Grants for Residency Training and Advanced Education in the 
                      General Practice of Dentistry

57.1101  To what projects do these regulations apply?
57.1102  Definitions.
57.1103  What entities are eligible to apply for a grant?
57.1104  How must an entity apply for a grant?
57.1105  What requirements must a project meet?
57.1106  How will applications be evaluated?
57.1107  How will grant awards be made?
57.1108  How will grant payments be made?
57.1109  Purposes for which grant funds may be spent.
57.1110  What additional Department regulations apply to grantees?
57.1111  What other audit and inspection requirements apply to grantees?
57.1112  What additional conditions apply to grantees?

Subparts M-O  [Reserved]

     Subpart P--Loan Guarantees and Interest Subsidies to Assist in 
   Construction of Teaching Facilities for Health Profession Personnel

57.1501  Applicability.
57.1502  Definitions.
57.1503  Eligibility.
57.1504  Application.
57.1505  Approval of applications.
57.1506  Priority.
57.1507  Limitations applicable to loan guarantee.
57.1508  Amount of interest subsidy payments; limitations.
57.1509  Forms of credit and security instruments.
57.1510  Security for loans.
57.1511  Opinion of legal counsel.
57.1512  Length and maturity of loans.

[[Page 273]]

57.1513  Repayment.
57.1514  Loan guarantee and interest subsidy agreements.
57.1515  Loan closing.
57.1516  Right of recovery-subordination.
57.1517  Waiver of right of recovery.
57.1518  Modification of loans.

  Subpart Q--Grants for Predoctoral, Graduate, and Faculty Development 
                  Education Programs in Family Medicine

57.1601  To what programs do these regulations apply?
57.1602  Definitions.
57.1603  Who is eligible to apply for a grant?
57.1604  What requirements must a project meet?
57.1605  How will applications be evaluated?
57.1606  How long does grant support last?
57.1607  For what purposes may grant funds be spent?
57.1608  What additional Department regulations apply to grantees?
57.1609  What other audit and inspection requirements apply to grantees?
57.1610  Additional conditions.

    Subpart R--Grants for the Establishment of Departments of Family 
                                Medicine

57.1701  To what programs do these regulations apply?
57.1702  Definitions.
57.1703  Who is eligible to apply for a grant?
57.1704  Program requirements.
57.1705  How will applications be evaluated?
57.1706  How long does grant support last?
57.1707  For what purposes may grant funds be spent?
57.1708  What additional Department regulations apply to grantees?
57.1709  What other audit and inspection requirements apply to grantees?
57.1710  Additional conditions.

  Subpart S--Educational Assistance to Individuals From Disadvantaged 
                               Backgrounds

57.1801  To what grant program do these regulations apply?
57.1802  Definitions.
57.1803  Who is eligible to apply for a grant?
57.1804  Who is eligible for educational assistance?
57.1805  Program requirements.
57.1806  How will applications be evaluated?
57.1807  How long does grant support last?
57.1808  For what purposes may grant funds be spent?
57.1809  What additional Department regulations apply to grantees?
57.1810  What other audit and inspection requirements apply to grantees?
57.1811  Additional conditions.

Subpart T  [Reserved]

     Subpart U--Armed Forces Health Professions Scholarship Program

57.2001  Applicability.
57.2002  Definitions.
57.2003  Determinations of increased enrollment solely for the program.

               Subpart V--Grants for Centers of Excellence

57.2101  To what projects do these regulations apply?
57.2102  Definitions.
57.2103  Who is eligible to apply for a grant?
57.2104  Project requirements.
57.2105  How will applications be evaluated?
57.2106  How long does grant support last?
57.2107  For what purposes may grant funds be spent?
57.2108  What additional Department regulations apply to grantees?
57.2109  What other audit and inspection requirements apply to grantees?
57.2110  Additional conditions.

          Subpart W--Physician Shortage Area Scholarship Grants

57.2201  Applicability.
57.2202  Definitions.
57.2203  Eligibility.
57.2204  Application.
57.2205  Priority for selection of scholarship recipients.
57.2206  Grant award.
57.2207  Amount of scholarship grant.
57.2208  Payment of scholarship grant.
57.2209  Conditions of scholarship grant.
57.2210  Failure to comply.
57.2211  Waiver or suspension.

Subpart X  [Reserved]

  Subpart Y--Grants for Nurse Practitioner and Nurse Midwifery Programs

57.2401  Applicability.
57.2402  Definitions.
57.2403  Eligibility.
57.2404  Application.
57.2405  Project requirements.
57.2406  Evaluation and grant awards.
57.2407  Grant payments.
57.2408  Expenditure of grant funds.
57.2409  What additional Department regulations apply to grantees?
57.2410  Additional conditions.

Appendix to Subpart Y--Guidelines for Nurse Practitioner and Nurse 
          Midwifery Programs

[[Page 274]]

         Subpart Z--Grants for Advanced Nurse Education Programs

57.2501  Applicability.
57.2502  Definitions.
57.2503  Eligibility.
57.2504  Application.
57.2505  Project requirements.
57.2506  Evaluation and grant awards.
57.2507  Grant payments.
57.2508  Expenditure of grant funds.
57.2509  What additional Department regulations apply to grantees?
57.2510  Additional conditions.

Subparts AA-BB  [Reserved]

   Subpart CC--Scholarships for Students of Exceptional Financial Need

57.2801  To what programs do these regulations apply?
57.2802  Definitions.
57.2803  How to apply for a grant.
57.2804  Students eligible for scholarships.
57.2805  Amount of scholarship award.
57.2806  How is the amount of grant award determined?
57.2807  For what purposes may grant funds be spent?
57.2808  What additional Department regulations apply to grantees?
57.2809  What other records, audit, and inspection requirements apply to 
          grantees?
57.2810  Additional conditions.

 Subpart DD--Financial Assistance for Disadvantaged Health Professions 
                                Students

57.2901  To what program do these regulations apply?
57.2902  Definitions.
57.2903  How to apply for a grant.
57.2904  Eligibility and selection of aid recipients.
57.2905  Amount of student award.
57.2906  How is the amount of the grant award determined?
57.2907  For what purposes may grant funds be spent?
57.2908  What additional Department regulations apply to grants?
57.2909  What other records, audit, and inspection requirements apply to 
          schools?
57.2910  Additional conditions.

    Subpart EE--Grants for Residency Training in Preventive Medicine

57.3001  To what programs do these regulations apply?
57.3002  Definitions.
57.3003  Who is eligible to apply for a grant?
57.3004  Project requirements.
57.3005  How will applications be evaluated?
57.3006  How long does grant support last?
57.3007  How is the amount of the grant award determined?
57.3008  For what purposes may grant funds be spent?
57.3009  What additional Department regulations apply to grantees?
57.3010  What other audit and inspection requirements apply to grantees?
57.3011  Additional conditions.

  Subpart FF--Grants for Residency Training and Faculty Development in 
           General Internal Medicine and/or General Pediatrics

57.3101  To what projects do these regulations apply?
57.3102  Definitions.
57.3103  Who is eligible to apply for a grant?
57.3104  What activities must be addressed in an application?
57.3105  Project requirements.
57.3106  How will applications be evaluated?
57.3107  How long does grant support last?
57.3108  How is the amount of the grant award determined?
57.3109  For what purposes may grant funds be spent?
57.3110  What additional Department regulations apply to grantees?
57.3111  What other audit and inspection requirements apply to grantees?
57.3112  Additional conditions.

       Subpart GG--Payment for Tuition and Other Educational Costs

57.3201  To which programs do these regulations apply?
57.3202  How will allowable increases be determined?

Subparts HH-LL  [Reserved]

            Subpart MM--Area Health Education Center Program

57.3801  To what programs do these regulations apply?
57.3802  Definitions.
57.3803  Who is eligible to apply for a cooperative agreement?
57.3804  Project requirements.
57.3805  When do the requirements of Sec. 57.3804 apply?
57.3806  How will applications be evaluated?
57.3807  How is the amount of the award determined?
57.3808  How long does support under a cooperative agreement last?
57.3809  For what purposes may cooperative agreement funds be spent?
57.3810  How will the Department participate in a cooperative agreement?
57.3811  What additional Department regulations apply to awardees?

[[Page 275]]

57.3812  What other audit and inspection requirements apply?
57.3813  Additional conditions.

Subpart NN  [Reserved]

           Subpart OO--Grants for Geriatric Education Centers

57.4001  To what projects do these regulations apply?
57.4002  Definitions.
57.4003  Who is eligible to apply for a grant?
57.4004  Program requirements.
57.4005  How will applications be evaluated?
57.4006  How long does grant support last?
57.4007  For what purposes may grant funds be spent?
57.4008  What additional Department regulations apply to grantees?
57.4009  What other audit and inspection requirements apply to grantees?
57.4010  Additional conditions.

 Subpart PP--Grants for Faculty Training Projects in Geriatric Medicine 
                              and Dentistry

57.4101  To what projects do these regulations apply?
57.4102  Definitions.
57.4103  Who is eligible to apply for a grant?
57.4104  For what projects may grant funds be requested?
57.4105  Project requirements.
57.4106  How will applications be evaluated?
57.4107  How long does grant support last?
57.4108  What financial support is available to fellows?
57.4109  Who is eligible for financial assistance as a fellow?
57.4110  What are the requirements for fellowships and the appointment 
          of fellows?
57.4111  Termination of fellowships.
57.4112  For what purposes may grant funds be spent?
57.4113  What additional Department regulations apply to grantees?
57.4114  What other audit and inspection requirements apply to grantees?
57.4115  Additional conditions.

Subparts A-B  [Reserved]



               Subpart C--Health Professions Student Loans

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended, 63 Stat. 35 (42 U.S.C. 216); secs. 740-747 of the Public 
Health Service Act, 77 Stat. 170-173, as amended by 90 Stat. 2266-2268, 
91 Stat. 390-391, 95 Stat. 920, 99 Stat. 532-536, and 102 Stat. 3125 (42 
U.S.C. 294m-q); renumbered as secs. 721-735, as amended by Pub. L. 102-
408, 106 Stat. 2011-2022 (42 U.S.C. 292q--292y).

    Source: 44 FR 29055, May 18, 1979, unless otherwise noted.



Sec. 57.201  Applicability.

    The regulations of this subpart apply to the federal capital 
contributions made by the Secretary to public or other nonprofit health 
professions schools for the establishment of health professions student 
loan funds and to loans made to students by schools from these funds.



Sec. 57.202  Definitions.

    As used in this subpart:
    Act means the Public Health Service Act, as amended.
    Date upon which a student ceases to be a full-time student means the 
first day of the month which is nearest to the date upon which an 
individual ceases to be a full-time student as defined in this section.
    Default means the failure of a borrower of a loan made under this 
subpart to make an installment payment when due, or comply with any 
other term of the promissory note for such loan, except that a loan made 
under this subpart shall not be considered to be in default if the loan 
is discharged in bankruptcy, the borrower's repayment schedule has been 
renegotiated and the borrower is complying with the renegotiated 
schedule, or the loan is in forbearance.
    Federal capital loan means a loan made by the Secretary to a school 
under section 744(a) of the Act, as in effect prior to October 1, 1977, 
the proceeds of which are to be returned to the Secretary.
    Full-time student means a student who is enrolled in a health 
professions school and pursuing a course of study which is a full-time 
academic workload, as determined by the school, leading to a degree 
specified in section 722(b) of the Act.
    Grace period means the period of 1 year beginning on the date upon 
which a student ceases to be a full-time student at a school of 
medicine, osteopathic medicine, dentistry, pharmacy, podiatric medicine, 
optometry, or veterinary medicine.

[[Page 276]]

    Health professions school or school, for purposes of this subpart, 
means a public or private nonprofit school of medicine, school of 
dentistry, school of osteopathic medicine, school of pharmacy, school of 
podiatric medicine, school of optometry, or school of veterinary 
medicine as defined in section 799(1)(A) of the Act.
    Health professions student loan means the amount of money advanced 
to a student by a school from a health professions student loan fund 
under a properly executed promissory note.
    Institutional capital contribution means the money provided by a 
school, in an amount not less than one-ninth of the federal capital 
contribution, and deposited in a health professions student loan fund.
    National of the United States means: (1) A citizen of the United 
States, or (2) a person who, though not a citizen of the United States, 
owes permanent allegiance to the United States, as defined in the 
Immigration and Nationality Act, at 8 U.S.C. section 1101(a)(22).
    School year means the traditional approximately 9-month September to 
June annual session. For the purpose of computing school year 
equivalents for students who, during a 12-month period, attend for a 
longer period than the traditional school year, the school year will be 
considered to be 9 months in length.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[44 FR 29055, May 18, 1979, as amended at 52 FR 20987, June 3, 1987; 53 
FR 46549, Nov. 17, 1988; 56 FR 19293, Apr. 26, 1991; 56 FR 25446, June 
4, 1991; 61 FR 6123, Feb. 16, 1996]



Sec. 57.203  Application by school.

    (a) Each school seeking a Federal capital contribution must submit 
an application at the time and in the form and manner that the Secretary 
may require. The application must be signed by an individual authorized 
to act for the applicant and to assume on behalf of the applicant the 
obligations imposed by the statute, the regulations of this subpart, and 
the terms and conditions of the award.
    (b) Each application will be reviewed to determine eligibility and 
the reasonableness of the amount of Federal support requested. The 
Secretary may require the applicant to submit additional data for this 
purpose.
    (c) An application will not be approved unless an agreement between 
the Secretary and the applicant school for a Federal capital 
contribution under section 721 of the Act is reached.

[44 FR 29055, May 18, 1979, as amended at 49 FR 38112, Sept. 27, 1984; 
56 FR 19293, Apr. 26, 1991; 57 FR 45734, Oct. 5, 1992; 61 FR 6123, Feb. 
16, 1996]



Sec. 57.204  Payment of Federal capital contributions and reallocation of funds remitted to the Secretary.

    (a) Annual payment. The Secretary will make payments to each school 
with which he or she has entered into an agreement under the Act at a 
time determined by him or her. If the total of the amounts requested for 
any fiscal year by all schools for Federal capital contributions exceeds 
the amount of Federal funds determined by the Secretary at the time of 
payment to be available for this purpose, the payment to each school 
will be reduced to whichever is smaller:
    (1) The amount requested in the application, or
    (2) An amount which bears the same ratio to the total amount of 
Federal funds determined by the Secretary at the time of payment to be 
available for that fiscal year for the Health Professions Student Loan 
Program as the number of full-time students estimated by the Secretary 
to be enrolled in that school bears to the estimated total number of 
full-time students in all participating schools during that year. 
Amounts remaining after these payments are made will be distributed in

[[Page 277]]

accordance with this paragraph among schools whose applications 
requested more than the amount paid to them, but with whatever 
adjustments that may be necessary to prevent the total paid to any 
school from exceeding the total requested by it.
    (b) Method of payment. The payment of Federal capital contributions 
to a school will be paid in a manner that avoids unnecessary 
accumulations of money in any health professions student loan fund.
    (c) Reallocation of funds remitted to the Secretary. All funds from 
a student loan fund established under this subpart which are remitted to 
the Secretary in any fiscal year shall be available for allotment under 
this subpart, in the same fiscal year and the succeeding fiscal year, to 
schools which, during the period beginning on July 1, 1972, and ending 
on September 30, 1985, established student loan funds with Federal 
capital contributions under this subpart. The Secretary will from time 
to time set dates by which the schools must file applications to receive 
a portion of these funds. If the total of the amounts requested for any 
fiscal year by eligible schools exceeds the amount of funds determined 
by the Secretary at the time of payment to be available for this 
purpose, the payment to each school will be reduced to whichever is 
smaller:
    (1) The amount requested in the application, or
    (2) An amount which bears the same ratio to the total amount of 
returned funds determined by the Secretary at the time of payment to be 
available for that fiscal year for the Health Professions Student Loan 
program as the number of full-time students estimated by the Secretary 
to be enrolled in that school bears to the estimated total number of 
full-time students in all eligible schools during that year.

Amounts remaining after these payments are made will be distributed in 
accordance with this paragraph among schools whose applications 
requested more than the amount paid to them, with whatever adjustments 
may be necessary to prevent the total paid to any school from exceeding 
the total requested by it.

[44 FR 29055, May 18, 1979, as amended at 53 FR 46549, Nov. 17, 1988; 56 
FR 19293, Apr. 26, 1991]



Sec. 57.205  Health professions student loan funds.

    (a) Funds established with Federal capital contributions. Any fund 
established by a school with Federal capital contributions will be 
accounted for separately from other funds, providing a clear audit trail 
for all transactions. At all times the fund must contain monies 
representing the institutional capital contribution. The school must at 
all times maintain all monies relating to the fund in one or more 
interest-bearing accounts or investment instruments which meet OMB 
requirements established for Federal monies held by third parties. The 
school must place all earnings into the fund but may first deduct from 
total earnings any reasonable and customary charges incurred through the 
use of an interest-bearing account. An institution shall exercise the 
level of care required of a fiduciary with regard to these deposits and 
investments, and shall be responsible for reimbursing the fund for any 
losses that occur due to the use of investments that are not federally 
insured.
    (1) The Federal capital contribution fund is to be used by the 
school only for:
    (i) Health professions student loans to full-time students;
    (ii) Capital distribution as provided in section 728 of the Act or 
as agreed to by the school and the Secretary; and
    (iii) Costs of litigation, costs associated with membership in 
credit bureaus, and to the extent specifically approved by the 
Secretary, other collection costs that exceed the usual expenses 
incurred in the collection of health professions student loans.
    (2) A school must review the balance in the fund on at least a semi-
annual basis to determine whether the fund balance compared with 
projected levels of expenditures and collections exceeds its needs. A 
school in closing status must review the balance in the fund on a 
quarterly basis. Monies identified as in excess of the school's needs 
must be

[[Page 278]]

reported, and the Federal share returned to the Federal Government, by 
the due date of the required report which identifies the excess monies. 
The school's determination is subject to the review and approval of the 
Secretary.
    (b) Funds established with Federal capital loans. (1) Each Federal 
capital loan is subject to the terms of the promissory note executed by 
an authorized official on behalf of the borrowing school.
    (2) The Federal capital loans must be carried in a special account 
of the school, to be used by the school only for (i) repayments of 
principal and interest on Federal capital loans; and (ii) costs of 
litigation; costs associated with membership in credit bureaus; and, to 
the extent specifically approved by the Secretary, other collection 
costs that exceed the usual expenses incurred in the collection of 
health professions student loans.
    (c) Failure to comply with the requirements of this section will 
subject a school to the noncompliance provisions of Sec. 57.218 and the 
Department's Claims Collections regulations (45 CFR part 30), as 
appropriate.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[44 FR 29055, May 18, 1979, as amended at 48 FR 25069, June 3, 1983; 56 
FR 40725, Aug. 15, 1991; 61 FR 6123, Feb. 16, 1996]



Sec. 57.206  Eligibility and selection of health professions student loan applicants.

    (a) Determination of eligibility. (1) Applicants are eligible for 
consideration for a health professions student loan if they are:
    (i) Residents of the United States and either a citizen or national 
of the United States, an alien lawfully admitted for permanent residence 
in the United States, a citizen of the Commonwealth of the Northern 
Mariana Islands, a citizen of the Republic of Palau, a citizen of the 
Republic of the Marshall Islands, or a citizen of the Federated States 
of Micronesia;
    (ii) Enrolled, or accepted for enrollment in the school as full-time 
students;
    (iii) In need of the amount of the loan to pursue a full-time course 
of study at the school;
    (iv) Of exceptional financial need in the case of students of 
medicine or osteopathic medicine. A student will be considered to 
demonstrate exceptional financial need if the school determines that his 
or her resources, as described in paragraph (b)(1) of this section, do 
not exceed the lesser of $6,700 or one-half of the costs of attendance 
at the school. Summer earnings, educational loans, veterans (G.I.) 
benefits and earnings during the school year will not be considered as 
resources in determining whether an applicant meets the eligibility 
criteria for exceptional financial need, but will be considered in 
determining the amount of funds a student may receive; and
    (v) In compliance with the requirement to register for the draft, if 
required to do so under section 3 of the Military Selective Service Act.
    (2) An applicant who has previously attended an institution of 
higher education must submit a financial aid transcript which includes 
at least the following data:
    (i) Applicant's name and social security number;
    (ii) Amounts and sources of loans and grants previously received by 
the applicant for study at an institution of higher education;
    (iii) Whether the applicant is in default on any of these loans, or 
owes a refund on any grants;
    (iv) Certification from each institution previously attended by the 
applicant that the applicant has received no financial aid, if 
applicable; and
    (v) From each institution previously attended, the signature of an 
official authorized by the institution to sign such transcripts on 
behalf of the institution.
    (b) Selection of applicants. The school will select qualified 
applicants, including medical (M.D. and D.O.) applicants, and determine 
the amount of student loans by considering:
    (1) The financial resources available to the student by using one of 
the national need analysis systems or any other procedure approved by 
the Secretary of Education in combination with other information which 
the school has regarding the student's financial status. The school must 
take

[[Page 279]]

into account, regardless of the tax status of the student, the expected 
contribution from parents, spouse, self or other family members; and
    (2) The costs reasonably necessary for the student's attendance at 
the school, including any special needs and obligations which directly 
affect the student's ability to attend the school on a full-time basis. 
The school must document the criteria used for determining these costs.
    (c) Selection of medical (M.D. and D.O.) student applicants. In 
addition to the factors in Sec. 57.206(b), the school must select 
medical (M.D. and D.O.) students graduating after June 30, 1979, based 
on the order of greatest need, taking into consideration the other 
resources available to the student through the school. For purposes of 
establishing priority for selecting medical (M.D. and D.O.) student 
applicants to receive health professions student loans, summer earnings, 
educational loans, veterans (G.I.) benefits, and earnings during the 
school year will be considered as financial resources.
    (d) Verification of loan information. The school must verify, to the 
best of its ability, the information provided by the student on the loan 
application. To comply with this requirement, a school may require that 
a student provide, for example: Photocopies of the parents', student's, 
and spouse's Federal income tax forms with original signatures for the 
most recent tax year (or certification that no Federal income tax return 
was filed); tax returns that are certified as having been received by 
the Internal Revenue Service; or other documentation that the school 
considers necessary to help assure that information on the loan 
application is correct.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[44 FR 32698, June 7, 1979, as amended at 48 FR 25069, June 3, 1983; 49 
FR 38112, Sept. 27, 1984; 52 FR 20987, June 3, 1987; 53 FR 46549, Nov. 
17, 1988; 56 FR 19293, Apr. 26, 1991; 61 FR 6123, Feb. 16, 1996]



Sec. 57.207  Maximum amount of health professions student loans.

    The total of the health professions student loans made from the fund 
to any student for a school year may not exceed $2,500 and the cost of 
tuition. The maximum amount loaned during a 12-month period to any 
student enrolled in a school which provides a course of study longer 
than the 9-month school year may be proportionately increased.



Sec. 57.208  Health professions student loan promissory note and disclosure requirements.

    (a) Promissory note form. Each health professions student loan must 
be evidenced by a properly executed promissory note in a form approved 
by the Secretary. The school must safeguard the promissory note against 
fire, theft, and tampering.
    (1) Each promissory note must state that the loan will bear interest 
on the unpaid balance computed only for periods during which repayment 
of the loan is required, at the rate of 5 percent per year.
    (2) Each promissory note must contain an acceleration clause 
provided by the Secretary, which will permit the acceleration of 
delinquent loans at the school's option.
    (3) A copy of each executed note must be supplied by the school to 
the student borrower.
    (b) Security. A school must require security or endorsement if the 
borrower is a minor and if, under the applicable State law, the note 
signed by him or her would not create a binding obligation. The school 
may not require security or endorsement in any other circumstances.
    (c) Disclosure requirements. (1) For any loan made after June 30, 
1986, the school shall, at the time the loan is made, provide the 
following loan information to the student:
    (i) The yearly and cumulative maximum amounts that may be borrowed 
by the student;
    (ii) The terms under which repayment of the loan will begin;
    (iii) The maximum number of years in which the loan must be repaid;
    (iv) The interest rate that will be paid by the borrower and the 
minimum amount of the required monthly payment;
    (v) The amount of any other fees charged to the borrower by the 
lender;

[[Page 280]]

    (vi) Any options the borrower may have for deferral, cancellation, 
prepayment, consolidation, or other refinancing of the loan;
    (vii) A definition of default on the loan and a specification of the 
consequences which will result to the borrower if the borrower defaults, 
including a description of any arrangements which may be made with 
credit bureau organizations;
    (viii) To the extent practicable, the effect of accepting the loan 
on the eligibility of the borrower for other forms of student 
assistance; and
    (ix) A description of the actions that may be taken by the Federal 
Government to collect the loan, including a description of the type of 
information concerning the borrower that the Federal Government may 
disclose to:
    (A) Officers, employees, or agents of the Department of Health and 
Human Services,
    (B) Officers, employees, or agents of schools with which the 
Secretary has an agreement under this subpart, or
    (C) Any other person involved in the collection of a loan under this 
subpart.
    (2) For any loan made after June 30, 1986, the school shall, prior 
to the borrower's completion or termination of studies at the school, 
provide the following loan information to the student:
    (i) Each amount borrowed by the student under this subpart;
    (ii) The total amount borrowed by the student under this subpart; 
and
    (iii) A schedule for the repayment of the amounts borrowed under 
this subpart, including the number, amount, and frequency of payments to 
be made.
    (3) In addition to the requirements set forth in paragraphs (c)(1) 
and (c)(2) of this section, the school must comply with the applicable 
requirements of Truth in Lending Regulation Z (12 CFR part 226).

(Approved by the Office of Management and Budget under control number 
0915-0047)

[44 FR 29055, May 18, 1979, as amended at 48 FR 25069, June 3, 1983; 50 
FR 34420, Aug. 23, 1985; 52 FR 20987, June 3, 1987; 56 FR 19293, Apr. 
26, 1991; 57 FR 45734, Oct. 5, 1992]



Sec. 57.209  Payment of health professions student loans.

    (a) Health professions student loans from any fund may be paid to or 
on behalf of student borrowers in installments considered appropriate by 
the school except that a school may not pay to or on behalf of any 
borrower more during any given installment period (e.g., semester, term, 
or quarter) than the school determines the student needs for that 
period.
    (b) No payment may be made from a fund to or on behalf of any 
student borrower if at the time of the payment the borrower is not a 
full-time student.



Sec. 57.210  Repayment and collection of health professions student loans.

    (a) Each health professions student loan, including accrued 
interests, will be repayable in equal or graduated periodic installments 
in amounts calculated on the basis of a 10-year repayment period. Except 
as otherwise provided in this paragraph, repayment of a loan must begin 
one year after the student ceases to be a full-time student.
    (1) If a borrower reenters the same or another school as a full-time 
student within the 1-year period, the date upon which interest will 
accrue and the repayment period will begin will be determined by the 
date on which the student last ceases to be a full-time student at that 
school.
    (2) The following periods will be excluded from the 10-year 
repayment period:
    (i) All periods for up to a total of 3 years of active duty 
performed by the borrower as a member of the Army, Navy, Air Force, 
Marine Corps, Coast Guard, National Oceanic and Atmospheric 
Administration Corps or the U.S. Public Health Service Corps;
    (ii) All periods for up to a total of 3 years of service as a 
volunteer under the Peace Corps Act;
    (iii) All periods of advanced professional training including 
internships and residencies, except as specified in paragraph (a)(2)(vi) 
of this section;
    (iv) All periods during which the borrower is pursuing a full-time 
course of study at an eligible health professions school;
    (v) A period not in excess of 2 years during which a borrower who is 
a full-

[[Page 281]]

time student in a health professions school leaves the school, with the 
intent to return to such school as a full-time student, to engage in a 
full-time educational activity which is directly related to the health 
profession for which the individual is preparing. To qualify for such 
deferment, the full-time educational activity must be one which:
    (A) Is part of a joint-degree program or a formal program of joint 
study in conjunction with the health profession for which the borrower 
is preparing at the school; or
    (B) Is an activity which will enhance the borrower's knowledge and 
skills in the health profession for which the borrower is preparing at 
the school, as determined by the school.

The borrower must request such deferment from the school in which he or 
she is enrolled no later than 60 days prior to leaving such school to 
engage in the full-time educational activity. The school must then 
determine, no later than 30 days prior to the borrower's leaving such 
school, whether the borrower qualifies for such deferment. A borrower 
who qualifies for this type of deferment receives the grace period upon 
completion or termination of his or her studies leading to the first 
professional degree in the health discipline being pursued. If the 
borrower fails to return to school, the school retroactively must begin 
the borrower's grace period based on the date the borrower terminated 
his or her studies at the school, and must begin the repayment period 
immediately following the end of the grace period; and
    (vi) A period not in excess of 2 years during which a borrower who 
is a graduate of a health professions school participates in:
    (A) A fellowship training program which is directly related to the 
health profession for which the borrower prepared at the school, as 
determined by the school from which the borrower received his or her 
loan, and is engaged in by the borrower no later than 12 months after 
the completion of the borrower's participation in advanced professional 
training as described in paragraph (a)(2)(iii) of this section, or prior 
to the completion of such borrower's participation in such training. To 
qualify for such deferment, the fellowship training program must be one 
which:
    (1) Is a full-time activity in research or research training or in 
health care policy; and
    (2) Is a formally established fellowship program which was not 
created for a specific individual; or
    (B) A full-time educational activity which is directly related to 
the health profession for which the borrower prepared at the school, as 
determined by the school from which the borrower received his or her 
loan, and is engaged in by the borrower no later than 12 months after 
the completion of the borrower's participation in advanced professional 
training as described in paragraph (a)(2)(iii) of this section, or prior 
to the completion of the borrower's participation in such training. To 
qualify for such deferment, the full-time educational activity must be 
one which:
    (1) Is part of a joint-degree program in conjunction with the health 
profession for which the borrower prepared at the school; or
    (2) Is required for licensure, registration, or certification in the 
health profession for which the borrower received the HPSL loan; or
    (3) Is a full-time educational program in public health, health 
administration, or a health care discipline directly related to the 
health profession for which the borrower received the loan.
    (3) To receive a deferment, a borrower must, no later than 30 days 
prior to the onset of the activity (or no later than 30 days prior to 
the due date of the first payment if the borrower begins the activity 
during the grace period), and annually thereafter, provide the lending 
school with evidence of his or her status in the deferrable activity, 
and evidence that verifies deferment eligibility of the activity. This 
evidence must include certification by the Program Director or other 
authorized official that the borrower's activity meets the deferment 
requirements. The borrower must also notify the school upon completion 
or termination of the activity. It is the responsibility of the borrower 
to provide the lending school

[[Page 282]]

with all required information or other information regarding the 
requested deferment. The school may deny a request for deferment if it 
is not filed in accordance with the requirements of this section.
    (4) Subject to the provisions of paragraph (b)(3) of this section, a 
borrower must establish a repayment schedule with the school providing 
for payments not less often than quarterly. Any borrower whose repayment 
is delinquent more than 60 days must establish a monthly repayment 
schedule with the school. However, a borrower may at his or her option 
and without penalty, prepay all or part of the principal and accrued 
interest at any time.
    (5) A school may grant forbearance whenever extraordinary 
circumstances such as unemployment, poor health or other personal 
problems temporarily affect the borrower's ability to make scheduled 
loan repayments.
    (b)(1) Each school at which a fund is established must exercise due 
diligence in the collection of health professions student loans due the 
fund. In the exercise of due diligence, a school must follow procedures 
which are at least as extensive and effective as those used in the 
collection of other student loan accounts due the school, and must use 
the steps outlined below in accordance with collection practices which 
are generally accepted among institutions of higher education:
    (i) Conduct and document an entrance interview (individually or in 
groups) with the borrower prior to disbursing HPSL funds in an academic 
year. During the entrance interview the school must obtain documentation 
which indicates that the borrower is aware of the rights and 
responsibilities associated with HPSL funds and personal information 
which would assist in locating the borrower if he or she fails to keep 
the school informed of his or her current address. The requirements of 
this subparagraph may be met by correspondence, if the school determines 
that a face-to-face meeting (individually or in groups) is 
impracticable.
    (ii) Conduct and document an exit interview (individually or in 
groups) with the borrower. During the exit interview, the school must 
provide each borrower with information necessary to carry out the terms 
of repayment, remind the borrower of the rights and responsibilities 
associated with HPSL funds, and update the personal information 
collected prior to disbursing HPSL funds which would assist in locating 
the borrower if he or she fails to keep the school informed of his or 
her current address. If the borrower terminates studies without advance 
notice, the school must document attempts to inform the borrower of the 
substance of the exit interview and to secure exit interview information 
from the borrower by mail.
    (iii) Notify the borrower in writing of the impending repayment 
obligation at least twice during the grace period;
    (iv) Notify a borrower who is in deferment status in writing of the 
impending repayment obligation 1 to 3 months prior to the expiration of 
the approved period of deferment;
    (v) Perform regular billing;
    (vi) Follow up past due payments with a series of at least four 
documented and reasonably spaced attempts to contact the borrower, at 
least three of which must be in writing at not more than 30-day 
intervals, prior to the loan becoming 120 days past due, provided that 
the school has a current address for the borrower;
    (vii) Perform address searches when necessary;
    (viii) Use collection agents, which may include the use of an 
internal collection agent;
    (ix) Institute legal proceedings against borrowers after all other 
attempts at collection have failed, unless the school determines, 
subject to the approval of the Secretary, that such litigation would not 
be cost-effective; and
    (x) Become a member of a credit bureau and notify the credit bureau 
of accounts past due by more than 120 days.

In place of one or more of the procedures outlined above schools may 
substitute collection techniques that are equally or more effective, but 
only after they have demonstrated the effectiveness of the techniques 
and obtained written approval from the Secretary.
    (2) Late charge. (i) For any health professions student loan made 
after June 30, 1969, but prior to October 22,

[[Page 283]]

1985, the school may fix a charge for failure of the borrower to pay all 
or any part of an installment when it is due and, in the case of a 
borrower who is entitled to deferment under section 722(c) of the Act 
for any failure to file timely and satisfactory evidence of the 
entitlement. The amount of the charge may not exceed $1 for the first 
month or part of a month by which the installment or evidence is late 
and $2 for each succeeding month or part of a month. The school may 
elect to add the amount of this charge to the principal amount of the 
loan as of the day after the day on which the installment or evidence 
was due, or to make the amount of the charge payable to the school no 
later than the due date of the next installment following receipt of the 
notice of the charge by the borrower.
    (ii) For any health professions student loan made on or after 
October 22, 1985, the school shall assess a charge for failure of the 
borrower to pay all or any part of an installment when the loan is more 
than 60 days past due and, in the case of a borrower who is entitled to 
deferment under section 722(c) of the Act, for any failure to file 
satisfactory evidence of the entitlement within 60 days of the date 
payment would otherwise be due. No charge may be made if the loan is 
less than 61 days past due. The amount of this charge may not exceed an 
amount equal to 6 percent of the amount due at the time the charge is 
calculated. The school may elect to add the amount of this charge to the 
principal amount of the loan as of the day on which the charge is 
calculated, or to make the amount of the charge payable to the school no 
later than the due date of the next installment following receipt of the 
notice of the charge by the borrower.
    (3) With respect to any health professions student loan made after 
June 30, 1969, the school may require the borrower to make payments of 
at least $15 per month on all outstanding health professions student 
loans during the repayment period.
    (4) A school must, on an annual basis, review and assess the 
collectibility of any loan more than 3 years past due. If the school 
determines that the prospects of future collection are promising enough 
to justify periodic review of the debt, and neither the statute of 
limitations nor the 10-year repayment period has expired, the school may 
retain the account for continued collections, provided that it makes an 
attempt at least semi-annually to collect from the borrower. When the 
due diligence procedures required by paragraph (b)(1) of this section 
have been exhausted, the school is responsible for determining the 
collection methods it will use for the semi-annual collection effort 
required on these loans. If the school determines that the prospects of 
future collection are not promising, or when the statute of limitations 
or the 10-year repayment period has expired, the loan must be considered 
uncollectible. A school may determine a loan to be uncollectible sooner 
than 3 years past due when it has evidence that the loan cannot be 
collected, but in no case should a school consider a loan as 
uncollectible if it has not been in default for a least 120 days. A 
school is not subject to the requirements in paragraphs (b)(4) (i) and 
(iii) of this section for loans that became uncollectible, as determined 
by the school, before August 1, 1985.
    (i) A school must request permission to write off an uncollectible 
loan within 30 days of the determination that it is uncollectible or 
reimburse the fund in the full amount of the loan, pursuant to 
Sec. 57.210(b)(4)(iii). The 30-day period for submitting the loan for 
write-off review begins on the date that the determination of 
uncollectibility is made, in accordance with paragraph (b)(4) of this 
section. In any instance where the Secretary determines that a school 
has failed to exercise due diligence in the collection of a loan, in 
accordance with the applicable regulatory requirements, the school will 
be required to place in the fund the full amount of principal, interest, 
and penalty charges that remains uncollected on the loan. Reimbursement 
must be made by the following June 30 or December 31, whichever is 
sooner, except that in no case will a school be required to reimburse 
the fund in less than 30 days following the Secretary's disapproval of 
the request for write-off approval.

[[Page 284]]

    (ii) If the Secretary determines that a school has exercised due 
diligence in the collection of a loan, in accordance with the applicable 
regulatory requirements, or if the school determines that the loan was 
uncollectible prior to August 1, 1985, the school will be permitted to 
reduce its accounts receivable for the HPSL fund by the full amount of 
principal, interest, and penalty charges that remains uncollected on 
that loan and will not be required to return the Federal share of the 
loss to the Secretary.
    (iii) If a school does not request permission to write off an 
uncollectible loan within the required timeframe, it must reimburse the 
fund for the full amount of principal, interest, and penalty charges 
that remains uncollected on that loan. This reimbursement must be made 
by the following June 30 or December 31, whichever is sooner, except 
that in no case will a school be required to reimburse the fund in less 
than 30 days following its determination that a loan is uncollectible.
    (iv) Failure to comply with the requirement of this section will 
subject a school to the noncompliance provisions of Sec. 57.218 and the 
Department's Claims Collection regulations (45 CFR part 30), as 
appropriate.
    (5) Disclosure of taxpayer identity information. Upon written 
request by the Secretary, the Secretary of the Internal Revenue Service 
(IRS) may disclose the address of any taxpayer who has defaulted on a 
health professions student loan, for use only by officers, employees, or 
agents of the Department, to locate the defaulted borrower to collect 
the loan. Any such mailing address may be disclosed by the Secretary to 
any school from which the defaulted borrower received a health 
professions student loan, for use only by officers, employees, or agents 
of the school whose duties relate to the collection of health 
professions student loan funds, to locate the defaulted borrower to 
collect the loan. Any school which requests and obtains this address 
information must comply with the requirements of the Secretary and the 
IRS regarding the safeguarding and proper handling of this information.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[44 FR 29055, May 18, 1979, as amended at 48 FR 25069, June 3, 1983; 49 
FR 38112, Sept. 27, 1984; 50 FR 34420, Aug. 23, 1985; 52 FR 20988, June 
3, 1987; 53 FR 6092, Feb. 29, 1988; 56 FR 19293, Apr. 26, 1991; 56 FR 
40726, Aug. 15, 1991; 57 FR 45734, Oct. 5, 1992; 61 FR 6123, Feb. 16, 
1996]



Sec. 57.211  Cancellation of health professions students loans for disability or death.

    (a) Permanent and total disability. The Secretary will cancel a 
student borrower's indebtedness in accordance with section 722(d) of the 
Act if the borrower is found to be permanently and totally disabled on 
recommendation of the school and as supported by whatever medical 
certification the Secretary may require. A borrower is totally and 
permanently disabled if he or she is unable to engage in any substantial 
gainful activity because of a medically determinable impairment, which 
the Secretary expects to continue for a long time or to result in death.
    (b) Death. The Secretary will cancel a student borrower's 
indebtedness in accordance with section 722(d) of the Act upon the death 
of the borrower. The school to which the borrower was indebted must 
secure a certification of death or whatever official proof is conclusive 
under State law.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[44 FR 29055, May 18, 1979, as amended at 56 FR 19293, Apr. 26, 1991; 61 
FR 6123, Feb. 16, 1996]



Sec. 57.212  [Reserved]



Sec. 57.213  Continuation of provisions for cancellation of loans made prior to November 18, 1971.

    Individuals who received health professions student loans as 
students of medicine, osteopathic medicine, dentistry or optometry prior 
to November 18, 1971, may still receive cancellation of these loans for 
practicing in a shortage area or for practicing in a rural shortage area 
characterized by low family income. The regulations set

[[Page 285]]

forth in 42 CFR 57.215(b) (1976), as adopted on February 7, 1974 remain 
applicable to cancellation on this basis. The provisions can be found at 
39 FR 4774 (February 7, 1974) and a copy can be obtained by writing to 
the Division of Student Assistance, Bureau of Health Professions, Room 
8-34, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857.

[49 FR 38112, Sept. 27, 1984, as amended at 56 FR 19294, Apr. 26, 1991]



Sec. 57.213a  Loan cancellation reimbursement.

    (a) For loans made prior to October 22, 1985, in the event that 
insufficient funds are available to the Secretary in any fiscal year to 
enable him or her to pay to all schools their proportionate shares of 
all loans and interest canceled under this subpart for practice in a 
shortage area, death, or disability:
    (1) Each school will be paid an amount bearing the same ratio to the 
total of the funds available for that purpose as the principal of loans 
canceled by that school in that fiscal year bears to the total principal 
of loans canceled by all schools in that year; and
    (2) Any additional amounts to which a school is entitled will be 
paid by the Secretary at the time of distribution of the assets of the 
school's Fund under section 728 of the Act.
    (b) For loans made on or after October 22, 1985, a school may assess 
the borrower a charge to insure against the loss of the institutional 
share of a loan canceled due to the borrower's death or permanent and 
total disability. The school must develop annually a rate which reflects 
its cancellation experience. This charge shall not exceed .6 percent of 
the loan amount. Funds collected under this provision must be maintained 
by the school in an insured, interest-bearing account (with any earned 
interest credited to this insurance fund), and used only to reimburse 
the school for the institutional share of any HPSL loan made on or after 
October 22, 1985, that is canceled due to the borrower's death or 
permanent and total disability. A school is not required to establish a 
separate bank account, but is required to maintain separate 
accountability.

[53 FR 46549, Nov. 17, 1988, as amended at 56 FR 19294, Apr. 26, 1991; 
57 FR 45734, Oct. 5, 1992; 61 FR 6123, Feb. 16, 1996]



Sec. 57.214  Repayment of loans made after November 17, 1971, for failure to complete a program of study.

    In the event that the Secretary undertakes to repay educational 
loans under section 722(k) of the Act, he or she will use the following 
criteria to make a determination as to each applicant's eligibility:
    (a) An applicant will be considered to have failed to complete the 
course of study leading to the first professional degree for which an 
eligible education loan was made upon certification by a health 
professions school that the individual ceased to be enrolled in the 
school subsequent to November 17, 1971;
    (b) An applicant will be considered to be in exceptionally needy 
circumstances if, upon comparison of the income and other financial 
resources of the applicant with his or her expenses and financial 
obligations, the Secretary determines that repayment of the loan would 
constitute a serious economic burden on the applicant. In making this 
determination, the Secretary will take into consideration the 
applicant's net financial assets, his or her potential earning capacity, 
and the relationship of the income available to the applicant to the 
low-income levels published annually by the Secretary under paragraph 
(c) of this section;
    (c) An applicant will be considered to be from a low-income family 
if the applicant comes from a family with an annual income below a level 
based on low-income thresholds according to family size published by the 
U.S. Bureau of the Census, adjusted annually for changes in the Consumer 
Price Index, and adjusted by the Secretary for use in this program, and 
the family has no substantial net financial assets. Income levels as 
adjusted will be published annually by the Secretary in the Federal 
Register.
    (d) An applicant will be considered to be from a disadvantaged 
family if the individual comes from a family in which the annual income 
minus unusual expenses which contribute to the

[[Page 286]]

economic burdens borne by the family does not exceed the low-income 
levels published by the Secretary under paragraph (c) of this section 
and the family has no substantial net financial assets;
    (e) An applicant will be considered as not having resumed his or her 
health professions studies within two years following the date the 
individual ceased to be a student upon a certification so stating from 
the applicant; and
    (f) An applicant will be considered as not reasonably expected to 
resume his or her health professions studies within two years following 
the date upon which he or she terminated these studies, based upon 
consideration of the reasons for the applicant's failure to complete 
these studies, taking into account such factors as academic, medical, or 
financial difficulties.

The Secretary will only repay education loans made subsequent to 
November 17, 1971.

[44 FR 29055, May 18, 1979, as amended at 61 FR 6123, Feb. 16, 1996; 61 
FR 9532, Mar. 8, 1996]



Sec. 57.215  Records, reports, inspection, and audit.

    (a) Each Federal capital contribution and Federal capital loan is 
subject to the condition that the school must maintain those records and 
file with the Secretary those reports relating to the operation of its 
health professions student loan funds as the Secretary may find 
necessary to carry out the purposes of the Act and these regualtions. A 
school must submit required reports to the Secretary within 45 days of 
the close of the reporting period.
    (1) A school which fails to submit a required report for its Federal 
capital contribution fund within 45 days of the close of the reporting 
period:
    (i) Shall be prohibited from receiving new Federal capital 
contributions;
    (ii) Must place the revolving fund and all subsequent collections in 
an insured interest-bearing account; and
    (iii) May make no loan disbursements.

The above restrictions apply until the Secretary determines that the 
school is in compliance with the reporting requirement.
    (2) A school that fails to submit a complete report within 6 months 
of the close of the reporting period will be subject to termination. The 
Secretary will provide the school with a written notice specifying his 
or her intention to terminate the school's participation in the program 
and stating that the school may request, within 30 days of the receipt 
of this notice, a formal hearing. If the school requests a hearing, it 
must within 90 days of the receipt of the notice, submit material, 
factual issues in dispute to demonstrate that there is cause for a 
hearing. These issues must be both substantive and relevant. The hearing 
will be held in the Washington, DC metropolitan area. The Secretary will 
deny a hearing if:
    (i) The request for a hearing is untimely (i.e., fails to meet the 
30-day requirement);
    (ii) The school does not provide a statement of material, factual 
issues in dispute within the 90-day required period; or
    (iii) The statement of factual issues in dispute is frivolous or 
inconsequential.

In the event that the Secretary denies a hearing, the Secretary will 
send a written denial to the school setting forth the reasons for 
denial. If a hearing is denied, or if as a result of the hearing, 
termination is still determined to be necessary, the school will be 
terminated from participation in the program and will be required to 
return the Federal share of the revolving fund to the Department. A 
school terminated for failure to submit a complete report within 6 
months of the close of the reporting period must continue to pursue 
collections and may reapply for participation in the program once it has 
submitted the overdue report.
    (3) The school must also comply with the requirements of 45 CFR part 
74 and section 798(e) of the Act concerning recordkeeping, audit, and 
inspection.
    (b) The following student records must be retained by the school for 
5 years after an individual student ceases to be a full-time student:
    (1) Approved student applications for health professions student 
loans;

[[Page 287]]

    (2) Documentation of the financial need of applicants; and
    (3) Copy of financial aid transcript(s).
    (c) The following repayment records for each individual borrower 
must be retained for at least 5 years from the date of retirement of a 
loan:
    (1) The amount and date of each loan;
    (2) The amount and date of each payment or cancellation;
    (3) Records of periods of deferment;
    (4) Date, nature and result of each contact with the borrower or 
proper endorser in the collection of an overdue loan;
    (5) Copies of all correspondence to or from the borrower and 
endorser;
    (6) Copies of all correspondence with collection agents related to 
the individual borrower;
    (7) Copies of all correspondence with a credit bureau related to an 
individual borrower; and
    (8) Copies of all correspondence relating to uncollectible loans 
which have been written off by the Federal Government or repaid by the 
school.
    (d) The school must also retain other records as the Secretary may 
prescribe. In all cases where questions have arisen as a result of a 
Federal audit, the records must be retained until resolution of all 
questions.
    (e) Institutional officials who have information which indicates the 
potential or actual commission of fraud or other offenses against the 
United States, involving these loan funds, should promptly provide this 
information to the appropriate Regional Office of Inspector General for 
Investigations.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[48 FR 25070, June 3, 1983, as amended at 50 FR 34421, Aug. 23, 1985; 53 
FR 46549, Nov. 17, 1988; 56 FR 19294, Apr. 26, 1991; 57 FR 45734, Oct. 
5, 1992; 61 FR 6123, Feb. 16, 1996]



Sec. 57.216  What additional Department regulations apply to schools?

    (a) Participating schools are advised that in addition to complying 
with the terms and conditions of these regulations, several other 
regulations apply under this subpart. These include, but are not limited 
to:

45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in Health and 
Human Services programs or activities receiving Federal financial 
assistance
45 CFR part 93--New Restrictions on Lobbying

    (b) The recipient may not discriminate on the basis of religion in 
the admission of individuals to its training programs.

[44 FR 29055, May 18, 1979, as amended at 56 FR 19294, Apr. 26, 1991; 57 
FR 45734, Oct. 5, 1992; 61 FR 6123, Feb. 16, 1996]



Sec. 57.216a  Performance standard.

    On June 30, 1984, and on each June 30 thereafter, except as provided 
in paragraph (b) of this section, each school must have a default rate 
(as calculated under paragraph (a) of this section) of not more than 5 
percent.
    (a) The default rate for each school shall be the ratio (stated as a 
percentage) that the defaulted principal amount outstanding of the 
school bears to the matured loans of the school. For this purpose:
    (1) The term defaulted principal amount outstanding means the total 
amount borrowed from the loan fund of a school that has reached the 
repayment stage (minus any principal amount repaid or canceled) on loans 
in default for more than 120 days; and
    (2) The term matured loans means the total principal amount of all 
loans made by a school under this subpart minus the total principal 
amount of loans made by the school to students who are:
    (i) Enrolled in a full-time course of study at the school; or
    (ii) In their grace period.

[[Page 288]]

    (b) Any school that has a default rate greater than 5 percent on 
June 30 of any year will be required to:
    (1) Reduce its default rate by 50 percent (or a school with a 
default rate below 10 percent must reduce its rate to 5 percent) by the 
close of the following 6-month period; and
    (2) By the end of each succeeding 6-month period, reduce its default 
rate to 50 percent of the required rate for the previous 6-month period, 
until it reaches 5 percent.
    (c) Any school subject to the provisions of paragraph (b) of this 
section which fails to comply with those requirements will receive no 
new HPSL funds and will be required to:
    (1) Place the revolving fund monies and all subsequent collections 
into an insured interest-bearing account;
    (2) Make no loan disbursements; and
    (3) By the end of the succeeding 6-month period, reduce its default 
rate to 50 percent of the rate it failed to achieve under paragraph (b) 
of this section, or 5 percent. A school that meets this requirement wil 
be permitted to resume the use of its health professions student loan 
funds, but must continue to comply with the requirements of paragraph 
(b)(2) of this section if its default rate is still greater than 5 
percent.
    (d) Any school subject to the provisions of paragraph (c)(3) of this 
section which fails to comply with those requirements will be subject to 
termination. The Secretary will provide the school with a written notice 
specifying his or her intention to terminate the school's participation 
in the program and stating that the school may request, within 30 days 
of the receipt of this notice, a formal hearing. If the school requests 
a hearing, it must within 90 days of the receipt of the notice, submit 
material, factual issues in dispute to demonstrate that there is cause 
for a hearing. These issues must be both substantive and relevant. The 
hearing will be held in the Washington, DC metropolitan area. The 
Secretary will deny a hearing if:
    (1) The request for a hearing is untimely (i.e., fails to meet the 
30-day requirement);
    (2) The school does not provide a statement of material, factual 
issues in dispute within the 90-day required period; or
    (3) The statement of factual issues in dispute is frivolous or 
inconsequential.

In the event that the Secretary denies a hearing, the Secretary will 
send a written denial to the school setting forth the reasons for 
denial. If a hearing is denied, or if as a result of the hearing, 
termination is still determined to be necessary, the school will be 
terminated from participation in the program and will be required to 
return the Federal share of the revolving fund to the Department. A 
school terminated for failure to comply with the provisions of paragraph 
(c)(3) of this section must continue to pursue collections and may 
reapply for participation in the program only when it has attained a 
default rate of 5 percent or less.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34423, Aug. 23, 1985, as amended at 52 FR 20988, June 3, 1987; 53 
FR 46550, Nov. 17, 1988; 56 FR 19294, Apr. 26, 1991]



Sec. 57.217  Additional conditions.

    The Secretary may with respect to any agreement entered into with 
any school under Sec. 57.205, impose additional conditions prior to or 
at the time of any award when in his or her judgment these conditions 
are necessary to assure or protect the advancement of the purposes of 
the agreement, the interest of the public health, or the conservation of 
funds awarded.



Sec. 57.218  Noncompliance.

    Wherever the Secretary finds that a participating school has failed 
to comply with the applicable provisions of the Act or the regulations 
of this subpart, he or she may, on reasonable notice to the school, 
withhold further payment of Federal capital contributions, and take such 
other action, including the termination of any agreement, as he or she 
finds necessary to enforce the Act and regulations. In this case no 
further expenditures shall be made from the health professions student 
loan fund or funds involved until the Secretary determines that there is 
no longer any failure of compliance.

[[Page 289]]



                    Subpart D--Nursing Student Loans

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
67 Stat. 631 (42 U.S.C. 216); secs. 835-842 of the Public Health Service 
Act, 77 Stat. 913-916, as amended by 99 Stat. 397-400, 536-537, and 102 
Stat. 3160-3161 (42 U.S.C. 297 a-i).

    Source: 50 FR 34434, Aug. 23, 1985, unless otherwise noted.



Sec. 57.301  Applicability.

    The regulations in this subpart apply to the Federal capital 
contributions made by the Secretary to public or other nonprofit schools 
of nursing for the establishment of nursing student loan funds and to 
loans made to students from these funds.



Sec. 57.302  Definitions.

    As used in this subpart:
    Academic year means the traditional, approximately 9-month September 
to June annual session. For the purpose of computing academic year 
equivalents for students who, during a 12-month period, attend for a 
longer period than the traditional academic year, the academic year will 
be considered to be of 9 months' duration.
    Act means the Public Health Service Act, as amended.
    Community health center means an entity as defined under section 
330(a) of the Public Health Service Act, and in regulations at 42 CFR 
51c.102(c).
    Date upon which a student ceases to be a full-time or half-time 
student means the first day of the month which is nearest to the date 
upon which an individual ceases to be a full-time or half-time student, 
as defined in this section.
    Default means the failure of a borrower of a loan made under this 
subpart to make an installment payment when due, or comply with any 
other term of the promissory note for such loan, except that a loan made 
under this subpart shall not be considered to be in default if the loan 
is discharged in bankruptcy, the borrower's repayment schedule has been 
renegotiated and the borrower is complying with the renegotiated 
schedule, or the loan is in forbearance.
    Federal capital loan means a loan made by the Secretary to a school 
under section 827(a) of the Act, as in effect prior to July 29, 1975, 
the proceeds of which are to be returned to the Secretary.
    Full-time student means a student who is enrolled in a school and 
pursuing a course of study which constitutes a full-time academic 
workload, as determined by the school, leading to a diploma in nursing, 
an associate degree in nursing or an equivalent degree, a baccalaureate 
degree in nursing or an equivalent degree, or a graduate degree in 
nursing.
    Good standing means the eligibility of a student to continue in 
attendance at the school where he or she is enrolled as a student in 
accordance with the school's standards and practices.
    Grace period means the period of 9 months beginning on the date upon 
which a student ceases to be a full-time or half-time student at a 
school of nursing.
    Half-time student means a student who is enrolled in a school and 
pursuing a course of study which constitutes at least one-half of a 
full-time academic workload but less than a full-time academic workload, 
as determined by the school, leading to a diploma in nursing, an 
associate degree in nursing or an equivalent degree, a baccalaureate 
degree in nursing or an equivalent degree, or a graduate degree in 
nursing.
    Indian Health Service health center means a health care facility 
(whether operated directly by the Indian Health Service or operated by a 
tribal contractor or grantee under the Indian Self-Determination Act), 
which is physically separated from a hospital, and which provides one or 
more clinical treatment services, such as physician, dentist or nursing 
services, available at least 40 hours a week for outpatient care to 
persons of Indian or Alaska Native descent.
    Institutional capital contribution means the money provided by a 
school, in an amount not less than one-ninth of the Federal capital 
contribution, and deposited in a nursing student loan fund.
    Migrant health center means an entity as defined under section 
329(a) of the Public Health Service Act, and in regulations at 42 CFR 
56.102(g).

[[Page 290]]

    National of the United States means: (1) A citizen of the United 
States, or (2) a person who, though not a citizen of the United States, 
owes permanent allegiance to the United States, as defined in the 
Immigration and Nationality Act, at 8 U.S.C. 1101(a)(22).
    Native Hawaiian health center means an entity (as defined in section 
8 of Public Law 100-579)--
    (a) Which is organized under the laws of the State of Hawaii,
    (b) Which provides or arranges for health care services through 
practitioners licensed by the State of Hawaii, where licensure 
requirements are applicable,
    (c) Which is a public or private nonprofit entity, and
    (d) In which Native Hawaiian health practitioners significantly 
participate in the planning, management, monitoring, and evaluation of 
health services.
    Nursing facility means a facility as defined in section 1919(a) of 
the Social Security Act (SSA) (for fiscal year (FY) 1991 and subsequent 
fiscal years), except for FYs 1989 and 1990, the term means a ``skilled 
nursing facility,'' as such term is defined in section 1861(j) of the 
SSA, and an ``intermediate care facility,'' as such term is defined in 
section 1905(c) of such Act.
    Nursing student loan means the amount of money advanced to a student 
by a school from a nursing student loan fund under a properly executed 
promissory note.
    Registered nurse means an individual who has been licensed by a 
State Board of Nursing to practice professional nursing in accordance 
with State licensing laws requiring as a minimum one of the degrees or 
diplomas specified in this section.
    Rural health clinic means an entity as defined under section 
1861(aa)(2) of the Social Security Act, and in regulations at 42 CFR 
491.2.
    School means a public or other nonprofit school of nursing, as 
defined in section 853 of the Act.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee to whom the authority involved has been 
delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[50 FR 34434, Aug. 23, 1985, as amended at 52 FR 10195, Mar. 30, 1987; 
53 FR 46554, Nov. 17, 1988; 56 FR 13771, Apr. 4, 1991; 61 FR 6123, Feb. 
16, 1996]



Sec. 57.303  Application by school.

    (a) Each school seeking a Federal capital contribution must submit 
an application at the time and in the form and manner that the Secretary 
may require. The application must be signed by an individual authorized 
to act for the applicant and to assume on behalf of the applicant the 
obligations imposed by the statute, the regulations of this subpart, and 
the terms and conditions of the award.
    (b) Each application will be reviewed to determine eligibility and 
the reasonableness of the amount of Federal support requested. The 
Secretary may require the applicant to submit additional data for this 
purpose.
    (c) An application will not be approved unless an agreement between 
the Secretary and the applicant school for a Federal capital 
contribution under section 835 of the Act is reached.

[50 FR 34434, Aug. 23, 1985, as amended at 56 FR 13771, Apr. 4, 1991; 57 
FR 45735, Oct. 5, 1992]



Sec. 57.304  Payment of Federal capital contributions and reallocation of funds remitted to the Secretary.

    (a) Annual payment. The Secretary will make payments at a time 
determined by him or her, to each school with which he or she has 
entered into an agreement under the Act.
    (1) For any fiscal year for which ``set-aside'' funds are available, 
the Secretary will first make payments in the manner described in (a)(2) 
of this section of not less than $1,000,000 of the amount of Federal 
funds determined by the Secretary at the time of payment to be available 
for making loans under this subpart. These funds will be paid to schools 
submitting an application for ``set-aside'' funds to be used only

[[Page 291]]

for the purpose of making loans to individuals qualified to receive 
loans under this subpart who, on the date they receive the loan, have 
not been employed on a full-time basis or been enrolled in any 
educational institution on a full-time basis for at least 7 years. An 
individual may not receive a loan under this subparagraph that exceeds 
$500 for any academic year.
    (2) If the total of the amounts requested for any fiscal year by all 
schools for Federal capital contributions minus the amount received 
under paragraph (a)(1) of this section exceeds the amount of Federal 
funds determined by the Secretary at the time of payment to be available 
for this purpose, the payment to each school will be reduced to 
whichever is smaller: (i) The amount requested in the application, or 
(ii) an amount which bears the same ratio to the total amount of Federal 
funds determined by the Secretary at the time of payment to be available 
for that fiscal year for the Nursing Student Loan program as the number 
of full-time students estimated by the Secretary to be enrolled in that 
school bears to the estimated total number of full-time students in all 
participating schools during that year.
    (3) Amounts remaining after these payments are made will be 
distributed in accordance with this paragraph among schools whose 
applications requested more than the amount paid to them, but with 
whatever adjustments that may be necessary to prevent the total paid to 
any school from exceeding the total requested by it.
    (b) Method of payment. The payment of Federal capital contributions 
to a school will be paid in a manner that avoids unnecessary 
accumulations of money in any nursing student loan fund.
    (c) Reallocation of funds remitted to the Secretary. (1) All funds 
from a student loan fund established under this subpart which are 
remitted to the Secretary in any fiscal year shall be available for 
allotment under this subpart, in the same fiscal year and the succeeding 
fiscal year, to eligible nursing schools. In making these allotments, 
the Secretary shall give priority to nursing schools which established a 
student loan fund under this subpart after September 30, 1975. The 
Secretary will make payments to eligible schools at a time determined by 
him or her, according to the procedures indicated in paragraphs (c)(2) 
and (c)(3) of this section.
    (2) Eligible schools which established a nursing student loan fund 
after September 30, 1975. The Secretary will make awards first to those 
eligible schools that established a nursing student loan fund after 
September 30, 1975. If the total of the amounts requested for any fiscal 
year by these schools exceeds the amount of funds determined by the 
Secretary at the time of payment to be available for this purpose, the 
payment to each school will be reduced to whichever is smaller:
    (i) The amount requested in the application, or
    (ii) An amount which bears the same ratio to the total amount of 
returned funds determined by the Secretary at the time of payment to be 
available for that fiscal year for the Nursing Student Loan program as 
the number of full-time students estimated by the Secretary to be 
enrolled in that school bears to the estimated total number of full-time 
students in these eligible schools during that year.

Amounts remaining after these payments are made will be distributed in 
accordance with this paragraph among schools whose applications 
requested more than the amount paid to them, with whatever adjustments 
may be necessary to prevent the total paid to any school from exceeding 
the total requested by it.
    (3) Eligible schools which established a nursing student loan fund 
prior to October 1, 1975. If there are funds remaining after making 
awards as specified by paragraph (c)(2) of this section, the Secretary 
will make awards to eligible schools which established a nursing student 
loan fund prior to October 1, 1975. If the total of the amounts 
requested for any fiscal year by these schools exceeds the amount of 
funds determined by the Secretary at the time of payment to be available 
for this purpose, the payment to each school will be reduced to 
whichever is smaller:
    (i) The amount requested in the application, or

[[Page 292]]

    (ii) An amount which bears the same ratio to the total amount of 
returned funds determined by the Secretary at the time of payment to be 
available for that fiscal year for the Nursing Student Loan program as 
the number of full-time students estimated by the Secretary to be 
enrolled in that school bears to the estimated total number of full-time 
students in these eligible schools during that year.

Amounts remaining after these payments are made will be distributed in 
accordance with this paragraph among schools whose applications 
requested more than the amount paid to them, with whatever adjustments 
may be necessary to prevent the total paid to any school from exceeding 
the total requested by it.

[50 FR 34434, Aug. 13, 1985, as amended at 53 FR 46554, Nov. 17, 1988]



Sec. 57.305  Nursing student loan funds.

    (a) Funds established with Federal capital contributions. Any fund 
established by a school with Federal capital contributions will be 
accounted for separately from other funds, providing a clear audit trail 
for all transactions. At all times the fund must contain monies 
representing the institutional capital contribution. The school must at 
all times maintain all monies relating to the fund in one or more 
interest-bearing accounts or investment instruments which meet OMB 
requirements established for Federal monies held by third parties, 
except that if the school documents that the costs associated with the 
use of an interest-bearing account would exceed expected earnings, the 
school is not required to maintain these monies in an interest-bearing 
account. The school must place all earnings into the fund but may first 
deduct from total earnings any reasonable and customary charges incurred 
through the use of an interest-bearing account. An institution shall 
exercise the level of care required of a fiduciary with regard to these 
deposits and investments, and shall be responsible for reimbursing the 
fund for any losses that occur due to the use of investments that are 
not federally insured.
    (1) The Federal capital contribution fund is to be used by the 
school only for:
    (i) Nursing student loans to full-time or half-time students;
    (ii) Capital distribution as provided in section 839 of the Act or 
as agreed to by the school and the Secretary; and
    (iii) Costs of litigation, costs associated with membership in 
credit bureaus, and to the extent specifically approved by the 
Secretary, other collection costs that exceed the usual expenses 
incurred in the collection of nursing student loans.
    (2) A school must review the balance in the fund on at least a semi-
annual basis to determine whether the fund balance compared with 
projected levels of expenditures and collections exceeds its needs. A 
school in closing status must review the balance in the fund on a 
quarterly basis. Monies identified as in excess of the school's needs 
must be reported, and the Federal share returned to the Federal 
Government, by the due date of the required report which identifies the 
excess monies. The school's determination is subject to the review and 
approval of the Secretary.
    (b) Funds established with Federal capital loans. (1) Each Federal 
capital loan is subject to the terms of the promissory note executed by 
an authorized official on behalf of the borrowing school.
    (2) The Federal capital loans must be carried in a special account 
of the school, to be used by the school only for: (i) Repayments of 
principal and interest on Federal capital loans; and (ii) costs of 
litigation, costs associated with membership in credit bureaus, and, to 
the extent specifically approved by the Secretary, other collection 
costs that exceed the usual expenses incurred in the collection of 
nursing student loans.
    (c) Failure to comply with the requirements of this section will 
subject a school to the noncompliance provisions of Sec. 57.318 and the 
Department's Claims Collections regulations (45 CFR part 30), as 
appropriate.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34434, Aug. 23, 1985, as amended at 56 FR 40734, Aug. 15, 1991; 
61 FR 6123, Feb. 16, 1996]

[[Page 293]]



Sec. 57.306  Eligibility and selection of nursing student loan applicants.

    (a) Determination of eligibility. (1) Applicants are eligible for 
consideration for a nursing student loan if they are:
    (i) Residents of the United States and either a citizen or national 
of the United States, an alien lawfully admitted for permanent residence 
in the United States, a citizen of the Commonwealth of the Northern 
Mariana Islands, a citizen of the Republic of Palau, a citizen of the 
Republic of the Marshall Islands, or a citizen of the Federated States 
of Micronesia;
    (ii) Enrolled, or accepted for enrollment in the school as full-time 
or half-time students;
    (iii) In need of the amount of the loan to pursue the course of 
study at the school; and
    (iv) Capable, in the opinion of the school, of maintaining good 
standing in the course of study.
    (2) An applicant who has previously attended an institution of 
higher education must submit a financial aid transcript which includes 
at least the following data:
    (i) Applicant's name and social security number;
    (ii) Amounts and sources of loans and grants previously received by 
the applicant for study at an institution of higher education;
    (iii) Whether the applicant is in default on any of these loans, or 
owes a refund on any grants;
    (iv) Certification from each institution previously attended by the 
applicant that the applicant has received no financial aid, if 
applicable; and
    (v) From each institution previously attended, the signature of an 
official authorized by the institution to sign such transcripts on 
behalf of the institution.
    (b) Selection of nursing student loan applicants and determinations 
of need. The school will select qualified applicants, make reasonable 
determinations of need, and determine the amount of student loans.
    (1) In selecting nursing student loan applicants the school will 
give preference to licensed practical nurses, and to persons with 
exceptional financial need. For purposes of this preference, a student 
will be considered to demonstrate exceptional financial need if the 
school determines that the student's resources, as described in 
paragraph (b)(2)(i) of this section, do not exceed one-half of the costs 
of attendance at the school. Summer earnings, educational loans, 
veterans (G.I.) benefits, earnings during the school year, and Aid to 
Families with Dependent Children (AFDC) will not be considered as 
resources in determining whether an applicant meets these criteria for 
exceptional financial need, but will be considered in determining the 
amount of funds a student may receive.
    (2) In determining whether a student is in need of a nursing student 
loan to pursue a full-time or half-time course of study at the school, 
the school will take into consideration:
    (i) The financial resources available to the student by using one of 
the national need analysis systems or any other procedure approved by 
the Secretary of Education in combination with other information which 
the school has regarding the student's financial status; and
    (ii) The costs reasonably necessary for the student's attendance at 
the school, including any special needs and obligations which directly 
affect the student's financial ability to attend the school on a full-
time or half-time basis. The school must document the criteria used for 
determining these costs.
    (c) Verification of loan information. The school must verify, to the 
best of its ability, the information provided by the student on the loan 
application. To comply with this requirement, a school may require that 
a student provide, for example: Photocopies of the parents', student's, 
and spouse's Federal income tax forms with original signatures for the 
most recent tax year (or certification that no Federal income tax return 
was filed); tax returns that are certified as having been received by 
the Internal Revenue Service; or other documentation that the school 
considers necessary to help assure that information on the loan 
application is correct.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34434, Aug. 23, 1985, as amended at 53 FR 46554, Nov. 17, 1988; 
56 FR 13771, Apr. 4, 1991; 61 FR 6123, Feb. 16, 1996]

[[Page 294]]



Sec. 57.307  Maximum amount of nursing student loans.

    The total of the nursing student loans made from the fund to any 
student for an academic year may not exceed $2,500, except that for each 
of the final 2 academic years of the program, the total must not exceed 
$4,000. The maximum amount loaned during a 12-month period to any 
student enrolled in a school which provides a course of study longer 
than the 9-month academic year may be proportionately increased. The 
total of all nursing student loans to any student must not exceed 
$13,000.

[56 FR 13771, Apr. 4, 1991]



Sec. 57.308  Nursing student loan promissory note.

    (a) Promissory note form. Each nursing student loan must be 
evidenced by a properly executed promissory note in a form approved by 
the Secretary. The school must safeguard the promissory note against 
fire, theft, and tampering.
    (1) Each promissory note must state that the loan will bear interest 
on the unpaid balance computed only for periods during which repayment 
of the loan is required, at the rate of 5 percent per year.
    (2) Each promissory note must contain an acceleration clause 
provided by the Secretary, which will permit the acceleration of 
delinquent loans at the school's option.
    (3) A copy of each executed note must be supplied by the school to 
the student borrower.
    (b) Security. A school must require security or endorsement if the 
borrower is a minor and if, under the applicable State law, the note 
signed by him or her would not create a binding obligation. The school 
may not require security or endorsement in any other circumstances.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34434, Aug. 23, 1985, as amended at 56 FR 13771, Apr. 4, 1991; 57 
FR 45735, Oct. 5, 1992]



Sec. 57.309  Payment of nursing student loans.

    (a) Nursing student loans from any fund may be paid to or on behalf 
of student borrowers in installments considered appropriate by the 
school except that a school may not pay to or on behalf of any borrower 
more during any given installment period (e.g., semester, term, or 
quarter) than the school determines the student needs for that period.
    (b) No payment may be made from a fund to or on behalf of any 
student borrower if at the time of the payment the borrower is not a 
full-time or half-time student.



Sec. 57.310  Repayment and collection of nursing student loans.

    (a) Each nursing student loan, including accrued interest, will be 
repayable in equal or graduated periodic installments in amounts 
calculated on the basis of a 10-year repayment period. Repayment of a 
loan must begin 9 months after the student ceases to be a full-time or 
half-time student, except that if a borrower reenters the same or 
another school as a full-time or half-time student within the 9-month 
period, the date upon which interest will accrue and the repayment 
period will begin will be determined by the date upon which the student 
last ceases to be a full-time or half-time student at that school.
    (1) The following periods will be excluded from the 10-year 
repayment period: (i) All periods up to a total of 3 years of active 
duty performed by the borrower as a member of the Army, Navy, Air Force, 
Marine Corps, Coast Guard, National Oceanic and Atmospheric 
Administration Corps or the U.S. Public Health Service Commissioned 
Corps;
    (ii) All periods up to a total of 3 years of service as a volunteer 
under the Peace Corps Act; and
    (iii) All periods up to a total of 10 years during which the 
borrower is pursuing a full-time or half-time course of study at a 
school leading to a baccalaureate degree in nursing or an equivalent 
degree, or to a graduate degree in nursing, or is otherwise pursuing 
advanced professional training in nursing (or training to be a nurse 
anesthetist). For purposes of this paragraph, ``otherwise pursuing 
advanced professional training in nursing'' shall include full-time or 
half-time training, beyond the

[[Page 295]]

first diploma or degree in nursing received by the particular borrower, 
of at least 1 academic year which will advance the borrower's knowledge 
of and strengthen his or her skills in the provision of nursing 
services.\1\
---------------------------------------------------------------------------

    \1\ Individuals who received nursing student loans prior to July 1, 
1969, remain subject to the repayment provisions of 42 CFR 
57.314(a)(3)(1976) as adopted on February 4, 1974. These provisions can 
be found at 39 FR 16473 (May 9, 1974), and a copy can be obtained by 
writing the Division of Student Assistance, Bureau of Health 
Professions, 5600 Fishers Lane, Parklawn Building, room 8-34, Rockville, 
MD 20857.
---------------------------------------------------------------------------

    (2) Subject to the provisions of paragraph (b)(3) of this section, a 
borrower must establish a repayment schedule with the school providing 
for payments not less often than quarterly. Any borrower whose repayment 
becomes more than 60 days past due must be placed on a monthly repayment 
schedule by the school. A borrower may at his or her option and without 
penalty, prepay all or part of the principal and accrued interest at any 
time.
    (3) A school may grant forbearance whenever extraordinary 
circumstances such as unemployment, poor health or other personal 
problems temporarily affect the borrower's ability to make scheduled 
loan repayments.
    (b) Collection of nursing student loans. (1) Each school at which a 
fund is established must exercise due diligence in the collection of 
nursing student loans due the fund. In the exercise of due diligence, a 
school must follow procedures which are at least as extensive and 
effective as those used in the collection of other student loan accounts 
due the school, and must use the steps outlined below in accordance with 
collection practices which are generally accepted among institutions of 
higher education:
    (i) Conduct and document an entrance interview (individually or in 
groups) with the borrower prior to disbursing NSL funds in any academic 
year. During the entrance interview the school must obtain documentation 
which indicates that the borrower is aware of the rights and 
responsibilities associated with NSL funds and personal information 
which would assist in locating the borrower if he or she fails to keep 
the school informed of his or her current address. The requirement of 
this subparagraph may be met by correspondence if the school determines 
that a face-to-face meeting (individually or in groups) is 
impracticable.
    (ii) Conduct and document an exit interview (individually or in 
groups) with the borrower. During the exit interview, the school must 
provide each borrower with information necessary to carry out the terms 
of repayment, remind the borrower of the rights and responsibilities 
associated with NSL funds, and update the personal information collected 
prior to disbursing NSL funds which would assist in locating the 
borrower if he or she fails to keep the school informed of his or her 
current address. If the borrower terminates studies without advance 
notice, the school must document attempts to inform the borrower of the 
substance of the exit interview and to secure exit interview information 
from the borrower by mail.
    (iii) Notify the borrower in writing of the impending repayment 
obligation at least twice during the grace period;
    (iv) Notify a borrower who is in deferment status in writing of the 
impending repayment obligation 1 to 3 months prior to the expiration of 
the approved period of deferment;
    (v) Perform regular billing;
    (vi) Follow up past due payments with a series of at least four 
documented and reasonably spaced attempts to contact the borrower, at 
least three of which must be in writing at not more than 30-day 
intervals, prior to the loan becoming 120 days past due, provided that 
the school has a current address for the borrower;
    (vii) Perform address searches when necessary;
    (viii) Use collection agents, which may include the use of an 
internal collection agent;
    (ix) Institute legal proceedings against borrowers after all other 
attempts at collection have failed, unless the school determines, 
subject to the approval of the Secretary, that such litigation would not 
be cost-effective; and

[[Page 296]]

    (x) Become a member of a credit bureau and notify the credit bureau 
of accounts past due by more than 120 days.

In place of one or more of the procedures outlined above schools may 
substitute collection techniques that are equally or more effective, but 
only after they have demonstrated the effectiveness of the techniques 
and obtained written approval from the Secretary.
    (2) Late charge. (i) For any nursing student loan made after June 
30, 1969, but prior to October 1, 1985, the school may fix a charge for 
failure of the borrower to pay all or any part of an installment when it 
is due and, in the case of a borrower who is entitled to deferment under 
section 836(b)(2) of the Act, or cancellation or repayment under section 
836(b)(3) of the Act, for any failure to file timely and satisfactory 
evidence of the entitlement. The amount of the charge may not exceed $1 
for the first month or part of a month by which the installment or 
evidence is late and $2 for each succeeding month or part of a month. 
The school may elect to add the amount of this charge to the principal 
amount of the loan as of the day after the day on which the installment 
or evidence was due, or to make the amount of the charge payable to the 
school no later than the due date of the next installment following 
receipt of the notice of the charge by the borrower.
    (ii) For any nursing student loan made on or after October 1, 1985, 
the school shall assess a charge for failure of the borrower to pay all 
or any part of an installment when the loan is more than 60 days past 
due and, in the case of a borrower who is entitled to deferment under 
section 836(b)(2) of the Act, for any failure to file satisfactory 
evidence of the entitlement within 60 days of the date payment would 
otherwise be due. No charge may be made if the loan is less than 61 days 
past due. The amount of this charge may not exceed an amount equal to 6 
percent of the amount due at the time the charge is calculated. The 
school may elect to add the amount of this charge to the principal 
amount of the loan as of the day on which the charge is calculated, or 
to make the amount of the charge payable to the school no later than the 
due date of the next installment following receipt of the notice of the 
charge by the borrower.
    (3) With respect to any nursing student loan made after June 30, 
1969, the school may require the borrower to make payments of at least 
$15 per month on all outstanding nursing student loans during the 
repayment period.
    (4) A school must, on an annual basis, review and assess the 
collectibility of any loan more than 3 years past due. If the school 
determines that the prospects of future collection are promising enough 
to justify periodic review of the debt, and neither the statute of 
limitations nor the 10-year repayment period has expired, the school may 
retain the account for continued collections, provided that it makes an 
attempt at least semi-annually to collect from the borrower. When the 
due diligence procedures required by paragraph (b)(1) of this section 
have been exhausted, the school is responsible for determining the 
collection methods it will use for the semi-annual collection effort 
required on these loans. If the school determines that the prospects of 
future collection are not promising, or when the statute of limitations 
or the 10-year repayment period has expired, the loan must be considered 
uncollectible. A school may determine a loan to be uncollectible sooner 
than 3 years past due when it has evidence that the loan cannot be 
collected, but in no case should a school consider a loan as 
uncollectible if it has not been in default for at least 120 days. A 
school is not subject to the requirements in paragraphs (b)(4) (i) and 
(iii) of this section for loans that became uncollectible, as determined 
by the school, before January 1, 1983.
    (i) A school must request permission to write off an uncollectible 
loan within 30 days of the determination that it is uncollectible or 
reimburse the fund in the full amount of the loan, pursuant to 
Sec. 57.310(b)(4)(iii). The 30-day period for submitting the loan for 
write-off review begins on the date that the determination of 
uncollectibility is made, in accordance with paragraph (b)(4) of this 
section. In any instance where the Secretary determines that a

[[Page 297]]

school has failed to exercise due diligence in the collection of a loan, 
in accordance with the applicable regulatory requirements, the school 
will be required to place in the fund the full amount of principal, 
interest, and penalty charges that remains uncollected on the loan. 
Reimbursement must be made by the following June 30 or December 31, 
whichever is sooner, except that in no case will a school be required to 
reimburse the fund in less than 30 days following the Secretary's 
disapproval of the request for write-off approval.
    (ii) If the Secretary determines that a school has exercised due 
diligence in the collection of a loan, in accordance with the applicable 
regulatory requirements, or if the school determines that the loan was 
uncollectible prior to January 1, 1983, the school will be permitted to 
reduce its accounts receivable for the NSL fund by the full amount of 
principal, interest, and penalty charges that remains uncollected on 
that loan and will not be required to return the Federal share of the 
loss to the Secretary.
    (iii) If a school does not request permission to write off an 
uncollectible loan within the required timeframe, it must reimburse the 
fund for the full amount of principal, interest, and penalty charges 
that remains uncollected on that loan. This reimbursement must be made 
by the following June 30 or December 31, whichever is sooner, except 
that in no case will a school be required to reimburse the fund in less 
than 30 days following its determination that a loan is uncollectible.
    (iv) Failure to comply with the requirements of this section will 
subject a school to the noncompliance provisions of Sec. 57.318 and the 
Department's Claims Collection regulations (45 CFR part 30), as 
appropriate.
    (5) Disclosure of taxpayer identity information. Upon written 
request by the Secretary, the Secretary of the Internal Revenue Service 
(IRS) may disclose the address of any taxpayer who has defaulted on a 
nursing student loan, for use only by officers, employees, or agents of 
the Department, to locate the defaulted borrower to collect the loan. 
Any such mailing address may be disclosed by the Secretary to any school 
from which the defaulted borrower received a nursing student loan, for 
use only by officers, employees, or agents of the school whose duties 
relate to the collection of nursing student loan funds, to locate the 
defaulted borrower to collect the loan. Any school which requests and 
obtains such address information must comply with the requirements of 
the Secretary and the IRS regarding the safeguarding and proper handling 
of this information.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34434, Aug. 23, 1985, as amended at 52 FR 10195, Mar. 30, 1987; 
56 FR 13771, Apr. 4, 1991; 56 FR 40734, Aug. 15, 1991; 57 FR 45735, Oct. 
5, 1992; 61 FR 6123, Feb. 16, 1996]



Sec. 57.311  Cancellation of nursing student loans for disability or death.

    (a) Permanent and total disability. The Secretary will cancel a 
borrower's indebtedness in accordance with section 836(b)(4) of the Act 
if the borrower is found to be permanently and totally disabled on 
recommendation of the school and as supported by whatever medical 
certification the Secretary may require. A borrower is totally and 
permanently disabled if he or she is unable to engage in any substantial 
gainful activity because of a medically determinable impairment, which 
the Secretary expects to continue for a long time or to result in death.
    (b) Death. The Secretary will cancel a borrower's indebtedness in 
accordance with section 836(b)(4) of the Act upon the death of the 
borrower. The school to which the borrower was indebted must secure a 
certification of death or whatever official proof is conclusive under 
State law.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34434, Aug. 23, 1985, as amended at 56 FR 13772, Apr. 4, 1991]



Sec. 57.312  Repayment of loans for service in a shortage area.

    (a) Service in a shortage area. Subject to the availability of 
funds, a person who:
    (1) Has obtained a degree as specified in section 846(a)(1) of the 
Act;

[[Page 298]]

    (2) Has obtained one or more nursing student loans or any other 
loans necessary for costs (including tuition, books, fees, equipment, 
living and other expenses which the Secretary determines were necessary) 
of attending a school of nursing; and
    (3) Enters into an agreement with the Secretary to serve as a full-
time registered nurse for a period of not less than 2 years in an Indian 
Health Service health center, a Native Hawaiian health center, a public 
hospital, a migrant health center, a community health center, a nursing 
facility, a rural health clinic, or in a health facility determined by 
the Secretary to have a critical shortage of nurses, will have a portion 
of these loans repaid by the Secretary in accordance with paragraph (c) 
of this section. Prior to entering an agreement for repayment of loans, 
other than nursing student loans, the Secretary will require that 
satisfactory evidence be provided of the existence and reasonableness of 
the education loans (i.e., a copy of the written loan agreement 
establishing the loan).
    (b) When entering into agreements under paragraph (a) of this 
section, the Secretary shall give priority to:
    (1) Applicants with the greatest financial need; and
    (2) Applicants that, with respect to health facilities described in 
paragraph (a)(3) of this section, agree to serve in such facilities 
located in geographic areas with a shortage of and need for nurses, as 
determined by the Secretary.
    (3) In addition to the priorities under paragraphs (b) (1) and (2) 
of this section, should specific needs warrant, the Secretary may 
establish additional preferences which will be announced from time to 
time in the Federal Register.
    (c) Repayment. Loan repayment will be made by the Secretary to 
persons who meet the conditions set forth in paragraph (a) of this 
section. Payment will be as follows:
    (1) Upon completion by the borrower of the first year of service as 
specified in the agreement, the Secretary will pay 30 percent of the 
principal of, and the interest on, each loan which was unpaid as of the 
date the borrower began his or her service;
    (2) Upon completion by the borrower of the second year of service, 
the Secretary will pay another 30 percent of the principal of, and the 
interest on, each loan which was unpaid as of the date the borrower 
began his or her service;
    (3) Upon completion by the borrower of a third year of service, the 
Secretary will pay another 25 percent of the principal of, and the 
interest on, each loan which was unpaid as of the date the borrower 
began his or her service; and
    (4) No more than 85 percent of the principal of any loan will be 
paid under this section.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34434, Aug. 23, 1985, as amended at 56 FR 13772, Apr. 4, 1991; 61 
FR 6123, Feb. 16, 1996]



Sec. 57.313  Loan cancellation for full-time employment as a registered nurse.

    (a) For loans made after November 18, 1971, and before September 29, 
1979. A person who: (1) Received one or more nursing student loans after 
November 18, 1971, and before September 29, 1979; (2) is in compliance 
with the requirements of title VIII of the Act and these regulations; 
and (3) engages in full-time employment as a registered nurse (including 
teaching in any of the fields of nurse training or service as an 
administrator, supervisor, or consultant in any of the fields of 
nursing) in any public or nonprofit private agency, institution, or 
organization (including neighborhood health centers) is entitled to have 
a portion of these nursing student loans canceled as follows: 15 percent 
of the total amount of the loans plus accrued interest on the loan which 
is unpaid on the first day of his or her service, for each of the first, 
second, and third year of service; and 20 percent of the total amount of 
the loan plus accrued interest on the loan for each complete fourth and 
fifth year of service thereafter, up to 85 percent of the total of the 
loans, plus accrued interest.
    (b) Continuation of provisions for cancellation of loans made prior 
to November 18, 1971. A person who received one or more nursing student 
loans prior to

[[Page 299]]

November 18, 1971, may still receive cancellation of these loans for 
service under section 836(h) of the Act. The regulations set forth in 42 
CFR 57.316 (a) and (b)(6) (1976), as adopted on February 4, 1974, remain 
applicable to cancellation on this basis. The provisions can be found at 
39 FR 16473 (May 9, 1974) and a copy can be obtained by writing to the 
Division of Student Assistance, Bureau of Health Professions, Room 8-34, 
Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857.
    (c) The determination of whether a person is entitled to have any 
portion of his or her nursing student loan canceled for full-time 
employment as a registered nurse will be made by the institution to 
whose fund his or her loan is payable, upon receipt and evaluation of an 
application for cancellation from that person.

[50 FR 34434, Aug. 23, 1985, as amended at 56 FR 13772, Apr. 4, 1991; 57 
FR 45735, Oct. 5, 1992; 61 FR 6123, Feb. 16, 1996]



Sec. 57.313a  Loan cancellation reimbursement.

    In the event that insufficient funds are available to the Secretary 
in any fiscal year to enable him or her to pay to all schools their 
proportionate shares of all loans and interest canceled under this 
subpart for full-time employment as a nurse, death, or disability:
    (a) Each school will be paid an amount bearing the same ratio to the 
total of the funds available for that purpose as the principal of loans 
canceled by that school in that fiscal year bears to the total principal 
of loans canceled by all schools in that year; and
    (b) Any additional amounts to which a school is entitled will be 
paid by the Secretary at the time of distribution of the assets of the 
school's fund under section 839 of the Act.



Sec. 57.314  Repayment of loans made after November 17, 1971, for failure to complete a program of study. \2\
---------------------------------------------------------------------------

    \2\ Effective November 26, 1984, the Secretary stopped accepting 
applications under Sec. 57.314 because Federal funds are not available 
for this provision.
---------------------------------------------------------------------------

    In the event that the Secretary undertakes to repay educational 
loans under section 836(i) of the Act, he or she will use the following 
criteria to make a determination as to each applicant's eligibility:
    (a) An applicant will be considered to have failed to complete the 
course of study in nursing for which an eligible education loan was made 
upon certification by a school of nursing that the individual ceased to 
be enrolled in the school subsequent to November 17, 1971;
    (b) An applicant will be considered to be in exceptionally needy 
circumstances if, upon comparison of the income and other financial 
resources of the applicant with his or her expenses and financial 
obligations, the Secretary determines that repayment of the loan would 
constitute a serious economic burden on the applicant. In making this 
determination, the Secretary will take into consideration the 
applicant's net financial assets, his or her potential earning capacity, 
and the relationship of the income available to the applicant to the 
low-income levels published annually by the Secretary in the Federal 
Register;
    (c) An applicant will be considered as not having resumed his or her 
nursing studies within 2 years following the date the individual ceased 
to be a student upon certification so stating from the applicant; and
    (d) An applicant will be considered as not reasonably expected to 
resume his or her nursing studies within 2 years following the date upon 
which he or she terminated these studies, based upon consideration of 
the reasons for the applicant's failure to complete these studies, 
taking into account such factors as academic, medical, or financial 
difficulties. The Secretary will only repay education loans made after 
November 17, 1971.

[50 FR 34434, Aug. 23, 1985, as amended at 56 FR 13772, Apr. 4, 1991; 57 
FR 45735, Oct. 5, 1992; 61 FR 6123, Feb. 16, 1996]



Sec. 57.315  Records, reports, inspection, and audit.

    (a) Records and reports. (1) Each Federal capital contribution and 
Federal capital loan is subject to the condition that the school must 
maintain those

[[Page 300]]

records and file with the Secretary those reports relating to the 
operation of its nursing student loan funds as the Secretary may find 
necessary to carry out the purposes of the Act and these regulations. A 
school must submit required reports to the Secretary within 45 days of 
the close of the reporting period.
    (i) A school which fails to submit a required report for its Federal 
capital contribution fund within 45 days of the close of the reporting 
period:
    (A) Shall be prohibited from receiving new Federal capital 
contributions;
    (B) Must place the revolving fund and all subsequent collections in 
an insured interest-bearing account; and
    (C) May make no loan disbursements.

The above restrictions apply until the Secretary determines that the 
school is in compliance with the reporting requirement.
    (ii) A school that fails to submit a complete report within 6 months 
of the close of the reporting period will be subject to termination. The 
Secretary will provide the school with a written notice specifying his 
or her intention to terminate the school's participation in the program 
and stating that the school may request, within 30 days of the receipt 
of this notice, a formal hearing. If the school requests a hearing, it 
must within 90 days of the receipt of the notice, submit material, 
factual issues in dispute to demonstrate that there is cause for a 
hearing. These issues must be both substantive and relevant. The hearing 
will be held in the Washington, DC metropolitan area. The Secretary will 
deny a hearing if:
    (A) The request for a hearing is untimely (ie., fails to meet the 
30-day requirement);
    (B) The school does not provide a statement of material, factual 
issues in dispute within the 90-day required period; or
    (C) The statement of factual issues in dispute is frivolous or 
inconsequential.

In the event that the Secretary denies a hearing, the Secretary will 
send a written denial to the school setting forth the reasons for 
denial. If a hearing is denied, or if as a result of the hearing, 
termination is still determined to be necessary, the school will be 
terminated from participation in the program and will be required to 
return the Federal share of the revolving fund to the Department. A 
school terminated for failure to submit a complete report within 6 
months of the close of the reporting period must continue to pursue 
collections and may reapply for participation in the program once it has 
submitted the overdue report.
    (2) The following student records must be retained by the school for 
5 years after the individual student ceases to be a full-time or half-
time student:
    (i) Approved student applications for nursing student loans;
    (ii) Documentation of the financial need of applicants; and
    (iii) Copy of financial aid transcripts.
    (3) The following repayment records for each individual borrower 
must be retained for at least 5 years from the date of retirement of a 
loan:
    (i) The amount and date of each loan;
    (ii) The amount and date of each payment or cancellation;
    (iii) Records of periods of deferment;
    (iv) Date, nature, and result of each contract with the borrower or 
proper endorser in the collection of an overdue loan;
    (v) Copies of all correspondence to or from the borrower and 
endorser;
    (vi) Copies of all correspondence with a collection agency related 
to the individual borrower;
    (vii) Copies of all correspondence with a credit bureau related to 
an individual borrower; and
    (viii) Copies of all correspondence relating to uncollectible loans 
which have been written off by the Federal Government or repaid by the 
school.
    (4) The school must also retain other records as the Secretary may 
prescribe. In all cases where questions have arisen as a result of a 
Federal audit, the records must be retained until resolution of all 
questions.
    (b) Inspection and audit. (1) Any application for a Federal capital 
contribution will constitute the consent of the applicant school to 
inspection and fiscal audit, by the Secretary and the Comptroller 
General of the United States or any of their duly authorized 
representatives, of the fiscal and other

[[Page 301]]

records of the applicant school which relate to the Federal capital 
contribution or Federal capital loan.
    (2) The school must comply with the audit requirements of the 
Department of Health and Human Services' Administration of Grants 
regulations which are set forth in 45 CFR part 74.
    (c) Institutional officials who have information which indicates the 
potential or actual commission of fraud or other offenses against the 
United States, involving these loan funds, should promptly provide this 
information to the appropriate Regional Office of Inspector General for 
Investigations.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34434, Aug. 23, 1985, as amended at 53 FR 46555, Nov. 17, 1988; 
56 FR 13772, Apr. 4, 1991; 57 FR 45735, Oct. 1, 1992]



Sec. 57.316  What additional Department regulations apply to schools?

    Participating schools are advised that in addition to complying with 
the terms and conditions of these regulations, several other regulations 
apply under this subpart. These include, but are not limited to:

45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in Health and 
Human Services programs or activities receiving Federal financial 
assistance
45 CFR part 93--New Restrictions on Lobbying

[56 FR 13772, Apr. 4, 1991, as amended at 57 FR 45735, Oct. 5, 1992; 61 
FR 6123, Feb. 16, 1996]



Sec. 57.316a  Performance standard.

    On June 30, 1986, and on each June 30 thereafter, except as provided 
in paragraph (b) of this section, each school must have a default rate 
(as calculated under paragraph (a) of this section) of not more than 5 
percent.
    (a) The default rate for each school shall be the ratio (stated as a 
percentage) that the defaulted principal amount outstanding of the 
school bears to the matured loans of the school. For this purpose:
    (1) The term ``defaulted principal amount outstanding'' means the 
total amount borrowed from the loan fund of a school that has reached 
the repayment stage (minus any principal amount repaid or canceled) on 
loans in default for more than 120 days; and
    (2) The term ``matured loans'' means the total principal amount of 
all loans made by a school under this subpart minus the total principal 
amount of loans made by the school to students who are:
    (i) Enrolled in a full-time or half-time course of study at the 
school; or
    (ii) In their grace period.
    (b) Any school that has a default rate greater than 5 percent on 
June 30, 1986, or on June 30 of any year thereafter will be required to:
    (1) Reduce its default rate by 50 percent (or a school with a 
default rate below 10 percent must reduce its rate to 5 percent) by the 
close of the following 6-month period; and
    (2) By the end of each succeeding 6-month period, reduce its default 
rate to 50 percent of the required rate for the previous 6-month period, 
until it reaches 5 percent.
    (c) Any school subject to the provisions of paragraph (b) of this 
section which fails to comply with those requirements will receive no 
new NSL funds and will be required to:
    (1) Place the revolving fund monies and all subsequent collections 
into an insured interest-bearing account;
    (2) Make no loan disbursements; and
    (3) By the end of the succeeding 6-month period, reduce its default 
rate to 50 percent of the rate it failed to achieve under paragraph(b) 
of this section, or 5 percent. A school that meets this requirement will 
be permitted to resume the use of its nursing student

[[Page 302]]

loan funds, but must continue to comply with the requirements of 
paragraph (b)(2) of this section if its default rate is still greater 
than 5 percent.

A school that meets the requirements of subparagraph (c)(3) of this 
section will be permitted to resume the use of its NSL funds, but must 
continue to comply with the requirements of subparagraph (b)(2) of this 
section if its delinquency rate is still greater than 5 percent.
    (d) Any school subject to the provisions of paragraph (c)(3) of this 
section which fails to comply with those requirements will be subject to 
termination. The Secretary will provide the school with a written notice 
specifying his or her intention to terminate the school's participation 
in the program and stating that the school may request, within 30 days 
of the receipt of this notice, a formal hearing. If the school requests 
a hearing, it must within 90 days of the receipt of the notice, submit 
material, factual issues in dispute to demonstrate that there is cause 
for a hearing. These issues must be both substantive and relevant. The 
hearing will be held in the Washington, DC metropolitan area. The 
Secretary will deny a hearing if:
    (1) The request for a hearing is untimely (i.e., fails to meet the 
30-day requirement);
    (2) The school does not provide a statement of material, factual 
issues in dispute within the 90-day required period; or
    (3) The statement of factual issues in dispute is frivolous or 
inconsequential.

In the event that the Secretary denies a hearing, the Secretary will 
send a written denial to the school setting forth the reasons for 
denial. If a hearing is denied, or if as a result of the hearing, 
termination is still determined to be necessary, the school will be 
terminated from participation in the program and will be required to 
return the Federal share of the revolving fund to the Department. A 
school terminated for failure to comply with the provisions of paragraph 
(c)(3) of this section must continue to pursue collections and may 
reapply for participation in the program only when it has attained a 
default rate of 5 percent or less.

(Approved by the Office of Management and Budget under control number 
0915-0047)

[50 FR 34434, Aug. 23, 1985, as amended at 52 FR 10195, Mar. 30, 1987; 
53 FR 46555, Nov. 17, 1988; 56 FR 13772, Apr. 4, 1991]



Sec. 57.317  Additional conditions.

    The Secretary may, with respect to any agreement entered into with 
any school under Sec. 57.305, impose additional conditions prior to or 
at the time of any award when in his or her judgment the conditions are 
necessary to assure or protect advancement of the purposes of the 
agreement, the interest of the public health, or the conservation of 
funds awarded.



Sec. 57.318  Noncompliance.

    Whenever the Secretary finds that a participating school has failed 
to comply with the applicable provisions of the Act or the regulations 
of this subpart he or she may, on reasonable notice to the school, 
withhold further payments of Federal capital contributions and take 
other action, including the termination of any agreement, as he or she 
finds necessary to enforce the Act and regulations. In such case no 
further expenditures shall be made from the nursing student loan fund or 
funds involved until the Secretary determines that there is no longer 
any failure of compliance.



     Subpart E--Grants for Construction of Nurse Training Facilities

    Authority: Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216.



Sec. 57.409  Good cause for other use of completed facility.

    If, within 20 years after completion of construction (or, in the 
case of interim facilities prior to the time at which teaching in such 
facilities is moved to a permanent facility, whichever comes first), the 
facility shall cease to be used for any one or more of the purposes for 
which it was constructed, the Secretary, in determining whether there is 
good cause for releasing the applicant or other owner of the facility 
from the obligation so to use the facility, shall

[[Page 303]]

take into consideration the extent to which:
    (a) The facility will be devoted by the applicant or other owner to 
the teaching of other health personnel;
    (b) There are reasonable assurances that for the remainder of such 
period other facilities not previously utilized for nurse training will 
be so utilized and are substantially the equivalent in nature and extent 
for such purposes.

[37 FR 20548, Sept. 30, 1972]



          Subpart F--Grants for Nurse Anesthetist Traineeships

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 67 Stat. 631 (42 U.S.C. 216); sec. 831(a) of the Public 
Health Service Act, 93 Stat. 580, as amended by 96 Stat. 2061, and 99 
Stat. 396-397 (42 U.S.C. 297-1).

    Source: 53 FR 9116, Mar. 21, 1988, unless otherwise noted.



Sec. 57.501  To what programs do these regulations apply?

    These regulations apply to grants awarded to public or private 
nonprofit institutions for the purpose of providing traineeships to 
registered nurses enrolled in nurse anesthetist training programs.



Sec. 57.502  Definitions.

    Act means the Public Health Service Act, as amended.
    Fiscal Year means the Federal fiscal year, beginning October 1 and 
ending the following September 30.
    National of the United States means a citizen of the United States 
or a person who, though not a citizen of the United States, owes 
permanent allegiance to the United States (as defined in 8 U.S.C. 
1101(a)(22), the Immigration and Nationality Act).
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations, no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Nurse anesthetist means a registered nurse who has successfully 
completed a nurse anesthetist training program.
    Nurse anesthetist training program means a full-time educational 
program which:
    (1) Is designed to qualify registered nurses as nurse anesthetists;
    (2) Is accredited by the Council on Accreditation of Nurse 
Anesthesia Educational Programs; and
    (3) Has students enrolled in the program who are beyond the twelfth 
month of study.
    Registered nurse means a person who has graduated from a school of 
nursing and is licensed to practice as a registered/professional nurse 
in a State.
    School of nursing means a collegiate, associate degree, or diploma 
school of nursing as defined in section 853 of the Act.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human 
Services, to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    Trainee means a student who is receiving a traineeship from a grant 
under this subpart.

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992; 61 
FR 6124, Feb. 16, 1996]



Sec. 57.503  Who is eligible to apply for a grant?

    Any public or private nonprofit institution which is located in a 
State and administers a nurse anesthetist training program is eligible 
to apply for a grant by submitting an application at the time and in the 
form that the Secretary may prescribe.

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]



Sec. 57.504  How will applications be evaluated?

    Within the limits of funds available, the Secretary will award a 
grant to each eligible institution whose application is found to meet 
the requirements

[[Page 304]]

of section 831(a) of the Act and these regulations. In determining the 
funding of applications, the Secretary will consider any special factors 
relating to national needs as the Secretary may from time to time 
announce in the Federal Register.



Sec. 57.505  How long does grant support last?

    (a) The Notice of Grant Award specifies the period during which 
grant funds are available for obligation by the grantee. This period, 
called the budget period, will not exceed 1 year.
    (b) The grant will initially be funded for 1 year, and subsequent 
awards will also be for 1 year at a time. Decisions about the amount of 
all awards will be made by formula as described in Sec. 57.506 of these 
regulations. In all cases awards require a determination by the 
Secretary that funding is in the best interest of the Federal 
Government.
    (c) Neither the approval of any application nor the award of any 
grant shall commit or obligate the United States in any way to make any 
additional award with respect to any approved application or portion of 
an approved application. For continuation support, grantees must make 
separate application at such times and in such a form as the Secretary 
may prescribe.

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]



Sec. 57.506  How is the amount of the award determined?

    (a) The Secretary will use the following formula to determine the 
amount of the grant to be awarded to each approved nurse anesthetist 
training program:
[GRAPHIC] [TIFF OMITTED] TC13NO91.000


G represents the amount of grant to be awarded. F represents the amount 
of traineeship funds appropriated to implement section 831(a) in the 
fiscal year in which application is made. E represents the total number 
of full-time students enrolled beyond the twelfth month of study in all 
the approved applicant nurse anesthetist training programs. N represents 
the number of full-time students enrolled beyond the twelfth month of 
study in the applicant nurse anesthetist training program. Should 
special factors for determining the funding of applications be announced 
from time to time in the Federal Register, N will be adjusted upward for 
those applicants meeting the specific criteria as announced. (This 
adjustment will result in the award of additional traineeship funds to 
successful applicants who meet the criteria of the special factors.)
    (b) Students will be counted as of October 15 of the Federal fiscal 
year in which application is made.



Sec. 57.507  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
for traineeships according to Sec. 57.508, the authorizing legislation, 
terms and conditions of the grant award, applicable cost principles 
specified in subpart Q of 45 CFR part 74, and these regulations.
    (b) A grantee may not spend grant funds for sectarian instruction or 
for any religious purpose.
    (c) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of the budget period may be 
carried forward provided specific approval is granted by the Secretary. 
If at any time during a budget period it becomes apparent to the 
Secretary that the amount of Federal funds awarded and made available to 
the grantee for that period, including any unobligated balance carried 
forward from prior periods, exceeds the grantee's need for that period, 
the Secretary may adjust the amounts awarded by withdrawing the excess. 
A budget period is an interval of time (usually 12 months) into which 
the project period is divided for funding and reporting purposes.

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]



Sec. 57.508  What financial support is available to trainees?

    Expenditures from traineeship funds are limited to:
    (a) Tuition and fees, in accordance with the established rates of 
the institution, except as limited by the Secretary.

[[Page 305]]

    (b) Stipends in whatever amount the grantee determines that each 
trainee needs to pursue the training program, as long as that amount 
does not exceed the limits established by the Public Health Service. 
Stipends may only be paid to the trainee in monthly installments.
    (c) A transportation allowance for travel to field training if the 
site is beyond a reasonable commuting distance and requires the trainee 
to establish a temporary new residence. However, the grantee may not pay 
an allowance for daily commuting from the new place of residence to the 
field training headquarters.

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]



Sec. 57.509  Who is eligible for financial assistance as a trainee?

    To be eligible for a traineeship, a registered nurse must:
    (a) Be a resident of the United States and either a citizen or 
national of the United States, an alien lawfully admitted for permanent 
residence in the United States, a citizen of the Commonwealth of the 
Northern Mariana Islands, a citizen of the Republic of Palau, a citizen 
of the Republic of the Marshall Islands, or a citizen of the Federated 
States of Micronesia;
    (b) Be enrolled as a full-time student beyond the twelfth month of 
study in a nurse anesthetist training program;
    (c) Demonstrate financial need, as determined by the institution; 
and
    (d) Not be receiving concurrent support for the same training from 
another Federal education award which provides a stipend or otherwise 
duplicates financial provisions except education benefits under the 
Veteran's Readjustment Benefits Act and loans from Federal sources.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992; 61 
FR 6124, Feb. 16, 1996]



Sec. 57.510  What are the requirements for traineeships and the appointment of trainees?

    (a)(1) The grantee must complete a statement which documents the 
appointment of each trainee. To complete this statement the grantee must 
require each trainee to provide information and documentation of his or 
her eligibility.
    (2) The statement of appointment must be completed by the beginning 
of the training period or as soon thereafter as possible if the trainee 
receives notice of his or her traineeship appointment after the training 
period has begun. The statement of appointment must include information 
to document the eligibility of the trainee and certify that there will 
be compliance with all applicable Public Health Service terms and 
conditions governing the appointment. The program director must sign the 
statement on behalf of the grantee, and the trainee must sign it thus 
certifying the statements are true and complete. The original copy of 
the statement must be retained by the grantee to be available for 
program review and financial audit. A copy shall be provided to the 
trainee for his or her records.
    (b) The grantee may not require trainees to perform any work which 
is not an integral part of the nurse anesthetist training program and 
required for all students in the program, or to perform services which 
detract from or prolong their training.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]



Sec. 57.511  Duration of traineeships.

    The initial appointment to a traineeship must be made for a full 
academic year, not to exceed 12 months, except that a shorter 
appointment may be made when necessary to enable the trainee to complete 
the training program. A second appointment may not exceed 6 months. The 
total period of support for any trainee may not exceed 18 months.



Sec. 57.512  Termination of traineeships.

    (a) The grantee must terminate a traineeship:
    (1) Upon request of the trainee;
    (2) If the trainee withdraws from the grantee institution; or
    (3) If the grantee determines that:

[[Page 306]]

    (i) The trainee is no longer an enrolled student; or
    (ii) The trainee is not eligible or able to continue in accordance 
with its standards and practices.
    (b) The grantee must deposit any Federal portion of the tuition 
refund owed to a trainee into the grant account and provide written 
notice to the trainee that it is doing so.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]



Sec. 57.513  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying.

[53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45736, Oct. 5, 1992; 61 
FR 6124, Feb. 16, 1996]



Sec. 57.514  Additional conditions.

    The Secretary may impose additional conditions on any grant award 
before or at the time of any award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.

Subpart G  [Reserved]



       Subpart H--Grants for Physician Assistant Training Programs

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 63 Stat. 35 (42 U.S.C. 216); sec. 783(a)(1) of the Public 
Health Service Act, 90 Stat. 2314, and 99 Stat. 524 (42 U.S.C. 295g-
3(a)(1)); redesignated as sec. 788(d) and amended by 102 Stat. 3135 (42 
U.S.C. 295g-8(d)); renumbered as sec. 750, as amended by Pub. L. 102-
408, 106 Stat. 2044 (42 U.S.C. 293n).



Sec. 57.701  Applicability.

    The regulations in this subpart apply to the award of grants to 
public or private nonprofit schools of medicine or osteopathic medicine, 
and other public or private nonprofit entities under section 750 of the 
Public Health Service Act (42 U.S.C. 293n) to meet the costs of projects 
to plan, develop, and operate or maintain programs for the training of 
physician assistants.

[57 FR 45736, Oct. 5, 1992; 57 FR 53815, Nov. 12, 1992; 61 FR 6124, Feb. 
16, 1996]



Sec. 57.702  Definitions.

    As used in this subpart:
    Act means the Public Health Service Act, as amended.
    Budget period means the interval of time into which the approved 
activity is divided for budgetary and reporting purposes, as specified 
in the grant award document.
    Health professional shortage area means an area designated under 
section 332 of the Act.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Physician assistant means an individual who is qualified by academic 
and clinical training to provide patient care services under the 
supervision and

[[Page 307]]

responsibility of a doctor of medicine or osteopathic medicine and who 
meets the requirements of 42 CFR 57.802.
    Primary care means health care which may be initiated by the patient 
or the provider, or both, in a variety of settings, and which consists 
of a broad range of personal health care services including promotion 
and maintenance of health, prevention of illness and disability, basic 
care during acute and chronic phases of illness, guidance and counseling 
of individuals and families, and referral to other health care providers 
and community resources when appropriate. In providing the services
    (1) The physical, emotional, social, and economic status of the 
patient is considered in the context of his or her cultural and 
environmental background, including the family and community, and
    (2) The patient is provided timely access to the health care system.
    Program for the Training of Physician Assistants or Program means a 
program for the training of physician assistants as defined in 42 CFR 
57.801-57.803.
    Project director means an individual designated by the grantee in 
the grant application and approved by the Secretary to direct the 
project being supported under this subpart.
    Project period means the total time for which support for a project 
has been approved including any extensions of the project.
    School of medicine or school of osteopathic medicine means a public 
or private nonprofit school which provides training leading respectively 
to a degree of doctor of medicine or a degree of doctor of osteopathic 
medicine, and which is accredited as provided in section 799(1)(E) of 
the Act.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    Supervised clinical practice means supervised clinical practice as 
defined in 42 CFR 57.802.

[44 FR 36178, June 21, 1979, as amended at 52 FR 24160, June 29, 1987; 
57 FR 45736, Oct. 5, 1992; 61 FR 6124, Feb. 16, 1996]



Sec. 57.703  Eligibility.

    Any public or private nonprofit school of medicine or osteopathic 
medicine or public or private nonprofit entity located in a State is 
eligible to apply for a grant under this subpart.

[57 FR 45736, Oct. 5, 1992]



Sec. 57.704  Application.

    (a) Each eligible applicant desiring a grant under this subpart 
shall submit an application in the form and at such time as the 
Secretary may prescribe.
    (b) The application must be signed by an individual authorized to 
act for the applicant and to assume on behalf of the applicant the 
obligations imposed by the terms and conditions of any award, including 
the regulations of this subpart.
    (c) In addition to other pertinent information which the Secretary 
may require, an application for a grant under this subpart must contain:
    (1) A detailed description of the proposed project and of the manner 
in which the applicant intends to conduct the project and carry out the 
requirements of section 750 of the Act and this subpart, in particular, 
the requirements of Sec. 57.705. This must include a budget for the 
proposed project and a justification for the amount of grant funds 
requested.
    (2) A copy of all laws and regulations pertaining to the practice of 
physician assistants in the State or States in which the applicant's 
supervised clinical practice will be conducted and in which the 
applicant will be encouraging its graduates to work.

[[Page 308]]

    (3) A description of the present employment of any graduates of the 
program, to the extent available, and a description of the methods to be 
used by the program in placing its graduates.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[44 FR 36178, June 21, 1979, as amended at 49 FR 38112, Sept. 27, 1984; 
52 FR 24160, June 29, 1987; 57 FR 45736, Oct. 5, 1992; 61 FR 6124, Feb. 
16, 1996]



Sec. 57.705  Project requirements.

    A project supported under this subpart must be conducted in 
accordance with the following requirements:
    (a) The project must conduct its program for the training of 
physician assistants in accordance with the requirements in 42 CFR 
57.803.
    (b) The program must (1) be accredited as an Educational Program for 
the Physician Assistant by the American Medical Association's Committee 
on Allied Health Education and Accreditation, or (2) have received a 
Letter of Review from the Accreditation Review Committee on Education 
for the Physician Assistant.
    (c) The program must be operational no later than 12 months after 
the award of a grant under this subpart.
    (d) The project must be conducted under the direction of the project 
director who must be employed full-time at the grantee institution(s). 
If the project director becomes unable to function in this capacity, the 
Secretary must be notified as soon as possible.
    (e) The project must evaluate the supervised clinical practice 
conducted by the program with respect to:
    (1) The variety of patient contact and care experiences afforded to 
participating students;
    (2) The adequacy and quality of supervision provided to 
participating students; and
    (3) The adequacy of the physical setting or settings in which the 
supervised clinical practice takes place.
    (f)(1) The project must provide on an annual basis, upon request and 
in a format acceptable to the Secretary, information in the aggregate 
regarding student characteristics, student attrition rate and student 
performance.
    (2) The project must provide on an annual basis, upon request and in 
a format acceptable to the Secretary, information in the aggregate 
regarding the employment of its graduates including place of employment.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[37 FR 20543, Sept. 30, 1972, as amended at 45 FR 41420, June 19, 1980; 
52 FR 24160, June 29, 1987; 57 FR 45736, Oct. 5, 1992]



Sec. 57.706  Evaluation of applications.

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will approve or disapprove 
all applications filed in accordance with Sec. 57.704, taking into 
consideration:
    (1) The degree to which the project plan adequately provides for 
meeting the requirements set forth in Sec. 57.705 and 42 CFR 57.803;
    (2) The potential effectiveness of the project in carrying out the 
purposes of section 750 of the Act and this subpart;
    (3) The capability of the applicant to carry out the proposed 
project;
    (4) The local, regional, and national needs the project proposes to 
serve;
    (5) The adequacy of the project's plan for placing graduates in 
health professional shortage areas;
    (6) The soundness of the fiscal plan for assuring effective use of 
grant funds;
    (7) The potential of the project to continue on a self-sustaining 
basis after the period of grant support; and
    (8) The adequacy of the project's plan to develop and use methods 
designed to attract and maintain minority and disadvantaged students to 
train as physician assistants.
    (b) In determining the funding of applications approved under 
paragraph (a) of this section, the Secretary will consider any special 
factors relating to national needs as the Secretary may

[[Page 309]]

from time to time announce in the Federal Register.

[44 FR 36178, June 21, 1979, as amended at 52 FR 24160, June 29, 1987; 
53 FR 14792, Apr. 26, 1988; 57 FR 45736, Oct. 5, 1992; 61 FR 6124, Feb. 
16, 1996]



Sec. 57.707  Grant award.

    (a) General. (1) Within the limits of funds available for this 
purpose, the Secretary may award grants to those applicants whose 
projects will, in his or her judgment best promote the purposes of 
section 750 of the Act as determined in accordance with Sec. 57.706.
    (2) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 5 years.
    (3) Neither the approval of any project nor any grant award shall 
commit or obligate the United States in any way to make any additional, 
supplemental, continuation, or other award with respect to any approved 
project or portion of an approved project. For continuation support, 
grantees must make separate application at such times and in such a form 
as the Secretary may prescribe.
    (b) The Secretary will determine the amount of any award on the 
basis of his or her estimate of the sum necessary for the cost 
(including both direct and indirect costs) of the project.
    (c) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be for 1 year at a time. 
Decisions regarding continuation awards and the funding levels of these 
awards will be made after consideration of such factors as the grantee's 
progress and management practices, existence of legislative authority, 
and the availability of funds. In all cases, continuation awards require 
a determination by the Secretary that continued funding is in the best 
interest of the Federal Government.

[44 FR 36178, June 21, 1979, as amended at 57 FR 45736, Oct. 5, 1992; 61 
FR 6124, Feb. 16, 1996]



Sec. 57.708  Grant payments.

    The Secretary will from time to time make payments to a grantee of 
all or a portion of any grant award, either in advance or by way of 
reimbursement.

[44 FR 36178, June 21, 1979]



Sec. 57.709  Purposes for which grant funds must be spent.

    (a) Grant funds must be spent solely for carrying out the approved 
project under section 750 of the Act, these regulations, the terms and 
conditions of the grant award, and applicable cost principles specified 
in subpart Q of 45 CFR part 74.
    (b) Grant funds may not be spent for sectarian instruction or for 
any religious purpose.
    (c) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried forward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amounts awarded by withdrawing the excess. A budget 
period is an interval of time (usually 12 months) into which the project 
period is divided for funding and reporting purposes.

[44 FR 36178, June 21, 1979, as amended at 52 FR 24160, June 29, 1987; 
57 FR 45736, Oct. 5, 1992; 61 FR 6124, Feb. 16, 1996]



Sec. 57.710  What additional Department regulations apply to grantees?

    Several other regulations apply to these grants. They include, but 
are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and

[[Page 310]]

Human Services effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation of the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance.
45 CFR part 93--New restrictions on lobbying.

[52 FR 24161, June 29, 1987, as amended at 57 FR 45736, Oct. 5, 1992; 61 
FR 6124, Feb. 16, 1996]



Sec. 57.711  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6124, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 57.712  Additional conditions.

    The Secretary may with respect to any grant award impose additional 
conditions prior to or at the time of any award when, in his or her 
judgment, these conditions are necessary to assure or protect 
advancement of the grant, the interest of the public health, or the 
conservation of grant funds.

[44 FR 36177, June 21, 1979. Redesignated at 52 FR 24161, June 29, 1987]



      Subpart I--Programs for the Training of Physician Assistants

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 63 Stat. 35 (42 U.S.C. 216); sec. 701(8)(B), 90 Stat. 
2247, as amended by 95 Stat. 913 and 99 Stat. 525-526 (42 U.S.C. 
292a(8)(B)); renumbered as sec. 750, as amended by Pub. L. 102-408, 106 
Stat. 2044 (42 U.S.C. 293n).



Sec. 57.801  Purpose and scope.

    (a) Section 750 of the Public Health Service Act (42 U.S.C. 293n) 
requires the Secretary to develop regulations for programs for the 
training of physician assistants. The purpose of this subpart is to 
comply with this requirement.
    (b) The regulations in this subpart apply to all programs for the 
training of physician assistants supported under title VII of the Public 
Health Service Act.

[44 FR 36177, June 21, 1979, as amended at 52 FR 24160, June 29, 1987; 
61 FR 6124, Feb. 16, 1996]



Sec. 57.802  Definitions.

    For purpose of this subpart:
    Academic year means the approximately 9-12 month period of time 
during which the program is in session.
    Disease prevention is the health strategy which emphasizes the 
development of individual and community measures to protect against 
disease or environmental hazards and their harmful consequence.
    Full-time student means a student who is enrolled in a program and 
pursuing a course of study which constitutes a full-time academic 
workload, as determined by the program, and which leads to a degree, 
diploma, or certificate of completion.
    Geriatric medicine is the prevention, diagnosis, care and treatment 
of illness and disability as required by the distinct needs of the 
elderly.
    Health professional shortage area means an area designated under 
section 322 of the Public Health Service Act.
    Health promotion is the health strategy which emphasizes individual 
responsibility for one's health, and community efforts to maintain and 
enhance well-being through lifestyle changes.
    Home health care is the provision of medical and other health care 
services to maintain or restore the health of an ill or disabled person 
in their place of residence.
    Medical director means the individual responsible for providing 
competent medical direction of the program.
    Physician assistant means an individual who is qualified by academic 
and clinical training to provide patient care services under the 
supervision and responsibility of a doctor of medicine

[[Page 311]]

or osteopathic medicine. At a minimum, the physician assistant is 
competent to:
    (1) Do the initial and follow-up evaluation of patients of various 
age groups in any setting to elicit a detailed and accurate history, 
perform an appropriate physical examination, and record and present 
pertinent data, including interpretive recommendations, in a manner 
meaningful to the physician;
    (2) Perform or assist in the performance of routine laboratory and 
related studies as appropriate for a specific practice setting, such as 
blood studies, urinalyses, and electrocardiographic tracings;
    (3) Perform routine therapeutic procedures such as injections, 
immunizations, and the assessment, suturing, and care of wounds;
    (4) Instruct and counsel patients regarding physical and mental 
health, including matters such as nutrition, illness, treatment, normal 
growth and development, and age, sex, or lifestyle risk factors;
    (5) Perform the following functions in a hospital setting: patient 
work-ups, making patient rounds, recording patient progress notes, 
accurately and appropriately transcribing or executing standing orders 
and other specific orders at the direction of the supervising physician, 
and compiling and recording detailed progress reports and narrative case 
summaries;
    (6) Deliver or assist in the delivery of services, including the 
review and monitoring of treatment and therapy plans, to patients 
requiring initial or continuing care in settings other than a hospital, 
such as the home, nursing homes, and extended care facilities;
    (7) Evaluate and treat life-threatening emergency situations;
    (8) Interact with those community health services and other 
community resources which will facilitate the patient's care and 
continuity of care.
    Primary care means primary care, as defined in 42 CFR 57.702.
    Supervised clinical practice means direct participation in patient 
care by observation, examination, and performance of procedures as are 
appropriate for the assigned role of the student for the purposes of 
instruction under the guidance and responsibility of a physician who 
holds a full and unrestricted license in the State in which the 
supervised clinical practice is located.

[44 FR 36177, June 21, 1979, as amended at 52 FR 24160, June 29, 1987; 
57 FR 45737, Oct. 5, 1992]



Sec. 57.803  Requirements.

    A program for the training of physician assistants must:
    (a)(1) Be accredited as an Educational Program for the Physician 
Assistant by the American Medical Association's Committee on Allied 
Health Education and Accreditation; or
    (2) Have received a Letter of Review from the Accreditation Review 
Committee on Education for the Physician Assistant for its plans for a 
program for the training of physician assistants;
    (b) Have a medical director who is licensed to practice medicine or 
osteopathic medicine in the State in which the program is located (or 
any State if the program is conducted by a Federal health facility) and 
who is experienced in the delivery of the type of health care services 
for which the program provides training;
    (c) Have an enrollment of not less than eight full-time students in 
each class;
    (d) Be a minimum of 1 academic year in length;
    (e) Consist of supervised clinical practice and at least 4 months 
(in the aggregate) of classroom instruction;
    (f) Provide training to students in the areas of primary care, 
health promotion, disease prevention, geriatric medicine and home health 
care;
    (g) Develop and use methods designed to encourage graduates of the 
program to work in health professional shortage areas, such as periods 
of supervised clinical practice in those areas;
    (h) Develop and use methods for placing graduates in positions for 
which they have been trained, including methods for placing graduates in 
positions in health professional shortage areas; and
    (i) Develop and use a method for evaluating the effectiveness of the 
program in training physician assistants, including:

[[Page 312]]

    (1) Evaluation by faculty and students of the program in relation to 
its objectives;
    (2) Evaluation of student performance in classroom instruction and 
supervised clinical practice; and
    (3) Evaluation of the number of graduates employed and the 
characteristics of their employment, such as geographical location, 
setting, and functions performed; and
    (4) Award a degree, diploma, or certificate of completion to 
individuals who have successfully completed the program.

[44 FR 36177, June 21, 1979, as amended at 52 FR 24160, June 29, 1987; 
57 FR 45737, Oct. 5, 1992]

Subparts J-K  [Reserved]



 Subpart L--Grants for Residency Training and Advanced Education in the 
                      General Practice of Dentistry

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 63 Stat. 35 (42 U.S.C. 216); sec. 786(b) of the Public 
Health Service Act, 90 Stat. 2317, as amended by 99 Stat. 540-541 (42 
U.S.C. 295g-6(b)); redesignated as sec. 785 and amended by 102 Stat. 
3130-3131 (42 U.S.C. 295g-5); renumbered as sec. 749, as amended by Pub. 
L. 102-408, 106 Stat. 2043-2044 (42 U.S.C. 293m).



Sec. 57.1101  To what projects do these regulations apply?

    These regulations apply to the award of grants under section 749 of 
the Public Health Service Act (42 U.S.C. 293m) to public or private 
nonprofit schools of dentistry and to accredited postgraduate dental 
training institutions to meet the costs of projects to:
    (a) Plan, develop and operate an approved residency training program 
in the general practice of dentistry or an approved advanced educational 
program in the general practice of dentistry; and
    (b) Provide financial assistance (in the form of traineeships and 
fellowships) to participants in such a program who are in need of 
financial assistance and who plan to practice general dentistry.

[52 FR 19145, May 21, 1987, as amended at 57 FR 45737, Oct. 5, 1992; 61 
FR 6124, Feb. 16, 1996]



Sec. 57.1102  Definitions.

    As used in this subpart:
    Accredited postgraduate dental training institution means a public 
or private nonprofit institution which operates a postgraduate dental 
training program that has received an accreditation classification of 
``accreditation eligible,'' ``preliminary provisional approval,'' 
``provisional approval,'' ``conditional approval,'' or ``approval'' by 
the Commission on Dental Accreditation.
    Act means the Public Health Service Act, as amended.
    Approved residency training program, approved advanced educational 
program, or program means a general practice residency program or an 
advanced educational program in general dentistry which has received an 
accreditation classification of ``accreditation eligible,'' 
``preliminary provisional approval,'' ``provisional approval,'' 
``conditional approval,'' or ``approval'' by the Commission on Dental 
Accreditation.
    Budget period means an interval of time into which the project 
period is divided for budgetary purposes, as specified in the grant 
award document.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned or operated by one or more corporations or 
associations no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Practice of general dentistry means a practice of dentistry in which 
the dentist:
    (1) Serves as a patient's first contact with the dental care system 
and provides the means of timely entry into that system;
    (2) Evaluates the patient's general medical status and relates this 
to anticipated dental treatment;
    (3) Assumes continuing responsibility for the patient's dental care 
and provides a comprehensive range of services

[[Page 313]]

which will minimize the need for patient referral; and
    (4) Coordinates dental treatment provided by dental specialists and 
by dental auxiliary personnel, including dental hygienists, dental 
assistants, and expanded function dental auxiliaries.
    Project period means the total time for which support for a project 
has been approved, including any extensions thereof.
    School of dentistry means a public or private nonprofit school which 
provides training leading to a degree of doctor of dentistry or an 
equivalent degree and which is accredited as provided in section 
799(1)(E) of the Act.
    Secretary means the Secretary of Health and Human Services, and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[43 FR 54931, Nov. 24, 1978, as amended at 52 FR 19145, May 21, 1987; 57 
FR 45737, Oct. 5, 1992; 61 FR 6124, Feb. 16, 1996]



Sec. 57.1103  What entities are eligible to apply for a grant?

    Any public or private nonprofit school of dentistry or accredited 
postgraduate dental training institution located in a State is eligible 
to apply for a grant.

[57 FR 45737, Oct. 5, 1992]



Sec. 57.1104  How must an entity apply for a grant?

    (a) To apply for a grant under this subpart, each entity shall 
submit an application in the form and at such time as the Secretary may 
prescribe.
    (b) The application must be signed by an individual authorized to 
act for the applicant and to assume, on behalf of the applicant, the 
obligations imposed by the terms and conditions of any award including 
the regulations of this subpart.
    (c) In addition to other pertinent information that the Secretary 
may require, an application for a grant under this subpart must contain:
    (1) A full and adequate description of the proposed project and of 
the manner in which the applicant intends to conduct the project and 
carry out the requirements of this subpart; and
    (2) A budget justification for the funds requested. If the applicant 
requests funds for stipend support of participants, the applicant must 
provide evidence showing that income available from other sources, 
including income derived from services of the participants in the 
program, will be insufficient to pay their stipends and that grant funds 
will not be used to supplant other available funds.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[43 FR 54931, Nov. 24, 1978, as amended at 49 FR 38112, Sept. 27, 1984; 
52 FR 19145, May 21, 1987; 57 FR 45737, Oct. 5, 1992; 62 FR 51374, Oct. 
1, 1997]



Sec. 57.1105  What requirements must a project meet?

    A project supported under this subpart must meet the following 
requirements:
    (a) The general practice residency or advanced education program in 
general dentistry must be accredited by the American Dental Association 
Commission on Dental Accredation;
    (b) Each project must have at least two participants enrolled in the 
training program; and
    (c) Each participant who receives stipend support must sign a 
statement of intent to work in the practive of general dentistry.

[62 FR 51374, Oct. 1, 1997]



Sec. 57.1106  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposal as contained in the application. The Secretary 
may not approve such an application unless a peer review

[[Page 314]]

group has recommended the application for approval. The Secretary will 
award grants to applicants whose projects will best promote the purposes 
of section 749 of the Act. The Secretary will approve or disapprove 
applications filed in accordance with Sec. 7thnsp;57.1104, taking into 
consideration, among other factors, the degree to which:
    (1) The proposal addresses the legislative intent of the program and 
has a well-documented rationale;
    (2) The objectives of the proposed project are consistent with the 
program's rationale, and are measurable and achievable within the 
project period;
    (3) The proposed project's methodology is consistent with the 
objectives and explained in appropriate detail;
    (4) The evaluation is linked to the objectives and addresses the 
project outcomes;
    (5) The applicant demonstrates the administrative and managerial 
capability to carry out the proposed project;
    (6) The proposed budget is complete, appropriate, cost-effective, 
and clearly justified;
    (7) The plan for institutionalizing the project outcomes is specific 
and realistic; and
    (8) The proposal plans to attract, maintain, and graduate minority 
and disadvantaged students.
    (b) In determining the funding of applications approved under 
paragraph 9a) of this section, the Secretary will consider any special 
factors relating to national needs as the Secretary may from time to 
time announce in the Federal Register.

[62 FR 51374, Oct. 1, 1997]



Sec. 57.1107  How will grant awards be made?

    (a) General. (1) Within the limit of funds available, the Secretary 
will award grants to those applicants whose approved projects will, in 
his or her judgment, best promote the purposes of section 749 of the 
Act, as determined in accordance with Sec. 57.1106.
    (2) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 3 years.
    (3) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be for 1 year at a time. 
Decisions regarding continuation awards and the funding levels of these 
awards will be made after consideration of such factors as the grantee's 
progress and management practices, existence of legislative authority, 
and the availability of funds. In all cases, continuation awards require 
a determination by the Secretary that continued funding is in the best 
interest of the Federal Government.
    (4) Neither the approval of any project nor the award of any grant 
shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved project or any portion of an approved project. For 
continuation support, grantees must make separate application at such 
times and in such a form as the Secretary may prescribe.
    (b) Determination of grant amount. The Secretary will determine the 
amount of any award under this subpart on the basis of his or her 
estimate of the sum necessary for the cost (including both direct and 
indirect costs) of the project. In addition, in determining the amount 
of stipend support to be made available for the general practice 
residency program, the amount of any stipend must be limited to that 
portion of the annual amount normally paid to other residents by the 
applicant which the Secretary determines, on the basis of the 
documentation required in the application, cannot reasonably be paid 
from other available funds, including the incomes derived from the 
residents' services. For the advanced educational program in general 
dentistry, stipends for participants (who are postdoctoral students) 
must be paid in accordance with established Public Health Service 
postdoctoral stipend rates.

[43 FR 54931, Nov. 24, 1978, as amended at 57 FR 45737, Oct. 5, 1992; 61 
FR 6125, Feb. 16, 1996]

[[Page 315]]



Sec. 57.1108  How will grant payments be made?

    The Secretary will, from time to time, make payments to a grantee of 
all or a portion of any grant award, either in advance or by way of 
reimbursement.

[43 FR 54931, Nov. 24, 1978]



Sec. 57.1109  Purposes for which grant funds may be spent.

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried forward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amounts awarded by withdrawing the excess. A budget 
period is an interval of time (usually 12 months) into which the project 
period is divided for funding and reporting purposes.
    (c) Grants funds may not be used for sectarian instruction or for 
any religious purpose.

[43 FR 54931, Nov. 24, 1978, as amended at 52 FR 19146, May 21, 1987; 57 
FR 45738, Oct. 5, 1992]



Sec. 57.1110  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide debarment and suspension (nonprocurement) 
and governmentwide requirements for drug-free workplace (grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
section 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying.

[52 FR 19146, May 21, 1987, as amended at 57 FR 45738, Oct. 5, 1992; 61 
FR 6125, Feb. 16, 1996]



Sec. 57.1111  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6125, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 57.1112  What additional conditions apply to grantees?

    The Secretary may with respect to any grant award impose additional 
conditions prior to or at the time of any award when in his or her 
judgment these conditions are necessary to assure or protect the 
advancement of the approved activity, the interest of the public health, 
or the conservation of grant funds.

[43 FR 54931, Nov. 24, 1978. Redesignated at 52 FR 19146, May 21, 1987; 
57 FR 45738, Oct. 5, 1992]

Subparts M-O  [Reserved]

[[Page 316]]



     Subpart P--Loan Guarantees and Interest Subsidies to Assist in 
   Construction of Teaching Facilities for Health Profession Personnel

    Authority: Sec. 727, Public Health Service Act. 77 Stat. 170, as 
amended (42 U.S.C. 293g).

    Source: 38 FR 31836, Nov. 19, 1973, unless otherwise noted.



Sec. 57.1501  Applicability.

    The regulations of this subpart are applicable to loan guarantees 
and interest subsidy payments made pursuant to section 729 of the Public 
Health Service Act (42 U.S.C. 293i) to assist nonprofit private entities 
which are eligible for grants under subpart B of this part in carrying 
out projects for construction of teaching facilities for health 
professions personnel.



Sec. 57.1502  Definitions.

    As used in this subpart:
    (a) All terms not defined herein shall have the same meanings as 
given them in section 724 of the Act.
    (b) Act means the Public Health Service Act, as amended.
    (c) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved may be delegated.
    (d) School means a school of medicine, dentistry, osteopathy, 
pharmacy, optometry, podiatry, veterinary medicine, or public health 
which provides a course of study or a portion thereof which leads 
respectively to a degree of doctor of medicine, doctor of dental surgery 
or an equivalent degree, doctor of osteopathy, doctor of optometry or an 
equivalent degree, doctor of podiatry or an equivalent degree, bachelor 
of science in pharmacy or an equivalent degree, doctor of veterinary 
medicine or an equivalent degree, or a graduate degree in public health, 
and which is accredited as provided in section 721(b)(1) of the Act.
    (e) Affiliated hospital or affiliated outpatient facility means a 
hospital or outpatient facility (as defined in section 645 of the Act) 
which, although not owned by such school, has a written agreement with a 
school of medicine, osteopathy, or dentistry eligible for assistance 
under subpart B of this part, providing for effective control by the 
school of the health professions teaching program in the hospital or 
outpatient facility.
    (f) Nonprofit as applied to any school, hospital, outpatient 
facility, or other entity means one which is owned and operated by one 
or more corporations or associations no part of the net earnings of 
which inures, or may lawfully inure to the benefit of any private 
shareholder or individual.
    (g) Council means the National Advisory Council on Health 
Professions Education (established pursuant to section 725 of the Act).



Sec. 57.1503  Eligibility.

    (a) Eligible applicants. In order to be eligible for a loan 
guarantee or interest subsidy under this subpart, the applicant shall:
    (1) Be a nonprofit private school of medicine, dentistry, 
osteopathy, pharmacy, optometry, podiatry, veterinary medicine, or 
public health, or any combination of such schools, or a nonprofit 
private affiliated hospital or affiliated outpatient facility: Provided, 
however, That in the case of an affiliated hospital or affiliated 
outpatient facility, an application which is approved by the school of 
medicine, osteopathy or dentistry with which the hospital or outpatient 
facility is affiliated and which otherwise complies with the 
requirements of subpart B of this part may be filed by any nonprofit 
private entity qualified to file an application under section 605 of the 
Act; and
    (2) Otherwise meet the applicable requirements set forth in section 
721(b) of the Act and Sec. 57.103 with respect to eligiblity for grants 
for construction of teaching facilities for health professions 
personnel.
    (b) Eligible loans. Subject to the provisions of this subpart, the 
Secretary may guarantee payment, when due, of principal and interest on, 
or may pay interest subsidies with respect to, or may both guarantee and 
pay interest subsidies with respect to any loan or

[[Page 317]]

portion thereof made to an eligible applicant by a non-Federal lender: 
Provided, That no such guarantee or interest subsidy shall apply to any 
loan the interest on which is exempt from Federal income taxation.



Sec. 57.1504  Application.

    Each applicant desiring to have a loan guaranteed or to have 
interest subsidies paid on its behalf, or any combination of such loan 
guarantee or interest subsidies, shall submit an application for such 
assistance in such form and manner and at such time as the Secretary may 
require.1
---------------------------------------------------------------------------

    \1\ Applications and instructions are available from the Division of 
Facilities Conversion and Utilization, Bureau of Health Maintenance 
Organizations and Resources Development, Parklawn Building, 5600 Fishers 
Lane, Rockville, MD 20857.
---------------------------------------------------------------------------

    (a) The application shall contain or be supported by such 
information as the Secretary may require to enable him to make the 
determinations required of him under the Act and this subpart.
    (b) The application shall be executed by an individual authorized to 
act for the applicant and to assume on behalf of the applicant the 
obligations imposed by the terms and conditions of any loan guarantee or 
agreement to pay interest subsidies, including the applicable 
regulations of this subpart.

[38 FR 31836, Nov. 19, 1973, as amended at 49 FR 38113, Sept. 27, 1984]



Sec. 57.1505  Approval of applications.

    (a) General. Any application for loan guarantee or interest 
subsidies, or for a combination of both, may be approved by the 
Secretary, after consultation with the Council, only if he makes each of 
the applicable determinations set forth in section 721(c) of the Act. In 
addition:
    (1) Any such approval shall be subject to compliance by the 
applicant with the applicable provisions set forth in Secs. 57.106, 
57.107, 57.108, and 57.110: Provided however, That for purposes of the 
title assurance in Sec. 57.107(a) the period shall be not less than 20 
years or the term of the guaranteed loan, whichever is longer or in the 
case of interim facilities, the term of the guaranteed loan, and
    (2) Any such application may be approved by the Secretary only if he 
determines:
    (i) That the applicant will have sufficient financial resources to 
enable him to comply with the terms and conditions of the loan;
    (ii) That the applicant has the necessary legal authority to 
finance, construct, and maintain the proposed project, to apply for and 
receive the loan, and to pledge or mortgage any assets or revenues to be 
given as security for such loan;
    (iii) That the loan will be made only with respect to the initial 
permanent financing of the project;
    (iv) That the loan will be secured by a lien against the facilities 
to be constructed or against other security satisfactory to the 
Secretary specified in Sec. 57.2210;
    (v) That the rate of interest on the loan does not exceed such 
percent per annum as the Secretary determines to be reasonable, taking 
into account the range of interest rates prevailing in the private 
market for similar loans and the risks assumed by the United States; and
    (vi) Such additional determinations as the Secretary finds necessary 
with respect to particular applications in order to protect the 
financial interests of the United States.
    (b) Loan guarantees. In addition to the requirements of paragraph 
(a) of this section, any application for a loan guarantee may be 
approved by the Secretary only if he determines that the loan with 
respect to which such guarantee is sought would not be available to the 
applicant on reasonable terms and conditions without such guarantee. To 
assist the Secretary in making such determination, each applicant for a 
loan guarantee shall submit statements from at least three non-Federal 
institutions normally engaged in making long-term loans for 
construction, describing whether, and the terms and conditions under 
which, each institution would make a loan to the applicant for the 
project described in the application.
    (c) Interest subsidies. In addition to the requirements of paragraph 
(a) of

[[Page 318]]

this section, any application for interest subsidies may be approved by 
the Secretary only if he determines that without such interest subsidy 
payments the applicant would not, over a substantial portion of the loan 
term, be able to repay the principal and interest of the loan without 
jeopardizing the quality of the educational program.



Sec. 57.1506  Priority.

    (a) Priority in approving applications for loan guarantee and/or 
interest subsidies shall be determined in accordance with the factors 
specified in section 721(d) of the Act, and the following: (1) The 
relative need for increased enrollment and the availability of students; 
(2) the relative effectiveness of the project relative to the cost to 
the Federal Government; and (3) the relative ability of the applicant to 
make efficient and productive use of the facility constructed.
    (b) In the case of applications to aid in the construction of new 
schools of medicine, osteopathy, or dentistry, the Secretary shall give 
special consideration to those applications which contain or are 
reasonably supported by assurances that, because of the use that will be 
made by such school of already existing facilities (including Federal 
medical or dental facilities), the school will be able to accelerate the 
date on which it will begin its teaching program.



Sec. 57.1507  Limitations applicable to loan guarantee.

    (a) The amount of loan with respect to which a guarantee is made 
under this subpart shall be determined by the Secretary based upon such 
considerations as the availability of funds and the applicant's need 
therefor; Provided, That: (1) Subject to paragraph (a)(2) of this 
section, no loan with respect to which a guarantee is made for any 
project under this subpart may be in an amount which, when added to the 
amount of any grant made with respect to such project under part B of 
title VII of the Act or any other law of the United States, or to the 
total of such grants, exceeds 90 percent of the eligible cost of 
construction of such project as determined by the Secretary;
    (2) Notwithstanding paragraph (a)(1) of this section, the Secretary 
may in particular cases guarantee loans in excess of the amount 
specified in paragraph (a)(1) of this section where he determines that, 
because of special circumstances, such additional loan guarantee will 
further the purposes of part B of title VII of the Act. In making such 
determinations, the Secretary will in each case consider the following 
factors:
    (i) The need for the project in the area to be served;
    (ii) The availability of financing for the project on reasonable 
terms and conditions without such additional loan guarantee;
    (iii) Whether the project can be constructed without such additional 
loan guarantee; and
    (iv) Other relevant factors consistent with the purpose of part B of 
title VII of the Act and this subpart.
    (3) In determining the cost of construction of the project there 
shall be excluded from such cost all fees, interest, and other charges 
relating or attributable to the financing of the project except the 
following:
    (i) Reasonable fees attributable to services rendered by legal 
counsel in connection with such loan;
    (ii) With the approval of the Secretary, reasonable fees 
attributable to the services of a financial advisor in assisting the 
applicant in securing the loan and arranging for repayment thereof; and
    (iii) Interest attributable to the interim financing of construction 
of the project prior to the initial permanent financing thereof.
    (b) No loan guarantee under this subpart shall apply to more than 90 
percent of the loss of principal of and interest on such loan incurred 
by the holder of such loan upon default by the applicant.



Sec. 57.1508  Amount of interest subsidy payments; limitations.

    The length of time for which interest subsidy payments will be made 
under the agreement, the amount of loan with respect to which such 
payments will be made, and the level of such payments shall be 
determined by the Secretary on the basis of the availability

[[Page 319]]

of funds and his determination of the applicant's need therefor taking 
into consideration his analysis of the present and reasonable projected 
future financial ability of the applicant to repay the principal and 
interest of the loan without jeopardizing the quality of its educational 
program: Provided however, That each such interest subsidy payment shall 
not exceed the amount necessary to reduce by 3 percent per annum the net 
effective interest rate otherwise payable on the loan or the portion 
thereof with respect to which such interest subsidy is paid.



Sec. 57.1509  Forms of credit and security instruments.

    Each loan with respect to which a guarantee is made or interest 
subsidies are paid under this subpart shall be evidenced by a credit 
instrument and secured by a security instrument in such forms as may be 
acceptable to the Secretary.



Sec. 57.1510  Security for loans.

    Each loan with respect to which a guarantee is made or interest 
subsidies are paid under this subpart shall be secured in a manner which 
the Secretary finds reasonably sufficient to insure repayment. The 
security may be one or a combination of the following:
    (a) A first mortgage on the facility and site thereof.
    (b) Negotiable stocks or bonds of a quality and value acceptable to 
the Secretary.
    (c) A pledge of unrestricted and unencumbered income from an 
endowment or other trust fund acceptable to the Secretary.
    (d) A pledge of a specified portion of annual general or special 
revenues of the applicant acceptable to the Secretary.
    (e) Such other security as the Secretary may find acceptable in 
specific instances.



Sec. 57.1511  Opinion of legal counsel.

    At appropriate stages in the application and approval procedure for 
a loan guarantee or interest subsidy, the applicant shall furnish to the 
Secretary a memorandum or opinion of legal counsel with respect to the 
legality of any proposed note issue, the legal authority of the 
applicant to issue the note and secure it by the proposed collateral, 
and the legality of the issue upon delivery. ``Legal counsel'' means 
either a law firm or individual lawyer, thoroughly experienced in the 
long-term financing of construction projects, and whose approving 
opinions have previously been accepted by lenders or lending 
institutions. The legal memorandum or opinion to be provided by legal 
counsel in each case shall be as follows:
    (a) A memorandum, submitted with the application for a loan 
guarantee or interest subsidy, stating that the applicant is or will be 
lawfully authorized to finance, construct, and maintain the project, and 
to issue the proposed obligations and to pledge or mortgage the assets 
and/or revenues offered to secure the loan, citing the basis for such 
authority; and
    (b) A final approving opinion, delivered to the Secretary at the 
time of delivery of the evidence of indebtedness to the lender, stating 
that the credit and security instruments executed by the applicant are 
duly authorized and delivered and that the indebtedness of the applicant 
is valid, binding, and payable in accordance with the terms on which the 
loan guarantee was approved by the Secretary.



Sec. 57.1512  Length and maturity of loans.

    The repayment period for loans with respect to which guarantees are 
made or interest subsidies paid under this subpart shall be limited to 
30 years: Provided, That:
    (a) The Secretary may, in particular cases where he determines that 
a repayment period of less than 30 years is more appropriate to an 
applicant's total financial plan, approve such shorter repayment period;
    (b) The Secretary may, in particular cases where he determines that, 
because of unusual circumstances, the applicant would be financially 
unable to amortize the loan over a repayment period of 30 years, approve 
a longer requirement period which shall in no case exceed 40 years; and

[[Page 320]]

    (c) In no case shall a loan repayment period exceed the useful life 
of the facility to be constructed with the assistance of the loan.



Sec. 57.1513  Repayment.

    Unless otherwise specifically authorized by the Secretary, each loan 
with respect to which a guarantee is made or interest subsidies are paid 
shall be repayable in substantially level total annual installments of 
principal and interest, sufficient to amortize the loan through the 
final year of the life of the loan.



Sec. 57.1514  Loan guarantee and interest subsidy agreements.

    For each application for a loan guarantee or interest subsidy, or 
combination thereof, which is approved by the Secretary under this 
subpart, an offer to guarantee such loan and/or make interest subsidy 
payments with respect thereto will be sent to the applicant, setting 
forth the pertinent terms and conditions for the loan guarantee and/or 
interest subsidy, and will be conditioned upon the fulfillment of such 
terms and conditions. The accepted offer will constitute the loan 
guarantee agreement, the interest subsidy agreement, or the loan 
guarantee and interest subsidy agreement, as the case may be. Each such 
agreement shall include the applicable provisions set forth below:
    (a) Loan guarantee. Each agreement pertaining to a loan guarantee 
shall include the following provisions:
    (1) That the loan guarantee evidenced by the agreement shall be 
incontestable (i) in the hands of the applicant on whose behalf such 
loan guarantee is made except for fraud or misrepresentation on the part 
of such applicant, and (ii) as to any person who makes or contracts to 
make a loan to such applicant in reliance on such guarantee, except for 
fraud or misrepresentation on the part of such other person.
    (2) That the applicant shall be permitted to prepay up to 15 percent 
of the original principal amount of such loan in any calendar year 
without additional charge. The applicant and the lender may further 
agree that the applicant shall be permitted to prepay in excess of 15 
percent of the original amount of the loan in any calendar year without 
additional charge, but no such payment in excess of 15 percent shall be 
made without the prior written approval of the Secretary.
    (3) That if the applicant shall default in making periodic payment, 
when due, of the principal and interest on the loan guaranteed under the 
agreement, the holder of the loan shall promptly give the Secretary 
written notification of such default. The Secretary shall, immediately 
upon receipt of such notice, provide the holder with written 
acknowledgement of such receipt.
    (4) That if such default in making periodic payment when due of the 
principal and interest on the guaranteed loan is not cured within 90 
days after receipt by the Secretary of notice of such default, the 
holder of the loan shall have the right to make demand upon the 
Secretary, in such form and manner as the Secretary may prescribe, for 
payment of 90 percent of the amount of the overdue payments of principal 
and accrued interest, together with such reasonable late charges as are 
made in accordance with the terms of the credit instrument or security 
instrument evidencing or securing such loan. The Secretary shall pay 
such amount from funds available to him for these purposes.
    (5) That in the event of exercise by the holder of the loan of any 
right to accelerate payment of such loan as a result of the applicants 
default in making periodic payment when due of the principal and 
interest on the guaranteed loan, the Secretary shall, upon demand by the 
holder not less than 90 days after receipt by the Secretary of 
notification of such default, pay to such holder 90 percent of the total 
amount of principal and of interest on the loan remaining unpaid after 
the holder has exercised his right to foreclose upon and dispose of the 
security and has applied the proceeds thereby received to reduce the 
outstanding balance of the loan, in accordance with applicable law and 
the terms of the security instrument.
    (6) That the Secretary shall not guarantee any funds which are 
disbursed by a lender following notification by the Secretary to such 
lender that the Assurance executed by the Applicant

[[Page 321]]

under section 799A of the Act is no longer satisfactory.
    (b) Interest subsidy. Each agreement pertaining to the payment of 
interest subsidies with respect to a loan shall include the following 
provisions:
    (1) That the holder of the loan shall have a contractual right to 
receive from the United States interest subsidy payments in amounts 
sufficient to reduce by up to 3 percent per annum the net effective 
interest rate determined by the Secretary to be otherwise payable on 
such loan.
    (2) That payments of interest subsidies pursuant to paragraph (b)(1) 
of this section will be made by the Secretary, in accordance with the 
terms of the loan with respect to which the interest subsidies are paid, 
directly to the holder of such loan, or to a trustee or agent designated 
in writing to the Secretary by such holder, until such time as the 
Secretary is notified in writing by the holder that such loan has been 
transferred. Pursuant to such written notification of transfer, the 
Secretary will make such interest payments directly to the new holder 
(transferee) of the loan: Provided, however, That it shall be the 
responsibility of the holder to remit any payments of interest subsidy 
to the new holder which the Secretary may have made to the holder after 
such transfer and prior to receipt of such written notice, and the 
Secretary shall not be liable to any party for amounts remitted to the 
holder prior to receipt of such written notice and acknowledgment in 
writing by the Secretary of receipt of such notice.
    (3) That the holder of the loan will promptly notify the Secretary 
of any default or prepayment by the applicant with respect to the loan.
    (4) In the event of any exercise by the holder of the loan of the 
right to accelerate payment of such loan, whether as a result of default 
on the part of the applicant or otherwise, the Secretary's obligations 
with respect to the payment of interest subsidies shall cease.
    (5) Where, during the life of the loan with respect to which 
interest subsidies are to be paid, the applicant ceases to use the 
facility for the purposes for which constructed, the Secretary's 
obligation with respect to the payment of interest subsidies shall 
cease: Provided, however, That where the applicant is continuing to use 
the facility for purposes eligible for support under part B of title VII 
of the act, the Secretary may make a determination, based upon the 
health manpower needs of the community served by the facility as well as 
other relevant factors, to continue to make interest subsidy payments in 
accord with the agreement.
    (6) Where during the life of the loan with respect to which interest 
subsidies are to be paid, it is determined, after an opportunity for a 
hearing pursuant to 45 CFR part 83, that the Assurance executed by the 
applicant under section 704 (or its predecessor, section 799A) of the 
Act, is no longer satisfactory, the Secretary's obligation with respect 
to the payment of interest subsidies shall cease: Provided, however, 
That the Secretary shall resume making interest subsidy payments if he 
determines that a subsequent Assurance submitted by the applicant is 
satisfactory.
    (7) Where during the life of the loan with respect to which interest 
subsidies are to be paid, it is determined by the Secretary, after an 
opportunity for a hearing pursuant to 45 CFR parts 80 and 81, that the 
applicant has ceased to comply with the Assurance it has executed under 
45 CFR 80.4(d) concerning nondiscrimination on the basis of race, color 
or national origin, the Secretary's obligation with respect to the 
payment of interest subsidies shall cease: Provided, however, That the 
Secretary shall resume making interest subsidy payments if he 
subsequently determines that the applicant has come into compliance with 
the requirements of title VI of the Civil Rights Act of 1964 and 
implementing regulations.
    (8) Where during the life of the loan with respect to which interest 
subsidies are to be paid, it is determined by the Secretary after an 
opportunity for a hearing pursuant to title IX of the Education 
Amendments of 1972, that the applicant has ceased to comply with such 
title, and its implementing regulations, the Secretary's obligation with 
respect to the payment

[[Page 322]]

of interest subsidies shall cease: Provided, however, That the Secretary 
shall resume making interest subsidy payments if he subsequently 
determines that the applicant has come into compliance with the 
requirements of title IX of the Education Amendments of 1972 and 
implementing regulations.
    (c) General. In addition to the applicable requirements of 
paragraphs (a) and (b) of this section, each agreement, whether 
pertaining to a loan guarantee or interest subsidy or both, shall 
contain such other provisions as the Secretary finds necessary in order 
to protect the financial interests of the United States.

[38 FR 31836, Nov. 19, 1973, as amended at 49 FR 38113, Sept. 27, 1984]



Sec. 57.1515  Loan closing.

    Closing of any loan with respect to which a guarantee is made or 
interest subsidies are paid under this subpart shall be accomplished at 
such time as may be agreed upon by the parties to such loan and found 
acceptable to the Secretary.



Sec. 57.1516  Right of recovery-subordination.

    (a) The United States shall be entitled to recover from the 
applicant for a loan guarantee under this subpart the amount of any 
payment made pursuant to such guarantee, unless the Secretary waives 
such right of recovery as provided in Sec. 57.1517.
    (b) Upon making of any payments pursuant to a loan guarantee under 
this subpart, the United States shall be subrogated to all of the rights 
of the recipient of the payments with respect to which the guarantee was 
made.



Sec. 57.1517  Waiver of right of recovery.

    In determining whether there is good cause for waiver of any right 
of recovery which he may have against any applicant by reason of any 
payments made pursuant to a loan guarantee under this subpart, the 
Secretary shall take into consideration the extent to which:
    (a) The facility with respect to which the loan guarantee was made 
will continue to be devoted by the applicant or other owner to the 
teaching of health professions personnel, or to other purposes in the 
sciences related to health for which funds are available under part B of 
title VII of the act and these regulations;
    (b) A hospital or outpatient facility will be used as provided for 
under title VI of the act;
    (c) There are reasonable assurances that for the remainder of the 
repayment period of the loan other facilities not previously utilized 
for the purpose for which the facility was constructed will be so 
utilized and are substantially equivalent in nature and extent for such 
purposes; and
    (d) Such recovery would seriously curtail the training of qualified 
health professions personnel in the area served by the facility.



Sec. 57.1518  Modification of loans.

    No official of the Department of Health and Human Services will 
approve any proposal to modify the terms of a loan guaranteed under 
title VII of the Public Health Service Act (42 U.S.C. 293 et seq.) and 
this subpart which would permit the use of the guaranteed loan (or the 
guarantee) as collateral for an issue of tax-exempt securities.

(Secs. 215 and 726, Public Health Service Act, 58 Stat. 690 and 85 Stat. 
432, 42 U.S.C. 216 and 293i, as amended).

[48 FR 42984, Sept. 21, 1983]



  Subpart Q--Grants for Predoctoral, Graduate, and Faculty Development 
                  Education Programs in Family Medicine

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 63 Stat. 35 (42 U.S.C. 216); sec. 786(a) of the Public 
Health Service Act, 90 Stat. 2316, and as amended by 102 Stat. 3146 (42 
U.S.C. 295g-6(a)); renumbered as sec. 747, as amended by Pub. L. 102-
408, 106 Stat. 2042-2043 (42 U.S.C. 293k).



Sec. 57.1601  To what programs do these regulations apply?

    These regulations apply to the award of grants under section 747 of 
the Public Health Service Act (42 U.S.C. 293k) to schools of medicine or 
osteopathic medicine, hospitals, and other public or

[[Page 323]]

private nonprofit entities for projects to: (a) Plan, develop, and 
operate, or participate in predoctoral, graduate, or faculty development 
educational programs in family medicine; and (b) provide financial 
assistance to trainees participating in predoctoral or graduate 
educational programs who are in need of financial assistance and who 
plan to practice family medicine or to trainees in faculty development 
programs who plan to teach in family medicine training programs.

[57 FR 45738, Oct. 5, 1992, as amended at 61 FR 6125, Feb. 16, 1996]



Sec. 57.1602  Definitions.

    Act means the Public Health Service Act, as amended.
    Clerkship means supervised clinical training in a specific field of 
medicine for predoctoral medical (M.D. or D.O.) students.
    Faculty development program means a systematic training program to 
increase faculty competence in teaching skills and in other areas 
related to academic responsibilities.
    Family medicine means the field of medicine, including osteopathic 
general practice, in which the physician:
    (a) Serves as a physician of first contact with families and with 
patients of all ages and provides a means of entry into the health care 
system;
    (b) Evaluates the patient's total health needs, provides personal 
medical care within one or more fields of medicine, and refers the 
patient, when indicated, to appropriate sources of care while preserving 
the continuity of care;
    (c) Assumes responsibility with the patient for comprehensive and 
continuous health care and acts as a leader or coordinator of others 
providing health services; and
    (d) Considers the patient's total health care within the context of 
his or her environment, including the community and the family or 
comparable social units.
    Hospital means a public or other nonprofit hospital which is 
accredited by the Joint Commission on Accreditation of Hospitals or the 
American Osteopathic Association.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations, no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Osteopathic internship program means an internship which emphasizes 
family medicine and is approved by the American Osteopathic Association.
    Preceptorship means an educational experience in which the trainee 
works individually with a designated physician, the preceptor, who 
teaches and personally supervises clinical activity.
    Predoctoral training program means an educational program in family 
medicine, including courses, clerkships or preceptorships in family 
medicine, which is part of a course of study leading to the degree of 
doctor of medicine or osteopathic medicine, and student assistantships 
in family medicine.
    Residency training program means:
    (a) A residency program in family practice which is fully or 
provisionally accredited by the Accreditation Council for Graduate 
Medical Education; or
    (b) A postdoctoral program in osteopathic general practice which 
emphasizes family medicine and is approved by the American Osteopathic 
Association.
    School of medicine or osteopathic medicine means a public or private 
nonprofit school in a State which provides training leading, 
respectively, to a degree of doctor of medicine or to a degree of doctor 
of osteopathic medicine and which is accredited as provided in section 
799(1)(E) of the Act.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employer of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    Student assistantship means a research program in family medicine 
for

[[Page 324]]

predoctoral medical (M.D. or D.O.) students.
    Trainee means a medical (M.D. or D.O.) student, intern, resident, or 
physician participating in a training program supported by a grant under 
these regulations.

[45 FR 68895, Oct. 16, 1980, as amended at 49 FR 11613, Mar. 26, 1984; 
57 FR 45738, Oct. 5, 1992; 61 FR 6125, Feb. 16, 1996]



Sec. 57.1603  Who is eligible to apply for a grant?

    (a) For predoctoral training programs, an applicant must be a school 
of medicine or osteopathic medicine located in a State.
    (b) For graduate and faculty development training programs, an 
applicant must be located in a State and be a school of medicine or 
osteopathic medicine, a hospital, or a public or private nonprofit 
entity which provides either health or educational programs as one of 
its major functions.
    (c) Each eligible applicant desiring a grant under this subpart 
shall submit an application in the form and at such time as the 
Secretary may prescribe.

[45 FR 68895, Oct. 16, 1980, as amended at 57 FR 45738, Oct. 5, 1992]



Sec. 57.1604  What requirements must a project meet?

    (a) General requirements. A project supported under this subpart 
must meet the following requirements:
    (1) Each project must have a project director who works at the 
grantee institution or training site institution, has relevant training 
and experience, and has been approved by the Secretary to direct the 
project.
    (2) Each project must have an appropriate administrative and 
organizational plan and appropriate faculty, staff, and facility 
resources for the achievement of stated objectives.
    (3) Each project must systematically evaluate the educational 
program including trainees and faculty preceptors, the administration of 
the program and the degree to which program and educational objectives 
are met.
    (4) Each project, other than a faculty development project, must use 
ambulatory care settings where family medicine is practiced and in which 
an adequate portion of the clinical training is conducted.
    (5) Each project, other than a faculty development project, must 
have a family medicine curriculum which:
    (i) Is appropriate for the academic level of the trainees and the 
specific length and nature of the educational program;
    (ii) Supplements any practical (including clinical) experiences with 
related education activities; and
    (iii) Emphasizes subjects pertinent to:
    (A) Ambulatory care;
    (B) Psychosocial skills and topics; and
    (C) Related nonclinical areas relevant to the practitioner of family 
medicine.
    (b) Additional requirements for predoctoral training programs. In 
addition to the requirements of paragraph (a) of this section, projects 
for predoctoral training programs must also meet the following 
additional requirements:
    (1) The training program must be sponsored and supervised by an 
appropriate administrative unit in family medicine, the faculty of which 
participates in the preparation of the preclerkship curriculum and 
required courses and activities, for which faculty may be 
interdisciplinary, such as physical diagnosis and clinical pathological 
conferences, and which coordinates the predoctoral offering of 
clerkships and other clinical experiences oriented to family medicine.
    (2) Each training program must be part of an integrated 
institutional strategy to provide education and training in family 
medicine designed to encourage an appropriate percentage of its 
graduates, annually, to seek graduate training in family medicine and 
eventually to enter a career in family medicine.
    (3) For projects which include preceptorships in family medicine:
    (i) The project must provide medical (M.D. or D.O.) students with 
ambulatory care training in a community setting.
    (ii) Preceptors must have practices which are consistent with the 
principles of family medicine and must be

[[Page 325]]

selected by the administrative unit in family medicine.
    (iii) Stipend support from grant funds may be given to trainees who 
are not receiving academic credit for the preceptorship only if they (A) 
need it; (B) indicate an interest in working in the field of family 
medicine; and (C) engage in the preceptorship full time for at least 4 
consecutive weeks. Stipend support from grant funds may be given to 
trainees who are receiving academic credit for the preceptorship only 
when the three conditions above are met and, additionally, when the 
trainee incurs extraordinary living expenses due to participation in the 
preceptorship.
    (4) For projects for student assistantships:
    (i) A family medicine faculty member of the administrative unit, 
identified under paragraph (b)(1) of this section, must supervise each 
student assistant.
    (ii) The grantee must give preference in admission to the training 
program to applicants considering a career in academic family medicine.
    (iii) Stipend support from grant funds may be given to trainees who 
are not receiving academic credit for the assistantship only if they (A) 
need it; (B) indicate an interest in working in the field of family 
medicine; and (C) engage in the assistantship full time for at least 8 
consecutive weeks. Stipend support from grant funds may be given to 
trainees who are receiving academic credit for the assistantship only 
when the three conditions above are met and, additionally, when the 
trainees incurs extraordinary living expenses, due to participation in 
the assistantship.
    (c) Additional requirements for graduate training projects (except 
faculty development). In addition to the requirements of paragraph (a) 
of this section, projects for approved or accredited residency training 
programs must meet the following additional requirements:
    (1) Each program must have a supervisor of training with appropriate 
experience and training who is responsible for coordination and 
supervision of training in the program.
    (2) Each program must use an appropriate resident or intern 
recruitment and selection process which assures that residents and 
interns in the program have applied specifically for training in the 
approved graduate training program.
    (3) Each program must provide education for a sufficient number of 
interns or residents to provide an adequate collegial environment for 
the educational program and to enhance cost efficiency.
    (4) Each program must have an adequate number of qualified faculty 
with training and experience in family medicine, behavioral sciences, 
and liaison specialties, for the number of interns or resident in the 
program. The faculty of the program must engage in periodic educational 
activities to improve their teaching skills.
    (5) Each program must provide an appropriate amount of clinical 
training for each intern or resident in ambulatory care settings 
emphasizing family medicine in each year of the training program. This 
training will be for the purpose of assuring an adequate education in 
the principles of the practice of family medicine throughout the 
program. In addition, each training program must provide clinical 
training in other ambulatory care settings relevant to family medicine, 
such as emergency units.
    (6) Each program must have adequate facilities for the provision of 
the educational activities and, in particular, have family medicine 
ambulatory care space sufficient to provide an adequate clinical 
experience for the interns or residents.
    (7) Each intern or resident must serve a sufficient number of 
families and individual patients with a variety of health care needs to 
provide the trainee with a broad clinical experience.
    (d) Additional requirements for faculty development programs. (1) 
Each project must have a curriculum which:
    (i) Directly applies to family medicine training programs;
    (ii) Emphasizes improvement of pedagogical skills for clinical and 
classroom settings; and
    (iii) Uses didactic and nondidactic teaching strategies.
    (2) Only physicians who teach or intend to teach in family medicine 
are eligible to participate as trainees in the program.

[[Page 326]]

    (3) Each program must have a sufficient number of trainees 
participating during the conduct of any educational activities to 
provide a collegial environment and to make the program cost efficient.
    (4) Stipend support from grant funds may be no longer than 24 
cumulative months for any trainee.
    (5) To be eligible for financial assistance from grant funds, a 
trainee must:
    (i) Intend to teach in family medicine training program on a full-
time basis; and
    (ii) Be a full-time participant in the training program for at least 
3 months.

[45 FR 68895, Oct. 16, 1980, as amended at 49 FR 11613, Mar. 26, 1984; 
54 FR 50374, Dec. 6, 1989; 57 FR 45738, Oct. 5, 1992]



Sec. 57.1605  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will approve projects which 
best promote the purposes of section 747 of the Act and these 
regulations. The Secretary will consider, among other factors:
    (1) The degree to which the proposed project provides for the 
project requirements in Sec. 57.1604;
    (2) The administrative and management ability of the applicant to 
carry out the proposed project in a cost-effective manner; and
    (3) The potential of the project to continue on a self-sustaining 
basis.
    (b) In determining the funding of projects approved under paragraph 
(a) of this section, the Secretary will consider any special factors 
relating to national needs as the Secretary may from time to time 
announce in the Federal Register.

[45 FR 68895, Oct. 16, 1980, as amended at 49 FR 11613, Mar. 26, 1984; 
53 FR 14792, Apr. 26, 1988; 61 FR 6125, Feb. 16, 1996]



Sec. 57.1606  How long does grant support last?

    (a) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 5 years.
    (b) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be for 1 year at a time. 
Decisions regarding continuation awards and the funding levels of these 
awards will be made after consideration of such factors as the grantee's 
progress and management practices, and the availability of funds. In all 
cases, continuation awards require a determination by the Secretary that 
continued funding is in the best interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved application or portion of an approved application. For 
continuation support, grantees must make separate application at such 
times and in such a form as the Secretary may prescribe.

[45 FR 68895, Oct. 16, 1980, as amended at 57 FR 45739, Oct. 5, 1992]



Sec. 57.1607  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) Grantees may not spend grant funds for sectarian instruction or 
for any religious purpose.
    (c) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any

[[Page 327]]

unobligated balance carried forward from prior periods, exceeds the 
grantee's needs for the period, the Secretary may adjust the amounts 
awarded by withdrawing the excess. A budget period is an interval of 
time (usually 12 months) into which the project period is divided for 
funding and reporting purposes.

[45 FR 68895, Oct. 16, 1980, as amended at 57 FR 45739, Oct. 5, 1992]



Sec. 57.1608  What additional Department regulations apply to grantees?

    Several other regulations apply to these grants. They include, but 
are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
Sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying.

[49 FR 38113, Sept. 27, 1984; 49 FR 40406, Oct. 16, 1984, as amended at 
57 FR 45739, Oct. 5, 1992; 61 FR 6125, Feb. 16, 1996]



Sec. 57.1609  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6125, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 57.1610  Additional conditions.

    The Secretary may impose additional conditions on any grant award 
before or at the time of an award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.

[45 FR 68895, Oct. 16, 1980. Redesignated at 49 FR 11613, Mar. 26, 1984]



    Subpart R--Grants for the Establishment of Departments of Family 
                                Medicine

    Authority: Sec. 215, Public Health Service Act, 58 Stat. 690, as 
amended by 63 Stat. 35 (42 U.S.C. 216); sec. 780, Public Health Service 
Act, 90 Stat. 2311, as amended by 95 Stat. 221 and 102 Stat. 3146 (42 
U.S.C. 295g); renumbered as sec. 747, as amended by Pub. L. 102-408, 106 
Stat. 2042-2043 (42 U.S.C. 293k).



Sec. 57.1701  To what programs do these regulations apply?

    These regulations apply to the award of grants under section 747 of 
the Public Health Service Act (42 U.S.C. 293k) to schools of medicine 
and osteopathic medicine to meet the costs of projects to establish, 
maintain, or improve academic administrative units to provide clinical 
instruction in family medicine. These projects may include:
    (a) The planning and development of model predoctoral, faculty 
development, and graduate medical education programs; and
    (b) Academic and clinical activities relevant to the field of family 
medicine.

[48 FR 20215, May 4, 1983, as amended at 57 FR 45739, Oct. 5, 1992; 60 
FR 28067, May 30, 1995]



Sec. 57.1702  Definitions.

    Academic administrative unit or unit means a department, division, 
or other formal academic unit of a school of medicine or osteopathic 
medicine or clinical campuses of such schools that

[[Page 328]]

provides clinical instruction in family medicine.
    Act means the Public Health Service Act, as amended.
    Clinical campus means a geographically separate educational entity 
of an accredited medical school that is recognized and identified as a 
clinical campus by the American Academy of Family Physicians and that 
has been given the responsibility to coordinate or provide all clinical 
training for that clinical campus.
    Family medicine includes ``osteopathic general practice'' and means 
the field of medicine in which the physician:
    (a) Serves as a physician of first contact with families and 
patients of all ages and provides a means of entry into the health care 
system;
    (b) Evaluates the patient's total health needs, provides personal 
medical care within one or more fields of medicine, and refers the 
patient, when indicated, to appropriate sources of care while preserving 
the continuity of care;
    (c) Assumes responsibility with the patient for comprehensive and 
continuous health care and acts as a leader or coordinator of others 
providing health services; and
    (d) Considers the patient's total health care within the context of 
his or her environment, including the community and the family or 
comparable social units.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations, no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Other major clinical units means formal academic units at the 
applicant school or its clinical campus that offer clinical instruction 
in internal medicine, obstetrics and gynecology, pediatrics, psychiatry, 
or surgery.
    Residency training program means a 3-year residency program in 
family practice that is fully or provisionally accredited by the 
Accreditation Council for Graduate Medical Education, or the equivalent 
of such a program as determined by the Secretary. In the case of 
osteopathic medicine, a postgraduate program of no less than 2 years' 
duration, including the osteopathic internship, as approved or 
provisionally approved by the American Osteopathic Association will be 
deemed such an equivalent.
    School of medicine or osteopathic medicine means a public or private 
nonprofit school in a State which provides training leading, 
respectively, to a degree of doctor of medicine or to a degree of doctor 
of osteopathic medicine and which is accredited as provided in section 
799(1)(E) of the Act.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[48 FR 20215, May 4, 1983, as amended at 57 FR 45739, Oct. 5, 1992; 60 
FR 28067, May 30, 1995; 61 FR 6125, Feb. 16, 1996]



Sec. 57.1703  Who is eligible to apply for a grant?

    Any school of medicine or osteopathic medicine which is located in a 
State is eligible to apply for a grant. Each eligible applicant desiring 
a grant under this subpart shall submit an application in the form and 
at such time as the Secretary may prescribe.

[57 FR 45739, Oct. 5, 1992]



Sec. 57.1704  Program requirements.

    Existing units supported under this subpart must meet all the 
requirements of this section no later than 12 months after initial award 
of the grant. Units which are being established with the aid of grants 
under this subpart must meet the requirement of paragraph (a) of this 
section no later than 12 months after initial award, and the remaining 
requirements of this section no later than 24 months after initial award 
of the grant. However, within the first 12 months of grant support,

[[Page 329]]

units which are being established must submit a continuation 
application. This application is expected to include a plan which 
details, in a format determined by the applicant, how the remaining 
project requirements will be met by the end of the second year of grant 
support. In addition to units that are initially establishing under this 
subpart, those that change organizational status (i.e., from division to 
department) are also considered establishing units for the purpose of 
this subpart. Those that maintain organizational status are considered 
existing units.
    (a) Each project must have a project director, who works at the 
grantee institution in an administrative unit of the grantee institution 
on an appointment consistent with other major departments, heads or will 
head the unit, and has relevant training and experience in family 
medicine.
    (b) The unit must have academic status comparable to that of one of 
the other major clinical units at the institution.
    (c) The unit must have administrative autonomy comparable to that of 
other academic units.
    (d) The unit must have control over a residency training program. 
The program must have the capacity to enroll a total of at least 9 
interns or residents annually. A unit whose applicant school or clinical 
campus does not have a residency program accredited under its direct 
authority will be considered as meeting this requirement if it has a 
written affiliation agreement with a hospital which conducts a residency 
program as described.
    (e) The unit (or units in the case of schools with one or more 
decentralized units) must have responsibility for providing instruction 
to each member of the student body who is engaged in an education 
program leading to a degree in doctor of medicine or doctor of 
osteopathic medicine. The amount of mandatory and elective curriculum 
must be comparable to the amount of mandatory and elective curriculum 
time required for other major clinical units at the school.
    (f) The unit must have, in the judgment of the Secretary, a 
sufficient number of full-time faculty to conduct the instruction. The 
number of family medicine faculty in the unit must be comparable to that 
of full-time faculty responsible for conducting the instruction of one 
of the other major clinical units either at the school or at the 
clinical campus, whichever is the same as the unit receiving the grant 
funds.
    (g) Each project must evaluate the program of instruction required 
in paragraph (f) of this section, including evaluation of faculty 
competence, the administration of the program, and the degree to which 
program objectives are met.
    (h) Where projects include the planning and development of model 
predoctoral, faculty development, or graduate medical education 
programs, those programs must be designed to eventually meet the 
requirements of the regulations implementing section 747 of the Act, 42 
CFR part 57, subpart Q.

(Approved by the Office of Management and Budget under control number 
0915--0060)

[48 FR 20215, May 4, 1983, as amended at 57 FR 45739, Oct. 5, 1992; 60 
FR 28067, May 30, 1995]



Sec. 57.1705  How will applications be evaluated?

    As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will award grants to 
applicants whose projects will best promote the purposes of section 747 
of the Act and this subpart. The Secretary will consider, among other 
factors:
    (a) The degree to which the proposed project adequately provides for 
the project requirements in Sec. 57.1704;
    (b) The administrative and management capability of the applicant to 
carry out the proposed project in a cost-effective manner;
    (c) The qualifications of the proposed staff and faculty of the 
unit; and

[[Page 330]]

    (d) The potential of the project to continue on a self-sustaining 
basis.

[48 FR 20215, May 4, 1983, as amended at 60 FR 28067, May 30, 1995]



Sec. 57.1706  How long does grant support last?

    (a) The notice of grant award specifies how long the Secretary 
intends to support the project without requiring the project to 
recompete for funds. This period, called the project period, will not 
exceed 5 years.
    (b) Generally, the grant will initially be funded for 1 year and 
subsequent noncompeting continuation awards will also be for 1 year at a 
time. Decisions regarding noncompeting continuation awards and the 
funding levels of these awards will be made after consideration of such 
factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, noncompeting continuation awards 
require a determination by the Secretary that continued funding is in 
the best interest of the Federal Government.
    (c) Neither the approval of any application, nor the award of any 
grant, shall commit or obligate the United States in any way to make any 
additional, supplemental, noncompeting continuation or other award with 
respect to any approved application or portion of an approved 
application. For continuation support, grantees must make separate 
application at such times and in such a form as the Secretary may 
prescribe.

[48 FR 20215, May 4, 1983, as amended at 57 FR 45739, Oct. 5, 1992]



Sec. 57.1707  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, the terms and conditions of the grant award, and the 
applicable cost principles in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) Grantees may not spend grant funds for sectarian instruction or 
for any religious purpose.
    (c) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried forward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amount awarded by withdrawing the excess. A budget period 
is an interval of time (usually 12 months) into which the project period 
is divided for funding and reporting purposes.

[48 FR 20215, May 4, 1983, as amended at 57 FR 45740, Oct. 5, 1992]



Sec. 57.1708  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under the subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS Programs or 
activities receiving Federal financial assistance

[[Page 331]]

45 CFR part 93--New restrictions on lobbying.

[49 FR 38114, Sept. 27, 1984, as amended at 57 FR 45740, Oct. 5, 1992; 
61 FR 6125, Feb. 16, 1996]



Sec. 57.1709  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[60 FR 38970, July 31, 1995]



Sec. 57.1710  Additional conditions.

    The Secretary may impose additional conditions on any grant award 
before or at the time of an award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.

[48 FR 20215, May 4, 1983]



  Subpart S--Educational Assistance to Individuals from Disadvantaged 
                               Backgrounds

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 63 Stat. 35 (42 U.S.C. 216); sec. 787 of the Public Health 
Service Act, 90 Stat. 2317, as amended by 95 Stat. 923, 99 Stat. 541, 
and 102 Stat. 3131-3132 (42 U.S.C. 295g-7); renumbered as sec. 740, as 
amended by Pub. L. 102-408, 106 Stat. 2032-2033 (42 U.S.C. 293d).



Sec. 57.1801  To what grant program do these regulations apply?

    These regulations apply to grants to eligible schools and entities 
under section 740 of the Public Health Service Act (42 U.S.C. 293d) to 
assist individuals from disadvantaged backgrounds to enter and graduate 
from health professions schools and schools of allied health.

[47 FR 54438, Dec. 3, 1982, as amended at 61 FR 6125, Feb. 16, 1996]



Sec. 57.1802  Definitions.

    Act means the Public Health Service Act, as amended.
    Allied health professions means professions which support, 
complement, or supplement the professional functions of physicians, 
dentists, and other health professionals in the delivery of health care 
to patients, or assist environmental engineers and other personnel in 
environmental health control and preventive medicine activities.
    Community-based program means a program whose organizational 
headquarters is located in and which primarily serves: A Metropolitan 
Statistical Area, as designated by the Office of Management and Budget; 
a Bureau of Economic Analysis, U.S. Department of Commerce designated 
nonmetropolitan economic area; a county; or Indian tribe(s) as defined 
in 42 CFR 36.102(c), i.e., an Indian tribe, band, nation, rancheria, 
Pueblo, colony or community, including an Alaska Native Village or 
regional or village corporation.
    Health professions means the professions of medicine, dentistry, 
osteopathic medicine, pharmacy, optometry, podiatric medicine, 
veterinary medicine, public health, chiropractic, health administration, 
and clinical psychology.
    Health professions schools means schools of medicine, dentistry, 
osteopathic medicine, pharmacy, optometry, podiatric medicine, 
veterinary medicine, public health, chiropractic, graduate programs in 
health administration, or graduate programs in clinical psychology, as 
defined in section 799(1)(A), (B), (C), and (D) of the Act and as 
accredited in section 799(1)(E) of the Act.
    National of the United States (as defined in 8 U.S.C. 1101(a)(22), 
the Immigration and Nationality Act) means a citizen of the United 
States or a person who, though not a citizen of the United States, owes 
permanent allegiance to the United States.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    School of allied health means a public or private nonprofit college, 
junior college, university or hospital-based educational entity which 
provides or is accredited to provide a degree program in

[[Page 332]]

an allied health discipline and which meets all the criteria in section 
799(4) of the Act.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands and the 
Federated States of Micronesia.

[45 FR 73052, Nov. 4, 1980, as amended at 47 FR 54438, Dec. 3, 1982; 56 
FR 40564, Aug. 15, 1991; 57 FR 45740, Oct. 5, 1992; 61 FR 6125, Feb. 16, 
1996]



Sec. 57.1803  Who is eligible to apply for a grant?

    (a) Health professions schools, schools of allied health, and public 
or private nonprofit health or educational entities which are located in 
a State and provide health or educational programs as one of their major 
functions may apply for a grant under this subpart. Each eligible 
applicant desiring a grant under this subpart shall submit an 
application in the form and at such time as the Secretary may prescribe.
    (b) Applicants which offer degree programs in the allied health 
professions must meet relevant standards and guidelines established by 
appropriate:
    (1) Accrediting bodies recognized by the Secretary of Education, or
    (2) Federal or State agencies.

[45 FR 73052, Nov. 4, 1980, as amended at 56 FR 40565, Aug. 15, 1991; 57 
FR 45740, Oct. 5, 1992]



Sec. 57.1804  Who is eligible for educational assistance?

    To be eligible for educational assistance under this program, an 
individual must:
    (a) Be a resident of the United States and either a citizen or 
national of the United States, an alien lawfully admitted for permanent 
residence in the United States, a citizen of the Commonwealth of the 
Northern Mariana Islands, a citizen of the Republic of Palau, a citizen 
of the Republic of the Marshall Islands, or a citizen of the Federated 
States of Micronesia;
    (b) Have completed at least the junior year of high school (or its 
equivalent), except in the case of Model Demonstration programs; and
    (c) Come from a disadvantaged background. For this program, an 
individual from a disadvantaged background is one who:
    (1) Comes from an environment that has inhibited the individual from 
obtaining the knowledge, skill, and abilities required to enroll in and 
graduate from a health professions school, or from a program providing 
education or training in an allied health profession; or
    (2) Comes from a family with an annual income below a level based on 
low income thresholds according to family size published by the U.S. 
Bureau of the Census, adjusted annually for changes in the Consumer 
Price Index, and adjusted by the Secretary for use in all health 
professions programs. The Secretary will periodically publish these 
income levels in the Federal Register.

[45 FR 73052, Nov. 4, 1980, as amended at 47 FR 54438, Dec. 3, 1982; 56 
FR 40565, Aug. 15, 1991; 61 FR 6126, Feb. 16, 1996]



Sec. 57.1805  Program requirements.

    (a) The Secretary will award grants to meet the cost of carrying out 
one or more of the following five purposes:
    (1) To identify individuals from disadvantaged backgrounds for 
education in the health or allied health professions through the 
development and application of criteria for this purpose, and to recruit 
these individuals through motivational activities which may involve 
dissemination of information, exposure to role models and health 
facilities, and counseling.
    (2) To provide individuals from disadvantaged backgrounds, for a 
period prior to their entry into a regular course of education of such a 
school, preliminary education designed to assist them to complete 
successfully such regular course of education in a health professions 
school or school of allied health, or to refer them to institutions

[[Page 333]]

which provide it. Preliminary education in this context is education 
designed to expand the academic ability of disadvantaged students during 
their preprofessional training. It may not include classes already 
taught as part of the regular course of education leading to a high 
school diploma or undergraduate degree. It may not be offered to 
students before they complete the junior year of high school.
    (3) To provide information to individuals from disadvantaged 
backgrounds about financial aid available to students in health 
professions schools, or schools of allied health, or schools and 
entities which provide training necessary to qualify for enrollment in 
health professions schools or schools of allied health.
    (4) To facilitate the entry of individuals from disadvantaged 
backgrounds into health professions schools or schools of allied health 
by engaging in activities which assist them to compete for admission, 
such as instruction designed to improve their performance on admission 
tests, and by assisting admission committees with the evaluation of 
disadvantaged applicants.
    (5) To provide counseling or other retention services, such as 
tutorial assistance and assistance in adjusting to the environment of 
the school, which are designed to help individuals from disadvantaged 
backgrounds who are enrolled in health professions schools or schools of 
allied health to complete this education.
    (b) The grantee must carry out at least two of the five purposes, 
even if grant funds are requested or awarded for only one of them.
    (c) The grantee must evaluate its program based on the plan provided 
in the grant application.
    (d) Grantees which: (1) Are schools of medicine, osteopathic 
medicine, public health, dentistry, veterinary medicine, optometry, 
pharmacy, allied health, chiropractic, podiatric medicine, and public 
and private nonprofit schools that offer graduate programs in clinical 
psychology; and
    (2) Have a proportionate enrollment of individuals from 
disadvantaged backgrounds that is less than 200 percent of the national 
average percentage of such individuals in all schools of each health 
professions discipline must assure the Secretary that during a period of 
3 years, commencing on the date of the award of the grant, they will 
increase their first-year enrollment of individuals from disadvantaged 
backgrounds by at least 20 percent over enrollments in the base year of 
1987.

[45 FR 73052, Nov. 4, 1980, as amended at 56 FR 40565, Aug. 15, 1991; 56 
FR 43648, Sept. 3, 1991; 57 FR 45740, Oct. 5, 1992]



Sec. 57.1806  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will decide which 
applications to approve by considering, among other factors:
    (1) The degree to which the proposed project adequately provides for 
the requirements in Sec. 57.1805;
    (2) The number and types of individuals who can be expected to 
benefit from the project;
    (3) The administrative and management ability of the applicant to 
carry out the proposed project in a cost-effective manner;
    (4) The adequacy of the staff and faculty;
    (5) The soundness of the budget; and
    (6) The potential of the project to continue without further support 
under this program.
    (b) Within the limits of funds available, the Secretary will award 
grants to approved applicants with projects that will best promote the 
purposes of section 740 of the Act. Of the amounts appropriated under 
this section for any fiscal year, 10 percent shall be obligated for 
community-based programs and 70 percent shall be obligated for grants to 
institutions of higher education and not more than 5 percent of such 
funds may be obligated for grants having the primary purpose of 
informing individuals about the existence and

[[Page 334]]

general nature of health careers. Section 740(a)(2)(G) authorizes the 
payment of such stipends as the Secretary may approve for participants 
in a project for any period of education at any school eligible for a 
grant under this subpart.
    (c) Funding priority. (1) In determining the funding of applications 
approved under paragraph (a) of this section, the Secretary shall give 
priority to schools described in Sec. 57.1805(d), beginning in fiscal 
year 1992--
    (i) Which previously received a grant under this subpart and 
increased its first-year enrollment of individuals from disadvantaged 
backgrounds by at least 20 percent over that enrollment in the base year 
1987 by the end of 3 years from the date of the award of the HCOP grant; 
and
    (ii) Which had not previously received a grant under this subpart 
that increased its first-year enrollment of individuals from 
disadvantaged backgrounds by at least 20 percent over that enrollment in 
the base year 1987, over any period of time.
    (2) In addition, should specific needs warrant, the Secretary will 
also consider other special factors relating to national needs as the 
Secretary may from time to time announce in the Federal Register.

[45 FR 73052, Nov. 4, 1980, as amended at 56 FR 40565, Aug. 15, 1991; 56 
FR 43648, Sept. 3, 1991; 61 FR 6126, Feb. 16, 1996]



Sec. 57.1807  How long does grant support last?

    (a) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 3 years.
    (b) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be funded for 1 year at a time. 
Decisions regarding continuation awards and the funding levels of these 
awards will be made after consideration of factors such as the grantee's 
progress and management practices, and the availability of funds. In all 
cases, continuation awards require a determination by the Secretary that 
continued funding is in the best interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved application or portion of an approved application. For 
continuation support, grantees must make separate application at such 
times and in such a form as the Secretary may prescribe.

[45 FR 73052, Nov. 4, 1980, as amended at 56 FR 40565, Aug. 15, 1991; 57 
FR 45740, Oct. 5, 1992]



Sec. 57.1808  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) Any balance of federally-obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during the budget period it becomes apparent to the Secretary 
that the amount of Federal funds provided and made available to the 
grantee for that period, including any unobligated balance carried 
forward from prior periods, exceeds the grantee's needs for the period, 
the Secretary may adjust the amounts provided by withdrawing the excess. 
A budget period is an interval of time (usually 12 months) into which 
the project period is divided for funding and reporting purposes.
    (c) The grantee may spend grant funds to provide one round trip for 
each individual in the program between his or her residence and the 
training site if:
    (1) The training site is beyond a reasonable commuting distance and 
requires the individual to establish a temporary new residence; and
    (2) The educational assistance is not offered at a time when the 
individual would be at the training site as a student in a regular 
course of education

[[Page 335]]

leading to a high school diploma, associate degree, undergraduate 
degree, or degree in the health or allied health professions.
    (d) The grantee may spend grant funds to pay individuals in the 
program a stipend when the grantee determines that:
    (1) The condition in paragraph (c)(2) of this section exists;
    (2) No other Federal financial assistance program is authorized to 
provide this support; and
    (3) The individual needs this support to participate in the program.
    (e) The grantee may not spend grant funds to pay tuition or fees, 
train program staff, retrain health professionals, or for sectarian 
instruction, or for any religious purpose.

[45 FR 73052, Nov. 4, 1980, as amended at 56 FR 40566, Aug. 15, 1991]



Sec. 57.1809  What additional Department regulations apply to grantees?

    Several other Department regulations apply to grantees. They include 
but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide debarment and suspension (non-
procurement) and governmentwide requirements for drug-free workplace 
(grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on Lobbying

[49 FR 38114, Sept. 27, 1984, as amended at 56 FR 40566, Aug. 15, 1991; 
57 FR 45740, Oct. 5, 1992; 61 FR 6126, Feb. 16, 1996]



Sec. 57.1810  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6126, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 57.1811  Additional conditions.

    The Secretary may impose additional conditions on any grant award 
before or at the time of any award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.

[45 FR 73052, Nov. 4, 1980]

Subpart T  [Reserved]



     Subpart U--Armed Forces Health Professions Scholarship Program

    Authority: Sec. 2(a), Pub. L. 92-426, 86 Stat. 719 (10 U.S.C. 
2127(d)).

    Source: 38 FR 20447, Aug. 1, 1973, unless otherwise noted.



Sec. 57.2001  Applicability.

    In the event the Secretary of Defense decides to enter into one or 
more contracts under 10 U.S.C. 2127(d), the regulations in this subpart 
outline considerations the Secretary of Defense will take into account 
in determining whether an accredited civilian educational institution 
has increased its total enrollment for the sole purpose of accepting 
members of the Armed Forces health professions scholarship program.



Sec. 57.2002  Definitions.

    As used in this subpart:

[[Page 336]]

    (a) Institution means a college, university, or other institution or 
a department, division, or other administrative unit within a college, 
university, or other institution, which provides primarily or 
exclusively a course of study in medicine, dentistry, or other health 
profession, as determined under regulations prescribed by the Secretary 
of Defense, leading to a degree in one of said health professions, and 
which is accredited by an accrediting agency or association recognized 
by the United States Commissioner of Education.
    (b) Enrollment in any fiscal year means the number of full-time 
students enrolled in an institution on October 15 of said year and 
pursuing a course of study which constitutes a full-time academic 
workload, as determined by the institution, leading to a degree in 
medicine, dentistry, or other health profession, as determined under 
regulations prescribed by the Secretary of Defense: Provided, That if 
the Secretary of Defense finds that a date other than October 15 would 
more accurately reflect an institution's enrollment in any fiscal year, 
the Secretary of Defense may use such other date in place of October 15 
in making his determination under this subpart.
    (c) Fiscal year means the Federal fiscal year beginning July 1 and 
ending on the following June 30.
    (d) Program means the Armed Forces health professions scholarship 
program established under section 2(a) of the Uniformed Services Health 
Professions Revitalization Act of 1972 (86 Stat. 713, Pub. L. 92-426), 
and codified in chapter 105 of 10 U.S.C.



Sec. 57.2003  Determinations of increased enrollment solely for the program.

    In the event the Secretary of Defense decides to enter into one or 
more contracts under 10 U.S.C. 2127(d), his determination as to whether 
an institution has increased its total enrollment in any fiscal year for 
the sole purpose of accepting members of the program will take into 
account the following considerations:
    (a) A comparison of the total enrollment in said fiscal year with 
the total enrollments in immediately preceding fiscal years;
    (b) Any increases in enrollment to which the institution has 
directly or indirectly committed itself in said fiscal year under: (1) 
Other Federal programs, such as those set forth in title VII and VIII of 
the Public Health Service Act (42 U.S.C. 292 et seq.), the Veterans' 
Administration Medical School Assistance and Health Manpower Training 
Act of 1972 (Pub. L. 92-541, 86 Stat. 1100 (38 U.S.C. 5070 et seq.)) and 
section 225 of the Public Health Service Act (sec. 5, Pub. L. 92-585, 86 
Stat. 1293 (42 U.S.C. 234)); (2) programs of State or local governments 
or other public or private agencies, or (3) any legally binding 
arrangement: Provided, That insofar as a single increase may be applied 
to satisfy the commitments under two or more programs and/or other 
arrangements, said increase shall be considered to meet all such 
commitments;
    (c) Any unusual factors, such as: (1) An institution having been 
newly established or (2) an institution experiencing what is for it an 
abnormal rate of attrition and/or admission.



               Subpart V--Grants for Centers of Excellence

    Authority: Sec. 788A of the Public Health Service Act, Pub. L. 100-
97, 101 Stat. 713-714 (42 U.S.C. 295g-8a), and redesignated as section 
782, as amended by Pub. L. 100-607, 102 Stat. 3136 (42 U.S.C. 295g-2); 
renumbered as sec. 739, as amended by Pub. L. 102-408, 106 Stat. 2027-
2031 (42 U.S.C. 293c).

    Source: 54 FR 28067, July 5, 1989, unless otherwise noted.



Sec. 57.2101  To what projects do these regulations apply?

    These regulations apply to grants awarded to public or nonprofit 
private health professions schools under section 739 of the Public 
Health Service Act (42 U.S.C. 293c) to assist such schools in supporting 
programs of excellence in health professions education for minority 
individuals.

[54 FR 28067, July 5, 1989, as amended at 61 FR 6126, Feb. 16, 1996]



Sec. 57.2102  Definitions.

    Act means the Public Health Service Act, as amended.

[[Page 337]]

    Health professions school means any accredited school of medicine, 
dentistry, osteopathic medicine, pharmacy, optometry, podiatric 
medicine, veterinary medicine, public health, and chiropractic or 
graduate programs in health administration, or graduate programs in 
clinical psychology, as defined in section 799(1) (A), (B), (C), and (D) 
of the Act and as accredited in section 799(1)(E) of the Act.
    Minority means an individual whose race/ethnicity is classified as 
American Indian or Alaskan Native, Asian or Pacific Islander, Black, or 
Hispanic.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[54 FR 28067, July 5, 1989, as amended at 57 FR 45740, Oct. 5, 1992; 61 
FR 6126, Feb. 16, 1996]



Sec. 57.2103  Who is eligible to apply for a grant?

    A health professions school described in section 799(1) (A), (B), 
(C), and (D) of the Act which has received support under section 788B 
(Advanced Financial Distress Assistance) of the Act for Fiscal Year 
1987, may apply for a grant under this subpart. Each eligible applicant 
desiring a grant under this subpart shall submit an application in the 
form and at the time the Secretary may prescribe.

[54 FR 28067, July 5, 1989, as amended at 57 FR 45740, Oct. 5, 1992; 61 
FR 6126, Feb. 16, 1996]



Sec. 57.2104  Project requirements.

    (a) The Secretary will award grants to meet the cost of carrying out 
three or more of the following six purposes, one of which must be the 
purpose provided in paragraph (a)(1) of this section:
    (1) Develop a plan to achieve institutional improvements, including 
financial independence, to enable such school to support programs of 
excellence in health professions education for minority individuals. 
This plan must be submitted within 6 months of the date of grant award;
    (2) Improve the capacity of such school to recruit and retain 
faculty;
    (3) Provide improved access to the library and information resources 
of such school;
    (4) Establish, strengthen, or expand programs to enhance the 
academic performance of students in such school;
    (5) Establish, strengthen, or expand programs to increase the number 
and quality of applicants for admission to such school. Activities 
designed to increase the number and quality of applicants to these 
schools may not be offered to students prior to the ninth grade; and
    (6) Develop curricula and carry out faculty training programs in 
order to enable such school to become, for the Nation's health care 
providers, a resource with respect to the health problems of minority 
communities, such as higher infant mortality rates and higher incidences 
of acquired immunodeficiency syndrome.
    (b) Each project must evaluate its program based on the evaluation 
plan provided in the grant application.



Sec. 57.2105  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will decide which 
applications to approve by considering, among other factors:

[[Page 338]]

    (1) The degree to which the applicant can arrange to continue the 
proposed project beyond the federally funded project period;
    (2) The degree to which the proposed project meets three or more of 
the purposes as described in Sec. 57.2104;
    (3) The relationship of the objectives of the proposed project to 
the goals of the plan that will be developed pursuant to 
Sec. 57.2104(a)(1);
    (4) The administration and managerial ability of the applicant to 
carry out the project in a cost effective manner;
    (5) The adequacy of the staff and faculty to carry out the program;
    (6) The soundness of the budget for assuring effective utilization 
of grant funds, and the proportion of total program funds which come 
from non-federal sources and the degree to which they are projected to 
increase over the grant period;
    (7) The number of individuals who can be expected to benefit from 
the project; and
    (8) The overall impact the project will have on strengthening the 
school's capacity to train minority health professionals and increase 
the supply of minority health professionals available to serve minority 
populations in underserved areas.
    (b) In determining the funding of applications approved under 
paragraph (a) of this section, the Secretary will consider any special 
factors relating to national needs as the Secretary may from time to 
time announce in the Federal Register.

[38 FR 20447, Aug. 1, 1973, as amended at 61 FR 6126, Feb. 16, 1996]



Sec. 57.2106  How long does grant support last?

    (a) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 3 years.
    (b) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be for 1 year at a time. 
Decisions regarding the continuation awards and the funding levels of 
these awards will be made after consideration of such factors as the 
grantee's progress, including the degree that the projected portion of 
non-federal funds supporting the project has been met, and management 
practices, the existence of legislative authority, and the availability 
of funds. In all cases, continuation awards require a determination by 
the Secretary that continued funding is in the best interest of the 
Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application. For 
continuation support, grantees must make separate application at such 
times and in such a form as the Secretary may prescribe.



Sec. 57.2107  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried foward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amounts awarded by withdrawing the excess. A budget 
period is an interval of time (usually 12 months) into which the project 
period is divided for funding and reporting purposes.
    (c) The grantee may spend grant funds to pay individual participants 
in the program a per diem when the grantee determines that--
    (1) The training program requires the individual to establish a 
temporary new residence;

[[Page 339]]

    (2) The program is offered at a time when the individual would not 
be at the training site in a regular course of education or employed as 
a faculty member at that institution; and
    (3) No other Federal financial assistance program is authorized to 
provide this support.
    (d) The grantee may spend grant funds to provide one round trip per 
participant between the place of residence and the training site, 
provided that conditions in paragraphs (c)(1) and (2) of this section 
are met.
    (e) The grantee may not spend grant funds for stipends, licensing 
exams, loan or scholarship support, support of research faculty or 
projects and related activities, establishment of research centers, 
establishment of planning offices, support of commercial ventures, 
entertainment, dependency allowances, new construction of facilities, 
acquisition of land, fund raising, or for sectarian instruction or any 
religious purpose.

[54 FR 28067, July 5, 1989, as amended at 57 FR 45740, Oct. 5, 1992]



Sec. 57.2108  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (non-
procurement) and Governmentwide Requirements for Drug-Free Workplace 
(Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this Title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying.

[54 FR 28067, July 5, 1989, as amended at 57 FR 45740, Oct. 5, 1992; 61 
FR 6126, Feb. 16, 1996]



Sec. 57.2109  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6126, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 57.2110  Additional conditions.

    The Secretary may impose additional conditions on any grant award 
before or at the time of any award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.



          Subpart W--Physician Shortage Area Scholarship Grants

    Authority: Sec. 215, 58 Stat. 690, as amended (42 U.S.C. 216).

    Source: 39 FR 28730, Aug. 9, 1974, unless otherwise noted.



Sec. 57.2201  Applicability.

    The regulations of this subpart are applicable to scholarship grants 
awarded under section 784 of the Public Health Service Act, which 
authorizes the Secretary to award scholarship grants to students of 
medicine and osteopathy who agree to engage in the full-time practice of 
primary care for a prescribed period of time (a) in a physician shortage 
area or (b) in such manner as to assure that of the patients receiving 
medical care in such practice a substantial portion will consist of 
migratory agricultural workers or members of their families.

[[Page 340]]



Sec. 57.2202  Definitions.

    As used in this subpart, the following terms shall have the 
following meanings:
    (a) Act means the Public Health Service Act, as amended.
    (b) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (c) School means a public or other nonprofit school of medicine or 
osteopathy which provides a course of study, or a portion thereof, which 
leads respectively to a degree of Doctor of Medicine or Doctor of 
Osteopathy and which is accredited as provided in section 721(b)(1)(B) 
of the Act.
    (d) Scholarship grant means the amount of money awarded to an 
individual by the Secretary for an academic year pursuant to section 
784(a) of the Act.
    (e) Full-time student means a student who is enrolled, or accepted 
for enrollment, in a school and pursuing a course of study which 
constitutes a full-time academic workload, as determined by the school, 
leading to a degree specified in paragraph (c) of this section.
    (f) Academic year means the traditional, approximately 9-month 
September to June annual session. For the purpose of computing academic 
year equivalents for students who, during a 12-month period, attend for 
a longer period than the traditional academic year, the academic year 
will be considered to be of 9 months' duration.
    (g) National of the United States means (1) a citizen of the United 
States or (2) a person who, though not a citizen of the United States, 
owes permanent allegiance to the United States (8 U.S.C. 1101(a)(22)).
    (h) Professional training means the course of study leading to the 
degree of doctor of medicine or doctor of osteopathy, plus a period, not 
to exceed a total of four years, of internship and residency training.
    (i) Low-income background as applied to any individual means that 
the individual comes from a family with an annual income below low-
income levels developed pursuant to Sec. 57.605(c).
    (j) The practice of primary care means the provision of health 
services characterized by the delivery of first contact medicine, the 
assumption of longitudinal responsibility for the patient regardless of 
the presence or absence of disease, and the integration of the physical, 
psychological and social aspects of health care to the limits of the 
capability of the practitioner. For purposes of this section, primary 
care shall include the fields of general practice, family practice, 
general internal medicine, general pediatrics, and general obstetrics 
and gynecology.
    (k) Migratory agricultural worker means a domestic agricultural 
migratory worker as defined in Sec. 56.102(d).
    (l) Physician shortage area means an area designated by the 
Secretary pursuant to Sec. 57.216(a)(5) as an area having a need for and 
shortage of physicians.



Sec. 57.2203  Eligibility.

    To be eligible for a scholarship grant under this subpart, the 
applicant must:
    (a) Be a national of the United States or a permanent resident of 
the Trust Territory of the Pacific Islands or a lawful permanent 
resident of the United States, Puerto Rico, the Virgin Islands or Guam;
    (b) Be a full-time student in a school located in the United States, 
the Trust Territory of the Pacific Islands, Puerto Rico, the Virgin 
Islands, the Canal Zone, American Samoa or Guam; and
    (c) Agree to engage in the full-time practice of primary care as 
defined in Sec. 57.2202(j) in accord with conditions specified in 
Sec. 57.2209.



Sec. 57.2204  Application.

    Each eligible applicant desiring a scholarship grant under this 
subpart shall submit an application at such time and in such form as the 
Secretary may prescribe.



Sec. 57.2205  Priority for selection of scholarship recipients.

    (a) When funds determined by the Secretary to be available for 
scholarship grants under this subpart are insufficient to permit the 
awarding of scholarships to all individuals applying therefor, the 
Secretary shall accord priority to eligible applicants as follows:

[[Page 341]]

    (1) First priority for scholarship grants shall be accorded to 
applicants who (i) are from a low-income background as defined in 
Sec. 57.2202 (i), (ii) reside in a physician shortage area and (iii) 
agree to return to such area and engage in the full-time practice of 
primary care. For purposes of this paragraph, an individual resides in a 
physician shortage area if he presently is residing in such an area or 
if he (or his parents) resided in such an area in the year prior to his 
admission to an institution of higher education.
    (2) Second priority shall be accorded to applicants meeting the 
criteria in paragraphs (a)(1) (ii) and (iii) of this section.
    (3) Third priority shall be accorded to applicants meeting the 
criterion in paragraph (a)(1)(i) of this section.
    (4) Fourth priority shall be accorded to other applicants.
    (b) Where there are insufficient funds available to make scholarship 
grants to all members of any single priority grouping enumerated in 
paragraph (a) of this section, the following criteria will be used to 
accord priority within each affected priority group:
    (1) Within the priority groupings specified in paragraphs (a) (1) 
and (2) of this section, the Secretary shall rank recipients according 
to the degree of the severity of shortage of physicians practicing 
primary care in such area. Scholarship grants shall be awarded within 
each priority group first to applicants within that grouping from 
physician shortage areas with the least favorable ratio of such 
physicians to the population to be served.
    (2) Within the priority groupings specified in paragraphs (a) (3) 
and (4) of this section, the Secretary shall award scholarship grants 
within each priority group first to applicants who agree to practice 
primary care in a physician shortage area with a substantial portion of 
migratory agricultural workers in such area; second, to applicants 
within that grouping who agree to practice in a physician shortage area; 
and third, to applicants within that grouping who agree to practice in 
such place or places, facility or facilities, and in such manner as the 
Secretary finds necessary to assure that, of the patients receiving 
medical care in such practice, a substantial portion will consist of 
persons who are migratory agricultural workers or members of their 
families.



Sec. 57.2206  Grant award.

    The Secretary may award scholarship grants to individuals who have 
been selected to receive scholarship grants in accordance with 
Sec. 57.2205. Any such award under this subpart shall state the specific 
conditions under which the award is being made and shall indicate the 
distribution between funds awarded to cover the costs of tuition and 
fees payable to the school and funds awarded for the costs of equipment, 
supplies, books, and living expenses payable to the individual.



Sec. 57.2207  Amount of scholarship grant.

    (a) The amount of the scholarship grant to any student for any 
academic year shall be the total of (1) the lesser of (i) $5,000 or (ii) 
the amount determined by the Secretary to be the cost of tuition and 
fees; plus (2) an allowance for equipment, supplies, books and living 
expenses which shall be the lesser of (i) $3,600 or (ii) the difference 
between $5,000 and the amount determined pursuant to paragraph (a)(1) of 
this section.
    (b) The maximum amount of a scholarship grant during a 12-month 
period to any student enrolled in a school which provides a course of 
study longer than the traditional 9-month academic year may be 
proportionately increased.



Sec. 57.2208  Payment of scholarship grant.

    The portion of a scholarship grant awarded for the costs of tuition 
and fees as indicated on the notice of grant award document will be paid 
directly to the school upon receipt of an invoice from the school. The 
portion of the scholarship grant awarded for the costs of equipment, 
supplies, books, and living expenses will be paid to the individual in 
equal monthly installments.



Sec. 57.2209  Conditions of scholarship grant.

    (a) Any scholarship grant made to any individual under this subpart 
shall be awarded upon the condition that

[[Page 342]]

such individual will, following completion of his professional training, 
engage in the full-time practice of primary care for a period of 12 
continuous months for each academic year (i.e., 9 months) for which a 
scholarship grant was made, as follows:
    (1) In the case of any individual selected pursuant to 
Sec. 57.2205(a) (1) or (2), such practice must be in the physician 
shortage area to which such individual agreed to return: Provided 
however, That if the Secretary determines at the time the individual 
proposes to engage in the required practice that such area is no longer 
a physician shortage area and cannot reasonably be expected to become 
such an area within 2 years from such time, such practice shall, at the 
option of the individual, be either in any then current physician 
shortage area, or in such place or places, facility, or facilities, and 
in such manner as the Secretary finds necessary to assure that, of the 
patients receiving medical care in such practice, a substantial portion 
will consist of persons who are migratory agricultural workers or 
members of their families.
    (2) In the case of any individual selected pursuant to 
Sec. 57.2205(a) (3) or (4), such practice must be in accordance with the 
agreement described in Sec. 57.2205(b)(2) (i.e., in a physician shortage 
area with a substantial portion of migratory agricultural workers in 
such area; a physician shortage area; or in such place or places, 
facility or facilities, and in such manner as may be necessary to assure 
that, of the patients receiving medical care in such practice, a 
substantial portion will consist of persons who are migratory 
agricultural workers or members of their families; as the case may be).
    (b) Subject to the provision of Sec. 57.2211(f) and except as 
provided in paragraph (c) of this section, any individual to whom the 
conditions of this section apply must complete the practice required by 
paragraph (a) of this section within a period beginning on the date of 
completion by the individual of his professional training, as determined 
by the Secretary, and not to exceed the period of practice determined in 
accordance with such paragraph (a) of this section, plus 6 months.
    (c) Where an individual to whom the conditions of this section apply 
is currently performing an active duty service obligation under section 
235 of the Act, the individual must complete the practice required by 
paragraph (a) of this section within a period beginning on the date of 
completion by the individual of his service obligation under section 225 
of the Act or completion of his internship and residency training (not 
to exceed four years) if not previously received, whichever comes later, 
and not to exceed the period of practice determined in accordance with 
paragraph (a) of this section, plus 6 months.
    (d) Where an individual has received scholarship grant support for 
four academic years, such individual shall be considered to have 
received scholarship grant support for only three academic years if the 
Secretary determines (1) that such individual has served his internship 
or residency in a hospital (i) which is located in a physician shortage 
area, or (ii) in which a substantial portion of the patients of such 
hospital consists of persons who are migratory agricultural workers or 
members of the families of such workers and (2) that while so serving 
such internship or residency, he has received training or professional 
experience designed to prepare him to engage in the practice of primary 
care.
    (e) For purposes of paragraph (c)(2) of this section, (1) 
internships which will be recognized by the Secretary as providing 
training or professional experience designed to prepare an individual to 
engage in the practice of primary care are: Rotating internships without 
a major emphasis, rotating internships with an emphasis on internal 
medicine, rotating internships with an emphasis on pediatrics, rotating 
internships with an emphasis on obstetrics and gynecology, straight 
internships in internal medicine, straight internships in pediatrics and 
straight internships in obstetrics and gynecology; Provided, That such 
internships are approved or provisionally approved by the Council on 
Medical Education of the American Medical Association or the Board of 
Trustees of the American Osteopathic Association; and

[[Page 343]]

    (2) Residencies which will be recognized as providing such training 
or experience are those in general practice, family practice, general 
internal medicine, general pediatrics and general obstetrics and 
gynecology; Provided, That such residencies are approved or 
provisionally approved by the Council on Medical Education of the 
American Medical Association or the Board of Trustees of the American 
Osteopathic Association.
    (f) No individual who has received a scholarship grant under this 
subpart may enter into an agreement with the Secretary pursuant to 
section 741(f) of the Act until either (1) such individual has completed 
the practice required by paragraph (a) of this section, or (2) the 
Secretary has determined that the United States is entitled to recover 
from such individual an amount determined in accordance with 
Sec. 57.2210. In no case, however, shall a scholarship grant under this 
subpart be considered an educational loan for purposes of section 741(f) 
of the Act.

[39 FR 28730, Aug. 9, 1974, as amended at 41 FR 26685, June 29, 1976]



Sec. 57.2210  Failure to comply.

    (a) Subject to the provision of Sec. 57.2211, if any individual 
fails to complete the course of study or fails, within the time period 
set forth in Sec. 57.2209(b), to meet the applicable conditions of 
practice imposed by receipt of a scholarship grant for the full number 
of months to which such condition is applicable, the United States shall 
be entitled to recover from such individual an amount determined in 
accordance with section 784(c)(3) of the Act; Provided however, That no 
interest shall accrue on any amount due the United States during any 
period for which the Secretary has suspended the obligation to repay 
pursuant to Sec. 57.2211(b).



Sec. 57.2211  Waiver or suspension.

    (a) Any obligation of any individual under this subpart will be 
cancelled upon the death of such individual as documented by a 
certification of death, or such other official proof as is conclusive 
under State law, and submitted to the Secretary.
    (b) Subject to the provision of paragraph (f) of this section, where 
an individual fails to complete the practice required by Sec. 57.2209(a) 
within the period prescribed in Sec. 57.2209(b), the Secretary may waive 
or suspend for such period as determined by the Secretary the obligation 
of such individual to repay pursuant to Sec. 57.2210 where the Secretary 
determines that compliance by such individual with such obligation (1) 
is impossible, or (2) would involve extreme hardship to such individual 
and enforcement of such obligation with respect to such individual would 
be against equity and good conscience.
    (c) For purposes of paragraph (b)(1) of this section, compliance by 
an individual will be deemed impossible where the Secretary determines, 
on the basis of such information and documentation as he may require, 
that the individual is permanently and totally disabled.
    (d) For purposes of paragraph (b)(2) of this section, in determining 
whether compliance by an individual would involve extreme hardship to 
such individual and would be against equity and good conscience, the 
Secretary will take into consideration the following:
    (1) The individual's present financial resources and obligations;
    (2) The individual's estimated future financial resources and 
obligations;
    (3) The reasons for the individual's failure to complete such 
practice within the prescribed period, such as problems of a personal 
nature; and
    (4) The extent to which the individual is practicing his profession 
in a manner consistent with the purposes of section 784 of the Act.
    (e) Where the Secretary determines that compliance by an individual 
with his obligation to engage in the practice of primary care in a 
specified shortage area pursuant to Sec. 57.2209(a) is impossible or 
would involve extreme hardship to such individual and enforcement of 
such obligation with respect to such individual would be against equity 
and good conscience, the Secretary may waive such obligation and permit 
the individual at his option to practice either in any then current 
physician shortage area, or in such place or places, facility or 
facilities, and in such manner as the Secretary finds necessary to 
assure that, of the

[[Page 344]]

patients receiving medical care in such practice, a substantial portion 
will consist of persons who are migratory agricultural workers or 
members of their families. The Secretary will take into consideration in 
determining whether to grant a waiver under this paragraph the extent to 
which the individual has problems of a personal nature, e.g., physical 
or mental disability, terminal illness in the family, or need for 
financial support that cannot be supplied by the required service, which 
intrude upon the individual's ability to perform the required service in 
the specified shortage area.
    (f) The Secretary may extend the period (prescribed in 
Sec. 57.2209(b)) within which an individual must complete the practice 
required pursuant to Sec. 57.2209(a) for a period not to exceed one year 
where the Secretary finds that (1) such individual is unable to complete 
such practice within such period because of a temporary physical or 
mental disability, or (2) completion by such individual of such practice 
within such period would involve extreme hardship to such individual and 
that failure to so extend such period would be against equity and good 
conscience.

Subpart X  [Reserved]



  Subpart Y--Grants for Nurse Practitioner and Nurse Midwifery Programs

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended, 63 Stat. 35 (42 U.S.C. 216); sec. 822(a) of the Public 
Health Service Act, 89 Stat. 361, as amended by 99 Stat. 394-395 and 548 
(42 U.S.C. 296m).



Sec. 57.2401  Applicability.

    The regulations of this subpart are applicable to the award of 
grants to public or private nonprofit schools of nursing and public 
health, public or private nonprofit schools of medicine which received 
grants under section 822(a) of the Public Health Service Act (42 U.S.C. 
296m) prior to October 1, 1985, public or private nonprofit hospitals, 
and other public or private nonprofit entities under section 822(a) to 
meet the cost of projects to (a) plan, develop, and operate, (b) expand, 
or (c) maintain programs for the education of nurse practitioners or 
nurse midwives.

[57 FR 45741, Oct. 5, 1992]



Sec. 57.2402  Definitions.

    As used in this subpart:
    (a) Act means the Public Health Service Act, as amended.
    (b) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (c) Council means the National Advisory Council on Nursing Education 
and Practice (established by section 851 of the Act).
    (d) School of nursing means a collegiate associate degree, or 
diploma school of nursing.
    (e) Collegiate school of nursing means a department, division, or 
other administrative unit in a college or university which provides 
primarily or exclusively a program of education in professional nursing 
and allied subjects leading to the degree of bachelor of arts, bachelor 
of science, bachelor of nursing, or to an equivalent degree, or to a 
graduate degree in nursing, and including advanced education related to 
such program of education provided by such school, but only if such 
program, or such unit, college or university is accredited as provided 
in section 853(6) of the Act.
    (f) Associate degree school of nursing means a department, division 
or other administrative unit in a junior college, community college, 
college, or university which provides primarily or exclusively a 2-year 
program of education in professional nursing and allied subjects leading 
to an associate degree in nursing or to an equivalent degree, but only 
if such program, or such unit, college, or university is accredited as 
provided in section 853(6) of the Act.
    (g) Diploma school of nursing means a school affiliated with a 
hospital or university, or an independent school, which provides 
primarily or exclusively a program of education in professional nursing 
and allied subjects leading to a diploma or to equivalent indicia that 
such program has been satisfactorily completed, but only if such 
program, or such affiliated school or

[[Page 345]]

such hospital or university or such independent school is accredited as 
provided in section 853(6) of the Act.
    (h) School of medicine means a school which provides education 
leading to a degree of doctor of medicine and which is accredited by a 
recognized body or bodies approved for such purpose by the Secretary of 
Education.
    (i) School of public health means a school which provides education 
leading to a graduate degree in public health and which is accredited by 
a recognized body or bodies approved for such purpose by the Secretary 
of Education.
    (j) Nonprofit refers to the status of an entity which is a 
corporation or association or is owned and operated by one or more 
corporations or associations no part of the net earnings of which 
inures, or may lawfully inure, to the benefit of any private shareholder 
or individual.
    (k) State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    (l) Program director means a qualified individual designated by the 
grantee and approved by the Secretary who is to be functionally 
responsible for the education program being supported under this 
subpart.
    (m) Project period mean the total time for which support for a 
project has been approved, including any extensions thereof.
    (n) Budget period means the interval of time into which the approved 
activity is divided for budgetary and reporting purposes.
    (o) Programs for the education of nurse practitioners or nurse 
midwives means full-time educational programs for registered nurses 
(irrespective of the type of school of nursing in which the nurses 
received their training) which meets the guidelines prescribed by the 
Secretary in the Appendix to this subpart and which has as its objective 
the education of nurses (including pediatric and geriatric nurses) who 
will, upon completion of their studies in such programs, be qualified to 
effectively provide primary health care, including primary health care 
in homes and in ambulatory care facilities, long-term care facilities 
(where appropriate), and other health care institutions.
    (p) Nurse practitioner means a registered nurse who has successfully 
completed a formal program of study designed to prepare registered 
nurses to perform in an expanded role in the delivery of primary health 
care including the ability to:
    (1) Assess the health status of individuals and families through 
health and medical history taking, physical examination, and defining of 
health and developmental problems;
    (2) Institute and provide continuity of health care to clients 
(patients), work with the client to insure understanding of and 
compliance with the therapeutic regimen within established protocols, 
and recognize when to refer the client to a physician or other health 
care provider;
    (3) Provide instruction and counseling to individuals, families, and 
groups in the areas of health promotion and maintenance, including 
involving such persons in planning for their health care; and
    (4) Work in collaboration with other health care providers and 
agencies to provide, and where appropriate, coordinate services to 
individuals and families.
    (q) Nurse-midwife means a registered nurse who has completed a 
formal program of study designed to prepare registered nurses to perform 
in an expanded role in the delivery of primary health care to women and 
babies including the management of normal antepartum, intrapartum, and 
postpartum care as well as family planning and gynecology.
    (r)(1) Primary health care means care which may be initiated by the 
client or provider in a variety of settings and which consists of a 
broad range of personal health care services including:
    (i) Promotion and maintenance of health;
    (ii) Prevention of illness and disability;
    (iii) Basic care during acute and chronic phases of illness;

[[Page 346]]

    (iv) Guidance and counseling of individuals and families;
    (v) Referral to other health care providers and community resources 
when appropriate; and
    (vi) Nurse midwifery services (when appropriate).
    (2) In providing such services--
    (i) The physical, emotional, social, and economic status, as well as 
the cultural and environmental backgrounds, of individuals, families, 
and communities (where applicable) are considered;
    (ii) The client is provided access to the health care system; and
    (iii) A single provider or team of providers, along with the client, 
is responsible for the continuing coordination and management of all 
aspects of basic health services needed for individual and family care.

[43 FR 43416, Sept. 25, 1978, as amended at 52 FR 27342, July 21, 1987; 
57 FR 45741, Oct. 5, 1992; 61 FR 6126, Feb. 16, 1996]



Sec. 57.2403  Eligibility.

    (a) Eligible applicants. To be eligible for a grant under this 
subpart the applicant shall:
    (1) Be a public or private nonprofit school of nursing or public 
health, a public or private nonprofit school of medicine which received 
grants under this subpart prior to October 1, 1985, public or private 
nonprofit hospital; or other public or private nonprofit entity; and
    (2) Be located in a State.
    (b) Eligible projects. A grant under this subpart may be made to an 
eligible applicant to meet the cost of:
    (1) A project to plan, develop, and operate a program for the 
education of nurse practitioners or nurse midwives (which will be in 
operation no later than 12 months after the award of a grant under this 
subpart);
    (2) A project to expand a program for the education of nurse 
practitioners or nurse midwives through one or a combination of the 
following activities:
    (i) A planned increase in student enrollment;
    (ii) The addition to the program of one or more fields of clinical 
practice;
    (iii) The addition of a new education site for the total program; or
    (3) A project to maintain a program for the education of nurse 
practitioners and nurse midwives.

[43 FR 43416, Sept. 25, 1978, as amended at 52 FR 27343, July 21, 1987; 
57 FR 45741, Oct. 5, 1992]



Sec. 57.2404  Application.

    (a) Each eligible applicant desiring a grant under this subpart 
shall submit an application in such form and at such time as the 
Secretary may prescribe.
    (b) The application shall be executed by an individual authorized to 
act for the applicant and to assume on behalf of the applicant the 
obligations imposed by the terms and conditions of any award, including 
the regulations of this subpart.
    (c) In addition to such other pertinent information as the Secretary 
may require, an application for a grant under this subpart shall contain 
the following:
    (1) A full and adequate description of the proposed project, 
including:
    (i) Information concerning the need for and significance of the 
proposed project.
    (ii) A description of the setting in which the education program 
will be conducted and the primary health care needs to which such 
program will be responsive.
    (iii) A detailed description of the planning and developmental 
activities to be carried out or which have been accomplished by the 
applicant.
    (iv) A detailed time plan for each year of the project period, 
identifying target dates for project activities and including any plans 
for continuing such activities beyond the project period.
    (v) A description of specific measurable objectives for the proposed 
project consistent with the purposes of section 822 of the Act.
    (vi) A detailed plan for achieving the stated objectives of the 
proposed project.
    (vii) A description of the program curriculum, including course 
content and the number of hours of classroom instruction, supervised 
laboratory, and clinical practice.
    (viii) A plan and methodology for evaluating the education program 
in

[[Page 347]]

accordance with the requirements of Sec. 57.2405(c).
    (ix) Where the education includes a preceptorship, a description of 
such preceptorship, including length, type of practice, and amount of 
faculty supervision.
    (x) A description of recruitment plans and criteria for the 
selection and admission of students.
    (xi) An estimate of the number of students to be enrolled during the 
project period.
    (xii) In the case of a project to expand a nurse practitioner or 
nurse midwifery education program, a description of the manner in which 
the program is to be expanded and a plan for achieving such expansion 
during the project period.
    (2) Evidence satisfactory to the Secretary that the applicant has 
secured any required institutional clearances and approvals for the 
planning, development, and operation of the program.
    (3) Information concerning the background and qualifications of the 
program director, staff, and consultants.
    (4) Evidence satisfactory to the Secretary that the applicant will 
have available adequate faculty, staff facilities, clinical practice 
settings, and equipment for the conduct of the proposed project.
    (5) A description of any written agreements with other institutions 
or organizations for carrying out the proposed project.
    (6) A detailed budget for the proposed project and a justification 
of the amount of grant funds requested.
    (7) A description of financial resources available to the applicant 
to assure the sound establishment, maintenance, and continuation of the 
proposed project beyond the project period.
    (d) The application shall contain an assurance satisfactory to the 
Secretary that--
    (1) In the case of a project to plan, develop, and operate a program 
for the education of nurse practitioners or nurse midwives, such program 
will upon its development meet the guidelines set forth in the Appendix 
of this subpart, or
    (2) In the case of a project to expand or maintain a program for the 
education of nurse practitioners or nurse midwives, such program meets 
the guidelines set forth in the appendix to this subpart.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[42 FR 60883, Nov. 29, 1977, as amended at 49 FR 38114, Sept. 27, 1984; 
52 FR 27343, July 21, 1987; 57 FR 45741, Oct. 5, 1992]



Sec. 57.2405  Project requirements.

    A project supported under this subpart shall be conducted in 
accordance with the following requirements:
    (a) The project shall conduct its program for the education of nurse 
practitioners or nurse midwives in accordance with the guidelines 
prescribed by the Secretary and set forth in the Appendix to this 
subpart.
    (b) The program director shall be responsible for the conduct of the 
education program unless replaced by another individual found by the 
Secretary to be qualified to carry out such responsibilities. Where the 
program director becomes unable to function in such capacity, the 
Secretary shall be notified as soon as possible.
    (c) In accordance with the plan set forth in its approved 
application, the project shall evaluate the effectiveness of the program 
in relation to its purposes and objectives.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[43 FR 43416, Sept. 25, 1978, as amended at 52 FR 27343, July 21, 1987; 
61 FR 51788, Oct. 4, 1996]]



Sec. 57.2406  Evaluation and grant awards.

    (a) Evaluation. (1) Within the limits of funds available for such 
purpose, the Secretary, after consultation with the Council, may award 
grants to those applicants whose projects will in his judgment best 
promote the purposes of section 822 of the Act, taking into 
consideration:
    (i) The degree to which the project plan adequately provides for 
meeting the requirements set forth in Sec. 57.2405 and the appendix to 
this subpart;
    (ii) The potential effectiveness of the proposed project in carrying 
out the education purposes of section 822 of the Act and this subpart;

[[Page 348]]

    (iii) The capability of the applicant to carry out the proposed 
project;
    (iv) The extent to which the project has joint program direction by 
qualified nurse and physician educators;
    (v) The soundness of the fiscal plan for assuring effective 
utilization of grant funds; and
    (vi) The potential of the project to continue on a self-sustaining 
basis after the project period.
    (2) Pursuant to section 822(a)(1) of the Act, the Secretary will 
give special consideration to:
    (i) Projects for programs for the education of nurse practitioners 
or nurse midwives who will practice in health professional shortage 
areas (designated under section 332 of the Act); and
    (ii) Projects for education programs which emphasize education 
respecting the special problems of geriatric patients (particularly 
problems in the delivery of preventive care, acute care, and long-term 
care, including home health care and institutional care to such 
patients) and education to meet the particular needs of nursing home 
patients and patients confined to their homes.
    (3) In determining the funding of applications approved under 
paragraph (a)(1) of this section, the Secretary will also consider other 
special factors relating to national needs as the Secretary may from 
time to time announce in the Federal Register.
    (b) Grant awards. (1) The Secretary will determine the amount of any 
award on the basis of his or her estimate on the sum necessary for the 
cost (including both direct and indirect costs) of the project.
    (2) All grant awards shall be in writing and shall set forth the 
amount of funds granted and the period for which such funds will be 
available for obligation by the grantee.
    (3) Neither the approval of any project nor the award of any grant 
shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved project or portion thereof. For continuation support, 
grantees must make separate application at such times and in such form 
as the Secretary may prescribe.
    (c) Noncompeting continuation awards. If a grantee has filed an 
application for continuation support and within the limits of funds 
available for this purpose, the Secretary may make a grant award for an 
additional budget period for any previously approved project if (1) the 
application is for a project which meets the regulations of this subpart 
and (2) on the basis of such progress and accounting records as may be 
required, the Secretary finds that the project's activities during the 
current budget period justify continued support of the project for an 
additional budget period. If the Secretary decides to continue support, 
the amount of the grant award will be determined in accordance with 
paragraph (b)(1) of this section. If the Secretary decides not to 
continue supporting a project for an additional budget period, he will 
notify the grantee in writing before the end of the current budget 
period. In addition, the Secretary may provide financial support for the 
orderly phaseout of the supported project, if he determines that such 
support is necessary.

[43 FR 43416, Sept. 25, 1978, as amended at 52 FR 27343, July 21, 1987; 
53 FR 14792, Apr. 26, 1988; 57 FR 45741, Oct. 5, 1992]



Sec. 57.2407  Grant payments.

    The Secretary will from time to time make payments to the grantee of 
all or a portion of any grant award, either by way of reimbursement for 
expenses incurred in the budget period, or in advance for expenses to be 
incurred, to the extent he determines such payments necessary to promote 
prompt intitiation and advancement of the approved project.

[42 FR 60883, Nov. 29, 1977]



Sec. 57.2408  Expenditure of grant funds.

    (a) Any funds granted pursuant to this subpart shall be expended 
solely for carrying out the approved project in accordance with section 
822 of the Act, the regulations of this subpart, the terms and 
conditions of the award, and the applicable cost principles prescribed 
by subpart Q of 45 CFR part 74; Provided, That such funds shall not be 
expended for sectarian instruction or for any religious purpose.

[[Page 349]]

    (b) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried forward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amounts awarded by withdrawing the excess. A budget 
period is an interval of time (usually 12 months) into which the project 
period is divided for funding and reporting purposes.

[43 FR 43416, Sept. 25, 1978, as amended at 52 FR 27343, July 21, 1987; 
57 FR 45741, Oct. 5, 1992]



Sec. 57.2409  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service Grant Appeals 
Procedure.
45 CFR part 16--Procedures of the Departmental Grant Appeals Board.
45 CFR part 46--Protection of Human Subjects.
45 CFR part 74--Administration of Grants.
45 CFR part 75--Informal Grant Appeals Procedures.
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination Under Programs Receiving Federal 
Assistance Through the Department of Health and Human Services 
Effectuation of title VI of the Civil Rights Act of 1964.
45 CFR part 81--Practice and Procedure for Hearings Under part 80 of 
this title.
45 CFR part 83--Regulation for the Administration and Enforcement of 
sections 794 and 855 of the Public Health Service Act.
45 CFR part 84--Nondiscrimination on the Basis of Handicap in Programs 
and Activities Receiving or Benefiting From Federal Financial 
Assistance.
45 CFR part 86--Nondiscrimination on the Basis of Sex in Education 
Programs and Activities Receiving or Benefiting From Federal Financial 
Assistance.
45 CFR part 91--Nondiscrimination on the Basis of Age in HHS Programs 
Activities Receiving Federal Financial Assistance.
45 CFR part 93--New restrictions on lobbying.

[52 FR 27344, July 21, 1987, as amended at 57 FR 45741, Oct. 5, 1992; 61 
FR 6126, Feb. 16, 1996]



Sec. 57.2410  Additional conditions.

    The Secretary may with respect to any grant award impose additional 
conditions prior to or at the time of any award when in his judgment 
such conditions are necessary to assure or protect advancement of the 
approved project, the interests of the public health, or the 
conservation of grant funds.

[43 FR 43416, Sept. 25, 1978. Redesignated at 52 FR 27344, July 21, 
1987]

   Appendix to Subpart Y--Guidelines for Nurse Practitioner and Nurse 
                           Midwifery Programs

    The guidelines set forth below have been prescribed by the Secretary 
after consultation with appropriate educational organizations and 
professional nursing and medical organizations, as required by section 
822(a)(2)(B) of the Public Health Service Act.
    A. Definitions. 1. ``Programs for the education of nurse 
pactitioners or nurse midwives'' means a full-time educational program 
for registered nurses (irrespective of the type of school of nursing in 
which the nurses received their training) which meets the guidelines 
prescribed herein and which has as its objective the education of nurses 
(including pediatric and geriatric nurses) who will, upon completion of 
their studies in such program be qualified to effectively provide 
primary health care, including primary health care in homes and in 
ambulatory care facilities, long-term care facilities, where 
appropriate, and other health care institutions.
    2. ``Nurse practitioner'' means a registered nurse who has 
successfully completed a formal program of study designed to prepare 
registered nurses to perform in an expanded role in the delivery of 
primary health care including the ability to:
    a. Assess the health status of individuals and families through 
health and medical history taking, physical examination, and defining of 
health and developmental problems;
    b. Institute and provide continuity of health care to clients 
(patients), work with the client to insure understanding of and 
compliance with the therapeutic regimen within established protocols, 
and recognize when to refer the client to a physician or other health 
care provider;
    c. Provide instruction and counseling to individuals, families and 
groups in the areas

[[Page 350]]

of health promotion and maintenance, including involving such persons in 
planning for their health care; and
    d. Work in collaboration with other health care providers and 
agencies to provide, and where appropriate, coordinate services to 
individuals and families.
    3. ``Nurse-midwife'' means a registered nurse who has completed a 
formal program of study designed to prepare registered nurses to perform 
in an expanded role in the delivery of primary health care to women and 
babies including the management of normal antepartum, intrapartum, and 
postpartum care as well as family planning and gynecology.
    4. ``Primary health care'' means care which may be initiated by the 
client or provider in a variety of settings and which consists of a 
broad range of personal health care services including:
    a. Promotion and maintenance of health;
    b. Prevention of illness and disability;
    c. Basic care during acute and chronic phases of illness;
    d. Guidance and counseling of individuals and families; and
    e. Referral to other health care providers and community resources 
when appropriate; and
    f. Nurse midwifery services (where appropriate).
    In providing such services (i) the physical, emotional, social, and 
economic status, as well as the cultural and environmental backgrounds 
of individuals, families, and communities (where applicable) are 
considered; (ii) the client is provided access to the health care 
system; and (iii) a single provider or team of providers, along with the 
client, is responsible for the continuing coordination and management of 
all aspects of basic health services needed for individual and family 
care.
    B. Organization and administration. 1. A nurse practitioner or 
nurse-midwifery education program shall have active collaboration with 
nurses and physicians who have expertise relevant to the nurse 
practitioner or nurse midwife role and primary health care, to assist in 
the planning, development, and operation of such a program. In addition, 
where the institution or organization conducting the program is other 
than a school of nursing, medicine, or public health, such collaboration 
shall be with nurses and physicians who are affiliated with either a 
collegiate school of nursing, school of medicine, or school of public 
health.
    2. Co-program directors from nursing and medicine are recommended.
    C. Student enrollment. 1. A nurse practitioner or nurse midwifery 
education program shall have an enrollment of not less than six full-
time equivalent students in each class.
    2. All students enrolled in a nurse practitioner or nurse midwifery 
education program must be licensed to practice nursing (a) at the time 
of enrollment, or (b) in the case of a program leading to a graduate 
degree in nursing, at or prior to the time of completion of a program.
    3. The policies for the recruitment and selection of students shall 
be consistent with the requirements of the sponsoring institution and 
developed in cooperation with the faculty responsible for conducting the 
education. Admission criteria shall take into consideration the 
educational background and work experience of applicants.
    D. Length of program. A nurse practitioner or nurse midwifery 
education program shall be a minimum of 1 academic year (or 9 months) in 
length and shall include at least 4 months (in the aggregate) of 
classroom instruction.
    E. Curriculum. 1. A nurse practitioner or nurse midwifery education 
program shall be a discrete program consisting of classroom instruction 
and faculty-supervised clinical practice designed to teach registered 
nurses the knowledge and skills needed to perform the functions of a 
nurse practitioner or nurse midwife specified in the defintion of that 
term as set forth in these guidelines. The curriculum shall be developed 
and implemented cooperatively by nurse educators, physicans, and 
appropriate representatives of other health disciplines. The following 
are examples of broad areas of program content which should be included: 
Communications and interviewing (history taking); basic physical 
examination including basic pathophysiology; positive health 
maintenance; care during acute and chronic phases of illness; management 
of chronic illness; health teaching and counseling; role realignment and 
establishment of collaborative roles with physicians and other health 
care providers; and community resources. The program content, both 
classroom instruction and clinical practice, should be developed so that 
the nurse practitioner or nurse midwife is prepared to provide primary 
health care as defined in these guidelines.
    2. The curriculum may include a preceptorship, in which the student 
is assigned to a designated preceptor (a nurse practitioner, nurse 
midwife, or physician) who is responsible for teaching, supervising, and 
evaluating the student and for providing the student with an environment 
which permits observation and active participation in the delivery of 
primary health care. If a preceptorship is included, it shall be under 
the direction and supervision of the faculty.
    F. Faculty qualifications. A nurse practitioner or nurse midwifery 
education program shall have a sufficient number of qualified nursing 
and medical (and other related professional) faculty with academic 
preparation and clinical expertise relevant to their areas

[[Page 351]]

of teaching responsibility and with demonstrated ability in the 
development and implementation of educational programs.
    G. Resources. 1. A nurse practitioner or nurse midwifery education 
program shall have available sufficient educational and clinical 
resources including a variety of practice settings, particularly in 
ambulatory care.
    2. Clinical practice facilities shall be adequate in terms of space 
and equipment, number of clients, diversity of client age, and need for 
care, number of students enrolled in the program, and other students 
using the facility for education purposes.
    3. Where the institution or organization conducting the program does 
not provide the clinical practice settings itself, it shall provide for 
such settings through written agreements with other appropriate 
institutions or organizations.
    4. Where the institution or organization conducting the program is 
other than a school of nursing, medicine, or public health, it shall 
provide for sufficient educational expertise through writtten 
agreeements with a collegiate school of nursing, school of medicine, or 
school of public health.

[42 FR 60883, Nov. 29, 1977, as amended at 43 FR 27837, June 27, 1978; 
52 FR 27344, July 21, 1987; 57 FR 45741, Oct. 5, 1992]



         Subpart Z--Grants for Advanced Nurse Education Programs

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 63 Stat. 35 (42 U.S.C. 216); sec. 821 of the Public Health 
Service Act, 89 Stat. 361; as amended by 95 Stat. 930, 99 Stat. 394 and 
548, and Pub. L. 102-408, 106 Stat. 2072 (42 U.S.C. 296l).



Sec. 57.2501  Applicability.

    The regulations of this subpart apply to the award of grants to 
public and private nonprofit collegiate schools of nursing under section 
821 of the Public Health Service Act (42 U.S.C. 296l) to meet the costs 
of projects to:
    (a) Plan, develop, and operate new programs; or
    (b) Significantly expand existing programs leading to advanced 
degrees that prepare nurses to serve as nurse educators or public health 
nurses, or in other clinical nurse specialties determined by the 
Secretary to require advanced education.

[61 FR 6127, Feb. 16, 1996]



Sec. 57.2502  Definitions.

    As used in this subpart:
    Act means the Public Health Service Act, as amended.
    Advanced nurse education program means a program of study in a 
collegiate school of nursing which leads to masters' and doctoral 
degrees and which prepares nurses to serve as nurse educators, 
administrators, or researchers or to serve in clinical nurse specialties 
determined by the Secretary to require advanced education.
    Budget period means the interval of time into which the approved 
activity is divided for budgetary purposes, as specified in the grant 
award document.
    Collegiate school of nursing means a department, division, or other 
administrative unit in a college or university which provides primarily 
or exclusively a program of education in professional nursing and allied 
subjects leading to the degree of bachelor of arts, bachelor of science, 
bachelor of nursing, or to an equivalent degree, or to masters' and 
doctoral degrees in nursing, and including advanced education related to 
this type of educational program provided by the school, but only if the 
program, or unit, college or university is accredited.
    Construction means (1) the construction of new buildings and the 
acquisition, expansion, remodeling, replacement, and alteration of 
existing buildings including architects' fees but not including the cost 
of acquisition of land (except in the case of acquisition of an existing 
building), offsite improvements, living quarters, or patient-care 
facilities, and (2) equipping new buildings and existing buildings, 
whether or not acquired, expanded, remodeled, or altered.
    Council means the National Advisory Council on Nurse Education and 
Practice established by section 851(a) of the Act.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Professional nurse means a registered nurse who has received initial 
nursing preparation from a diploma, associate

[[Page 352]]

degree, or collegiate school of nursing as defined in section 853 of the 
Act and who is currently licensed to practice nursing.
    Project period means the total time for which support for a project 
has been approved, as specified in the grant award document.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[43 FR 43416, Sept. 25, 1978, as amended at 48 FR 45113, Oct. 3, 1983; 
52 FR 27346, July 21, 1987; 57 FR 45741, Oct. 5, 1992; 61 FR 6127, Feb. 
16, 1996]



Sec. 57.2503  Eligibility.

    (a) Eligible applicants. To be eligible for a grant under this 
subpart the applicant shall:
    (1) Be a public or private nonprofit collegiate school of nursing.
    (2) Be located in a State.
    (b) Eligible projects. A grant under this subpart may be made to an 
eligible applicant to meet the cost of:
    (1) A project to plan, develop, and operate an advanced nurse 
education program. The planning period of this project is limited to 1 
year. The project must enroll students before the end of the project 
period;
    (2) A project to significantly expand an advanced nurse education 
program through one or more of the following activities:
    (i) The addition to the masters' or doctoral program of a new 
clinical, research, or functional (administration or teaching) specialty 
area,
    (ii) A planned increase in student enrollment during the project 
period, or
    (iii) The addition of a new educational site for the program; or

[43 FR 43416, Sept. 25, 1978, as amended at 48 FR 45113, Oct. 3, 1983; 
52 FR 27346, July 21, 1987; 57 FR 45741, Oct. 5, 1992; 61 FR 6127, Feb. 
16, 1996]



Sec. 57.2504  Application.

    (a) Each eligible applicant desiring a grant under this subpart 
shall submit an application in the form and at such time as the 
Secretary may prescribe.
    (b) The application shall be signed by an individual authorized to 
act for the applicant and to assume on behalf of the applicant the 
obligations imposed by the terms and conditions of any award, including 
the regulations of this subpart.
    (c) In addition to other pertinent information which the Secretary 
may require, an application for a grant under this subpart shall 
contain:
    (1) A proposal for a project to:
    (i) Plan, develop, and operate; or
    (ii) Significantly expand an advanced nurse education program;
    (2) Information documenting the need for the proposed project;
    (3) A description of specific attainable and measurable objectives 
for the proposed project consistent with the purposes of section 821 of 
the Act;
    (4) A detailed plan for achieving and measuring the stated 
objectives of the proposed project;
    (5) A description of the anticipated impact of the proposed project, 
including its potential contribution to nursing;
    (6) Evidence satisfactory to the Secretary that the applicant will 
have available adequate resources for the conduct of the proposed 
project, including adequate faculty, staff, equipment, facilities, and 
an appropriate clinical practice setting or settings;
    (7) A detailed budget for the proposed project and a justification 
of the amount of grant funds requested;
    (8) A description of any Federal financial support related to the 
proposed project which the applicant is currently receiving;

[[Page 353]]

    (9) A detailed timetable for carrying out the activities of the 
proposed project, including any plans for continuing activities beyond 
the project period;
    (10) A description of the background and qualifications of the 
project staff and any proposed consultants;
    (11) Information concerning the source and number of potential 
students for the education program and a description of plans, if any, 
to encourage graduates of the education program to practice in States in 
need of nurses prepared in the specialty in which education is to be 
provided;
    (12) A plan to sustain the project beyond the period during which 
Federal assistance is available; and
    (13) A plan to attract and retain a higher than average number of 
minority and financially needy students.
    (d) In the case of a project to significantly expand an advanced 
nurse education program, the application shall contain an assurance 
satisfactory to the Secretary that the applicant will expend, in 
carrying out the program for which a grant under this subpart is sought, 
an amount of non-Federal funds (excluding costs of construction) at 
least as great as the average amount of non-Federal funds (excluding 
expenditures of a nonrecurring nature, including costs of construction) 
expended for this purpose during the 3 fiscal years immediately 
preceding the fiscal year for which the grant is sought.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[43 FR 43416, Sept. 25, 1978, as amended at 48 FR 45113, Oct. 3, 1983; 
52 FR 27346, July 21, 1987; 57 FR 45741, Oct. 5, 1992; 61 FR 6127, Feb. 
16, 1996]



Sec. 57.2505  Project requirements.

    (a) A project supported under this subpart shall be conducted in 
accordance with its approved application.
    (b) A project supported under this subpart shall enroll professional 
nurses, as defined in Sec. 57.2502, or students who will be professional 
nurses, as defined in Sec. 57.2502, at or prior to completion of the 
advanced nurse education program.

[43 FR 43416, Sept. 25, 1978, as amended at 52 FR 27347, July 21, 1987]



Sec. 57.2506  Evaluation and grant awards.

    (a) Evaluation. Within the limits of funds available for this 
purpose, the Secretary, after consultation with the Council, may award 
grants to those applicants whose projects will, in his or her judgment, 
best promote the purposes of section 821 of the Act, taking into 
consideration among other pertinent factors:
    (1) The need for the proposed project including, with respect to 
projects to provide education in professional nursing specialties 
determined by the Secretary to require advanced education:
    (i) The current or anticipated need for professional nurses educated 
in the specialty; and
    (ii) The relative number of programs offering advanced education in 
the specialty;
    (2) The need for nurses in the specialty in which education is to be 
provided in the State in which the education program is located, as 
compared with the need for these nurses in other States;
    (3) The degree to which the applicant proposes to recruit students 
from States in need of nurses in the specialty in which education is to 
be provided, and to promote their return to these States following 
education;
    (4) The degree to which the applicant proposes to encourage 
graduates to practice in States in need of nurses in the specialty in 
which education is to be provided;
    (5) The potential effectiveness of the proposed project in carrying 
out the educational purposes of section 821 of the Act and this subpart;
    (6) The capability of the applicant to carry out the proposed 
project;
    (7) The soundness of the fiscal plan for assuring effective 
utilization of grant funds; and
    (8) The potential of the project to continue on a self-sustaining 
basis after the period of grant support; and
    (9) The degree to which the applicant proposes to attract, retain 
and graduate minority and financially needy students.
    (b) Funding preference. In determining the funding of applications 
approved under paragraph (a) of this section, the

[[Page 354]]

Secretary may from time to time announce in the Federal Register special 
factors relating to national needs.
    (c) Grant awards. (1) The Secretary will determine the amount of any 
award on the basis of his or her estimate on the sum necessary for the 
cost (including both direct and indirect costs) of the project.
    (2) All grant awards shall be in writing and shall set forth the 
amount of funds granted and the period for which the funds will be 
available for obligation by the grantee.
    (3) Neither the approval of any project nor the award of any grant 
shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved project or portion thereof. For continuation support, 
grantees must make separate application annually in a form and at the 
time that the Secretary may require.
    (d) Noncompeting continuation awards. Within the limits of funds 
available for this purpose, the Secretary may make a grant award for an 
additional budget period for any previously approved project on the 
basis of an application and those progress and accounting records which 
may be required. If the Secretary finds that the project's activities 
during the current budget period justify continued support of the 
project for an additional budget period, and the Secretary decides to 
continue support, the amount of the grant award will be determined in 
accordance with paragraph (c)(1) of this section. If the Secretary 
decides not to continue support for an additional budget period, he or 
she will notify the grantee in writing before the end of the current 
budget period. The Secretary may provide financial support for the 
orderly phase-out of the supported project, if he or she determines that 
this support is necessary.

[43 FR 43416, Sept. 25, 1978, as amended at 52 FR 27347, July 21, 1987; 
52 FR 28511, July 30, 1987; 53 FR 14792, Apr. 26, 1988; 61 FR 6127, Feb. 
16, 1996]



Sec. 57.2507  Grant payments.

    The Secretary will from time to time make payments to the grantee of 
all or a portion of any grant award, either by way of reimbursement for 
expenses incurred in the budget period, or in advance for expenses to be 
incurred, to the extent he or she determines these payments necessary to 
promote prompt initiation and advancement of the approved project.

[43 FR 43416, Sept. 25, 1978]



Sec. 57.2508  Expenditure of grant funds.

    (a) Any funds granted under this subpart as well as other funds to 
be used in performance of the approved project shall be expended solely 
for carrying out the approved project in accordance with section 821 of 
the Act, the regulations of this subpart, the terms and conditions of 
the award, except that funds shall not be expended for sectarian 
instruction or for any religious purpose.
    (b) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried forward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amounts awarded by withdrawing the excess. A budget 
period is an interval of time (usually 12 months) into which the project 
period is divided for funding and reporting purposes.

[43 FR 43416, Sept. 25, 1978, as amended at 52 FR 27347, July 21, 1987; 
57 FR 45742, Oct. 5, 1992]



Sec. 57.2509  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service Grant Appeals 
Procedure.
45 CFR part 16--Procedures of the Departmental Grant Appeals Board.
45 CFR part 46--Protection of Human Subjects.
45 CFR part 74--Administration of Grants.
45 CFR part 75--Informal Grant Appeals Procedures.

[[Page 355]]

45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination Under Programs Receiving Federal 
Assistance Through the Department of Health and Human Services 
Effectuation of title VI of the Civil Rights Act of 1964.
45 CFR part 81--Practice and Procedure for Hearings Under part 80 of 
this title.
45 CFR part 83--Regulation for the Administration and Enforcement of 
Section 794 and 855 of the Public Health Service Act.
45 CFR part 84--Nondiscrimination on the Basis of Handicap in Programs 
and Activities Receiving or Benefiting From Federal Financial 
Assistance.
45 CFR part 86--Nondiscrimination on the Basis of Sex in Education 
Programs and Activities Receiving or Benefiting From Federal Financial 
Assistance.
45 CFR part 91--Nondiscrimination on the Basis of Age in HHS Programs or 
Activities Receiving Federal Financial Assistance.
45 CFR part 93--New restrictions on lobbying.

[52 FR 27347, July 21, 1987, as amended at 57 FR 45742, Oct. 5, 1992; 61 
FR 6127, Feb. 16, 1996]



Sec. 57.2510  Additional conditions.

    The Secretary may with respect to any grant award impose additional 
conditions prior to or at the time of any award when in his or her 
judgment such conditions are necessary to assure or protect advancement 
of the approved project, the interests of the public health, or the 
conservation of grant funds.

[43 FR 43416, Sept. 25, 1978. Redesignated at 52 FR 27347, July 21, 
1987]

Subparts AA-BB  [Reserved]



   Subpart CC--Scholarships for Students of Exceptional Financial Need

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended, 63 Stat. 35 (42 U.S.C. 216); sec. 758 of the Public Health 
Service Act, 90 Stat. 2289, as amended by 102 Stat. 3126-3127 (42 U.S.C. 
294z); renumbered as sec. 736, as amended by Pub. L. 102-408, 106 Stat. 
2022 (42 U.S.C. 293).

    Source: 45 FR 40583, June 16, 1980, unless otherwise noted.



Sec. 57.2801  To what programs do these regulations apply?

    These regulations apply to grants under section 736 of the Public 
Health Service Act (42 U.S.C. 293) for scholarships for full-time 
students of exceptional financial need.

[45 FR 40583, June 16, 1980, as amended at 57 FR 45742, Oct. 5, 1992; 61 
FR 6127, Feb. 16, 1996]



Sec. 57.2802  Definitions.

    Act means the Public Health Service Act, as amended.
    Full-time student means a student enrolled in a school and pursuing 
a course of study which constitutes a full-time academic workload, as 
determined by the school, leading to a degree from a health professions 
school, as specified in section 799(1)(A) of the Act.
    Health professions school or school means, for this subpart, a 
public or private nonprofit school of medicine, osteopathic medicine, 
dentistry, optometry, podiatric medicine, pharmacy, or veterinary 
medicine providing a course of study, or a portion thereof, as defined 
in section 799(1)(A) of the Act and as accredited in section 799(1)(E) 
of the Act.
    National of the United States means (1) a citizen of the United 
States, or (2) a person who, though not a citizen of the United States, 
owes permanent allegiance to the United States, as defined in the 
Immigration and Nationality Act, at 8 U.S.C. 1101(a)(22).
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department to whom the authority 
involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[45 FR 40583, June 16, 1980, as amended at 57 FR 45742, Oct. 5, 1992; 61 
FR 6127, Feb. 16, 1996]

[[Page 356]]



Sec. 57.2803  How to apply for a grant.

    (a) Any health professions school located in a State may apply for a 
grant. Each eligible applicant desiring a grant under this subpart shall 
submit an application in the form and at such time as the Secretary may 
prescribe.
    (b) In addition to other information that the Secretary may require, 
an application must contain:
    (1) A listing of eligible scholarship recipients in order of 
greatest financial need, indicating resident or nonresident status as 
well.
    (2) The name of the need analysis service used in evaluating the 
financial status of applicants.

(Approved by the Office of Management and Budget under control number 
0915-0028)

[45 FR 40583, June 16, 1980, as amended at 57 FR 45743, Oct. 5, 1992]



Sec. 57.2804  Students eligible for scholarships.

    (a) A scholarship may be awarded only to a student who:
    (1) Is a resident of the United States, and either a citizen or 
national of the United States, an alien lawfully admitted for permanent 
residence in the United States, a citizen of the Commonwealth of the 
Northern Mariana Islands, a citizen of the Republic of Palau, a citizen 
of the Republic of the Marshall Islands, or a citizen of the Federated 
States of Micronesia.
    (2) Has been accepted for enrollment as a full-time student by a 
health professions school.
    (3) Has exceptional financial need as determined under paragraph (b) 
of this section.
    (b)(1) For the purpose of this subpart, a student will have 
exceptional financial need if the school determines that his or her 
resources, as described in (b)(2) of this section, do not exceed the 
lesser of $5,000 or one-half of the cost of attendance at the school.
    (2) The school will determine the financial resources of a student 
by using one of the national need analysis systems or any other 
procedure approved by the Secretary of Education and other information 
which the school has regarding the student's financial status. The 
school must take into account, regardless of the tax status of the 
student, the expected contribution from parents, spouse, or other family 
members. Student summer earnings, educational loans, veterans (G.I) 
benefits and earnings during the school year will not be considered 
resources for purposes of this subpart.
    (3) The school will determine cost of attendance at the school by 
considering expenses reasonably necessary for the student's attendance 
at the school, including any special needs and obligations which 
directly affect the student's ability to attend the school on a full-
time basis. The school must document the criteria used for determining 
these costs.
    (c) A recipient of a National Health Service Corps Scholarship, 
under section 751 of the Act, or an Indian Health Scholarship, under 
section 757 of the Act, is ineligible for a scholarship under this 
subpart.

(Approved by the Office of Management and Budget under control number 
0915-0028)

[45 FR 40583, June 16, 1980, as amended at 57 FR 45743, Oct. 5, 1992; 61 
FR 6127, Feb. 16, 1996]



Sec. 57.2805  Amount of scholarship award.

    A scholarship will consist of:
    (a) The tuition of the student in such school year;
    (b) The cost of all other reasonable educational expenses including 
fees, books, and laboratory expenses of the student for the school year; 
and
    (c) A stipend of $400 per month (adjusted in accordance with section 
338A(g)(3) of the Act) for 12 consecutive months beginning with the 
first month of the school year.

[45 FR 40583, June 16, 1980, as amended at 57 FR 45743, Oct. 5, 1992; 61 
FR 6127, Feb. 16, 1996]



Sec. 57.2806  How is the amount of grant award determined?

    (a) A school which receives a grant under this subpart must award 
each scholarship successively to the eligible individual as specified in 
Sec. 57.2803(b)(1) of greatest financial need at that school.
    (b) The Secretary will make a randomized list of all eligible 
applicant

[[Page 357]]

schools of medicine, dentistry and osteopathic medicine and a second 
randomized list of all remaining eligible applicant schools. To the 
extent of available funds, the Secretary will award grant funds 
sufficient for one scholarship to each eligible applicant school on the 
first list, and then proceed to the list of all other eligible applicant 
schools and award one scholarship to each school in the same manner. 
These scholarships must go to students who have no financial resources 
for the first year of study at the school, as determined under 
Sec. 57.2804. The Secretary will then allocate any remaining funds 
according to paragraph (c) of this section.
    (c)(1) Proceeding in sequence through the list of schools of 
medicine, dentistry and osteopathic medicine, the Secretary will award 
each school of medicine, dentistry, and osteopathic medicine sufficient 
grant funds for a second scholarship which must be given to a student 
with no financial resources as determined under Sec. 57.2804. This 
procedure will be repeated until all the scholarship requests of the 
applicant schools of medicine, osteopathic medicine, and dentistry for 
scholarships for students with no financial resources have been 
satisfied or until all the available grant funds have been allocated. If 
there are additional grant funds, the Secretary will then proceed to the 
list of all other eligible applicant schools and will allocate 
scholarships for students with no financial resources using the same 
procedure.
    (2) If additional grant funds remain after fulfilling all requests 
for scholarships for students with no financial resources at all 
eligible applicant schools, using the method described in paragraph 
(c)(1) of this section the Secretary will allocate funds for 
scholarships to students who have resources from one to 500 dollars. 
With any remaining funds after completion of these awards, the Secretary 
will, in the same manner, award grants for scholarships to students with 
resources in increments of $500 until all grant funds are awarded or 
students who have $5,000 in resources or 50 percent of the cost of 
education at the school have received awards.

[45 FR 40583, June 16, 1980, as amended at 57 FR 45743, Oct. 5, 1992]



Sec. 57.2807  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application, the authorizing legislation, 
terms and conditions of the grant award, and these regulations.
    (b) The grantee must discontinue all scholarship payments and remit 
the unused balance of the scholarship to the Federal Government in the 
event that a recipient ceases to be a full-time student at the school.



Sec. 57.2808  What additional Department regulations apply to grantees?

    Several other regulations apply to these grants. They include, but 
are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants).
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying.

[49 FR 38114, Sept. 27, 1984, as amended at 57 FR 45743, Oct. 5, 1992; 
61 FR 6127, Feb. 16, 1996]

[[Page 358]]



Sec. 57.2809  What other records, audit, and inspection requirements apply to grantees?

    (a) Each entity which receives a grant under this subpart must meet 
the requirements of 45 CFR part 74 concerning audit and inspection.
    (b) The grantee must also maintain: (1) A record of all applications 
for scholarships, and the basis for approving or disapproving each 
application, including a copy of the total need analysis and 
determination of resources for each applicant and documentation for any 
changes made to the need analysis report used by the school; (2) A 
record of the amount of funds awarded to each recipient.

(Approved by the Office of Management and Budget under control number 
0915-0028)

[45 FR 40583, June 16, 1980, as amended at 57 FR 45743, Oct. 5, 1992; 61 
FR 6127, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 57.2810  Additional conditions.

    The Secretary may impose additional conditions on any grant award 
before or at the time of an award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.



 Subpart DD--Financial Assistance for Disadvantaged Health Professions 
                                Students

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 63 Stat. 35 (42 U.S.C. 216); sec. 787 of the Public Health 
Service Act, 90 Stat. 2309, as amended by 95 Stat. 923, 99 Stat. 541 (42 
U.S.C. 295g-7); renumbered as sec. 740, as amended by Pub. L. 102-408, 
106 Stat. 2032-2033 (42 U.S.C. 293d).

    Source: 52 FR 18675, May 18, 1987, unless otherwise noted.



Sec. 57.2901  To what program do these regulations apply?

    These regulations apply to grants to eligible schools under section 
740(a)(2) (F) and (d) of the Public Health Service Act for financial 
assistance for disadvantaged health professions students of exceptional 
financial need.

[52 FR 18675, May 18, 1987, as amended at 61 FR 6128, Feb. 16, 1996]



Sec. 57.2902  Definitions.

    Act means the Public Health Service Act, as amended.
    Full-time student means a student enrolled in a school and pursuing 
a course of study which constitutes a full-time academic workload, as 
determined by the school, leading to a degree from a school of medicine, 
school of osteopathic medicine, or school of dentistry, as specified in 
section 799(1)(A) of the Act.
    National of the United States means--
    (1) A citizen of the United States; or
    (2) A person who, though not a citizen of the United States, owes 
permanent allegiance to the United States, as defined in the Immigration 
and Nationality Act, at 8 U.S.C. 1101(a)(22).
    School means a public or private nonprofit school of medicine, 
osteopathic medicine, or dentistry, as defined in section 799(1)(A) of 
the Act.
    School year means the traditional approximately 9-month September to 
June annual session. For the purpose of computing school year 
equivalents for students who, during a 12-month period, attend for a 
longer period than the traditional school year, the school year will be 
considered to be 9 months in length.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department to whom the authority 
involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[52 FR 18675, May 18, 1987, as amended at 57 FR 45743, Oct. 5, 1992; 61 
FR 6128, Feb. 16, 1996]



Sec. 57.2903  How to apply for a grant.

    (a) Any school located in a State may apply for a grant. Each school 
seeking a grant must submit an application at the time and in the form 
and manner that the Secretary may require. The

[[Page 359]]

application must be signed by an individual authorized to act for the 
applicant and to assume on behalf of the applicant the obligations 
imposed by the statute, the regulations of this subpart, and the terms 
and conditions of the award.
    (b) Each application will be reviewed to determine eligibility and 
the reasonableness of the amount of Federal support requested. The 
Secretary may require the applicant to submit additional data for this 
purpose.



Sec. 57.2904  Eligibility and selection of aid recipients.

    (a) Determination of eligibility. An individual is eligible for 
consideration for financial assistance under this program if he or she:
    (1) Is a resident of the United States and either a citizen or 
national of the United States, an alien lawfully admitted for permanent 
residence in the United States, a citizen of the Commonwealth of the 
Northern Mariana Islands, a citizen of the Republic of Palau, a citizen 
of the Republic of the Marshall Islands, or a citizen of the Federated 
States of Micronesia.
    (2) Is enrolled or has been accepted for enrollment as a full-time 
student at a school;
    (3) Comes from a disadvantaged background. For purposes of this 
program, an individual from a disadvantaged background is one who--
    (i) Comes from an environment that has inhibited the individual from 
obtaining the knowledge, skills, and abilities required to enroll in and 
graduate from a school; or
    (ii) Comes from a family with an annual income below a level based 
on low income thresholds according to family size published by the U.S. 
Bureau of the Census, adjusted annually for changes in the Consumer 
Price Index, and adjusted by the Secretary for use in all health 
professions programs. The Secretary will periodically publish these 
income levels in the Federal Register; and
    (4) Has exceptional financial need. For purposes of this program, a 
student will have exceptional financial need if the school determines 
that the student's resources, as described in paragraph (b)(1) of this 
section, do not exceed the lesser of $5,000 or one-half of the cost of 
attendance at the school. Student summer earnings, educational loans, 
veterans (G.I.) benefits, and earnings during the school year will not 
be considered resources for purposes of determining whether a student 
has exceptional financial need.
    (b) Selection of aid recipients. The school will select qualified 
recipients and determine the amount of aid to be awarded to provide its 
needy students with the maximum possible benefit.
    (1) In determining the amount of aid an eligible student needs to 
pursue a full-time course of study at the school, the school will take 
into consideration:
    (i) The financial resources available to the student by using one of 
the national need analysis systems or any other procedure approved by 
the Secretary of Education in combination with other information which 
the school has regarding the student's financial status. The school must 
take into account, regardless of the tax status of the student, the 
expected contribution from parents, spouse, self, or (as appropriate) 
other family members. In making this determination, the school must 
consider photocopies of the parents', student's, and spouse's Federal 
income tax forms with original signatures for the most recent tax year 
(or certification that no Federal income tax return was filed and 
documentation of the total income for the most recent tax year), and may 
require tax returns that are certified as having been received by the 
Internal Revenue Service (IRS); and
    (ii) The costs reasonably necessary for the student's attendance at 
the school. The school must document the criteria used for determining 
these costs. This documentation must include resource materials used by 
the school to determine the dollar amount for each category of expenses 
in its standard student budgets.
    (2) The school must select aid recipients in order of greatest need, 
as determined by the school. The school may consider other scholarship, 
grant, or

[[Page 360]]

fellowship funds that a student has received or will receive for the 
award period when determining the order of greatest need.

(Approved by the Office of Management and Budget under control number 
0915-0028)

[52 FR 18675, May 18, 1987, as amended at 57 FR 45743, Oct. 5, 1992; 61 
FR 6128, Feb. 16, 1996]



Sec. 57.2905  Amount of student award.

    (a) The total award made under this program to any student, plus all 
other sources of aid the student has received or will receive for the 
award period, may not exceed the amount the school determines that the 
student needs to meet the costs of education (i.e., tuition, fees, 
books, equipment, other expenses required by the school, and reasonable 
living expenses) for the period covered by the award. The total award 
made under this program to any student may be less than the amount the 
school determines that the student needs to meet the costs of education 
for the period covered by the award.
    (b) The total award made under this program to any student for a 
school year may not exceed $10,000. The maximum amount awarded during a 
12-month period to any student enrolled in a school which provides a 
full-time course of study longer than the traditional 9-month school 
year may be proportionately increased.
    (c) The school must disburse this award to the student in payments 
based on the student's need during each academic period (e.g. semester, 
quarter, trimester) of a school year.



Sec. 57.2906  How is the amount of the grant award determined?

    (a) The amount of the grant to each eligible school will be the 
amount requested in its application, except that if the total of the 
amounts requested for any fiscal year by all schools for these funds 
exceeds the amount of Federal funds determined by the Secretary at the 
time of payment to be available for this purpose, the grant to each 
school will be reduced to whichever is smaller:
    (1) The amount requested in the application; or
    (2) An amount which bears the same ratio to the total amount of 
Federal funds determined by the Secretary at the time of grant award to 
be available for that fiscal year for this program as the number of 
eligible students at the school bears to the total number of eligible 
students at all participating schools during that year.
    (b) Amounts remaining after the calculation described in paragraph 
(a) will be distributed in accordance with paragraph (a)(2) of this 
section among schools whose applications requested more than the amount 
paid to them, but with whatever adjustments may be necessary to prevent 
the total grant to any school from exceeding the amount requested by it.



Sec. 57.2907  For what purposes may grant funds be spent?

    (a) A school shall only spend funds it receives under this subpart 
in accordance with the approved application, the authorizing 
legislation, terms and conditions of the grant award, and these 
regulations.
    (b) The school must discontinue all payments to a recipient in the 
event that the recipient ceases to be a full-time student at the school, 
and must remit any unused balance of funds to the Federal Government in 
the event it is unable to make full use of its grant award during the 
award period.



Sec. 57.2908  What additional Department regulations apply to grants?

    Several other regulations apply to these grants. They include, but 
are not limited to, the following:

42 CFR part 50, subpart D--Public Health Service Grant Appeals Procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of Grants
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants).
45 CFR part 80--Nondiscrimination Under Programs Receiving Federal 
Assistance Through the Department of Health and Human Services 
Effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and Procedure for Hearings Under part 80 of 
this title
45 CFR part 83--Regulation for the Administration and Enforcement of 
sections 794 and 855 of the Public Health Service Act

[[Page 361]]

45 CFR part 84--Nondiscrimination on the Basis of Handicap in Programs 
and Activities Receiving or Benefiting From Federal Financial Assistance
45 CFR part 86--Nondiscrimination on the Basis of Sex in Education 
Programs and Activities Receiving or Benefiting From Federal Financial 
Assistance
45 CFR part 91--Nondiscrimination on the Basis of Age in HHS Programs or 
Activities Receiving Federal Financial Assistance
45 CFR part 93--New restrictions on lobbying.

[52 FR 18675, May 18, 1992, as amended at 57 FR 45743, Oct. 5, 1992; 61 
FR 6128, Feb. 16, 1996]



Sec. 57.2909  What other records, audit, and inspection requirements apply to schools?

    (a) Each entity which receives a grant under this subpart must meet 
the requirements of 45 CFR part 74 concerning audit and inspection.
    (b) The school must also maintain the following records in computer, 
electronic, microfiche, microfilm, or paper form:
    (1) A record of all recipients of aid under this program which 
includes, for each recipient, a copy of the total need analysis and 
determination of resources, documentation for any changes made to the 
need analysis report used by the school, documentation that the 
recipient met the eligibility requirements, a copy of the student budget 
used to determine the recipient's costs of attendance, and documentation 
of other sources of aid received by the recipient;
    (2) A record of the amount of funds awarded to each recipient; and
    (3) A record of each institutional application for funding, 
including documentation to support the number of eligible students 
listed on each application and how they met the eligibility criteria.
    (c) Institutional officials who have information which indicates the 
potential or actual commission of fraud or other offenses against the 
United States, involving these funds, should promptly provide this 
information to the appropriate Regional Office of Inspector General for 
Investigations.

(Approved by the Office of Management and Budget under control number 
0915-0028)

[52 FR 18675, May 18, 1987, as amended at 61 FR 6128, Feb. 16, 1996; 61 
FR 51020, Sept. 30, 1996]



Sec. 57.2910  Additional conditions.

    The Secretary may impose additional conditions on any grant award 
before or at the time of an award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.



    Subpart EE--Grants for Residency Training in Preventive Medicine

    Authority: Sec. 793 of the Public Health Service Act, 95 Stat. 928 
(42 U.S.C. 295h-1c); redesignated as section 788(c) of the Public Health 
Service Act, 102 Stat. 3134-3135 (42 U.S.C. 295g-8(e)); renumbered as 
sec. 763, as amended by Pub. L. 102-408, 106 Stat. 2047 (42 U.S.C. 
294b).



Sec. 57.3001  To what programs do these regulations apply?

    These regulations apply to the award of grants under section 763 of 
the Public Health Service Act (42 U.S.C. 294b) to schools of medicine, 
osteopathic medicine and public health to meet the costs of projects to 
(a) plan and develop new approved residency training programs and to 
maintain or improve existing approved residency training programs in 
preventive medicine and (b) provide financial assistance to residency 
trainees enrolled in such programs.

[51 FR 11031, Apr. 1, 1986, as amended at 57 FR 45743, Oct. 5, 1992; 61 
FR 6128, Feb. 16, 1996]



Sec. 57.3002  Definitions.

    Academic year means course work sufficient to satisfy the 
requirements for the Master of Public Health degree or its equivalent 
which is required by all approved residency programs. In the usual 
situation, this course work is taken during a single year.

[[Page 362]]

    Act means the Public Health Service Act, as amended.
    Approved residency training program means the entirety or that part 
of a residency training program in preventive medicine which is fully or 
provisionally accredited by the Accreditation Council for Graduate 
Medical Education or approved by the American Osteopathic Association.
    Clinical year means postgraduate training which provides experience 
in direct patient care including ambulatory and inpatient experience. 
The one year of required training can be provided in an accredited 
program in one of the recognized clinical specialties or through 
clinical training sponsored by a preventive medicine residency training 
program. The clinical year is generally a prerequisite for the 
preventive medicine residency training program or the first year of such 
program.
    Field year means specialized instruction and supervised experience 
in the resident's selected area of emphasis, and is usually one year in 
duration. The field year is usually the last year of the preventive 
medicine residency training program and is generally conducted at a site 
remote from that of such program.
    Fields of Preventive Medicine means the following group of basic 
components common to all preventive medicine specialties (a) 
biostatistics, (b) epidemiology, (c) administration of health and 
medical programs, (d) environmental hazards to health, (e) social, 
cultural and behavorial factors in medicine, and (f) the application of 
preventive principles in clinical practice.
    Full-time faculty means an individual or individuals who are 
employed as faculty of a school of medicine, osteopathic medicine or 
public health on a full-time basis as defined by the general policies of 
the applicant institution.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations, no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Preventive Medicine is a specialized area of medical practice 
composed of distinct disciplines which use skills focusing on the health 
of defined populations in order to promote and maintain health and well-
being and prevent disease, disability, and premature death. The 
specialties of preventive medicine are: General preventive medicine, 
public health, occupational health, and aerospace medicine.
    Program Director means an individual appointed by the grantee 
institution to direct and supervise the residency training program who 
is certified or otherwise qualified as required by the Accreditation 
Council for Graduate Medical Education.
    Secretary means the Secretary of Health and Human Services, and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.

[51 FR 11031, Apr. 1, 1986, as amended at 57 FR 45743, Oct. 5, 1992; 61 
FR 6128, Feb. 16, 1996]



Sec. 57.3003  Who is eligible to apply for a grant?

    Accredited public or private nonprofit schools of medicine, 
osteopathic medicine or public health located in a State are eligible to 
apply for a grant. Each eligible applicant desiring a grant under this 
subpart shall submit an application at the time and in such a form that 
the Secretary may prescribe. To be eligible for a grant, an applicant 
must demonstrate that it has, or will have by the end of 1 year of grant 
support, full-time faculty with training and experience in the fields of 
preventive medicine and support from other faculty members trained in 
public health and other relevant specialties and disciplines.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[57 FR 45743, Oct. 5, 1992]

[[Page 363]]



Sec. 57.3004  Project requirements.

    A project supported under this subpart must be conducted in 
accordance with the following requirements:
    (a) Each project must have a project director who works at the 
grantee institution on an appointment consistent with other major 
departments, heads or will head the unit, and has relevant training and 
experience in preventive medicine.
    (b) Each project must have an appropriate administrative and 
organizational plan and appropriate staff and facility resources for the 
achievement of stated objectives.
    (c) Each project must systematically evaluate the educational 
program, including the performance and competence of trainees and 
faculty, the administration of the program, and the degree to which 
program and educational objectives are met.
    (d) All field experiences must be supervised by a qualified faculty 
member.
    (e) All applicants must either demonstrate an increase in minority 
and disadvantaged residents or show evidence of efforts to recruit 
minority and disadvantaged residents.

(Approved by the Office of Management and Budget under control number 
0915--0060)

[51 FR 11031, Apr. 1, 1986, as amended at 57 FR 45744, Oct. 5, 1992]



Sec. 57.3005  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will decide which 
applications to approve by considering, among other factors:
    (1) The potential effectiveness of the proposed project in carrying 
out the training purposes of section 763 of the PHS Act;
    (2) The extent of responsiveness to the project requirements 
described in Sec. 57.3004;
    (3) The administrative and management capability of the applicant to 
carry out the proposed project in a cost-effective manner;
    (4) The degree to which the proposed training program emphasizes 
health promotion and disease prevention;
    (5) The degree to which the applicant demonstrates institutional 
commitment to the proposed program; and
    (6) The history of the program including number of residents who 
successfully completed the program.
    (b) In determining the funding of applications approved under 
paragraph (a) of this section, the Secretary will consider any special 
factors relating to national needs as the Secretary may from time to 
time announce in the Federal Register.

[51 FR 11031, Apr. 1, 1986, as amended at 53 FR 14792, Apr. 26, 1988; 57 
FR 45744, Oct. 5, 1992; 61 FR 6128, Feb. 16, 1996]



Sec. 57.3006  How long does grant support last?

    (a) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 3 years.
    (b) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be for 1 year at a time. 
Decisions regarding continuation awards and the funding levels of these 
awards will be made after consideration of such factors as the grantee's 
progress and management practices, existence of legislative authority, 
and the availability of funds. In all cases, continuation awards require 
a determination by the Secretary that continued funding is in the best 
interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved application or portion of any approved application. For 
continuation support,

[[Page 364]]

grantees must make separate application at such times and in such a form 
as the Secretary may prescribe.

[51 FR 11031, Apr. 1, 1986, as amended at 57 FR 45744, Oct. 5, 1992]



Sec. 57.3007  How is the amount of the grant award determined?

    (a) The amount of any award will be limited to that portion of the 
annual program costs which the Secretary determines, on the basis of the 
documentation required in the application, cannot reasonably be paid 
from other available funds. Moreover, the amount of any stipend will be 
limited to that portion of the annual amount normally paid to other 
residents by the applicant which the Secretary determines, on the basis 
of the documentation required in the application, cannot reasonably be 
paid from other available funds. The applicant must document attempts to 
pursue other sources of funding.
    (b) Stipend support may only be given to residents in the academic 
and field years of training, and support to each resident is limited to 
2 years of training, excluding the clinical year.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[51 FR 11031, Apr. 1, 1986, as amended at 57 FR 45744, Oct. 5, 1992]



Sec. 57.3008  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) Grantees may not spend grant funds for sectarian instruction or 
for any religious purpose.
    (c) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried forward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amounts awarded by withdrawing the excess. A budget 
period is an interval of time (usually 12 months) into which the project 
period is divided for funding and reporting purposes.

[51 FR 11031, Apr. 1, 1986, as amended at 57 FR 45744, Oct. 5, 1992]



Sec. 57.3009  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying.

[51 FR 11031, Apr. 1, 1986, as amended at 57 FR 45744, Oct. 5, 1992; 61 
FR 6128, Feb. 16, 1996]

[[Page 365]]



Sec. 57.3010  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6128, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 57.3011  Additional conditions.

    The Secretary may impose additional conditions in the grant award 
before or at the time of the award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.

[51 FR 11031, Apr. 1, 1986]



  Subpart FF--Grants for Residency Training and Faculty Development in 
           General Internal Medicine and/or General Pediatrics

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
63 Stat. 35 (42 U.S.C. 216); sec. 784 of the Public Health Service Act, 
90 Stat. 2315, as amended by 95 Stat. 922-923 and 99 Stat. 540 (42 
U.S.C. 295g-4); renumbered as sec. 748, as amended by Pub. L. 102-408, 
106 Stat. 2043 (42 U.S.C. 293l).



Sec. 57.3101  To what projects do these regulations apply?

    The regulations of this subpart apply to grants to schools of 
medicine and osteopathic medicine and public or private nonprofit 
hospitals and other public or private nonprofit entities under section 
748 of the Public Health Service Act (42 U.S.C. 293l) to assist in 
meeting the cost of projects--
    (a) To plan, develop and operate approved residency training 
programs in internal medicine and/or pediatrics which emphasize the 
training of residents for the practice of general internal medicine and/
or general pediatrics;
    (b) To provide financial assistance (in the form of traineeships and 
fellowships) to residents who are participants in this type of program, 
and who plan to practice general internal medicine and/or general 
pediatrics;
    (c) To plan, develop and operate a program for the training of 
physicians who plan to teach in a general internal medicine and/or 
general pediatrics training program; and
    (d) To provide financial assistance (in the form of traineeships or 
fellowships) to physicians who are participants in any such program and 
who plan to teach in a general internal medicine and/or general 
pediatrics training program.

[53 FR 50408, Dec. 15, 1988, as amended at 57 FR 45744, Oct. 5, 1992; 61 
FR 6128, Feb. 16, 1996]



Sec. 57.3102  Definitions.

    For purposes of this subpart:
    Act means the Public Health Service Act, as amended.
    Approved residency training program or program is the entirety or 
that part of a residency training program which is fully or 
provisionally accredited by the Accreditation Council for Graduate 
Medical Education or approved by the American Osteopathic Association 
and which emphasizes the training of residents for the practice of 
general internal medicine or general pediatrics.
    Faculty development program means a systematic training program to 
increase faculty competence in teaching skills and in other areas 
related to academic responsibility.
    Health professional shortage area means an area designated under 
section 332 of the Act.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations, no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Nurse practitioner means a nurse practitioner as defined in 42 CFR 
57.2402.
    Practice of general internal medicine or general pediatrics means a 
practice which is limited to adult or child and adolescent medicine 
respectively, and in which the physician:
    (1) Serves as physician of first contact with the patient and 
provides a timely means of entry into the health care system;
    (2) Evaluates the patient's health needs, provides personal health 
care

[[Page 366]]

and refers the patient, if indicated, to appropriate sources of health 
care while preserving the continuity of care;
    (3) Assumes with the patient responsibility for the patient's 
longitudinal and comprehensive (including preventive and psychosocial) 
health care and acts as coordinator of the provision of health services 
to the patient;
    (4) Considers the patient's health care within the context of his or 
her environment including the community and family or comparable social 
units; and
    (5) Where applicable, plans and shares the above functions with 
other physicians.
    Project director means a fully licensed physician on the faculty of 
the grantee, designated by the grantee in the grant application and 
approved by the Secretary to direct the project being supported under 
this subpart.
    School of medicine and osteopathic medicine means a public or 
private nonprofit school which provides training leading respectively to 
a degree of doctor of medicine or to a degree of doctor of osteopathic 
medicine and which is accredited as provided in section 799(1)(E) of the 
Act.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department to whom the authority 
involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    Trainee means an allopathic or osteopathic general internist or 
general pediatrician participating in a faculty development training 
program supported by a grant under section 748 and receiving stipend 
support for such grant.

[45 FR 51202, Aug. 1, 1980, as amended at 49 FR 6906, Feb. 24, 1984; 53 
FR 50408, Dec. 15, 1988; 57 FR 45744, Oct. 5, 1992; 61 FR 6128, Feb. 16, 
1996]



Sec. 57.3103  Who is eligible to apply for a grant?

    Any school of medicine or osteophathic medicine, public or private 
nonprofit hospital or any other public or private nonprofit entity, 
located in a State, may apply for a grant under this subpart. Each 
eligible applicant desiring a grant under this subpart shall submit an 
application in the form and at such time as the Secretary may prescribe.

[57 FR 45744, Oct. 5, 1992]



Sec. 57.3104  What activities must be addressed in an application?

    In addition to other pertinent information which the Secretary may 
require, an application for a grant under this subpart must contain the 
following:
    (a) A proposal for a project to plan, develop, and operate an 
approved residency training or faculty development program in internal 
medicine and/or pediatrics--
    (1) Which emphasizes the training of residents for the practice of 
general internal medicine and/or general pediatrics and faculty for 
teaching in such programs, and
    (2) Which may provide financial assistance to residents and trainees 
who are participants in the programs and who plan to practice or teach 
in general internal medicine and/or general pediatrics.
    (b) A full and adequate description of the proposed project and of 
the manner in which the applicant intends to conduct the project and 
carry out the requirements of this subpart.
    (c) A description of the resources to be used by the applicant for 
the conduct of the proposed project, including faculty, staff, 
equipment, facilities, and appropriate clinical practice settings 
(including those which are used to meet the requirements of 
Sec. 57.3105(j) and (l)).
    (d) In programs other than faculty development, a description of the 
type and amount of training to be offered to residents in each year of 
each residency program in accordance with the requirements of 
Sec. 57.3105 with special attention to the requirements of 
Sec. 57.3105(a)(11).

[[Page 367]]

    (e) In programs other than faculty development, the number of 
residents to be enrolled in each program, at each level of training, for 
each year of the project period.
    (f) A detailed budget for the proposed project and a justification 
of the amount of grant funds requested.
    (g) Documentation showing that funds available from other sources 
will be insufficient to meet the costs of the project and that grant 
funds will not be used to supplant other available funds.
    (h) If stipend support is requested by an applicant to provide a 
portion of the salary of residents enrolled in the program, 
documentation showing that income available from alternative sources, 
including income derived from the services of the residents in the 
program, will be insufficient to pay their salaries and that grant funds 
will not be used to supplant other available funds. Stipend support 
requested for trainees in the faculty development program must be paid 
in accordance with established Public Health Service postdoctoral 
stipend levels.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[45 FR 51202, Aug. 1, 1980, as amended at 49 FR 6906, Feb. 24, 1984; 53 
FR 50408, Dec. 15, 1988]



Sec. 57.3105  Project requirements.

    (a) For each residency program, a project must:
    (1) Have a residency program director.
    (2) Employ an individual with relevant experience or training who is 
responsible for curriculum development and evaluation.
    (3) Employ faculty members experienced in the practice of general 
internal medicine and/or general pediatrics who participate as 
instructors at principal training settings.
    (4) Employ individual(s) with formal education in behavioral 
sciences who participate in the preparation and implementation of the 
curriculum and in clinical consultation.
    (5) Use a resident recruitment and selection process which assures 
that residents in the program have applied specifically for training in 
a program that emphasizes the practice of general internal medicine and/
or general pediatrics.
    (6) Provide financial assistance from grant funds only to residents 
who have signed statements of their intention to specialize or work in 
the practice of general internal medicine and/or general pediatrics.
    (7) Have, in each program of a school of medicine, at least four 
residents in training by the beginning of the second year of Federal 
support, and at least 12 residents in training by the beginning of the 
fourth year of Federal support. By the beginning of the fourth year of 
Federal support, a program may meet this requirement with less than 12 
residents in training if the number of internal medicine or pediatric 
residents in primary care training is at least 50 percent of the total 
number of internal medicine or pediatric residents at the institution. 
The Secretary may suspend this requirement for a period which he or she 
finds appropriate if the Secretary determines that a grantee has made a 
good faith effort to comply with the requirement and has met the other 
requirements of this Subpart and the Act, but is unable to have the 
required number of residents in the program due to circumstances beyond 
its control.
    (8) Have, in each program of a school of osteopathic medicine, at 
least two residents in training by the beginning of the second year of 
Federal support; and at least six residents in training in 3-year 
programs and at least four residents in training in 2-year programs by 
the beginning of the fourth year of Federal support. The Secretary may 
suspend any of these requirements for a period which he or she finds 
appropriate if the Secretary determines a grantee has made a good faith 
effort to comply with the requirement and has met the other requirements 
of this Subpart and the Act, but is unable to have the required number 
of residents in the program due to circumstances beyond its control.
    (9) Plan to have residents distributed so that there is no decrease 
in numbers of residents in successive levels of training by the time the 
program is fully operational.

[[Page 368]]

    (10) Use one or more ambulatory care training settings which 
actively promote the practice of general internal medicine and/or 
general pediatrics, and which:
    (i) Attract patients for primarily longitudinal and comprehensive 
(including psychosocial and preventive) health care;
    (ii) Organize personnel, including residents, into functional units 
providing comprehensive health services and provide residents with 
experience working with various types of health personnel;
    (iii) Have systems for referring patients to other specialists, and 
subspecialists, which assure coordination with the patients' own 
practitioners of general internal medicine and/or general pediatrics;
    (iv) Use an appointment system which facilitates the assignment of 
patients to their practitioner of general internal medicine and/or 
general pediatrics or to a particluar team of practitioners; and
    (v) Use a medical record system which:
    (A) Gives practitioners of general internal medicine and/or general 
pediatrics ready access to a patient's medical records including data 
relating to members of the patient's family which is pertinent to the 
patient's care;
    (B) Is suitable for audit by organizations or individuals who 
perform this work with adequate safeguards against unauthorized 
disclosures; and
    (C) Assures systematic review of the records.
    (11) Make provision for each resident to serve a panel of patients 
and/or families who recognize him or her as their provider of 
longitudinal and comprehensive (including preventive and psychosocial) 
health care. The panel must be sufficiently numerous and varied to 
provide the resident with broad clinical experience. The clinical 
experience must be scheduled principally in ambulatory care settings as 
described in paragraph (a)(10) of this section.
    (12) Offer ambulatory care training relevant to general internal 
medicine and/or general pediatrics in settings such as emergency rooms 
and specialty clinics.
    (13) Have a planned curriculum which:
    (i) Supplements the residents' inpatient and ambulatory patient care 
experiences with related educational activities such as courses, 
presentations, discussions, and reading assignments;
    (ii) Emphasizes subjects pertaining to:
    (A) Ambulatory care;
    (B) Psychosocial skills and topics; and
    (C) Non-clinical areas relevant to the practitioner of general 
internal medicine and/or general pediatrics; and
    (iii) Is annually evaluated, using previously established criteria 
and objectives in a manner which includes the participation of 
residents.
    (14) Develop and use systematic procedures to assess the individual 
resident's needs and to assist in educational planning and evaluation of 
the resident's competence.
    (b) For each faculty development program, a project must:
    (1) Have a project director who is employed by the grantee or 
training institution, has relevant training and experience, and has been 
approved by the Secretary to direct the project;
    (2) Have an appropriate administrative and organizational plan and 
appropriate faculty, staff and facility resources to achieve the stated 
objectives;
    (3) Have a curriculum which:
    (i) Directly applies to general internal medicine and/or general 
pediatrics,
    (ii) Emphasizes improvement of pedagogical skills and techniques for 
clinical teaching in classroom and ambulatory health care settings, and
    (iii) Uses structured didactic and experiential teaching strategies.
    (iv) With respect to training programs of 9 or more months duration, 
the curriculum must also include:
    (A) A research component, with a research project to be completed by 
each trainee, and
    (B) An administrative component which addresses the non-teaching 
roles and functions of faculty;
    (4) Systematically evaluate the educational program, including 
trainees and faculty, the administration of the program, and the degree 
to which the

[[Page 369]]

program and educational objectives are met;
    (5) Have as trainees only physicians who teach or plan teaching 
careers in general internal medicine and/or general pediatrics;
    (6) To be eligible for stipend support from grant funds, a trainee 
must:
    (i) Be a general internist or a general pediatrician,
    (ii) Intend to teach in a general internal medicine and/or general 
pediatrics program on a full-time basis,
    (iii) Be a full-time participant in the training project for at 
least 3 months, and
    (iv) Receive less than full institutional salary during the period 
of Federal support of stipends; and
    (7) Stipend support from grant funds may be no longer than 24 
cumulative months for any trainee.

[45 FR 51202, Aug. 1, 1980, as amended at 49 FR 6906, Feb. 24, 1984; 53 
FR 50409, Dec. 15, 1988; 54 FR 51745, Dec. 18, 1989; 57 FR 45744, Oct. 
5, 1992]



Sec. 57.3106  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will award grants to 
applicants whose projects best promote the purposes of section 748 of 
the Act. The Secretary will take into consideration, among other 
factors:
    (1) The degree to which the proposed project adequately provides for 
the project requirements set forth in Sec. 57.3105;
    (2) The administrative and management capability of the applicant to 
carry out the proposed project in a cost-effective manner;
    (3) The qualifications of the proposed staff and faculty;
    (4) The potential of the project to continue on a self-sustaining 
basis; and
    (5) For faculty development programs, the applicant must demonstrate 
the institution's commitment to general internal medicine and/or general 
pediatrics as defined under Sec. 57.3102.
    (b) In determining the funding of applications approved under 
paragraph (a) of this section, the Secretary shall give priority to 
applicants that demonstrate a commitment to general internal medicine 
and general pediatrics in their medical education training programs. 
However, should specific needs warrant, the Secretary will consider any 
other special factors relating to national needs as the Secretary may 
from time to time announce in the Federal Register.

[45 FR 51202, Aug. 1, 1980, as amended at 53 FR 14792, Apr. 26, 1988; 53 
FR 50409, Dec. 15, 1988; 61 FR 6128, Feb. 16, 1996]



Sec. 57.3107  How long does grant support last?

    (a) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 5 years.
    (b) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be for 1 year at a time. 
Decisions regarding continuation awards and the funding levels of these 
awards will be made after consideration of such factors as the grantee's 
progress and management practices, and the availability of funds. In all 
cases, continuation awards require a determination by the Secretary that 
continued funding is in the best interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved application or portion of an approved application. For 
continuation support, grantees must make separate application at such 
times and in such a form as the Secretary may prescribe.

[45 FR 51202, Aug. 1, 1980, as amended at 53 FR 50409, Dec. 15, 1988; 57 
FR 45744, Oct. 5, 1992]

[[Page 370]]



Sec. 57.3108  How is the amount of the grant award determined?

    The amount of any award will be limited to that portion of the 
annual program costs which the Secretary determines, on the basis of the 
documentation required in the application, cannot reasonably be paid 
from other available funds. Further, the amount of any stipend will be 
limited to that portion of the annual amount normally paid to other 
residents by the applicant which the Secretary determines, on the basis 
of the documentation required in the application, cannot reasonably be 
paid from other available funds, including the incomes derived by the 
hospital from the residents' services.

[45 FR 51202, Aug. 1, 1980]



Sec. 57.3109  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) Grantees may not spend grant funds for sectarian instruction or 
for any religious purpose.
    (c) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds provided and made available to the 
grantee for that period, including any unobligated balance carried 
forward from prior periods, exceeds the grantee's needs for the period, 
the Secretary may adjust the amounts provided by withdrawing the excess. 
A budget period is an interval of time (usually 12 months) into which 
the project period is divided for funding and reporting purposes.

[45 FR 51202, Aug. 1, 1980, as amended at 53 FR 50409, Dec. 15, 1988; 57 
FR 45745, Oct. 5, 1992]



Sec. 57.3110  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying.

[49 FR 38115, Sept. 27, 1984, as amended at 57 FR 45745, Oct. 5, 1992; 
61 FR 6129, Feb. 16, 1996]



Sec. 57.3111  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6129, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 57.3112  Additional conditions.

    The Secretary may impose additional conditions in the grant award 
before or at the time of the award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity,

[[Page 371]]

the interest of the public health, or the conservation of grant funds.

[45 FR 51202, Aug. 1, 1980]



       Subpart GG--Payment for Tuition and Other Educational Costs

    Authority: Sec. 215, Public Health Service Act, 58 Stat. 690, as 
amended by 63 Stat. 35 (42 U.S.C. 216); sec. 711, Public Health Service 
Act, 90 Stat. 2253; section 710, PHS Act, as redesignated by Pub. L. 97-
35, 95 Stat. 915 (42 U.S.C. 292k).



Sec. 57.3201  To which programs do these regulations apply?

    The regulations in this subpart establish the criteria to be used in 
determining allowable increases in tuition and other educational costs 
for which the Secretary is responsible for payment under the following 
sections of the Public Health Service Act: The National Health Service 
Corps Scholarship Program (sec. 338A) (42 U.S.C. 254l) and the Indian 
Health Scholarship Program (awarded pursuant to sec. 338A-339G of the 
PHS Act) (25 U.S.C. 1613a). These programs are referred to herein as the 
``scholarship programs.'' The regulations apply to increases in tuition 
and other educational costs occurring after the school year beginning 
immediately before October 1, 1981.

[57 FR 45745, Oct. 5, 1992]



Sec. 57.3202  How will allowable increases be determined?

    (a) The Secretary is responsible for increases in tuition and other 
educational costs only if the same increase is charged to all students 
in the same category (for example, the same class year or place of 
residence) and without regard to whether the student is receiving 
support under the scholarship programs. A student participating in the 
scholarship programs may not be denied eligibility because of this 
participation for any discounts or rebates in tuition or other 
educational costs given to all other students in the same category at 
the institution.
    (b) Institutions whose enrollment contains 25 percent or more 
students participating in the scholarship programs, and whose percentage 
increase in tuition and other educational costs in any school year 
exceeds the previous calendar year's average inflation rate as indicated 
by the Consumer Price Index for All Urban Areas, may be requested to 
provide the Secretary with detailed cost breakdowns justifying the 
increase.
    (c) In the case of a school which is requested to provide the 
Secretary with cost increase justification under paragraph (b) of this 
section, the Secretary will be responsible for increases in tuition and 
other educational costs charged to students participating in the 
scholarship programs over the amount charged for the school year 
immediately preceding the increase only to the extent that they are: (1) 
Attributable to uncontrollable costs, such as fuel costs, mandated cost-
of-living increases in wages, salaries and fringe benefits, (2) 
attributable to costs of maintaining and improving the quality of the 
health professions education provided by the institution, such as hiring 
additional faculty to improve the faculty-student ratio, costs incurred 
in off-site training of students, and necessary improvements in teaching 
equipment. Increases in patient care and research costs are allowable as 
part of an increase in tuition and other educational costs only to the 
extent that they can be documented as clearly necessary to maintain and 
improve the quality of the education being supported; or (3) 
attributable to loss of revenue from other sources which was used solely 
for the maintenance and improvement of the educational system.

These three categories of valid escalators of tuition and other 
educational costs are exclusive. However, the examples within each 
category are merely illustrative and not meant to be inclusive.
    (d) If the Secretary, after reviewing all available data, 
information, and justifications submitted by an institution, determines 
that an increase in tuition and other educational costs is not allowable 
under the criteria described in paragraph (a) or (c) of this section, 
the Secretary will provide the affected institution a detailed written 
explanation of the basis of that determination. The Secretary will be 
responsible for that portion of tuition

[[Page 372]]

and other educational costs the Secretary determines to be allowable.

[45 FR 71568, Oct. 29, 1980]

Subparts HH-LL  [Reserved]



            Subpart MM--Area Health Education Center Program

    Authority: Sec. 215, Public Health Service Act, 58 Stat. 690, as 
amended by 63 Stat. 35 (42 U.S.C. 216); sec. 781, Public Health Service 
Act, 90 Stat. 2312 (42 U.S.C. 295g-1), as amended.

    Source: 48 FR 7446, Feb. 22, 1983, unless otherwise noted.



Sec. 57.3801  To what programs do these regulations apply?

    The regulations of this subpart apply to cooperative agreements 
entered into by the Secretary under section 781 of the Public Health 
Service Act (42 U.S.C. 295g-1) with schools of medicine or osteopathy 
for the planning, development, and operation of area health education 
center programs.



Sec. 57.3802  Definitions.

    Act means the Public Health Service Act.
    Allied health personnel means individuals as defined in 42 CFR 
58.502.
    Area health education center or center means a public or nonprofit 
private entity which has a cooperative arrangement with one or more 
schools of medicine or osteopathy for the planning, development, and 
operation of an area health education center program. A center must be 
an entity which is recognized under the laws of the State in which it is 
located and which has as one of its principal functions the operation of 
the area health education center.
    Area health education center program or project means a cooperative 
program among one or more schools of medicine or osteopathy and one or 
more area health education centers, which is capable of performing the 
functions described in sections 781(c) and (d) (2) of the Act and 
Sec. 57.3804 of these regulations, and which is designed to improve the 
distribution, supply, quality, utilization, and efficiency of health 
personnel in the health services delivery system and to encourage the 
regionalization of educational responsibilities of health professions 
schools.
    Cooperative agreement means a legal instrument that reflects an 
assistance relationship between the Federal Government and the recipient 
in which substantial programmatic involvement is anticipated between the 
Federal agency and the recipient during performance of the contemplated 
activity.
    Clerkship means supervised clinical training.
    Continuing medical education or continuing education means any 
education for the purpose of maintaining or enhancing the knowledge, 
attitudes or abilities of a health professional in his or her field 
which does not lead to any formal advanced standing in the profession.
    Health professional means any physician, dentist, optometrist, 
podiatrist, pharmacist, nurse, nurse practitioner, physician assistant 
or allied health personnel.
    Nurse practitioner means an individual as defined in 42 CFR 57.2402.
    Physician assistant means an individual as defined in 42 CFR 57.802.
    Preceptorship means an educational experience in which the student 
works with a designated health professional, the preceptor, who teaches 
in the student's field of study and personally supervises the student's 
clinical activity.
    School of medicine, osteopathy, dentistry, optometry, podiatry, 
pharmacy, public health or veterinary medicine means a school as defined 
in section 701(4) of the Act which is accredited as provided in section 
772(b) of the Act.
    School of nursing means a collegiate, associate degree or diploma 
school of nursing as defined in section 853 of the Act.
    Training center for allied health professions means a training 
center as defined in 42 CFR 58.402
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, only the District of 
Columbia, the Commonwealth of Puerto Rico,

[[Page 373]]

the Commonwealth of Northern Mariana Islands, the Virgin Islands, Guam, 
American Samoa, and the Trust Territory of the Pacific Islands.



Sec. 57.3803  Who is eligible to apply for a cooperative agreement?

    (a) Any public or nonprofit private school of medicine or osteopathy 
located in a State is eligible to submit a proposal.
    (b) More than one accredited school of medicine or osteopathy may 
submit a joint proposal for the planning, development and operation of 
an area health education center program. In this case, each school must 
conduct the activities required by section 781(c) of the Act and 
Sec. 57.3804(d) of these regulations.



Sec. 57.3804  Project requirements.

    A project supported under this subpart must be conducted in 
accordance with the following requirements:
    (a) Each area health education center program must have a program 
director who holds a faculty appointment at a medical or osteopathic 
school participating in the program and who is responsible for the 
overall direction and coordination of the program.
    (b) Each area health education center program must have a program 
advisory committee to advise the program director on all aspects of the 
conduct of the program including administration, education and 
evaluation. This committee must include representatives of schools and 
programs of health professions which actively participate in the area 
health education center program under Sec. 57.3804(d)(5) of this subpart 
and section 781(c)(4) of the Act, individuals with training and 
experience in the fields of medicine or osteopathy, dentistry, nursing, 
and an allied health profession, as well as a representative of each of 
the centers cooperating in the program.
    (c) Each area health education center program must annually evaluate 
its activities to ascertain the extent to which it is meeting the 
purposes described in section 781(a) of the Act.
    (d) Requirements for schools of medicine or osteopathy. A school of 
medicine or osteopathy participating in an area health education program 
(with the exception of a school whose only function is to provide 
resources by purchase agreement to a center) must meet the following 
requirements. However, a school of medicine or osteopathy must fulfill 
the requirement of Sec. 57.3804(d)(4) only if no other school of 
medicine or osteopathy participating in the program meets this 
requirement. Each school of medicine or osteopathy must:
    (1) Have a cooperative arrangement with an area health education 
center, as evidenced by a written agreement. This agreement must provide 
at a minimum that the schools participating in the program will perform 
the following functions:
    (i) Provide faculty to assist in the conduct of the center's 
educational activities, as necessary;
    (ii) Provide an agreed upon amount of funds to the center to assist 
the center in meeting the costs of its activities, including those 
described in section 781(d)(2) of the Act;
    (iii) Be responsible for the quality of the education received in 
the center, including evaluating the quality of the educational programs 
required by section 781(d)(2) of the Act and the performance of its 
students while receiving clinical training in the center. The area 
health education center must agree to conduct the activities described 
in section 781(d)(2) of the Act and these regulations, and assist the 
schools participating in the program in meeting the requirements in 
section 781(c) of the Act and these regulations.
    (2) Provide for the active participation in the program by 
individuals who are associated with the administration of the school, 
and staff or faculty members of each of the departments (or specialties 
if the school has no departments) of internal medicine, pediatrics, 
obstetrics and gynecology, surgery, psychiatry and family medicine. 
These persons may participate in the program in either the school or 
center and must perform, among others, the following functions: provide 
guidance on educational program or curriculum development and operation; 
instruct students (including residents and other practicing health 
professionals); perform student or program evaluation; and assist in 
program administration.

[[Page 374]]

    (3) Conduct no less than 10 percent of all undergraduate medical or 
osteopathic clinical education of the school in one or more centers and 
in clinical settings which are part of or affiliated with a center and 
in which the center arranges and supports the clinical education. The 
school shall assure that, annually, the ratio of student weeks of 
clinical education received by its undergraduate students in centers to 
the total number of student weeks of clinical education received by its 
undergraduate students, in any location, is no less than 0.10. For 
purposes of this paragraph, undergraduate medical or osteopathic 
clinical education means any clerkships, preceptorships, or other 
educational activities which are offered in the following fields: family 
medicine, internal medicine and its subspecialties, pediatrics and its 
subspecialties, dermatology, obstetrics and gynecology, surgery and its 
subspecialties, anesthesiology, psychiatry and its subspecialties, 
neurology, physical medicine and rehabilitation, emergency medicine, 
nuclear medicine and general preventive medicine, including community 
medicine. Courses, seminars, and other educational programs which are 
entirely didactic or laboratory in nature or which are primarily in 
anatomy, biochemistry, physiology, microbiology, pharmacology, or 
pathology are not included in this definition.
    (i) The Secretary may waive, for good cause shown, all or part of 
the requirement of this paragraph if another such school participating 
in the same program meets the requirement.
    (ii) To obtain a waiver, a school must submit a written request to 
the Secretary fully describing and documenting the good cause and 
stating which school meets the requirement. This request must include 
the following information:
    (A) The extent to which the school for which the waiver has been 
requested has attempted to meet this requirement. A description of 
efforts and the reasons why the school cannot meet the requirement must 
demonstrate that the school has made a good faith effort, but 
constraints beyond its control have caused these efforts to be 
unsuccessful.
    (B) The length of time for which this waiver is requested, and a 
plan and timetable for meeting the requirement.
    (C) The alternative mechanisms the schools will use to provide 
clinical experiences in locations removed from the site of the teaching 
facilities where the major part of the educational program of any 
participating schools is conducted if the waiver is granted.
    (4) Be responsible for, or conduct a program for the training of 
physician assistants, which meets the requirements of 42 CFR part 57, 
subpart I, or nurse practitioners, which meets the requirements of 42 
CFR part 57, subpart Y, appendix. If one school which is participating 
in the area health education center program provides for or conducts a 
program for the training of physician assistants or nurse practitioners 
meeting this requirement, other schools participating in the program 
may, but need not, provide for or conduct a physician assistant or nurse 
practitioner program. Where the school is responsible for, but does not 
conduct one of these programs, it must participate in the presentation, 
review, and evaluation of one of these programs at an affiliated 
institution so that at least part of the education in the program is 
provided by faculty of the school. The school must give special 
consideration to the enrollment in these programs of individuals from or 
who plan to practice in the area served by the center by either:
    (i) Giving preference to applicants whose place of residence has 
been in the area served by the center at any time prior to application; 
or
    (ii) Obtaining a signed statement from applicants, indicating an 
intent to practice the skills acquired in the program in the areas.
    (5) Provide for the active participation of at least two schools or 
programs of other health professions in the educational program 
conducted in the area served by the center(s). In meeting this 
requirement:
    (i) One of the participating schools or programs must be a school of 
dentistry, if there is one affiliated with the university with which the 
school of medicine or osteopathy is affiliated;
    (ii) Only the following schools or programs of other health 
professions may

[[Page 375]]

be included to meet the requirement of this paragraph:
    (A) Training centers for the allied health professions;
    (B) Schools of nursing;
    (C) Schools of optometry;
    (D) Schools of pharmacy;
    (E) Schools of podiatry; or
    (F) Schools of public health.
    (iii) Each school or program participating in the area health 
education center program under this paragraph must have a written 
agreement with the school(s) of medicine or osteopathy, under which the 
school or program agrees to assist and participate, as is appropriate, 
in the activities of each center as required under section 781(d)(2) of 
the Act.
    (iv) Each school or program participating in the area health 
education center under this paragraph must have a written agreement with 
each center, under which the school or program agrees to provide some or 
all of its students with educational experiences in the center or in 
settings affiliated with the center, and the center agrees to arrange 
for and support the provision of the educational programs. This 
agreement may be part of the agreement required by paragraph (d)(1) of 
this section.
    (e) Requirements for area health education centers. Each area health 
education center participating in an area health education center 
program must:
    (1) Designate either a geographic area or medically underserved 
population which it will serve (``the area served by the center''). This 
area or population must be in a location remote from the main site of 
the teaching facilities of the schools which participate in the program. 
For purposes of this requirement,
    (i) A medically underserved population means the population of a 
geographic area designated as a primary medical personnel shortage area 
under section 332 of the Act or a population group designated under 
section 332 of the Act as having a shortage of primary medical care 
personnel;
    (ii) An area or population will meet this requirement if its 
location is removed from the site of the teaching facilities where the 
major part of the educational program of any participating school is 
conducted. The area served by the center must not duplicate, in whole or 
in part, the area served by any other center.
    (2) Provide for or conduct training in health education services, in 
the area served by the center. This training must consist of courses and 
programs to train health professionals to instruct the public or 
patients in medical self-help, disease prevention, accident prevention, 
nutrition, physical fitness, and other subjects relating to health 
maintenance, and must include the principles of nutrition, the 
evaluation of nutritional status, and nutritional counseling. The 
training must be oriented toward the ethnic and cultural backgrounds of 
the people in the area.
    (3) Assess the health manpower needs of the area served by the 
center and assist in the planning and development of training programs 
to meet these needs. In meeting this requirement, the center should work 
with existing health systems agencies designated for the area served by 
the center and other appropriate entities by cooperatively developing 
and sharing data on health personnel needs of the area for the next 10 
years and in developing a plan for training programs to meet these 
needs. In areas where HSAs exist, the planned training programs must be 
consistent with the health personnel projections developed by the health 
systems agencies. At a minimum, the center must assess the need for (i) 
personnel to provide health education and nutrition counseling services; 
(ii) primary care health personnel including physicians in family 
practice, general internal medicine, general pediatrics, and obstetrics 
and gynecology, physician assistants, and nurse practitioners; (iii) 
mental health practitioners; (iv) dentists; and (v) nurses. In carrying 
out its responsibility to assess health personnel needs in the area, the 
center shall, to the maximum extent practicable, use existing data 
(including data used for the designation of shortage areas under 
sections 332 and 836(h) of the Act).
    (4) Provide for or conduct a rotating osteopathic internship or 
medical residency training program in family practice, general internal 
medicine or general pediatrics, or osteopathy in which

[[Page 376]]

no fewer than six persons are enrolled in first-year positions in the 
program. If one center which is participating in the area health 
education center program provides for or conducts a medical residency 
training program meeting this requirement, other centers participating 
in the program may, but need not, provide for or conduct a medical 
residency training program in these fields. In meeting this requirement:
    (i) A family practice residency for allopathic and osteopathic 
physicians must meet the requirements of section 786(a) of the Act, and 
implementing regulations.
    (ii) A general internal medicine or general pediatrics residency 
must meet the requirements of 42 CFR 57.3104, except for the 
requirements in paragraphs (h) and (i) of that section.
    (iii) The center must conduct the medical residency training program 
at a site which is part of the center or provide for the conduct of this 
program, by written affiliation agreement with an appropriate entity 
located in the area served by the center.
    (5) Provide opportunities for continuing medical education 
(including education in disease prevention) to all physicians and other 
health professionals practicing within the area served by the center. 
This continuing medical education must include courses, seminars, 
lectures, grand rounds, clinical pathological conferences, mini-
residencies, library services, or in-house training, as appropriate, for 
all health professionals in the area. In meeting this requirement:
    (i) The center must assess the need for providing continuing medical 
education taking into consideration the numbers, needs and location of 
health professionals in the area as well as educational activities 
available through other entities.
    (ii) The center must announce the availability of continuing medical 
education activities offered in the center, as well as those provided 
through other entities in the area, through appropriate and usual 
distribution channels.
    (6) Provide continuing medical education and other educational 
support services to the National Health Service Corps (Corps) members 
assigned to the area served by the center, after notification of the 
assignment(s) by the Secretary. In meeting this requirement, the center 
must:
    (i) Establish an organized program which will provide for the 
assessment of the continuing medical education needs of the members of 
the Corps and offer to members of the Corps, at a cost not to exceed the 
cost to any other participant, continuing medical education relevant to 
these identified needs.
    (ii) Assist in identifying resources for and encouraging the 
provision of:
    (A) Consultation services, if needed, including telephone 
consultation to Corps personnel.
    (B) A patient referral system, if necessary, to Corps patients and 
assistance to these patients in obtaining laboratory and pathological 
services at accessible locations.
    (C) Supervision and consultation for non-physician and non-dentist 
members of the Corps in the area.
    (D) Temporary substitutes for Corps personnel, as needed.
    (7) Encourage the utilization of nurse practitioners and physician 
assistants in the area and the recruitment of individuals for training 
in these professions at the participating medical or osteopathic 
schools. In meeting this requirement, the center must:
    (i) Inform potential employers in the area regarding the following, 
among other subjects;
    (A) The function and utilization of nurse practitoners and physician 
assistants;
    (B) State laws and regulations governing nurse practitioners and 
physician assistants; and
    (C) Reimbursement and malpractice coverage for services rendered by 
nurse practitioners and physician assistants.
    (ii) Determine employment opportunities for nurse practitioners and 
physician assistants and participate in referral and recruitment of 
persons for these positions.
    (iii) Distribute information in the area concerning the nurse 
practitioner or physician assistant training program(s) provided for or 
conducted by the schools of medicine or osteopathy participating in the 
program, and participate in recruiting persons in the area for the 
programs.

[[Page 377]]

    (8) Arrange and support educational opportunities for medical and 
other students at affiliated health facilities, ambulatory care centers, 
and health agencies throughout the area served by the center. In meeting 
this requirement, the center must:
    (i) Coordinate the conduct of the following programs, including 
assisting in their planning and development, obtaining the necessary 
resources and providing administrative support services for:
    (A) Clinical education for undergraduate medical or osteopathic 
students in at least family practice, general internal medicine or 
general pediatrics;
    (B) Education for undergraduate and, as appropriate, graduate 
students, at a school of dentistry, if one is participating in the 
program;
    (C) Education for students of the other schools or programs 
participating in the area health education center program under 
paragraph (d)(5) of this section; and
    (D) Orientation for high school and post-high school students in 
schools in the area to develop awareness of health careers and health 
opportunities.
    (9) Have an advisory board of which at least 75 percent of the 
members are persons from the area served by the center, including health 
service providers and consumers. For this purpose, health service 
providers are individuals who derive more than 10 percent of their 
annual income from the health care industry. In meeting this 
requirement:
    (i) The advisory board must be reasonably divided between:
    (A) Providers of health care, including at least one physician, 
dentist, nurse, and allied health professional who is actively engaged 
in the practice of his or her profession in the area served by the 
center; and
    (B) Consumers, including students, who reside in the area and are 
broadly representative of the population in the area in terms of 
demographic factors, such as race, ethnic background and sex. The 
advisory board shall advise the chief administrative official of the 
center on all major policies concerning the operation of the center, on 
the establishment of center program priorities and on other issues, as 
necessary.



Sec. 57.3805  When do the requirements of Sec. 57.3804 apply?

    (a) The period of time in which any entity will have to meet all the 
requirements or Sec. 57.3804 will be negotiated on a case-by-case basis, 
depending upon the nature and scope of the planned area health education 
center program. No cooperative agreement, however, shall provide funds 
solely for the planning or development of a program for a period of 
longer than two years.
    (b) Each area health education center program must begin planning 
for at least one center during the first year of support so that at 
least one center is fully operational and meets all the applicable 
requirements of Sec. 57.3804 during the third year of support. 
Additional centers may be phased in during the first four years of 
Federal support except that once planning for any center is initiated, 
it must become fully operational and meet all the applicable 
requirements of Sec. 57.3804 within three years.
    (c) Each school with which the Secretary enters into a cooperative 
agreement under this subpart must meet all the requirements of 
Sec. 57.3804 during the first four years of Federal support, except that 
once planning to add any school is initiated, it must meet all the 
applicable requirements of Sec. 57.3804 within three years.



Sec. 57.3806  How will applications be evaluated?

    (a) After consulting with the National Advisory Council on Health 
Professions Education established by section 702 of the Act, the 
Secretary will award cooperative agreements to applicants whose projects 
will best promote the purposes of section 781 of the Act and these 
regulations, taking into consideration among other factors:
    (1) The degree to which the proposed project adequately provides for 
the program requirements set forth in Sec. 57.3804;
    (2) The capability of the applicant to carry out the proposed 
project; and

[[Page 378]]

    (3) The extent of the need of the area to be served by the proposed 
area health education center.
    (b) In determining the funding of applications approved under 
paragraph (a) of this section, the Secretary will consider any special 
factors relating to national needs as the Secretary may from time to 
time announce in the Federal Register.

[48 FR 7446, Feb. 22, 1983, as amended at 53 FR 14792, Apr. 26, 1988]



Sec. 57.3807  How is the amount of the award determined?

    (a) The amount of the award will be based on the Secretary's 
estimate of the sum necessary for the approved activity.
    (b) The Secretary will not provide in any year under this subpart 
more than 75 percent of the total operating funds of an area health 
education center program.



Sec. 57.3808  How long does support under a cooperative agreement last?

    (a) The cooperative agreement will specify the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. In addition, the maximum period during which a 
project may be funded will be specified in each cooperative agreement.
    (b) Generally, the project will initially be funded for one year, 
and subsequent continuation awards will also be for one year at a time. 
A school which enters into a cooperative agreement must submit a 
separate application to have the support continued for each subsequent 
year. Decisions regarding continuation awards and the funding levels of 
these continuation awards will be made after consideration of such 
factors as the applicant's progress and management practices, and the 
availability of funds. In all cases, continuation awards require a 
determination by the Secretary that continued funding is in the best 
interest of the Federal Government.
    (c) Neither the approval of any application nor the entering into of 
any cooperative agreement commits or obligates the Federal Government in 
any way to make any additional, supplemental, continuation or other 
award with respect to any approved application or portion of an approved 
application.
    (d) Any balance of federally obligated funds remaining unobligated 
by the school at the end of a budget period may be carried forward to 
the next budget period, for use as prescribed by the Secretary, provided 
a continuation award is made. If at any time during a budget period it 
becomes apparent to the Secretary that the amount of Federal funds 
awarded and available to the school for that period, including any 
unobligated balance carried forward from prior periods, exceeds the 
school's needs for the period, the Secretary may adjust the amounts 
awarded by withdrawing the excess. A budget period is an interval of 
time (usually 12 months) into which the project period is divided for 
funding and reporting purposes.



Sec. 57.3809  For what purposes may cooperative agreement funds be spent?

    (a) A school which is awarded a cooperative agreement shall only 
spend funds it receives under this subpart according to the approved 
application and budget, the authorizing legislation, terms and 
conditions of the cooperative agreement award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) The area health education center program must spend at least 75 
percent of the funds provided under this subpart in any year in area 
health education centers.
    (c) Schools which are awarded cooperative agreements may not spend 
cooperative agreement funds for sectarian instruction or for any 
religious purpose.



Sec. 57.3810  How will the Department participate in a cooperative agreement?

    The Secretary anticipates substantial Federal involvement in the 
management of the project supported under the cooperative agreement. 
This involvement may include, as determined necessary, the following 
activities, among others:

[[Page 379]]

    (a) Reviewing and approving plans, upon which continuation of the 
cooperative agreement is contingent, to permit appropriate direction and 
conduct of activities;
    (b) Reviewing and approving all contracts between the cooperating 
school of medicine, other health professions schools, and area health 
education centers;
    (c) Participating with project staff in the development of funding 
projections;
    (d) Developing with project staff data collection systems and 
procedures; and
    (e) Participating with project staff in the design of project 
evaluation protocols and methodologies.



Sec. 57.3811  What additional Department regulations apply to awardees?

    Several other regulations apply to cooperative agreements under this 
subpart. These include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Debarment and suspension from eligibility for financial 
assistance
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 799A and 845 of the Public Health Service Act 1

    \1\ Section 799A of the Public Health Service Act was redesignated 
as section 704 by Pub. L. 94-484; section 845 of the Public Health 
Service Act was redesignated as section 855 by Pub. L. 94-63.

45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

[49 FR 38115, Sept. 27, 1984]



Sec. 57.3812  What other audit and inspection requirements apply?

    Each school which enters into a cooperative agreement must, in 
addition to the requirements of 45 CFR part 74, meet the requirements of 
section 705 of the Act concerning audit and inspection.



Sec. 57.3813  Additional conditions.

    The Secretary may impose additional conditions on any award before 
or at the time of any award if the Secretary determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the continued viability of the school, the interest 
of the public health, or the conservation of public funds.

Subpart NN  [Reserved]



           Subpart OO--Grants for Geriatric Education Centers

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
67 Stat. 631 (42 U.S.C. 216); sec. 788(d) of the Public Health Service 
Act, 99 Stat. 542 (42 U.S.C. 295g-8); redesignated as sec. 789(a), as 
amended by Pub. L. 100-607, 102 Stat. 3136-37 (42 U.S.C. 295g-9(a)); 
renumbered as sec. 777(a), as amended by Pub. L. 102-408, 106 Stat. 
2052-54 (42 U.S.C. 294o).

    Source: 54 FR 5617, Feb. 6, 1989, unless otherwise noted.



Sec. 57.4001  To what projects do these regulations apply?

    These regulations apply to grants to eligible schools and programs 
under section 777(a) of the Public Health Service Act for geriatric 
training projects.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992; 58 
FR 66298, Dec. 20, 1993]



Sec. 57.4002  Definitions.

    Act means the Public Health Service Act, as amended.
    Allied health professional means a health professional who has 
received a certificate, an associate's degree, a bachelor's degree, a 
master's degree, a

[[Page 380]]

doctoral degree, or postbaccalaureate training, in a science relating to 
health care and meets the requirements as established in section 799(5) 
of the Act.
    Budget period means the interval of time into which the project 
period is divided for budgetary and reporting purposes, as specified in 
the grant award document.
    Continuing education means structured educational programs for 
practicing health professionals and allied health professionals for the 
purpose of improving the knowledge and skills in geriatrics of such 
practitioners with respect to treatment of the health problems of 
elderly individuals.
    Geriatrics is the total health and social care of the elderly.
    Geriatric Medicine means the prevention, diagnosis, care and 
treatment of illness and disability as required by the distinct needs of 
the elderly.
    Graduate program in clinical social work and graduate program in 
marriage and family therapy means an accredited graduate program as 
defined in section 799(1)(C) of the Act.
    Graduate program in mental health practice means a graduate program 
in clinical psychology, clinical social work, or marriage and family 
therapy (section 799(1)(D) of the Act).
    Health professional means, for purposes of this subpart, any 
allopathic or osteopathic physician, dentist, optometrist, podiatrist, 
pharmacist, professional nurse (as defined in Sec. 57.2502), and nurse 
practitioner (as defined in Sec. 57.2402), physician assistant, 
chiropractor, clinical psychologist, health administrator, or allied 
health professional.
    Health professions schools means any school of medicine, dentistry, 
osteopathic medicine, pharmacy, optometry, podiatric medicine, 
veterinary medicine, public health, chiropractic, graduate programs in 
health administration, or graduate programs in clinical psychology, as 
defined in section 799(1) (A), (B), (C), and (D) of the Act and as 
accredited in section 799(1)(E) of the Act.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Program for the training of physician assistants means any 
educational programs as defined in section 799(3) of the Act.
    Project director means an individual designated by the grantee in 
the grant application and approved by the Secretary to direct the 
project being supported under this subpart.
    Project period means the total time for which support for a project 
has been approved including any extensions of the project.
    School of allied health means a public or private nonprofit junior 
college, college, university or hospital-based educational entity which 
provides or is accredited to provide a program of education to enable 
individuals to become allied health professionals or to provide 
additional training for allied health professionals and which meets the 
criteria set forth in section 799(4) of the Act.
    School of nursing means a collegiate, associate degree, or diploma 
school of nursing in a State (section 853(2) of the Act).
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    Training and retraining of faculty means a program to train and 
retrain faculty to provide geriatric instruction which is not a 1-year 
retraining program for faculty in schools of medicine and osteopathic 
medicine in geriatrics or a 1-year or 2-year internal medicine or family 
medicine fellowship program as identified in section 777(3)(A) and (B) 
of the Act.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992; 58 
FR 66298, Dec. 20, 1993; 61 FR 6129, Feb. 16, 1996]

[[Page 381]]



Sec. 57.4003  Who is eligible to apply for a grant?

    Any public or private nonprofit health professions school, school of 
allied health, or program for the training of physician assistants 
located in a State may apply for a grant under this subpart. Each 
eligible applicant desiring a grant under this subpart shall submit an 
application in the form and at the time the Secretary may prescribe.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992]



Sec. 57.4004  Program requirements.

    (a) The Secretary will award grants to meet the cost of carrying out 
one or more of the following six purposes:
    (1) Improve the training of health professionals in geriatrics;
    (2) Develop and disseminate curricula relating to the treatment of 
the health problems of elderly individuals;
    (3) Expand and strengthen instruction in methods of geriatric 
treatment;
    (4) Support the training and retraining of faculty;
    (5) Support continuing education of health professionals and allied 
health professionals who provide geriatric treatment; and
    (6) Establish new affiliations with nursing homes, chronic and acute 
disease hospitals, ambulatory care centers, and senior centers in order 
to provide students with clinical training in geriatric medicine.
    (b) Projects must include one or more of the activities in 
paragraphs (a) (1) through (6) of this section for four or more types of 
health professionals as defined in Sec. 57.4002 of this subpart.
    (c) Each project must evaluate the program systematically, including 
the determination of a baseline at the outset of the project and the 
measurement of the degree to which program and educational objectives 
are met.

[54 FR 5617, Feb. 6, 1989, as amended at 58 FR 66299, Dec. 20, 1993]



Sec. 57.4005  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will decide which 
applications to approve by considering, among other factors:
    (1) The degree to which the proposed project adequately provides for 
the project requirement described in Sec. 57.4004;
    (2) The extent to which the rationale and specific objectives of the 
project are based upon a needs assessment of the status of geriatrics 
training in the institutions to be assisted and/or the geographic area 
to be served;
    (3) The ability of the project to achieve the project objectives 
within the proposed geographic area;
    (4) The adequacy of educational facilities and clinical training 
settings to accomplish objectives;
    (5) The adequacy of organizational arrangement involving 
professional schools and other organizations necessary to carry out the 
project;
    (6) The adequacy of the qualifications and experience in geriatrics 
of the project director, staff and faculty;
    (7) The administrative and managerial ability of the applicant to 
carry out the proposed project in a cost-effective manner; and
    (8) The potential of the project to continue on a self-sustaining 
basis.
    (b) In determining the funding of applications approved under 
paragraph (a) of this section, the Secretary will consider any special 
factors relating to national needs as the Secretary may from time to 
time announce in the Federal Register.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992; 58 
FR 66299, Dec. 20, 1993]



Sec. 57.4006  How long does grant support last?

    (a) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 3 years. The maximum period of support, including

[[Page 382]]

the initial project period and competitive extensions, may not exceed 6 
years.
    (b) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be for 1 year at a time. 
Decisions regarding continuation awards and the funding levels of these 
awards will be made after consideration of such factors as the grantee's 
progress and management practices, existence of legislative authority, 
and the availability of funds. In all cases, continuation awards require 
a determination by the Secretary that continued funding is in the best 
interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant shall commit or obligate the United States in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved application or portion of an approved application. For 
continuation support, grantees must make separate application at such 
times and in such a form as the Secretary may prescribe.

[54 FR 5617, Feb. 6, 1989, as amended at 58 FR 66299, Dec. 20, 1993]



Sec. 57.4007  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations.
    (b) Grantees may not spend grant funds for sectarian instruction or 
for any religious purpose.
    (c) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried forward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amounts awarded by withdrawing the excess. A budget 
period is an interval of time (usually 12 months) into which the project 
period is divided for funding and reporting purposes.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992]



Sec. 57.4008  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart.
    These include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
and Governmentwide Requirements for Drug-Free Workplace (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992; 61 
FR 6129, Feb. 16, 1996]



Sec. 57.4009  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6129, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]

[[Page 383]]



Sec. 57.4010  Additional conditions.

    The Secretary may impose additional conditions in the grant award 
before or at the time of the award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.



 Subpart PP--Grants for Faculty Training Projects in Geriatric Medicine 
                              and Dentistry

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
67 Stat. 631 (42 U.S.C. 216); sec. 789(b) of the PHS Act, as amended by 
Public Law 100-607, 102 Stat. 3136-3138 (42 U.S.C. 295g-9(b)); 
renumbered as sec. 777(b), as amended by Pub. L. 102-408, 106 Stat. 
2052-54 (42 U.S.C. 294o).

    Source: 55 FR 37481, Sept. 12, 1990, unless otherwise noted.



Sec. 57.4101  To what projects do these regulations apply?

    These regulations apply to grants to eligible schools and programs 
under section 777(b) of the Act (42 U.S.C. 294o) for the purpose of 
providing support for projects to train physicians and dentists who plan 
to teach geriatric medicine, geriatric psychiatry, or geriatric 
dentistry, including traineeships, and fellowships for participation in 
these programs.

[59 FR 63902, Dec. 12, 1994]



Sec. 57.4102  Definitions.

    Act means the Public Health Service Act, as amended.
    Budget period means the interval of time (usually 12 months) into 
which the project period is divided for budgetary and funding purposes.
    Elderly means a population with health care conditions and needs 
which differ significantly from those of younger people, which are often 
complicated by the physical, behavioral, and social changes associated 
with aging. This would include all persons over 60, but may include 
slightly younger people who are subject to similar physical and/or 
mental conditions.
    Extended care facility means a health care institution or distinct 
part of an institution that furnishes, in lieu of hospitalization, room 
and board and medically-prescribed skilled nursing care or 
rehabilitative services 24 hours a day by an organized health care 
staff.
    Fellow means an allopathic physician, osteopathic physician, or 
dentist participating in a retraining program or fellowship program 
supported by a grant under section 777(b).
    Fellowship program means a 2-year organized training effort 
sponsored by an allopathic or osteopathic medical school, a teaching 
hospital, or a graduate medical education program which is designated to 
provide training for--
    (1) Physicians who have completed a graduate medical education 
program in internal medicine, family medicine (including osteopathic 
general practice), psychiatry, neurology, gynecology, or rehabilitation 
medicine; and
    (2) Dentists who have demonstrated a commitment to an academic 
career and who have completed postdoctoral dental training, including 
postdoctoral dental education programs or who have relevant advanced 
training or experience.
    Full-time teaching physician means an allopathic or osteopathic 
physician who is a faculty member of the grantee institution and who is 
engaged in teaching, research, clinical, and administrative activities 
normally performed by teaching faculty employed on a full-time basis, as 
defined by the grantee institution.
    Full-time teaching dentist means a dentist who is a faculty member 
and who is engaged in teaching, research, clinical, and administrative 
activities normally performed by teaching faculty employed on a full-
time basis, as defined by the institution. The dental faculty member 
does not have to be employed by the grantee institution but can be a 
dental faculty member at another institution which has an affiliation 
agreement with the grantee institution.
    Full-time training means full-time training, as defined by the 
grantee institution.
    Geriatric dentistry means the provision of dental care for elderly 
persons, particularly those with one or more chronic or debilitating, 
physical or

[[Page 384]]

mental illnesses with associated medication or psychosocial problems.
    Geriatric medicine means the prevention, diagnosis, and medical 
treatment of illness and disability as required by the needs of the 
elderly.
    Geriatric psychiatry means the prevention, diagnosis, evaluation and 
treatment of mental disorders and disturbances seen in older adults.
    Graduate medical education program means a program sponsored by a 
school of medicine, a school of osteopathic medicine, a hospital, or a 
public or private nonprofit institution, which:
    (1) Offers postgraduate medical training in the specialties and 
subspecialties of medicine; and
    (2) Has been accredited by the Accreditation Council for Graduate 
Medical Education or the American Osteopathic Association through its 
Committee on Postdoctoral Training.
    Grantee means an entity that receives a grant and assumes legal and 
financial responsibility both for the awarded funds and for the 
performance of the grant-supported activity.
    Longitudinal care means the provision of medical or dental care to 
the same panel of elderly patients for a period of at least 9 months in 
each year of training.
    Part-time teaching dentist means a dentist who is a faculty member 
and who is engaged in teaching, research, clinical, and administrative 
activities normally performed by teaching faculty employed on a part-
time basis, as defined by the institution. The dental faculty member 
does not have to be employed by the grantee institution but can be a 
dental faculty member at another institution which has an affiliation 
agreement with the grantee institution.
    Postdoctoral dental education program means a program sponsored by a 
school of dentistry, a hospital, or a public or private nonprofit 
institution, which:
    (1) Offers postdoctoral training in the specialties of dentistry, 
advanced education in general dentistry, or a dental general practice 
residency; and
    (2) Has been accredited by the Commission on Dental Accreditation.
    Primary care means health care which may be initiated by the patient 
or the provider, or both, in a variety of settings, and which consists 
of a broad range of personal health care services including promotion 
and maintenance of health, prevention of illness and disability, basic 
care during acute and chronic phases of illness, guidance and counseling 
of individuals and families, and referral to other health care providers 
and community resources when appropriate. In providing the services:
    (1) The physical, emotional, social, and economic status of the 
patient is considered in the context of his or her cultural and 
environmental back ground, including the family and community; and
    (2) The patient is provided timely access to the health care system.
    Project means all activities, including training programs, specified 
or described in a grant application as approved for funding.
    Project director means an individual designated by the recipient and 
approved by the Secretary to direct the project being supported under 
section 777(b).
    Project period means the total time for which support for a project 
has been approved, including any extension thereof, by the awarding 
unit.
    Relevant advanced training or experience means at least one of the 
following: (1) Completion of at least a 12-month graduate training 
program in a health-related discipline, the basic sciences, or 
education; (2) a minimum of 2 years of teaching experience in an 
accredited dental education program of which at least 12 months were 
devoted in part to issues pertaining to the care of older adults; or (3) 
a minimum of 2 years of clinical practice, of which at least 12 months 
were devoted in part to managing older dental patients in a hospital, 
long-term care facility, or other setting.
    Retraining program means a 1-year program of full-time 
individualized training in clinical geriatrics and geriatric research 
for physicians who are faculty members in departments of internal 
medicine, family medicine (including osteopathic general practice), 
gynecology, geriatrics, or psychiatry at schools of medicine and 
osteopathic medicine, and dentists who are faculty members at schools of 
dentistry or at hospital departments of dentistry.

[[Page 385]]

    School of medicine or school of osteopathic medicine means a public 
or private nonprofit school which provides training leading, 
respectively, to a degree of doctor of medicine or a degree of doctor of 
osteopathic medicine, and which is accredited as provided in section 
799(1)(E) of the Act.
    Secretary means the Secretary of Health and Human Services, and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    Teaching hospital means a public or private nonprofit hospital which 
is:
    (1) Accredited by the Joint Commission on Accreditation of Hospitals 
or the American Osteopathic Association; and
    (2) Operates at least one postdoctoral training program which is 
fully or provisionally accredited by the Accreditation Council for 
Graduate Medical Education or approved by the American Osteopathic 
Association.

[55 FR 37481, Sept. 12, 1990, as amended at 56 FR 29194, June 26, 1991; 
57 FR 45746, Oct. 5, 1992; 59 FR 63902, Dec. 12, 1994; 61 FR 6129, Feb. 
16, 1996]



Sec. 57.4103  Who is eligible to apply for a grant?

    Public or private nonprofit schools of medicine, schools of 
osteopathic medicine, teaching hospitals, and graduate medical education 
programs located in a State are eligible to apply for a grant under this 
subpart. Each eligible applicant desiring a grant under this subpart 
shall submit an application in the form and at such time as the 
Secretary may prescribe.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992]



Sec. 57.4104  For what projects may grant funds be requested?

    Each eligible applicant must propose a fellowship program or a 
retraining program.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992]



Sec. 57.4105  Project requirements.

    A project supported under this subpart must be conducted in 
accordance with the following requirements:
    (a) The project must have a project director who is employed full 
time by the grantee institution;
    (b) Projects must have an appropriate administrative and 
organizational plan, and adequate faculty, physical, and administrative 
resources for the achievement of stated objectives;
    (c) Projects must systematically evaluate the training program, 
including the performance and competence of trainees and faculty, the 
administration of the program, and the degree to which program and 
educational objectives are met;
    (d) The project must be under the programmatic control of a graduate 
medical education program in internal medicine or family medicine 
(including osteopathic general practice) or in a department of 
geriatrics or psychiatry;
    (e) The project must be staffed by at least two physicians in full-
time teaching positions who have experience or training in geriatric 
medicine or geriatric psychiatry and be staffed, or enter into an 
agreement with an institution staffed, by at least one dentist who is 
employed in a full- or part-time teaching position and has experience or 
training in geriatrics;
    (f) The project must provide fellows with training in geriatrics and 
exposure to the physical and mental disabilities of a diverse population 
of elderly individuals. The population must include:
    (1) Elderly in various levels of wellness from fully independent and 
well, to patients confined to bed with serious illness; and
    (2) Elderly from a range of socioeconomic, racial and ethnic 
backgrounds;
    (g) The project must provide medical and dental training experiences 
in:

[[Page 386]]

    (1) An ambulatory care setting;
    (2) An inpatient service; and
    (3) An extended care facility,

During the course of the training, each fellow must receive experience 
in primary care, consultation, and longitudinal care;
    (h) Fellowship programs must have a curriculum which includes 
training in clinical geriatrics, teaching skills, administrative skills, 
and research skills for physicians and dentists;
    (i) Retraining programs must provide 1 year of full-time training 
suited to the individual needs of each fellow. To assure that the needs 
of all fellows can be met, each retraining program must have the 
resources available to provide clinical, research, administrative, and 
teacher-training experience; and
    (j) Effective in the second year of grant support, a minimum of 
three entering fellows, including at least one physician and one 
dentist, must be enrolled in each training program for which grant 
support is received. The Secretary may suspend this requirement if the 
Secretary determines that a grantee has made a good faith effort to 
comply with this requirement through the various recruitment means 
available in its institution and at the national level, and has met the 
other requirements stated in this section but is unable to have the 
required number of fellows in the program due to circumstances beyond 
its control.

[55 FR 37481, Sept. 12, 1990, as amended at 56 FR 29194, June 26, 1991; 
57 FR 45746, Oct. 5, 1992; 59 FR 63902, Dec. 12, 1994]



Sec. 57.4106  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will award grants to 
applicants whose projects will best promote the purposes of section 
777(b) of the Act and these regulations. The Secretary will consider, 
among other factors:
    (1) The extent to which the proposed training program will prepare 
physicians and dentists to perform the research, teaching, 
administrative and clinical duties of a faculty member specializing in 
geriatrics;
    (2) The degree to which the project plan adequately provides for 
meeting the requirements set forth in Sec. 57.4105;
    (3) The administrative, management and resource capability of the 
applicant to carry out the proposed project in a cost-effective manner;
    (4) The potential for the applicant to continue the program without 
Federal support after completion of the requested project period; and
    (5) The extent to which the project will increase the number of 
geriatric fellowship and retraining positions available for individuals 
who want to prepare for academic careers in geriatric medicine, 
psychiatry, or dentistry.
    (b) In determining the funding of applications approved under 
paragraph (a) of this section, the Secretary will consider any special 
factors relating to national needs as the Secretary may from time to 
time announce in the Federal Register.

[55 FR 37481, Sept. 12, 1990, as amended at 59 FR 63902, Dec. 12, 1994]



Sec. 57.4107  How long does grant support last?

    (a) The notice of grant award specifies the length of time the 
Secretary intends to support the project without requiring the project 
to recompete for funds. This period, called the project period, will not 
exceed 5 years.
    (b) Generally, the grant will initially be funded for 1 year, and 
subsequent continuation awards will also be for 1 year at a time. 
Decisions regarding continuation awards and the funding levels of these 
awards will be made after consideration of such factors as the grantee's 
progress and management practices, existence of legislative authority, 
and the availability of funds. In all cases, continuation awards require 
a determination by the Secretary that continued funding is in the best 
interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant shall

[[Page 387]]

commit or obligate the United States in any way to make any additional, 
supplemental, continuation, or other award with respect to any approved 
application or portion of an approved application. For continuation 
support, grantees must make separate application at such time and in 
such a form as the Secretary may prescribe.

[55 FR 37481, Sept. 12, 1990, as amended at 57 FR 45746, Oct. 5, 1992]



Sec. 57.4108  What financial support is available to fellows?

    Expenditures from funds are limited to:
    (a) Tuition and fees, in accordance with the established rates of 
the institution, except as limited by the Secretary;
    (b) Stipend support, in accordance with established Public Health 
Service postdoctoral stipend levels; and
    (c) Travel to field training if the site is beyond a reasonable 
commuting distance and requires the fellow to establish a temporary new 
residence. However, fellowship funds may not be used for daily commuting 
from the new place of residence to the field training headquarters.



Sec. 57.4109  Who is eligible for financial assistance as a fellow?

    To be eligible for a fellowship an individual must:
    (a) Be a resident of the United States and either a citizen or 
national of the United States, an alien lawfully admitted for permanent 
residence in the United States, a citizen of the Commonwealth of the 
Northern Mariana Islands, a citizen of the Republic of Palau, a citizen 
of the Republic of the Marshall Islands, or a citizen of the Federated 
States of Micronesia;
    (b) Be a physician or a dentist enrolled in a ``fellowship program'' 
or a ``retraining program'' as defined in Sec. 57.4102; and
    (c) Not be receiving concurrent support for the same training from 
another Federal education award which provides a stipend or otherwise 
duplicates financial provisions except education benefits under the 
Veteran's Readjustment Benefits Act, and loans from Federal sources.

[55 FR 37481, Sept. 12, 1990, as amended at 61 FR 6129, Feb. 16, 1996]



Sec. 57.4110  What are the requirements for fellowships and the appointment of fellows?

    (a) The grantee must complete a statement which documents the 
appointment of each fellow. To complete this statement the grantee must 
require the provision of information and documentation of eligibility by 
each fellow. The statement of appointment must be completed by the 
beginning of the training period or as soon thereafter as possible if 
the fellow receives notice of his or her fellowship appointment after 
the training period has begun. The statement of appointment must include 
information to document the eligibility of the fellow and certify that 
there will be compliance with all applicable Public Health Service terms 
and conditions governing the appointment. The program director must sign 
the statement on behalf of the grantee, and the fellow must sign it thus 
certifying the statements are true and complete. The original copy of 
the statement must be retained by the grantee to be available for 
program review and financial audit. A copy shall be provided to the 
fellow for his or her records.
    (b) The grantee may not require fellows to perform work which is not 
an integral part of the geriatric training program, or to perform 
services which detract from or prolong their training.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[55 FR 37481, Sept. 12, 1990, as amended at 56 FR 29194, June 26, 1991]



Sec. 57.4111  Termination of fellowships.

    (a) The grantee must terminate a fellowship:
    (1) Upon request of the fellow;
    (2) If the fellow withdraws from the grantee institution; or
    (3) If the grantee determines that:
    (i) The fellow is no longer an active participant in the training 
program; or
    (ii) The fellow is not eligible or able to continue in accordance 
with its standards and practices.

[[Page 388]]

    (b) The grantee must deposit any Federal portion of the tuition 
refund owed to a fellow into the grant account and provide written 
notice to the fellow that it is doing so.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[55 FR 37481, Sept. 12, 1990, as amended at 56 FR 29194, June 26, 1991. 
Redesignated at 59 FR 63902, Dec. 12, 1994]



Sec. 57.4112  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and this subpart.
    (b) Grantees may not spend grant funds for sectarian instruction or 
for any religious purpose.
    (c) Any balance of federally-obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward provided specific approval is granted by the Secretary. If at 
any time during a budget period, it becomes apparent to the Secretary 
that the amount of Federal funds awarded and available to the grantee 
for that period, including any unobligated balance carried forward from 
prior periods, exceeds the grantee's needs for the period, the Secretary 
may adjust the amounts awarded by withdrawing the excess. A budget 
period is an interval of time (usually 12 months) into which the project 
period is divided for funding and reporting purposes.

[55 FR 37481, Sept. 12, 1990, as amended at 57 FR 45746, Oct. 5, 1992. 
Redesignated at 59 FR 63903, Dec. 12, 1994]



Sec. 57.4113  What additional Department regulations apply to grantees?

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide Debarment and Suspension (nonprocurement) 
          and Governmentwide Requirements for Drug-Free Workplace 
          (Grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
          assistance through the department of Health and Human Services 
          effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
          this title
45 CFR part 83--Regulation for the administration and enforcement of 
          sections 794 and 855 of the Public Health Services Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
          and activities receiving or benefiting from Federal financial 
          assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
          programs and activities receiving or benefiting from Federal 
          financial assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
          activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying

[55 FR 37481, Sept. 12, 1990, as amended at 57 FR 45746, Oct. 5, 1992. 
Redesignated at 59 FR 63903, Dec. 12, 1994; 61 FR 6129, Feb. 16, 1996]



Sec. 57.4114  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[59 FR 63903, Dec. 12, 1994]



Sec. 57.4115  Additional conditions.

    The Secretary may impose additional conditions on any grant award 
before or at the time of any award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.

[55 FR 37481, Sept. 12, 1990. Redesignated at 59 FR 63903, Dec. 12, 
1994]



PART 58--GRANTS FOR TRAINING OF PUBLIC HEALTH AND ALLIED HEALTH PERSONNEL--Table of Contents




Subparts A-B  [Reserved]

[[Page 389]]

Subpart C--Grants for Public Health Traineeships for Students in Schools 
      of Public Health and in Other Graduate Public Health Programs

Sec.
58.201  To what grant program do these regulations apply?
58.202  Definitions.
58.203  Who is eligible to apply for a grant?
58.204  How will applications be evaluated?
58.205  How is the amount of the award determined?
58.206  How long does grant support last?
58.207  For what purposes may grant funds be spent?
58.208  What are the requirements for appointment of trainees?
58.209  Who is eligible for financial assistance as a trainee?
58.210  What financial support is available to trainees?
58.211  Duration of traineeships.
58.212  Termination of traineeships.
58.213  What additional Department regulations apply to grantees?
58.214  What other audit and inspection requirements apply to grantees?
58.215  Additional conditions.

  Subpart D--Grants for Health Administration Traineeships and Special 
                            Projects Program

58.221  To what grant program do these regulations apply?
58.222  Definitions.
58.223  Who is eligible to apply for a grant?
58.224  How will applications be evaluated?
58.225  How is the amount of the award determined?
58.226  How long does grant support last?
58.227  For what purposes may grant funds be spent?
58.228  Who is eligible for financial assistance as a trainee?
58.229  What financial support is available to trainees?
58.230  Duration of traineeships.
58.231  Termination of traineeships.
58.232  What additional Department regulations apply to grantees?
58.233  What other audit and inspection requirements apply to grantees?
58.234  Additional conditions.

Subparts E-F  [Reserved]

Subparts A-B  [Reserved]



Subpart C--Grants for Public Health Traineeships for Students in Schools 
      of Public Health and in Other Graduate Public Health Programs

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended by 63 Stat. 35 (42 U.S.C. 216); sec. 748 of the Public Health 
Service Act, 90 Stat. 2279, as amended by 91 Stat. 1505; as amended and 
redesignated as sec. 792 of the Public Health Service Act by 95 Stat. 
927 (42 U.S.C. 295h-1b); renumbered as sec. 761, as amended by Pub. L. 
102-408, 106 Stat. 2045 (42 U.S.C. 294).

    Source: 45 FR 73661, Nov. 6, 1980, unless otherwise noted.



Sec. 58.201  To what grant program do these regulations apply?

    These regulations apply to the award of grants to eligible 
educational entities under section 761 of the Public Health Service Act 
(42 U.S.C. 294) to provide funds for traineeships for students enrolled 
in graduate or specialized training in public health.

[47 FR 54439, Dec. 3, 1982, as amended by 61 FR 6129, Feb. 16, 1996]



Sec. 58.202  Definitions.

    Act means the Public Health Service Act, as amended.
    Educational entity means a school, college, or university which is 
accredited by a body or bodies recognized for this purpose by the 
Secretary of Education or an institution which provides specialized 
training in public health.
    Fiscal year means the Federal fiscal year, beginning October 1 and 
ending the following September 30.
    Full-time student means a student who is either (1) in a residency 
program in preventive medicine or dentistry or (2) is enrolled on a 
full-time basis in a graduate program in public health and who is 
enrolled for a sufficient number of credit hours in a semester or other 
academic term to enable the student to complete the course of study 
within not more than the number of semesters of other academic terms 
normally required to complete that course of study on a full-time basis 
at the school in which the student is enrolled.

[[Page 390]]

    Graduate program or graduate training means a program of education 
leading to a master's degree or equivalent or doctoral degree or 
equivalent.
    National of the United States means (as defined in the Immigration 
and Nationality Act at 8 U.S.C. 1101(a)(22)) (1) a citizen of the United 
States or (2) a person who, though not a citizen of the United States, 
owes permanent allegiance to the United States.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations no part of the net earnings of which inures, or may 
lawfully insure, to the benefit of any private shareholder or 
individual.
    School of Public Health means a public or non-profit private school 
which provides training leading to a graduate degree in public health or 
equivalent degree and is accredited according to section 799(1)(E) of 
the Public Health Service Act.
    Secretary means the Secretary of the Department of Health and Human 
Services or any officer or employee of the Department to whom the 
authority involved has been delegated.
    Specialized training in public health or specialized training in 
preventive medicine or denistry means a residency training program 
approved by the Liaison Committee on Graduate Medical Education or by 
the Commission on Dental Accreditation leading to board eligibility in a 
specialty in preventive medicine or dental public health respectively.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    Trainee means a student who is receiving traineeship funds from a 
grant made under these regulations.

[45 FR 73661, Nov. 6, 1980, as amended at 47 FR 54439, Dec. 3, 1982; 61 
FR 6129, Feb. 16, 1996]



Sec. 58.203  Who is eligible to apply for a grant?

    The following are eligible for grants:
    (a) Any accredited school of public health which is located in a 
State; and
    (b) Any other public or nonprofit private eduational entity which is 
located in a State and provides graduate or specialized training in 
public health. However, no entity of this type may obtain an award under 
this subpart to support traineeships in health administration, hospital 
administration, or health policy analysis and planning.1
---------------------------------------------------------------------------

    1 For traineeships in health administration, hospital 
administration, or health policy analysis and planning, eduational 
entities which are not accredited schools of public health may only 
apply under section 771 of the Act.

[45 FR 73661, Nov. 6, 1980, as amended at 47 FR 54439, Dec. 3, 1982; 61 
FR 6130, Feb. 16, 1996]



Sec. 58.204  How will applications be evaluated?

    (a) The Secretary will award a grant to each eligible school of 
public health which submits an application containing all the 
information and assurances requested in the required form and time.
    (b) For public and nonprofit educational entities other than schools 
of public health, the Secretary will decide which applications to 
approve by considering, among other factors:
    (1) The administrative and management ability of the applicant to 
carry out the proposed project in a cost-effective manner;
    (2) The degree of need for the professionals to be trained; and
    (3) The adequacy of the staff and faculty; and
    (4) Whether the applicant's graduate programs in environmental or 
occupational health or dietetics and nutrition, or both, meet the 
requirements in paragraphs Sec. 58.208 (c) and (d).

Within the limits of funds available for competing awards the Secretary 
will award grants to those approved applicants whose traineeship 
programs will best promote the purposes of section 761 of the Act.

[45 FR 73661, Nov. 6, 1980, as amended at 47 FR 54439, Dec. 3, 1982; 61 
FR 6130, Feb. 16, 1996]

[[Page 391]]



Sec. 58.205  How is the amount of the award determined?

    (a) Grants to schools of public health. The Secretary will use a 
formula to determine the amount of the grant to be awarded to each 
school of public health with an approved application.
    This formula is
    [GRAPHIC] [TIFF OMITTED] TR16FE96.000
    

    G is the amount of the grant award; SS is the number of eligible 
full-time and full-time equivalent students of each applicant enrolled 
in severe shortage occupations targeted for support (epidemiology, 
environmental health, biostatistics, toxicology, public health 
nutrition, and maternal and child health); TS is the total number of 
students enrolled in graduate and specialized training in all schools of 
public health with approved applications; and AF is the amount of 
traineeship funds under this program that the Secretary has designated 
for award to schools of public health for that fiscal year. The 
Secretary will determine the number of students enrolled in graduate and 
specialized training in public health at the school (SS) with the 
formula

[GRAPHIC] [TIFF OMITTED] TR16FE96.001


    FTS is the number of full-time students, and PTC is the total number 
of credit hours in which part-time students are enrolled. If necessary, 
the figure for

[GRAPHIC] [TIFF OMITTED] TR16FE96.002


will be rounded to the next highest number. Students will be counted as 
of October 15 of the fiscal year in which application is made. The 
amount of a grant will never exceed the amount requested by the 
applicant.

    (b) Grants to public and nonprofit private educational entities. The 
remaining funds will be available to meet continuation commitments and 
to award on a competitive basis to eligible public or nonprofit private 
educational entities other than schools of public health. The Secretary 
will determine the amount of these awards by estimating the sum 
necessary during the budget period to cover the tuition, fees, stipends, 
and allowances (including travel costs approved by the Secretary) for 
full-time students, and the tuition and fees for part-time students 
which the applicant proposes to provide to its trainees.

[45 FR 73661, Nov. 6, 1980, as amended at 47 FR 54440, Dec. 3, 1982; 61 
FR 6130, Feb. 16, 1996]



Sec. 58.206  How long does grant support last?

    (a) The written notice of grant award specifies the period during 
which formula grant funds are available for obligation by the grantee, 
or the period during which the recipient of a competitive grant award 
need not recompete for funds. This period will not exceed one year for 
formula grants and 3 years for competitve grants. The period during 
which recompetition is not necessary is called the project period.
    (b) Generally a competitive grant will initially be funded for one 
year, and subsequent continuation awards will also be for one year at a 
time. A grantee must submit a separate application to have the support 
continued for each subsequent year. Decisions regarding continuation 
awards and the funding levels of these awards will be made after 
consideration of such factors as the grantee's progress and management 
practices, and the availability of funds. In all cases, continuation 
awards require a determination by the Secretary that continued funding 
is in the best interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved application or portion of an approved application.
    (d) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward to the next budget period, for use as prescribed by the 
Secretary, provided a continuation award is made. If at any time during 
a budget period it becomes apparent to the Secretary that the amount of 
Federal funds awarded and available to the grantee for that period, 
including any unobligated balance carried forward

[[Page 392]]

from prior periods, exceeds the grantee's needs for the period, the 
Secretary may adjust the amounts awarded by withholding the excess. A 
budget period is an interval of time (usually 12 months) into which the 
project period is divided for funding and reporting purposes.



Sec. 58.207  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles specified in subpart Q of 45 CFR part 74, and these 
regulations. Use of grant funds to meet the direct or indirect 
administrative costs of the training institution is not authorized.
    (b) Grantees may not spend grant funds for sectarian instruction or 
for any religious purpose.



Sec. 58.208  What are the requirements for appointment of trainees?

    (a) The grantee must require each trainee to complete a statement of 
appointment by the beginning of the training period, or as soon as 
possible if the trainee receives notice of his or her traineeship 
appointment after the training period has begun. The program director 
must sign the statement on behalf of the grantee and the original copy 
of the statement must be retained by the grantee to be available for 
program review and financial audit. The grantee must also send a copy of 
the statement to the Secretary upon request.
    (b) The grantee must require full-time trainees to sign a statement 
that they will not undertake employment during their traineeships which 
would interfere with their ability to satisfactorily complete the 
training program in a timely fashion.
    (c) The grantee may not require trainees to perform any work which 
is not an integral part of their training program and required of all 
students in the program, or to perform services which detract from or 
prolong their training.
    (d) The grantee must advise each trainee who is enrolled in a course 
of study which requires more than twelve months that continued support 
under this program is contingent upon the continued availability of 
grant funds.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[45 FR 73661, Nov. 6, 1980, as amended at 47 FR 54440, Dec. 3, 1982; 61 
FR 6130, Feb. 16, 1996]



Sec. 58.209  Who is eligible for financial assistance as a trainee?

    (a) To be eligible for a traineeship, an individual must meet the 
following conditions:
    (1) Trainees must be United States citizens, non-citizen nationals, 
or foreign nationals having in their possession a visa permitting 
permanent residence in the United States.
    (2) New trainees must be pursuing a graduate degree in a health 
professions field in which there is a severe shortage of health 
professionals (including the fields of epidemiology, environmental 
health, biostatistics, toxicology, public health nutrition, and maternal 
and child health). Ongoing traineeship commitment will be continued.
    (3) All trainees must meet the school's admission requirements 
specified in the approved grant application.
    (b) Traineeship support may not be provided to:
    (1) Individuals who do not meet the qualifications for admission as 
specified in the approved application;
    (2) Full-time Federal employees unless they are on Leave Without Pay 
status;
    (3) Students pursuing training at the undergraduate level;
    (4) Students in programs designed to prepare them for careers in 
research;
    (5) Preventive medicine and dental public health residents (section 
763 of the Act may be used for these students); or
    (6) Individuals on temporary or student visas.

[61 FR 6130, Feb. 16, 1996]



Sec. 58.210  What financial support is available to trainees?

    (a) Expenditures are limited to:

[[Page 393]]

    (1) Tuition and fees, in accordance with the established rates of 
the institution except as limited by the Secretary.
    (2) Stipends, for full time students, in whatever amount the grantee 
determines that each trainee needs to pursue the training program, as 
long as that amount does not exceed the limits established by the 
Secretary.
    (3) Transportation allowances on an individual basis when prior 
approval has been obtained from the Secretary in the following 
circumstances:
    (i) In cases of extreme need, the grantee may pay a trainee an 
allowance from grant funds for travel from his or her residence to the 
training site.
    (ii) The grantee may pay a trainee an allowance from grant funds for 
travel to field training if the site is beyond a reasonable commuting 
distance and requires the trainee to establish a temporary new 
residence. However, the grantee may not pay an allowance for daily 
commuting from the new place of residence to the field training 
headquarters.
    (iii) The grantee may pay a trainee an allowance from grant funds 
for domestic travel to conduct research to meet dissertation 
requirements.
    (b) The grantee may not give a stipend or allowance to a part-time 
trainee, but may give a traineeship award to pay a part-time trainee's 
tuition and fees.



Sec. 58.211  Duration of traineeships.

    Traineeships must be for a full academic year, except an appointment 
for less than a full academic year may be made when the student will 
complete the program of study at the termination of the appointment, or 
when joint-degree programs require enrollment at another unit of the 
grantee institution for part of the academic year. A traineeship may not 
exceed 12 months in duration. However, consecutive or subsequent 
traineeship appointments may be made if a student's required program of 
study exceeds 12 months. Training for which the student receives a 
traineeship must begin during the period for which funds are made 
available, but may extend beyond the end of this period.



Sec. 58.212  Termination of traineeship.

    The grantee must terminate a traineeship:
    (a) Upon request of the trainee;
    (b) If the trainee withdraws from the grantee institution; or
    (c) If the grantee determines that
    (1) The trainee is no longer an enrolled student; or
    (2) The trainee is not eligible or able to continue in attendance in 
accordance with its standards and practices.



Sec. 58.213  What additional Department regulations apply to grantees?

    Several other regulations apply to grantees. They include, but are 
not limited to:

42 CFR part 50--subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 80--Nondiscrimination under programs receiving Federal 
financial assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying

[49 FR 38116, Sept. 27, 1984, as amended at 61 FR 6130, Feb. 16, 1996]



Sec. 58.214  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6130, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]

[[Page 394]]



Sec. 58.215  Additional conditions.

    The Secretary may impose additional conditions in the grant award 
before or at the time of the award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.



  Subpart D--Grants for Health Administration Traineeships and Special 
                            Projects Program

    Authority: Sec. 215 of the Public Health Service Act. 58 Stat. 690, 
67 Stat. 631 (42 U.S.C. 216); sec. 749 of the Public Health Service Act, 
90 Stat. 2280, Pub. L. 94-484 (42 U.S.C. 294s); redesignated as sec. 
791A, amended by 95 Stat. 927, Pub. L. 97-35 and 96 Stat. 2061, Pub. L. 
97-414 (42 U.S.C. 295h-1a); renumbered as sec. 771, amended by 106 Stat. 
2049, Pub. L. 102-408 (42 U.S.C. 294i).

    Source: 45 FR 73658, Nov. 6, 1980, unless otherwise noted.



Sec. 58.221  To what grant program do these regulations apply?

    These regulations apply to the award of grants to eligible 
educational entities under section 771 of the Public Health Service Act 
(42 U.S.C. 294i) to provide funds for traineeships for students enrolled 
in graduate programs in health administration, hospital administration, 
or health policy analysis and planning.

[45 FR 73658, Nov. 6, 1980, as amended at 49 FR 21535, May 22, 1984; 61 
FR 6130, Feb. 16, 1996]



Sec. 58.222  Definitions.

    Act means the Public Health Service Act, as amended.
    Educational entity means a school, college, or university which is 
accredited by a body or bodies recognized for this purpose by the 
Secretary of Education.
    Fiscal year means the Federal fiscal year, beginning October 1 and 
ending the following September 30.
    Full-time student means a student who is enrolled on a full-time 
basis in a graduate program in health administration, hospital 
administration, or health policy analysis and planning, and who is 
enrolled for a sufficient number of credit hours in any semester or 
other academic term to enable him or her to complete the course of study 
within not more than the number of semesters or other academic terms 
normally required to complete that course of study at the school in 
which the student is enrolled.
    Graduate program means a program of education leading to a master's 
degree or equivalent or a doctoral degree or equivalent.
    National of the United States (as defined in 8 U.S.C. 110(a)(22), 
the Immigration and Nationality Act) means: (1) A citizen of the United 
States or (2) a person who, though not a citizen of the United States, 
owes permanent allegiance to the United States.
    Nonprofit refers to the status of an entity which is a corporation 
or association, or is owned and operated by one or more corporations or 
associations no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or individual.
    Secretary means the Secretary of the Department of Health and Human 
Services or any officer or employee of the Department to whom the 
authority involved has been delegated.
    School of public health means a public or private school in a State 
providing education leading to a graduate degree in public health or an 
equivalent degree, including advanced training related to public health, 
which is accredited as provided for in section 799(1)(E) of the Act.
    State means, in addition to the several States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    Trainee means a student who is receiving traineeship funds from a 
grant made under these regulations.

[45 FR 73658, Nov. 6, 1980, as amended at 49 FR 21535, May 22, 1984; 61 
FR 6130, Feb. 16, 1996]

[[Page 395]]



Sec. 58.223  Who is eligible to apply for a grant?

    Any public or nonprofit private educational entity (excluding 
schools of public health) located in a State is eligible to apply for a 
grant to support traineeships in its graduate program in health 
administration, hospital administration, or health policy analysis and 
planning which has been accredited, or is about to be accredited, 
according to section 799(1)(E) of the Act.

[49 FR 21535, May 22, 1984, as amended at 61 FR 6130, Feb. 16, 1996]



Sec. 58.224  How will applications be evaluated?

    (a) As required by section 798(a) of the Act, each application for a 
grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval.
    (b) The following criteria will be used for review of applications:
    (1) The administrative and management ability of the applicant to 
carry out the proposed project in a cost-effective manner;
    (2) The adequacy of the staff and faculty;
    (3) The adequacy of institutional resources available to conduct 
graduate level education, to include the adequacy of teaching 
facilities;
    (4) The adequacy of recruitment and placement assistance for 
students in accord with the legislative purpose and intent; and
    (5) The extent to which the application justifies the purpose, 
scope, and need for traineeship and or special project grant.

(Approved by the Office of Management and Budget under control number 
0915-0060)

[61 FR 6130, Feb. 16, 1996]



Sec. 58.225  How is the amount of the award determined?

    The Secretary will use a formula to determine the amount of the 
grant award for each entity with an approved application. This formula 
is:
[GRAPHIC] [TIFF OMITTED] TC13NO91.001


G is the amount of the grant award; SS is the number of students 
enrolled in approved graduate programs in health administration, 
hospital administration, or health policy analysis and planning at the 
school; TS is the total number of students in these programs at all 
schools with approved applications, and AF is the amount of available 
funds authorized under section 771 for traineeships in a given fiscal 
year. The Secretary will determine the number of students enrolled in 
these programs at the school (SS) with the formula:
[GRAPHIC] [TIFF OMITTED] TC13NO91.002

FTS is the number of full-time students enrolled in these programs and 
PTC is the total number of credit hours in which part-time students are 
enrolled. If necessary, the figure for PTC/9 will be rounded to the next 
highest number. Students will be counted as of October 15 of the fiscal 
year in which application is made. The amount of a grant will never 
exceed the amount requested by the applicant.

[45 FR 73658, Nov. 6, 1980, as amended at 49 FR 21536, May 22, 1984; 61 
FR 6131, Feb. 16, 1996]



Sec. 58.226  How long does grant support last?

    (a) The notice of grant award specifies the period during which 
funds are available for obligation by the grantee. This period will not 
exceed one year. If at any time during the period of the grant it 
becomes apparent to the Secretary that the amount of Federal funds 
awarded and available to the grantee for that period, exceeds the 
grantee's needs for that period, the Secretary may adjust the amounts 
awarded by withdrawing the excess.
    (b) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved application or portion of an approved application.

[[Page 396]]



Sec. 58.227  For what purposes may grant funds be spent?

    (a) A grantee shall only spend funds it receives under this subpart 
according to the approved application and budget, the authorizing 
legislation, terms and conditions of the grant award, applicable cost 
principles in subpart Q of 45 CFR part 74, and these regulations. Use of 
traineeship funds to meet the direct or indirect administrative costs of 
the training institution is not authorized.
    (b) Grantees may not spend grant funds for sectarian instruction or 
for any religious purpose.



Sec. 58.228  Who is eligible for financial assistance as a trainee?

    To be eligible for a traineeship, an individual must meet the 
following conditions:
    (a) The individual must be a resident of the United States and 
either a citizen or national of the United States, an alien lawfully 
admitted for permanent residence in the United States, a citizen of the 
Commonwealth of the Northern Mariana Islands, a citizen of the Republic 
of Palau, a citizen of the Republic of the Marshall Islands or a citizen 
of the Federated States of Micronesia.
    (b) The individual must be accepted for enrollment, or be enrolled 
in a grantee's accredited graduate program in health administration, 
hospital administration, or health policy analysis and planning;
    (c) The individual may not be receiving concurrent support for the 
same training from another Federal source except education benefits 
under the Veteran's Readjustment Benefits Act.

[45 FR 73658, Nov. 6, 1980, as amended at 49 FR 21536, May 22, 1984. 
Redesignated and amended at 61 FR 6131, Feb. 16, 1996]



Sec. 58.229  What financial support is available to trainees?

    (a) The grantee may use grant funds to pay for:
    (1) Tuition and fees, in accordance with the established rates of 
the institution except as limited by the Secretary;
    (2) Stipends, for full time trainees in whatever amount the grantee 
determines that each trainee needs to pursue the training program, as 
long as that amount does not exceed the limits established by the 
Secretary;
    (3) Transportation allowances on an individual basis when prior 
approval has been obtained from the Secretary in the following 
circumstances:
    (i) In cases of extreme need, the grantee may pay a trainee an 
allowance from grant funds for travel from his or her residence to the 
training site.
    (ii) The grantee may pay a trainee an allowance from grant funds for 
travel to field training if the site is beyond a reasonable commuting 
distance and requires the trainee to establish a temporary new 
residence. However, the grantee may not pay an allowance for daily 
commuting from the new place of residence to the field training 
headquarters.
    (iii) The grantee may pay a trainee an allowance from grant funds 
for domestic travel to conduct research to meet dissertation 
requirements.
    (b) The grantee may not give a stipend or allowance to a part-time 
trainee, but may give a traineeship award to pay a part-time trainee's 
tuition and fees.

[45 FR 73658, Nov. 6, 1980. Redesignated at 61 FR 6131, Feb. 16, 1996]



Sec. 58.230  Duration of traineeships.

    A traineeship must be for a full academic year except that an 
appointment for less than a full academic year may be made to a student 
who will complete his or her program of study in a lesser time or when 
joint-degree programs require enrollment at another unit of the grantee 
institution for part of the academic year. A traineeship may not exceed 
12 months in duration. However a grantee may make consecutive or 
subsequent traineeship appointments to students whose required program 
of study exceeds 12 months. The training for which a student receives a 
traineeship must begin during the period for which funds are made 
available, but may extend beyond that period.

[45 FR 73658, Nov. 6, 1980. Redesignated at 61 FR 6131, Feb. 16, 1996]

[[Page 397]]



Sec. 58.231  Termination of traineeships.

    The grantee must terminate a traineeship:
    (a) Upon request of the trainee;
    (b) If the trainee withdraws from the grantee institution; or
    (c) If the grantee determines that:
    (1) The trainee is no longer an enrolled student; or
    (2) The trainee is not eligible or able to continue in attendance in 
accordance with its standards and practices.

[45 FR 73658, Nov. 6, 1980. Redesignated at 61 FR 6131, Feb. 16, 1996]



Sec. 58.232  What additional Department regulations apply to grantees?

    Several other Department regulations apply to grantees. They 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 83--Regulation for the administration and enforcement of 
sections 794 and 855 of the Public Health Service Act
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 93--New restrictions on lobbying

[49 FR 38116, Sept. 27, 1984. Redesignated and amended at 61 FR 6131, 
Feb. 16, 1996]



Sec. 58.233  What other audit and inspection requirements apply to grantees?

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6131, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]



Sec. 58.234  Additional conditions.

    The Secretary may impose additional conditions in the grant award 
before or at the time of the award if he or she determines that these 
conditions are necessary to assure or protect the advancement of the 
approved activity, the interest of the public health, or the 
conservation of grant funds.

[45 FR 73658, Nov. 6, 1980. Redesignated at 61 FR 6131, Feb. 16, 1996]

Subparts E-F  [Reserved]



PART 59--GRANTS FOR FAMILY PLANNING SERVICES--Table of Contents




         Subpart A--Project Grants for Family Planning Services

Sec.
59.1  To what programs do these regulations apply?
59.2  Definitions.
59.3  Who is eligible to apply for a family planning services grant?
59.4  How does one apply for a family planning services grant?
59.5  What requirements must be met by a family planning project?
59.6  What procedures apply to assure the suitability of informational 
          and educational material?
59.7  Standards of compliance with prohibition on abortion.
59.8  Prohibition on counseling and referral for abortion services; 
          limitation of program services to family planning.
59.9  Maintenance of program integrity.
59.10  Prohibition on activities that encourage, promote or advocate 
          abortion.
59.11  What criteria will the Department of Health and Human Services 
          (HHS) use to decide which family planning services projects to 
          fund and in what amount?
59.12  How is a grant awarded?
59.13  For what purposes may grant funds be used?
59.14  What other HHS regulations apply to grants under this subpart?
59.15  Confidentiality.
59.16  Inventions or discoveries.
59.17  Additional conditions.

Subpart B  [Reserved]

         Subpart C--Grants for Family Planning Service Training

59.201  Applicability.
59.202  Definitions.
59.203  Eligibility.
59.204  Application for a grant.

[[Page 398]]

59.205  Project requirements.
59.206  Evaluation and grant award.
59.207  Payments.
59.208  Use of project funds.
59.209  Civil rights.
59.210  Inventions or discoveries.
59.211  Publications and copyright.
59.212  Grantee accountability.
59.213  [Reserved]
59.214  Additional conditions.
59.215  Applicability of 45 CFR part 74.



         Subpart A--Project Grants for Family Planning Services

    Authority: 42 U.S.C. 300a-4.

    Source: 45 FR 37436, June 3, 1980, unless otherwise noted.

    Editorial Note: At 58 FR 7462-7463, Feb. 5, 1993, the Secretary of 
Health and Human Services (HHS) suspended the effectiveness of the 
provisions of Subpart A issued at 53 FR 2922, Feb. 2, 1988. The actions 
taken on Feb. 2, 1988, were:
    1.  The authority citation for subpart A of 42 CFR part 59 is 
revised.

    2.  In 42 CFR 59.2, the following definitions are added:

        Family planning

        Grantee

        Prenatal care

        Program and project

        Title X

        Title X program and Title X project

    3.  In 42 CFR 59.5(a), paragraph (a)(5) is removed and paragraphs 
(a)(6) through (a)(11) are redesignated as paragraphs (a)(5) through 
(a)(10), respectively.

    4.  42 CFR 59.5(b)(3)(i) is revised.

    5.  In 42 CFR part 59, Sec. 59.7 through Sec. 59.13 are redesignated 
as Sec. 59.11 through Sec. 59.17 respectively, and new Sec. 59.7 through 
Sec. 59.10 are added.

    6.  In addition to the amendments set forth above, in 42 CFR part 59 
remove the words ``project'' or ``projects'' or ``project's'' and add in 
their place, the words ``Title X project'' or ``Title X projects'' or 
``Title X project's'' respectively, in the following places:

    (a) Section 59.2 definition of ``low income family'';
    (b) Section 59.5(a)(1);
    (c) Section 59.5(b) introductory text;
    (d) Section 59.5(b)(3)(iii);
    (e) Section 59.5(b)(4);
    (f) Section 59.5(b)(7);
    (g) Section 59.5(b)(10);
    (h) Section 59.6(a);
    (i) Newly redesignated Sec. 59.11(a);
    (k) Newly redesignated Sec. 59.11(a)(7);
    (l) Newly redesignated Sec. 59.11(b);
    (m) Newly redesignated Sec. 59.11(c);
    (n) Newly redesignated Sec. 59.12(a), the first time it appears;
    (o) Newly redesignated Sec. 59.15;
    (p) Newly redesignated Sec. 59.16(a).



Sec. 59.1  To what programs do these regulations apply?

    The regulations of this subpart are applicable to the award of 
grants under section 1001 of the Public Health Service Act (42 U.S.C. 
300) to assist in the establishment and operation of voluntary family 
planning projects. These projects shall consist of the educational, 
comprehensive medical, and social services necessary to aid individuals 
to determine freely the number and spacing of their children.



Sec. 59.2  Definitions.

    As used in this subpart:
    Act means the Public Health Service Act, as amended.
    Family means a social unit composed of one person, or two or more 
persons living together, as a household.
    Family planning means the process of establishing objectives for the 
number and spacing of one's children and selecting the means by which 
those objectives may be achieved. These means include a broad range of 
acceptable and effective methods and services to limit or enhance 
fertility, including contraceptive methods (including natural family 
planning and abstinence) and the management of infertility (including 
adoption). Family planning services includes preconceptional counseling, 
education, and general reproductive health care (including diagnosis and 
treatment of infections which threaten reproductive capability). Family 
planning does not include pregnancy care (including obstetric or 
prenatal care). As required by section 1008 of the Act, abortion may not 
be included as a method of family planning in the title X project. 
Family planning, as supported under this subpart, should reduce the 
incidence of abortion.
    Grantee means the organization to which a grant is awarded under 
section 1001 of the Act.
    Low income family means a family whose total annual income does not 
exceed 100 percent of the most recent Community Services Administration

[[Page 399]]

Income Poverty Guidelines (45 CFR 1060.2). Low-income family also 
includes members of families whose annual family income exceeds this 
amount, but who, as determined by the title X project director, are 
unable, for good reasons, to pay for family planning services. For 
example, unemancipated minors who wish to receive services on a 
confidential basis must be considered on the basis of their own 
resources.
    Nonprofit, as applied to any private agency, institution, or 
organization, means that no part of the entity's net earnings benefit, 
or may lawfully benefit, any private shareholder or individual.
    Prenatal care means medical services provided to a pregnant woman to 
promote maternal and fetal health.
    Program and project are used interchangeably and mean a coherent 
assembly of plans, activities and supporting resources contained within 
an administrative framework.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means one of the 50 States, the District of Columbia, Puerto 
Rico, Guam, the Virgin Islands, American Samoa, Northern Marianas, or 
the Trust Territory of the Pacific Islands.
    Title X means title X of the Act, 42 U.S.C. 300, et seq.
    Title X program and title X project are used interchangeably and 
mean the identified program which is approved by the Secretary for 
support under section 1001 of the Act, as the context may require. Title 
X project funds include all funds allocated to the title X program, 
including but not limited to grant funds, grant-related income or 
matching funds.

[45 FR 37436, June 3, 1980, as amended at 48 FR 3614, Jan, 26, 1983; 49 
FR 38118, Sept. 27, 1984; 53 FR 2944, 2946, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.2 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.3  Who is eligible to apply for a family planning services grant?

    Any public or nonprofit private entity in a State may apply for a 
grant under this subpart.



Sec. 59.4  How does one apply for a family planning services grant?

    (a) Application for a grant under this subpart shall be made on an 
authorized form.
    (b) An individual authorized to act for the applicant and to assume 
on behalf of the applicant the obligations imposed by the terms and 
conditions of the grant, including the regulations of this subpart, must 
sign the application.
    (c) The application shall contain--
    (1) A description, satisfactory to the Secretary, of the project and 
how it will meet the requirements of this subpart;
    (2) A budget and justification of the amount of grant funds 
requested;
    (3) A description of the standards and qualifications which will be 
required for all personnel and for all facilities to be used by the 
project; and
    (4) Such other pertinent information as the Secretary may require.



Sec. 59.5  What requirements must be met by a family planning project?

    (a) Each project supported under this part must:
    (1) Provide a broad range of acceptable and effective medically 
approved family planning methods (including natural family planning 
methods) and services (including infertility services and services for 
adolescents). If an organization offers only a single method of family 
planning, such as natural family planning, it may participate as part of 
a title X project as long as the entire title X project offers a broad 
range of family planning services.
    (2) Provide services without subjecting individuals to any coercion 
to accept services or to employ or not to employ any particular methods 
of family planning. Acceptance of services must be solely on a voluntary 
basis and may not be made a prerequisite to eligibility for, or receipt 
of, any other

[[Page 400]]

service, assistance from or participation in any other program of the 
applicant.1
---------------------------------------------------------------------------

    1 Section 205 of Pub. L. 94-63 states: ``Any (1) officer or 
employee of the United States, (2) officer or employee of any State, 
political subdivision of a State, or any other entity, which administers 
or supervises the administration of any program receiving Federal 
financial assistance, or (3) person who receives, under any program 
receiving Federal assistance, compensation for services, who coerces or 
endeavors to coerce any person to undergo an abortion or sterilization 
procedure by threatening such person with the loss of, or 
disqualification for the receipt of, any benefit or service under a 
program receiving Federal financial assistance shall be fined not more 
than $1,000 or imprisoned for not more than one year, or both.''
---------------------------------------------------------------------------

    (3) Provide services in a manner which protects the dignity of the 
individual.
    (4) Provide services without regard to religion, race, color, 
national origin, handicapping condition, age, sex, number of 
pregnancies, or marital status.
    (5) Provide that priority in the provision of services will be given 
to persons from low-income families.
    (6) Provide that no charge will be made for services provided to any 
person from a low-income family except to the extent that payment will 
be made by a third party (including a Government agency) which is 
authorized to or is under legal obligation to pay this charge.
    (7) Provide that charges will be made for services to persons other 
than those from low-income families in accordance with a schedule of 
discounts based on ability to pay, except that charges to persons from 
families whose annual income exceeds 250 percent of the levels set forth 
in the most recent CSA Income Poverty Guidelines (45 CFR 1060.2) will be 
made in accordance with a schedule of fees designed to recover the 
reasonable cost of providing services.
    (8) If a third party (including a Government agency) is authorized 
or legally obligated to pay for services, all reasonable efforts must be 
made to obtain the third-party payment without application of any 
discounts. Where the cost of services is to be reimbursed under title 
XIX or title XX of the Social Security Act, a written agreement with the 
title XIX or title XX agency is required.
    (9)(i) Provide that if an application relates to consolidation of 
service areas or health resources or would otherwise affect the 
operations of local or regional entities, the applicant must document 
that these entities have been given, to the maximum feasible extent, an 
opportunity to participate in the development of the application. Local 
and regional entities include existing or potential subgrantees which 
have previously provided or propose to provide family planning services 
to the area proposed to be served by the applicant.
    (ii) Provide an opportunity for maximum participation by existing or 
potential subgrantees in the ongoing policy decisionmaking of the 
project.
    (10) Provide for an Advisory Committee as required by Sec. 59.6.
    (b) In addition to the requirements of paragraph (a) of this 
section, each title X project must meet each of the following 
requirements unless the Secretary determines that the title X project 
has established good cause for its omission. Each title X project must:
    (1) Provide for medical services related to family planning 
(including physician's consultation, examination prescription, and 
continuing supervision, laboratory examination, contraceptive supplies) 
and necessary referral to other medical facilities when medically 
indicated, and provide for the effective usage of contraceptive devices 
and practices.
    (2) Provide for social services related to family planning, 
including counseling, referral to and from other social and medical 
service agencies, and any ancillary services which may be necessary to 
facilitate clinic attendance.
    (3) Provide for informational and educational programs designed to 
(i) achieve community understanding of the objectives of the title X 
program, (ii) inform the community of the availability of services, and 
(iii) promote continued participation in the title X project by persons 
to whom family planning services may be beneficial.
    (4) Provide for orientation and inservice training for all title X 
project personnel.

[[Page 401]]

    (5) Provide services without the imposition of any durational 
residency requirement or requirement that the patient be referred by a 
physician.
    (6) Provide that family planning medical services will be performed 
under the direction of a physician with special training or experience 
in family planning.
    (7) Provide that all services purchased for title X project 
participants will be authorized by the title X project director or his 
designee on the title X project staff.
    (8) Provide for coordination and use of referral arrangements with 
other providers of health care services, local health and welfare 
departments, hospitals, voluntary agencies, and health services projects 
supported by other Federal programs.
    (9) Provide that if family planning services are provided by 
contract or other similar arrangements with actual providers of 
services, services will be provided in accordance with a plan which 
establishes rates and methods of payment for medical care. These 
payments must be made under agreements with a schedule of rates and 
payment procedures maintained by the grantee. The grantee must be 
prepared to substantiate that these rates are reasonable and necessary.
    (10) Provide, to the maximum feasible extent, an opportunity for 
participation in the development, implementation, and evaluation of the 
title X project by persons broadly representative of all significant 
elements of the population to be served, and by others in the community 
knowledgeable about the community's needs for family planning services.

(Sec. 215, Public Health Service Act, 58 Stat. 690, 42 U.S.C. 216; sec. 
1006(a), Public Health Service Act, 84 Stat. 1507, 42 U.S.C. 300a-4(a); 
sec. 931(b)(1) of Pub. L. 97-35, 95 Stat. 570, 42 U.S.C. 300(a))

[45 FR 37436, June 3, 1980, as amended at 49 FR 38118, Sept. 27, 1984; 
53 FR 2944, 2946, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.5 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.6  What procedures apply to assure the suitability of informational and educational material?

    (a) A grant under this section may be made only upon assurances 
satisfactory to the Secretary that the title X project shall provide for 
the review and approval of informational and educational materials 
developed or made available under the title X project by an Advisory 
Committee prior to their distribution, to assure that the materials are 
suitable for the population or community to which they are to be made 
available and the purposes of title X of the Act. The title X project 
shall not disseminate any such materials which are not approved by the 
Advisory Committee.
    (b) The Advisory Committee referred to in paragraph (a) of this 
section shall be established as follows:
    (1) Size. The Committee shall consist of no fewer than five but not 
more than nine members, except that this provision may be waived by the 
Secretary for good cause shown.
    (2) Composition. The Committee shall include individuals broadly 
representative (in terms of demographic factors such as race, color, 
national origin, handicapped condition, sex, and age) of population or 
community for which the materials are intended.
    (3) Function. In reviewing materials, the Advisory Committee shall:
    (i) Consider the educational and cultural backgrounds of individuals 
to whom the materials are addressed;
    (ii) Consider the standards of the population or community to be 
served with respect to such materials;
    (iii) Review the content of the material to assure that the 
information is factually correct;
    (iv) Determine whether the material is suitable for the population 
or community to which it is to be made available; and
    (v) Establish a written record of its determinations.

[45 FR 37436, June 3, 1980, as amended at 53 FR 2946, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.6 which have been 
suspended, see the Editorial Note following the Source of Subpart A.

[[Page 402]]



Sec. 59.7  Standards of compliance with prohibition on abortion.

    A project may not receive funds under this subpart unless it 
provides assurance satisfactory to the Secretary that it does not 
include abortion as a method of family planning. Such assurance must 
include, as a minimum, representations (supported by such documentation 
as the Secretary may request) as to compliance with each of the 
requirements in Sec. 59.8 through Sec. 59.10. A project must comply with 
such requirements at all times during the period for which support under 
title X is provided.

[53 FR 2944, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.7 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.8  Prohibition on counseling and referral for abortion services; limitation of program services to family planning.

    (a)(1) A title X project may not provide counseling concerning the 
use of abortion as a method of family planning or provide referral for 
abortion as a method of family planning.
    (2) Because title X funds are intended only for family planning, 
once a client served by a title X project is diagnosed as pregnant, she 
must be referred for appropriate prenatal and/or social services by 
furnishing a list of available providers that promote the welfare of 
mother and unborn child. She must also be provided with information 
necessary to protect the health of mother and unborn child until such 
time as the referral appointment is kept. In cases in which emergency 
care is required, however, the title X project shall be required only to 
refer the client immediately to an appropriate provider of emergency 
medical services.
    (3) A title X project may not use prenatal, social service or 
emergency medical or other referrals as an indirect means of encouraging 
or promoting abortion as a method of family planning, such as by 
weighing the list of referrals in favor of health care providers which 
perform abortions, by including on the list of referral providers health 
care providers whose principal business is the provision of abortions, 
by excluding available providers who do not provide abortions, or by 
``steering'' clients to providers who offer abortion as a method of 
family planning.
    (4) Nothing in this subpart shall be construed as prohibiting the 
provision of information to a project client which is medically 
necessary to assess the risks and benefits of different methods of 
contraception in the course of selecting a method; provided, that the 
provision of this information does not include counseling with respect 
to or otherwise promote abortion as a method of family planning.
    (b) Examples. (1) A pregnant client of a title X project requests 
prenatal care services, which project personnel are qualified to 
provide. Because the provision of such services is outside the scope of 
family planning supported by title X, the client must be referred to 
appropriate providers of prenatal care.
    (2) A title X project discovers an ectopic pregnancy in the course 
of conducting a physical examination of a client. Referral arrangements 
for emergency medical care are immediately provided. Such action is in 
compliance with the requirements of paragraph (a)(2) of this section.
    (3) A pregnant woman asks the title X project to provide her with a 
list of abortion providers in the area. The title X project tells her 
that it does not refer for abortion but provides her a list which 
includes, among other health care providers, a local clinic which 
principally provides abortions. Inclusion of the clinic on the list is 
inconsistent with paragraph (a)(3) of this section.
    (4) A pregnant woman asks the title X project to provide her with a 
list of abortion providers in the area. The project tells her that it 
does not refer for abortion and provides her a list which consists of 
hospitals and clinics and other providers which provide prenatal care 
and also provide abortions. None of the entries on the list are 
providers that principally provide abortions. Although there are several 
appropriate providers of prenatal care in the area which do not provide 
or refer for abortions, none of these providers are included on the 
list. Provision of the list is inconsistent with paragraph (a)(3) of 
this section.

[[Page 403]]

    (5) A pregnant woman requests information on abortion and asks the 
title X project to refer her to an abortion provider. The project 
counselor tells her that the project does not consider abortion an 
appropriate method of family planning and therefore does not counsel or 
refer for abortion. The counselor further tells the client that the 
project can help her to obtain prenatal care and necessary social 
services, and provides her with a list of such providers from which the 
client may choose. Such actions are consistent with paragraph (a) of 
this section.
    (6) Title X project staff provide contraceptive counseling to a 
client in order to assist her in selecting a contraceptive method. In 
discussing oral contraceptives, the project counselor provides the 
client with information contained in the patient package insert 
accompanying a brand of oral contraceptives, referring to abortion only 
in the context of a discussion of the relative safety of various 
contraceptive methods and in no way promoting abortion as a method of 
family planning. The provision of this information does not constitute 
abortion counseling or referral.

[53 FR 2945, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.8 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.9  Maintenance of program integrity.

    A title X project must be organized so that it is physically and 
financially separate, as determined in accordance with the review 
established in this section, from activities which are prohibited under 
section 1008 of the Act and Sec. 59.8 and Sec. 59.10 of these 
regulations from inclusion in the title X program. In order to be 
physically and financially separate, a title X project must have an 
objective integrity and independence from prohibited activities. Mere 
bookkeeping separation of title X funds from other monies is not 
sufficient. The Secretary will determine whether such objective 
integrity and independence exist based on a review of facts and 
circumstances. Factors relevant to this determination shall include (but 
are not limited to):
    (a) The existence of separate accounting records;
    (b) The degree of separation from facilities (e.g., treatment, 
consultation, examination, and waiting rooms) in which prohibited 
activities occur and the extent of such prohibited activities;
    (c) The existence of separate personnel;
    (d) The extent to which signs and other forms of identification of 
the title X project are present and signs and material promoting 
abortion are absent.

[53 FR 2945, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.9 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.10  Prohibition on activities that encourage, promote or advocate abortion.

    (a) A title X project may not encourage, promote or advocate 
abortion as a method of family planning. This requirement prohibits 
actions to assist women to obtain abortions or increase the availability 
or accessibility of abortion for family planning purposes. Prohibited 
actions include the use of title X project funds for the following:
    (1) Lobbying for the passage of legislation to increase in any way 
the availability of abortion as a method of family planning;
    (2) Providing speakers to promote the use of abortion as a method of 
family planning;
    (3) Paying dues to any group that as a significant part of its 
activities advocates abortion as a method of family planning;
    (4) Using legal action to make abortion available in any way as a 
method of family planning; and
    (5) Developing or disseminating in any way materials (including 
printed matter and audiovisual materials) advocating abortion as a 
method of family planning.
    (b) Examples. (1) Clients at a title X project are given brochures 
advertising an abortion clinic. Provision of the brochure violates 
paragraph (a) of this section.
    (2) A title X project makes an appointment for a pregnant client 
with

[[Page 404]]

an abortion clinic. The title X project has violated paragraph (a) of 
this section.
    (3) A title X project pays dues to a state association which, among 
other activities, lobbies at state and local levels for the passage of 
legislation to protect and expand the legal availability of abortion as 
a method of family planning. The association spends a significant amount 
of its annual budget on such activity. Payment of dues to the 
association violates paragraph (a)(3) of this section.
    (4) An organization conducts a number of activities, including 
operating a title X project. The organization uses non-project funds to 
pay dues to an association which, among other activities, engages in 
lobbying to protect and expand the legal availability of abortion as a 
method of family planning. The association spends a significant amount 
of its annual budget on such activity. Payment of dues to the 
association by the organization does not violate paragraph (a)(3) of 
this section.
    (5) An organization that operates a title X project engages in 
lobbying to increase the legal availability of abortion as a method of 
family planning. The project itself engages in no such activities and 
the facilities and funds of the project are kept separate from 
prohibited activities. The project is not in violation of paragraph 
(a)(1) of this section.
    (6) Employees of a title X project write their legislative 
representatives in support of legislation seeking to expand the legal 
availability of abortion, using no project funds to do so. The title X 
project has not violated paragraph (a)(1) of this section.
    (7) On her own time and at her own expense, a title X project 
employee speaks before a legislative body in support of abortion as a 
method of family planning. The title X project has not violated 
paragraph (a) of this section.

[53 FR 2945, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.10 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.11  What criteria will the Department of Health and Human Services use to decide which family planning services projects to fund and in what amount?

    (a) Within the limits of funds available for these purposes, the 
Secretary may award grants for the establishment and operation of those 
title X projects which will in the Department's judgment best promote 
the purposes of section 1001 of the Act, taking into account:
    (1) The number of patients and, in particular, the number of low-
income patients to be served;
    (2) The extent to which family planning services are needed locally;
    (3) The relative need of the applicant;
    (4) The capacity of the applicant to make rapid and effective use of 
the Federal assistance;
    (5) The adequacy of the applicant's facilities and staff;
    (6) The relative availability of non-Federal resources within the 
community to be served and the degree to which those resources are 
committed to the project; and
    (7) The degree to which the title X project plan adequately provides 
for the requirements set forth in these regulations.
    (b) The Secretary shall determine the amount of any award on the 
basis of his estimate of the sum necessary for the performance of the 
title X project. No grant may be made for less than 90 percent of the 
title X project's costs, as so estimated, unless the grant is to be made 
for a title X project which was supported, under section 1001, for less 
than 90 percent of its costs in fiscal year 1975. In that case, the 
grant shall not be for less than the percentage of costs covered by the 
grant in fiscal year 1975.
    (c) No grant may be made for an amount equal to 100 percent of the 
title X project's estimated costs.

[45 FR 37436, June 3, 1980. Redesignated and amended at 53 FR 2944, 
2946, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.11 which have been 
suspended, see the Editorial Note following the Source of Subpart A.

[[Page 405]]



Sec. 59.12  How is a grant awarded?

    (a) The notice of grant award specifies how long HHS intends to 
support the title X project without requiring the project to recompete 
for funds. This period, called the project period, will usually be for 3 
to 5 years.
    (b) Generally the grant will initially be for 1 year and subsequent 
continuation awards will also be for 1 year at a time. A grantee must 
submit a separate application to have the support continued for each 
subsequent year. Decisions regarding continuation awards and the funding 
level of such awards will be made after consideration of such factors as 
the grantee's progress and management practices, and the availability of 
funds. In all cases, continuation awards require a determination by HHS 
that continued funding is in the best interest of the Government.
    (c) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.

[45 FR 37436, June 3, 1980. Redesignated and amended at 53 FR 2944, 
2946, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.12 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.13  For what purpose may grant funds be used?

    Any funds granted under this subpart shall be expended solely for 
the purpose for which the funds were granted in accordance with the 
approved application and budget, the regulations of this subpart, the 
terms and conditions of the award, and the applicable cost principles 
prescribed in subpart Q of 45 CFR part 74.

[45 FR 37436, June 3, 1980. Redesignated at 53 FR 2944, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.13 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.14  What other HHS regulations apply to grants under this subpart?

    Attention is drawn to the following HHS Department-wide regulations 
which apply to grants under this subpart: These include:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
42 CFR part 122, subpart E--Health Systems Agency review of certain 
proposed uses of Federal health funds
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 19--Limitations on payment or reimbursement for drugs
45 CFR part 74--Administration of grants
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

[49 FR 38116, Sept. 27, 1984. Redesignated at 53 FR 2944, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.14 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.15  Confidentiality.

    All information as to personal facts and circumstances obtained by 
the title X project staff about individuals receiving services must be 
held confidential and must not be disclosed without the individual's 
consent, except as may be necessary to provide services to the patient 
or as required by law, with appropriate safeguards for confidentiality. 
Otherwise, information may be disclosed only in summary, statistical, or 
other form which does not identify particular individuals.

[45 FR 37436, June 3, 1980. Redesignated and amended at 53 FR 2944, 
2946, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.15 which have been 
suspended, see the Editorial Note following the Source of Subpart A.

[[Page 406]]



Sec. 59.16  Inventions or discoveries.

    (a) A title X project grant award is subject to the regulations of 
HHS as set forth in 45 CFR parts 6 and 8, as amended. These regulations 
shall apply to any activity of the title X project for which grant funds 
are used, whether the activity is part of an approved title X project or 
is an unexpected byproduct of that title X project.
    (b) The grantee and the Secretary shall take appropriate measures to 
assure that no contracts, assignments, or other arrangements 
inconsistent with the grant obligation are continued or entered into and 
that all personnel involved in the grant activity are aware of and 
comply with such obligations.

[45 FR 37436, June 3, 1980. Redesignated and amended at 53 FR 2944, 
2946, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.16 which have been 
suspended, see the Editorial Note following the Source of Subpart A.



Sec. 59.17  Additional conditions.

    The Secretary may, with respect to any grant, impose additional 
conditions prior to or at the time of any award, when in the 
Department's judgment these conditions are necessary to assure or 
protect advancement of the approved program, the interests of public 
health, or the proper use of grant funds.

[45 FR 37436, June 3, 1980. Redesignated at 53 FR 2944, Feb. 2, 1988]

    Editorial Note: For provisions of Sec. 59.17 which have been 
suspended, see the Editorial Note following the Source of Subpart A.

Subpart B  [Reserved]



         Subpart C--Grants for Family Planning Service Training

    Authority: Sec. 6(c), 84 Stat. 1507, 42 U.S.C. 300a-4; sec. 6(c), 84 
Stat. 1507, 42 U.S.C. 300a-1.

    Source: 37 FR 7093, Apr. 8, 1972, unless otherwise noted.



Sec. 59.201  Applicability.

    The regulations in this subpart are applicable to the award of 
grants pursuant to section 1003 of the Public Health Service Act (42 
U.S.C. 300a-1) to provide the training for personnel to carry out family 
planning service programs described in sections 1001 and 1002 of the 
Public Health Service Act (42 U.S.C. 300, 300a).



Sec. 59.202  Definitions.

    As used in this subpart:
    (a) Act means the Public Health Service Act.
    (b) State means one of the 50 States, the District of Columbia, 
Puerto Rico, Guam, the Virgin Islands, American Samoa, or the Trust 
Territory of the Pacific Islands.
    (c) Nonprofit private entity means a private entity no part of the 
net earnings of which inures, or may lawfully inure, to the benefit of 
any private shareholder or individual.
    (d) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (e) Training means job-specific skill development, the purpose of 
which is to promote and improve the delivery of family planning 
services.



Sec. 59.203  Eligibility.

    (a) Eligible applicants. Any public or nonprofit private entity 
located in a State is eligible to apply for a grant under this subpart.
    (b) Eligible projects. Grants pursuant to section 1003 of the Act 
and this subpart may be made to eligible applicants for the purpose of 
providing programs, not to exceed three months in duration, for training 
family planning or other health services delivery personnel in the 
skills, knowledge, and attitudes necessary for the effective delivery of 
family planning services: Provided, That the Secretary may in particular 
cases approve support of a program whose duration is longer than three 
months where he determines (1) that such program is consistent with the 
purposes of this subpart and (2) that the program's objectives cannot be 
accomplished within three months because of the unusually complex or

[[Page 407]]

specialized nature of the training to be undertaken.

[37 FR 7093, Apr. 8, 1972, as amended at 40 FR 17991, Apr. 24, 1975]



Sec. 59.204  Application for a grant.

    (a) An application for a grant under this subpart shall be submitted 
to the Secretary at such time and in such form and manner as the 
Secretary may prescribe.1 The application shall contain a 
full and adequate description of the project and of the manner in which 
the applicant intends to conduct the project and carry out the 
requirements of this subpart, and a budget and justification of the 
amount of grant funds requested, and such other pertinent information as 
the Secretary may require.
---------------------------------------------------------------------------

    1 Applications and instructions may be obtained from the 
Program Director, Family Planning Services, at the Regional Office of 
the Department of Health and Human Services for the region in which the 
project is to be conducted, or the Office of Family Planning, Office of 
the Assistant Secretary for Health, Washington, DC 20201.
---------------------------------------------------------------------------

    (b) The application shall be executed by an individual authorized to 
act for the applicant and to assume for the applicant the obligations 
imposed by the regulations of this subpart and any additional conditions 
of the grant.

(Sec. 6(c), Public Health Service Act, 84 Stat. 1506 and 1507 (42 U.S.C. 
300, 300a-1, and 300a-4))

[37 FR 7093, Apr. 8, 1972, as amended at 49 FR 38116, Sept. 27, 1984]



Sec. 59.205  Project requirements.

    An approvable application must contain each of the following unless 
the Secretary determines that the applicant has established good cause 
for its omission:
    (a) Assurances that:
    (1) No portion of the Federal funds will be used to train personnel 
for programs where abortion is a method of family planning.
    (2) No portion of the Federal funds will be used to provide 
professional training to any student as part of his education in pursuit 
of an academic degree.
    (3) No project personnel or trainees shall on the grounds of sex, 
religion, or creed be excluded from participation in, be denied the 
benefits of, or be subjected to discrimination under the project.
    (b) Provision of a methodology to assess the particular training 
(e.g., skills, attitudes, or knowledge) that prospective trainees in the 
area to be served need to improve their delivery of family planning 
services.
    (c) Provision of a methodology to define the objectives of the 
training program in light of the particular needs of trainees defined 
pursuant to paragraph (b) of this section.
    (d) Provision of a method for development of the training curriculum 
and any attendant training materials and resources.
    (e) Provision of a method for implementation of the needed training.
    (f) Provision of an evaluation methodology, including the manner in 
which such methodology will be employed, to measure the achievement of 
the objectives of the training program.
    (g) Provision of a method and criteria by which trainees will be 
selected.



Sec. 59.206  Evaluation and grant award.

    (a) Within the limits of funds available for such purpose, the 
Secretary may award grants to assist in the establishment and operation 
of those projects which will in his judgment best promote the purposes 
of section 1003 of the Act, taking into account:
    (1) The extent to which a training program will increase the 
delivery of services to people, particularly low-income groups, with a 
high percentage of unmet need for family planning services;
    (2) The extent to which the training program promises to fulfill the 
family planning services delivery needs of the area to be served, which 
may include, among other things:
    (i) Development of a capability within family planning service 
projects to provide pre- and in-service training to their own staffs;
    (ii) Improvement of the family planning services delivery skills of 
family planning and health services personnel;
    (iii) Improvement in the utilization and career development of 
paraprofessional and paramedical manpower in family planning services;

[[Page 408]]

    (iv) Expansion of family planning services, particularly in rural 
areas, through new or improved approaches to program planning and 
deployment of resources;
    (3) The capacity of the applicant to make rapid and effective use of 
such assistance;
    (4) The administrative and management capability and competence of 
the applicant;
    (5) The competence of the project staff in relation to the services 
to be provided; and
    (6) The degree to which the project plan adequately provides for the 
requirements set forth in Sec. 59.205.
    (b) The amount of any award shall be determined by the Secretary on 
the basis of his estimate of the sum necessary for all or a designated 
portion of direct project costs plus an additional amount for indirect 
costs, if any, which will be calculated by the Secretary either: (1) On 
the basis of his estimate of the actual indirect costs reasonably 
related to the project, or (2) on the basis of a percentage of all, or a 
portion of, the estimated direct costs of the project when there are 
reasonable assurances that the use of such percentage will not exceed 
the approximate actual indirect costs. Such award may include an 
estimated provisional amount for indirect costs or for designated direct 
costs (such as travel or supply costs) subject to upward (within the 
limits of available funds) as well as downward adjustments to actual 
costs when the amount properly expended by the grantee for provisional 
items has been determined by the Secretary.
    (c) Allowability of costs shall be in conformance with the 
applicable cost principles prescribed by Subpart Q of 35 CFR part 74.
    (d) All grant awards shall be in writing, shall set forth the amount 
of funds granted and the period for which support is recommended.
    (e) Neither the approval of any project nor any grant award shall 
commit or obligate the United States in any way to make any additional, 
supplemental, continuation, or other award with respect to any approved 
project or portion thereof. For continuation support, grantees must make 
separate application annually at such times and in such form as the 
Secretary may direct.

[37 FR 7093, Apr. 8, 1972, as amended at 38 FR 26199, Sept. 19, 1973]



Sec. 59.207  Payments.

    The Secretary shall from time to time make payments to a grantee of 
all or a portion of any grant award, either in advance or by way of 
reimbursement for expenses incurred or to be incurred in the performance 
of the project to the extent he determines such payments necessary to 
promote prompt initiation and advancement of the approved project.



Sec. 59.208  Use of project funds.

    (a) Any funds granted pursuant to this subpart as well as other 
funds to be used in performance of the approved project shall be 
expended solely for carrying out the approved project in accordance with 
the statute, the regulations of this subpart, the terms and conditions 
of the award, and, except as may otherwise be provided in this subpart, 
the applicable cost principles prescribed by subpart Q of 45 CFR part 
74.
    (b) Prior approval by the Secretary of revision of the budget and 
project plan is required whenever there is to be a significant change in 
the scope or nature of project activities.
    (c) The Secretary may approve the payment of grant funds to trainees 
for:
    (1) Return travel to the trainee's point of origin.
    (2) Per diem during the training program, and during travel to and 
from the program, at the prevailing institutional or governmental rate, 
whichever is lower.

[37 FR 7093, Apr. 8, 1972, as amended at 38 FR 26199, Sept. 19, 1973]



Sec. 59.209  Civil rights.

    Attention is called to the requirements of Title VI of the Civil 
Rights Act of 1964 (78 Stat. 252, 42 U.S.C. 2000d et seq.) and in 
particular section 601 of such Act which provides that no person in the 
United States shall, on the grounds of race, color, or national origin 
be excluded from participation in,

[[Page 409]]

be denied the benefits of, or be subjected to discrimination under any 
program or activity receiving Federal financial assistance. A regulation 
impelmenting such title VI, which applies to grants made under this 
part, has been issued by the Secretary of Health and Human Services with 
the approval of the President (45 CFR part 80).



Sec. 59.210  Inventions or discoveries.

    Any grant award pursuant to Sec. 59.206 is subject to the 
regulations of the Department of Health and Human Services as set forth 
in 45 CFR parts 6 and 8, as amended. Such regulations shall apply to any 
activity for which grant funds are in fact used whether within the scope 
of the project as approved or otherwise. Appropriate measures shall be 
taken by the grantee and by the Secretary to assure that no contracts, 
assignments or other arrangements inconsistent with the grant obligation 
are continued or entered into and that all personnel involved in the 
supported activity are aware of and comply with such obligations. 
Laboratory notes, related technical data, and information pertaining to 
inventions and discoveries shall be maintained for such periods, and 
filed with or otherwise made available to the Secretary, or those he may 
designate at such times and in such manner, as he may determine 
necessary to carry out such Department regulations.



Sec. 59.211  Publications and copyright.

    Except as may otherwise be provided under the terms and conditions 
of the award, the grantee may copyright without prior approval any 
publications, films or similar materials developed or resulting from a 
project supported by a grant under this part, subject, however, to a 
royalty-free, nonexclusive, and irrevocable license or right in the 
Government to reproduce, translate, publish, use, disseminate, and 
dispose of such materials and to authorize others to do so.



Sec. 59.212  Grantee accountability.

    (a) Accounting for grant award payments. All payments made by the 
Secretary shall be recorded by the grantee in accounting records 
separate from the records of all other grant funds, including funds 
derived from other grant awards. With respect to each approved project 
the grantee shall account for the sum total of all amounts paid by 
presenting or otherwise making available evidence satisfactory to the 
Secretary of expenditures for direct and indirect costs meeting the 
requirements of this part: Provided, however, That when the amount 
awarded for indirect costs was based on a predetermined fixed-percentage 
of estimated direct costs, the amount allowed for indirect costs shall 
be computed on the basis of such predetermined fixed-percentage rates 
applied to the total, or a selected element thereof, of the reimbursable 
direct costs incurred.
    (b) [Reserved]
    (c) Accounting for grant-related income--(1) Interest. Pursuant to 
section 203 of the Intergovernmental Cooperation Act of 1968 (42 U.S.C. 
4213), a State will not be held accountable for interest earned on grant 
funds, pending their disbursement for grant purposes. A State, as 
defined in section 102 of the Intergovernmental Cooperation Act, means 
any one of the several States, the District of Columbia, Puerto Rico, 
any territory or possession of the United States, or any agency or 
instrumentality of a State, but does not include the governments of the 
political subdivisions of the State. All grantees other than a State, as 
defined in this subsection, must return all interest earned on grant 
funds to the Federal Government.
    (d) Grant closeout--(1) Date of final accounting. A grantee shall 
render, with respect to each approved project, a full account, as 
provided herein, as of the date of the termination of grant support. The 
Secretary may require other special and periodic accounting.
    (2) Final settlement. There shall be payable to the Federal 
Government as final settlement with respect to each approved project the 
total sum of:
    (i) Any amount not accounted for pursuant to paragraph (a) of this 
section;
    (ii) Any credits for earned interest pursuant to paragraph (c)(1) of 
this section;

[[Page 410]]

    (iii) Any other amounts due pursuant to subparts F, M, and O of 45 
CFR part 74.

Such total sum shall constitute a debt owed by the grantee to the 
Federal Government and shall be recovered from the grantee or its 
successors or assignees by setoff or other action as provided by law.

[36 FR 18465, Sept. 15, 1971, as amended at 38 FR 26199, Sept. 19, 1973]



Sec. 59.213  [Reserved]



Sec. 59.214  Additional conditions.

    The Secretary may with respect to any grant award impose additional 
conditions prior to or at the time of any award when in his judgment 
such conditions are necessary to assure or protect advancement of the 
approved project, the interests of public health, or the conservation of 
grant funds.



Sec. 59.215  Applicability of 45 CFR part 74.

    The provisions of 45 CFR part 74, establishing uniform 
administrative requirements and cost principles, shall apply to all 
grants under this subpart to State and local governments as those terms 
are defined in subpart A of that part 74. The relevant provisions of the 
following subparts of part 74 shall also apply to grants to all other 
grantee organizations under this subpart.

                             45 CFR Part 74

Subpart:
A  General.
B  Cash Depositories.
C  Bonding and Insurance.
D  Retention and Custodial Requirements for Records.
F  Grant-Related Income.
G  Matching and Cost Sharing.
K  Grant Payment Requirements.
L  Budget Revision Procedures.
M  Grant Closeout, Suspension, and Termination.
O  Property.
Q  Cost Principles.

[38 FR 26199, Sept. 19, 1973]



PART 59a--NATIONAL LIBRARY OF MEDICINE GRANTS--Table of Contents




   Subpart A--Grants for Establishing, Expanding, and Improving Basic 
                                Resources

Sec.
59a.1  Programs to which these regulations apply.
59a.2  Definitions.
59a.3  Who is eligible for a grant?
59a.4  How are grant applications evaluated?
59a.5  Awards.
59a.6  How may funds or materials be used?
59a.7  Other HHS regulations that apply.

         Subpart B--Establishment of Regional Medical Libraries

59a.11  Programs to which these regulations apply.
59a.12  Definitions.
59a.13  Who is eligible for a grant?
59a.14  How to apply.
59a.15  Awards.
59a.16  What other conditions apply?
59a.17  Other HHS regulations that apply.

    Source: 56 FR 29189, June 26, 1991, unless otherwise noted.



   Subpart A--Grants for Establishing, Expanding, and Improving Basic 
                                Resources

    Authority: 42 U.S.C. 286b-2, 286b-5.



Sec. 59a.1  Programs to which these regulations apply.

    (a) The regulations of this subpart apply to grants of funds, 
materials, or both, for establishing, expanding, and improving basic 
medical library resources as authorized by section 474 of the Act (42 
U.S.C. 286b-5).
    (b) This subpart also applies to cooperative agreements awarded for 
this purpose. In these circumstances, references to ``grant(s)'' shall 
include ``cooperative agreements(s).''



Sec. 59a.2  Definitions.

    Undefined terms have the same meaning as provided in the Act. As 
used in this subpart:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.).
    Project period--See Sec. 59a.5(c).

[[Page 411]]

    Related instrumentality means a public or private institution, 
organization, or agency, other than a medical library, whose primary 
function is the acquisition, preservation, dissemination, and/or 
processing of information relating to the health sciences.
    Secretary means the Secretary of Health and Human Services and any 
other official of the Department of Health and Human Services to whom 
the authority involved is delegated.



Sec. 59a.3  Who is eligible for a grant?

    Except as otherwise prohibited by law, any public or private 
nonprofit institution, organization, or agency authorized or qualified 
to carry on the functions of a medical library, and any public or 
private related instrumentality, is eligible for a grant under this 
subpart.



Sec. 59a.4  How are grant applications evaluated?

    The Secretary shall evaluate grant applications using the officers 
and employees, and experts, consultants, or groups engaged by the 
Secretary for that purpose. The Secretary's evaluation shall consider 
the scope of library or related services for the population and purposes 
served by the applicant. This evaluation shall include consideration of 
the following information which must be set forth in the grant 
application and such other information the Secretary considers 
pertinent:
    (a) Evidence of the applicant's efficiency in providing services,
    (b) Amount of available equipment and other resources on hand to 
satisfy the needs of the area served by the facility,
    (c) Extent of coordination with other libraries and related 
facilities, and
    (d) Potential for testing or demonstration of new or improved 
techniques in health-sciences informational services.

(Approved by the Office of Management and Budget under control number 
0925-0276)



Sec. 59a.5  Awards.

    (a) General. Within the limits of funds available, the Secretary may 
award grants to those applicants whose proposals for establishments, 
expansion, or improvement will, in the Secretary's judgment, best 
promote the purposes of section 474 of the Act (42 U.S.C. 286b-5).
    (b) Determination of award amount. An Award may not exceed 
$1,000,000 or other amount established by law for any fiscal year.
    (1) The scope of medical-library or related services provided by the 
applicant for the population and purposes it serves considering:
    (i) The number of graduate and undergraduate students, and 
physicians and other practitioners in health-related sciences making use 
of the applicant's library resources;
    (ii) The type and availability of library support staff;
    (iii) The type, size, and qualifications of the faculty of any 
school with which the applicant is affiliated;
    (iv) The staff of any hospitals or clinics with which the 
applicant's library is affiliated;
    (v) The geographic area served and, within that area, the medical-
library or related services otherwise available; and
    (2) The amount adequate to insure continuing financial support from 
non-Federal sources of the applicant's proposed activity during and 
after the period of award. The Secretary shall consider the level of 
non-Federal support for the proposed activity for periods prior to the 
fiscal year in which a grant is made. The Secretary shall require the 
applicant's assurance that non-Federal support will not be diminished as 
a result of the award and that adequate support for this activity will 
be continued during and after the period of Federal assistance.
    (c) Project period. (1) the notice of grant award specifies how long 
the Secretary intends to support the project without requiring the 
project to recompete for funds. This period, called the project period, 
will usually be for one to five years.
    (2) Generally, the grant will initially be for one year at a time 
and subsequent continuation awards will also be for one year at a time. 
A grantee must submit a separate application to have the support 
continued for each subsequent year. Decisions regarding continuation 
awards and the funding level

[[Page 412]]

of these awards will be made after consideration of such factors as the 
grantee's progress and management practices, and the availability of 
funds. In all cases, continuation awards require a determination by the 
Secretary that continued funding is in the best interest of the Federal 
Government.
    (3) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award for any approved 
application or portion of an approved application.

[56 FR 29189, June 26, 1991, as amended at 59 FR 59168, Nov. 16, 1994]



Sec. 59a.6  How may funds or materials be used?

    The grantee shall expend funds or use materials provided by a grant 
under this subpart solely for the purposes for which the funds or 
materials were granted, in accordance with the pertinent provisions of 
the approved application and budget, the regulations of this subpart, 
the terms and conditions of the award, and the applicable cost 
principles in subpart Q of 45 CFR part 74.



Sec. 59a.7  Other HHS regulations that apply.

    Several other regulations apply to grants under this subpart. These 
include, but are not necessarily limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR parts 6 and 8--Inventions and patents
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76 subparts A-F--Governmentwide debarment and suspension 
          (nonprocurement) and requirements for drug-free workplace 
          (grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
          assistance through the Department of Health and Human 
          Services--effectuation of title VI of the Civil Rights Act of 
          1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
          this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
          and activities receiving or benefiting from Federal financial 
          assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
          programs and activities receiving or benefiting from Federal 
          financial assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
          activities receiving Federal financial assistance
45 CFR part 92--Uniform administrative requirements for grants and 
          cooperative agreements to state and local governments



         Subpart B--Establishment of Regional Medical Libraries

    Authority: 42 U.S.C. 286b-2, 286b-6.



Sec. 59a.11  Programs to which these regulations apply.

    (a) This subpart applies to grants made under section 475 of the Act 
(42 U.S.C. 286b-6). Grants are awarded to medical libraries to enable 
them to serve as regional medical libraries for their geographic areas. 
The purpose of the program is to develop a national system of regional 
medical libraries, each of which would have sufficient facilities to 
supplement the services of other medical libraries in its region.
    (b) The purpose of the program may also be supported by contracts. 
Since the primary purpose of these contracts is to assist regional 
libraries and is not for the purpose of acquiring supplies or services 
for use of the Federal Government, the provisions of the Federal 
Acquisition Regulation (48 CFR chapter 1) do not apply. Any contract 
awarded pursuant to section 475 of the Act shall be subject to the 
applicable provisions of this subpart.



Sec. 59a.12  Definitions.

    Underfined terms have the same meaning as provided in the Act.
    As used in this subpart:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.).
    Annual operating expenses means the average annual operating 
expenses for the actual years of operation or an estimated amount based 
on the expenses of libraries or institutions of similar size and 
function.

[[Page 413]]

    Board means the Board of Regents of the National Library of Medicine 
established by section 466 of the Act (42 U.S.C. 286a).
    Geographic area means an area that forms an academically and 
professionally integrated region. Factors considered are location and 
extent of communication facilities and systems, presence and 
distribution of educational and medical and health facilities and 
programs and other activities which, in the Secretary's opinion, justify 
the establishment and operation of a regional medical library.
    Modify and increase means the use of Federal funds or materials to 
supplement rather than supplant non-Federal funds available for library 
resources and services.
    Project period--See Sec. 59a.15(b).
    Secretary means the Secretary of Health and Human Services and any 
other official of the Department of Health and Human Services to whom 
the authority involved is delegated.



Sec. 59a.13  Who is eligible for a grant?

    Except as otherwise prohibited by law, any public or private 
nonprofit organization which is authorized and qualified to operate a 
medical library is eligible for a grant under this subpart.



Sec. 59a.14  How to apply.

    In addition to any other pertinent information which the Secretary 
may require, the applicant shall submit a grant application containing a 
detailed description of a program to provide health-sciences 
informational services for the geographic area in which it is located. 
The description shall include:
    (a) The need for services;
    (b) The adequacy of the applicant's existing or proposed facilities 
and resources to attain the purposes stated in the application;
    (c) The size and nature of the population to be served;
    (d) The region to be served;
    (e) Cooperative arrangements in effect, or proposed, with other 
qualified organizations; and
    (f) The justification for the funds requested.

(Approved by the Office of Management and Budget under control number 
0925-0276)



Sec. 59a.15  Awards.

    (a) General. The Secretary, with the advice of the Board in each 
case, shall award grants to those applicants whose arrangements and 
proposed services will, in the Secretary's judgment, have the greatest 
potential for fulfilling the need for a regional medical library. The 
Secretary, in determining the priority assigned an applicant, must 
consider:
    (1) The adequacy of the applicant's library in terms of collections, 
personnel, equipment, and other facilities; and
    (2) The size and nature of the population to be served in the 
applicant's region.
    (b) Project period. (1) The notice of grant award specifies how long 
the Secretary intends to support the project without requiring the 
project to recompete for funds. This period, called the project period, 
will usually be for one to five years.
    (2) Generally, the grant will initially be for one year and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit a separate application to have the support continued 
for each subsequent year. Decisions regarding continuation awards and 
the funding level of these awards will be made after consideration of 
such factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, continuation awards require a 
determination by the Secretary that continued funding is in the best 
interest of the Federal Government.
    (3) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award for any approved 
application or portion of an approved application.



Sec. 59a.16  What other conditions apply?

    Although the Secretary may approve exceptions which are consistent 
with program purposes, in addition to other terms, conditions, and 
assurances required by law, each grantee must meet the following 
requirements:
    (a) Use of funds. Any funds granted under this subpart shall be 
expended

[[Page 414]]

solely for the purpose for which the funds were granted in accordance 
with the approved application and budget, the regulations of this 
subpart, the terms and conditions of the award, and the applicable cost 
principles in subpart Q of 45 CFR part 74.
    (b) Library resources--(1) Provision of services. The grantee shall 
modify and increase its library resources to provide supportive services 
to other health-sciences informational activities.
    (2) Access to and fees for services. The grantee shall provide free 
loan services to qualified users or, in lieu of loans, make available 
photoduplicated or facsimile copies of biomedical materials which 
qualified requesters may retain. Reasonable fees may be charged for 
copies or other services (other than free loan services) provided by a 
grantee under this subpart: Provided, That equal access to the health-
information resources of the region or of the national network is 
assured. These fees shall be designed to recover expenses. The grantee's 
access policies shall determine the qualifications of individuals or 
organizations for access to the services provided under the grant, so 
long as those policies are consistent with the mandatory service 
undertakings of the program. The Secretary may review the grantee's 
access policies to assure compliance with this requirement.

(Approved by the Office of Management and Budget under control number 
0925-0276)



Sec. 59a.17  Other HHS regulations that apply.

    Several other regulations apply to grants under this subpart. These 
include, but are not necessarily limited to:

42 CFR part 50, subpart A--Responsibilities of PHS awardee and applicant 
          institutions for dealing with and reporting possible 
          misconduct in science
42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR parts 6 and 8--Inventions and patents
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76, subparts A-F--Governmentwide debarment and suspension 
          (nonprocurement) and requirements for drug-free workplace 
          (grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
          assistance through the Department of Health and Human 
          Services--effectuation of title VI of the Civil Rights Act of 
          1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
          this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
          and activities receiving or benefiting from Federal financial 
          assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
          programs and activities receiving or benefiting from Federal 
          financial assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
          activities receiving Federal financial assistance
45 CFR part 92--Uniform administrative requirements for grants and 
          cooperative agreements to state and local governments



PART 60--HEALTH EDUCATION ASSISTANCE LOAN PROGRAM--Table of Contents




                 Subpart A--General Program Description

Sec.
60.1  What is the HEAL program?

                         Subpart B--The Borrower

60.5  Who is an eligible student borrower?
60.6  Who is an eligible nonstudent borrower?
60.7  The loan application process.
60.8  What are the borrower's major rights and responsibilities?

                           Subpart C--The Loan

60.10  How much can be borrowed?
60.11  Terms of repayment.
60.12  Deferment.
60.13  Interest.
60.14  The insurance premium.
60.15  Other charges to the borrower.
60.16  Power of attorney.
60.17  Security and endorsement.
60.18  Consolidation of HEAL loans.
60.19  Forms.
60.20  The Secretary's collection efforts after payment of a default 
          claim.
60.21  Refunds.

                    Subpart D--The Lender and Holder

60.30  Which organizations are eligible to apply to be HEAL lenders and 
          holders?
60.31  The application to be a HEAL lender or holder.
60.32  The HEAL lender or holder insurance contract.

[[Page 415]]

60.33  Making a HEAL loan.
60.34  HEAL loan account servicing.
60.35  HEAL loan collection.
60.36  Consequence of using an agent.
60.37  Forbearance.
60.38  Assignment of a HEAL loan.
60.39  Death and disability claims.
60.40  Procedures for filing claims.
60.41  Determination of amount of loss on claims.
60.42  Records, reports, inspection, and audit requirements for HEAL 
          lenders and holders.
60.43  Limitation, suspension, or termination of the eligibility of a 
          HEAL lender or holder.

                          Subpart E--The School

60.50  Which schools are eligible to be HEAL schools?
60.51  The student loan application.
60.52  The student's loan check.
60.53  Notification to lender or holder of change in enrollment status.
60.54  Payment of refunds by schools.
60.55  Administrative and fiscal procedures.
60.56  Records.
60.57  Reports.
60.58  Federal access to school records.
60.59  Records and federal access after a school is no longer a HEAL 
          school.
60.60  Limitation, suspension, or termination of the eligibility of a 
          HEAL school.
60.61  Responsibilities of a HEAL school.

    Authority: Sec. 215, of the Public Health Service Act, 58 Stat. 690, 
as amended, 63 Stat. 35 (42 U.S.C. 216); secs. 727-739A of the Public 
Health Service Act, 90 Stat. 2243, as amended, 93 Stat. 582, 99 Stat. 
529-532, 102 Stat. 3122-3125 (42 U.S.C. 294-294l-1); renumbered as secs. 
701-720, as amended by 106 Stat. 1994-2011 (42 U.S.C. 292-292p).

    Source: 48 FR 38988, Aug. 26, 1983, unless otherwise noted.



                 Subpart A--General Program Description



Sec. 60.1  What is the HEAL program?

    (a) The Health Education Assistance Loan (HEAL) program is a program 
of Federal insurance of educational loans to graduate students in the 
fields of medicine, osteopathic medicine, dentistry, veterinary 
medicine, optometry, podiatric medicine, pharmacy, public health, 
chiropractic, health administration and clinical psychology. The basic 
purpose of the program is to encourage lenders to make loans to students 
in these fields who desire to borrow money to pay for their educational 
costs. In addition, certain nonstudents (such as doctors serving as 
interns or residents) can borrow in order to pay the current interest 
charges accruing on earlier HEAL loans. By taking a HEAL loan, the 
borrower is obligated to repay the lender or holder the full amount of 
the money borrowed, plus all interest which accrues on the loan.
    (b) HEAL loans may be made by schools, banks, credit unions, State 
agencies, and other institutions eligible as lenders under Sec. 60.30. 
HEAL school eligibility is described in Sec. 60.50.
    (c) The Secretary insures each lender or holder for the losses of 
principal and interest it may incur in the event that a borrower dies; 
becomes totally and permanently disabled; files for bankruptcy under 
chapter 11 or 13 of the Bankruptcy Act; files for bankruptcy under 
chapter 7 of the Bankruptcy Act and files a compliant to determine the 
dischargeability of the HEAL loan; or defaults on his or her loan. In 
these instances, if the lender or holder has complied with all HEAL 
statutes and regulations, and with the lender's or holder's insurance 
contract, and the Secretary pays the amount of the loss to the lender or 
holder, the borrower's loan is then assigned to the Secretary. Only at 
that time, the United States Government becomes the borrower's direct 
creditor and will actively pursue the borrower for repayment of the 
debt, including reporting the borrower's default on the loan to consumer 
credit reporting agencies or to the Internal Revenue Service for 
purposes of locating such taxpayer or for income tax refund offset, and 
referral to the Department of Justice for litigation.
    (d) Any person who knowingly makes a false statement or 
misrepresentation in a HEAL loan transaction, bribes or attempts to 
bribe a Federal official, fraudulently obtains a HEAL loan, or commits 
any other illegal action in connection with a HEAL loan is subject to 
possible fine and imprisonment under Federal statute.
    (e) Calculating time periods. In counting the number of days allowed 
to comply with any provisions of these regulations, Saturdays, Sundays, 
and holidays are to be included. However, if a

[[Page 416]]

due date falls on a Saturday, Sunday, or Federal holiday, the due date 
is the next Federal work day.

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 745, Jan. 8, 1987; 56 
FR 42700, Aug. 29, 1991; 57 FR 28793, June 29, 1992]



                         Subpart B--The Borrower



Sec. 60.5  Who is an eligible student borrower?

    To receive a HEAL loan, a student must satisfy the following 
requirements:
    (a) He or she must be a citizen, national, or lawful permanent 
resident of the United States, permanent resident of the Trust Territory 
of the Pacific Islands (the Republic of Palau), the Republic of the 
Marshall Islands, the Federated States of Micronesia, the Commonwealth 
of the Northern Mariana Islands, or American Samoa, or lawful permanent 
resident of the Commonwealth of Puerto Rico, the Virgin Islands or Guam;
    (b) He or she must be enrolled or accepted for enrollment at a HEAL 
school in a course of study that leads to one of the following degrees:

Doctor of Medicine
Doctor of Osteopathic Medicine
Doctor of Dentistry or equivalent degree
Doctor of Veterinary Medicine or equivalent degree
Doctor of Optometry or equivalent degree
Doctor of Podiatric Medicine or equivalent degree
Bachelor or Master of Science in Pharmacy or equivalent degree
Graduate or equivalent degree in Public Health
Doctor of Chiropractic or equivalent degree
Doctoral degree in Clinical Psychology
Masters or doctoral degree in Health Administration

    (c) He or she must be carrying or plan to carry, during the period 
for which the loan is intended, the normal work load of a full-time 
student, as determined by the school. The student's work load may 
include any combination of courses, work experience, research or special 
studies that the school considers sufficient to classify the student as 
full time.
    (d) If currently enrolled in school, he or she must be in good 
standing, as determined by the school.
    (e)(1) In the case of a pharmacy student, he or she must have 
satisfactorily completed 3 years of training toward the pharmacy degree. 
These 3 years of training may have been taken at the pharmacy school or 
at a different school whose credits are accepted on transfer by the 
pharmacy school.
    (2) The Doctor of Pharmacy degree is considered to be an equivalent 
degree if it is taken in a school that does not require the Bachelor or 
Master of Science in pharmacy as a prerequisite for the Doctor of 
Pharmacy degree.
    (f) In the case of a medical, dental or osteopathic student enrolled 
in a 6-year program that the student may enter directly from secondary 
school, the student must be enrolled in the last 4 years of the program.
    (g) He or she must agree that all funds received under the proposed 
loan will be used solely for tuition, other reasonable educational 
expenses, including fees, books, supplies and equipment, and laboratory 
expenses, reasonable living expenses, reasonable transportation costs 
(only to the extent that they are directly related to the borrower's 
education), and the HEAL insurance premium.
    (h) He or she must require the loan to pursue the course of study at 
the school. This determination of the maximum amount of the loan will be 
made by the school, applying the considerations in Sec. 60.51(f).
    (i) If required under section 3 of the Military Selective Service 
Act to present himself for and submit to registration under such 
section, he must have presented himself and submitted to registration 
under such section.

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30644, Aug. 28, 1986; 
52 FR 745, Jan. 8, 1987; 57 FR 28793, June 29, 1992]



Sec. 60.6  Who is an eligible nonstudent borrower?

    To receive a HEAL loan, a person who is not a student must satisfy 
all of the following requirements:
    (a) He or she must have received a HEAL loan prior to August 13, 
1981, for which he or she is required to make payments of interest, but 
not principal, during the period for which the new loan is intended. 
This may be the grace

[[Page 417]]

period or a period of internship, residency or deferment.
    (b) He or she must continue to meet the citizenship, nationality, or 
residency qualifications required of student borrowers.
    (c) He or she must agree that all funds received under the proposed 
loan will be used solely for payment of currently accruing interest on 
HEAL loans and the HEAL insurance premium.
    (d) If required under section 3 of the Military Selective Service 
Act to present himself for and submit to registration under such 
section, he must have presented himself and submitted to registration 
under such section.

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30644, Aug. 28, 1986]



Sec. 60.7  The loan application process.

    (a)(1)(i) A student seeking a HEAL loan applies to a participating 
lender for a HEAL loan by submitting an application form supplied by the 
school.
    (ii) The applicant must fill out the applicant sections of the form 
completely and accurately.
    (2) The student applicant must be informed of the Federal debt 
collection policies and procedures in accordance with the Department's 
Claims Collection Regulation (45 CFR part 30) prior to the student 
receiving the loan. The applicant must sign a certification statement 
attesting that the applicant has been notified of the actions the 
Federal Government can take in the event that the applicant fails to 
meet the scheduled payments. This signed statement must be maintained by 
the school and the lender or holder as part of the borrower's official 
record.
    (3) A student applicant must have his or her school complete a 
portion of the application providing information relating to:
    (i) The applicant's eligibility for the loan.
    (ii) The cost of his or her education; and
    (iii) The total financial resources that are actually available to 
the applicant for his or her costs of education for the period covered 
by the proposed HEAL loan, as determined in accordance with 
Sec. 60.51(f), and other student aid that the applicant has received or 
will receive for the period covered by the proposed HEAL loan.
    (4) The student applicant must certify on the application that the 
information provided reflects the applicant's total financial resources 
actually available for his or her costs of education for the period 
covered by the proposed HEAL loan and the applicant's total 
indebtedness, and that the applicant has no other financial resources 
that are available to the applicant or that the applicant will receive 
for the period covered by the proposed HEAL loan.
    (5) A student applicant must certify on the application that if 
required under section 3 of the Military Selective Service Act to 
present himself for and submit to registration under such section, he 
has presented himself and submitted to registration under such section.
    (b) The applicant pursuing a full-time course of study at an 
institution of higher education that is a ``participating school'' in 
the Guaranteed Student Loan Program but is not pursuing a course of 
study listed in Sec. 60.5(b), applies for a HEAL loan as a nonstudent 
under paragraph (c) of this section.
    (c)(1)(i) A nonstudent seeking a HEAL loan applies to a 
participating lender for a HEAL loan by submitting an application form 
supplied by the lender.
    (ii) The applicant must fill out the applicant sections of the form 
completely and accurately.
    (2) The nonstudent applicant must be informed of the Federal debt 
collection policies and procedures in accordance with the Department's 
Claims Collection Regulation (45 CFR part 30) prior to the nonstudent 
receiving the loan. The applicant must sign a certification statement 
attesting that the applicant has been notified of the actions the 
Federal Government can take in the event that the applicant fails to 
meet the scheduled payments. This signed statement will be maintained by 
the lender or holder as part of the borrower's official record.
    (3) A nonstudent applicant must have his or her employer or 
institution, whichever is relevant, certify on the application that the 
applicant is:

[[Page 418]]

    (i) Enrolled as a full-time student in an eligible school, as 
described in Sec. 60.12;
    (ii) A participant in an accredited internship or residency program, 
as described in Sec. 60.11(a);
    (iii) A member of the Armed Forces of the United States;
    (iv) A Peace Corps volunteer;
    (v) A member of the National Health Service Corps; or
    (vi) A full-time VISTA volunteer under Title I of the Domestic 
Volunteer Service Act of 1973.
    (4) The nonstudent applicant seeking a HEAL loan during the grace 
period applies to the lender directly.
    (5) A nonstudent applicant must certify on the application that if 
required under section 3 of the Military Selective Service Act to 
present himself for and submit to registration under such section, he 
has presented himself and submitted to registration under such section.
    (6) The nonstudent applicant must certify on the application that 
the information provided reflects the applicant's total financial 
resources and indebtedness.

(Approved by the Office of Management and Budget under control numbers 
0915-0038 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30644, Aug. 28, 1986; 
52 FR 746, Jan. 8, 1987; 57 FR 28794, June 29, 1992]



Sec. 60.8  What are the borrower's major rights and responsibilities?

    (a) The borrower's rights. (1) Once the terms of the HEAL loan have 
been established, the lender or holder may not change them without the 
borrower's consent.
    (2) The lender must provide the borrower with a copy of the 
completed promissory note when the loan is made. The lender or holder 
must return the original note to the borrower when the loan is paid in 
full.
    (3) A lender must disburse HEAL loan proceeds as described in 
Sec. 60.33(f).
    (4) The lender or holder must provide the borrower with a copy of 
the repayment schedule before repayment begins.
    (5) If the loan is sold from one lender or holder to another lender 
or holder, or if the loan is serviced by a party other than the lender 
or holder, the buyer must notify the borrower within 30 days of the 
transaction.
    (6) The borrower does not have to begin repayment until 9 full 
months after leaving school or an accredited internship or residency 
program as described in Sec. 60.11.
    (7) The borrower is entitled to deferment from repayment of the 
principal and interest installments during periods described in 
Sec. 60.12.
    (8) The borrower may prepay the whole or any portion of the loan at 
any time without penalty.
    (9) The lender or holder must allow the borrower to repay a HEAL 
loan according to a graduated repayment schedule.
    (10) The borrower's total loan obligation is cancelled in the event 
of death or total and permanent disability.
    (11) To assist the borrower in avoiding default, the lender or 
holder may grant the borrower forbearance. Forbearance, including 
circumstances in which the lender or holder must grant forbearance, is 
more fully described in Sec. 60.37.
    (12) Any borrower who received a fixed interest rate HEAL loan in 
excess of 12 percent per year may enter into an agreement with the 
lender which made this loan for the reissuance of the loan in accordance 
with section 739A of the Public Health Service Act.
    (b) The borrower's responsibilities. (1) The borrower must pay any 
insurance premium that the lender may require as more fully described in 
Sec. 60.14.
    (2) The borrower must pay all interest charges on the loan as 
required by the lender or holder.
    (3) The borrower must immediately notify the lender or holder in 
writing in the event of:
    (i) Change of address;
    (ii) Change of name;
    (iii) Failure to enroll in a HEAL school for the period for which 
the loan is intended;
    (iv) Transfer to another school;
    (v) Withdrawal from a HEAL school or change in status to less than 
full-time attendance at a HEAL school;
    (vi) Graduation;
    (vii) Failure to enter into or interruption in an internship or 
residency program; or

[[Page 419]]

    (viii) Change of status that authorizes deferment.
    (4) The borrower must repay the loan in accordance with the 
repayment schedule.
    (5) A borrower may not have a HEAL loan discharged in bankruptcy 
during the first 5 years of the repayment period. This prohibition 
against the discharge of a HEAL loan applies to bankruptcy under any 
chapter of the Bankruptcy Act, including Chapter 13. A borrower may have 
a HEAL loan discharged in bankruptcy after the first 5 years of the 
repayment period only upon a finding by the Bankruptcy Court that the 
non-discharge of such debt would be unconscionable and upon the 
condition that the Secretary shall not have waived his or her rights to 
reduce any Federal reimbursements or Federal payments for health 
services under any Federal law in amounts up to the balance of the loan.
    (6) If the borrower fails to make payments on the loan on time, the 
total amount to be repaid by the borrower may be increased by additional 
interest, late charges, attorney's fees, court costs, and other 
collection charges. In addition, the Secretary may offset amounts 
attributable to an unpaid loan from reimbursements or payment for health 
services provided under any Federal law to a defaulted borrower 
practicing his or her profession.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 746, Jan. 8, 1987; 57 
FR 28794, June 29, 1992]



                           Subpart C--The Loan



Sec. 60.10  How much can be borrowed?

    (a) Student borrower. An eligible student may borrow an amount to be 
used solely for expenses, as described in Sec. 60.5(g), incurred or to 
be incurred over a period of up to an academic year and disbursed in 
accordance with Sec. 60.33(f). The maximum amount he or she may receive 
for that period shall be determined by the school in accordance with 
Sec. 60.51(f) within the following limitations:
    (1) A student enrolled in a school of medicine, osteopathic 
medicine, dentistry, veterinary medicine, optometry or podiatric 
medicine may borrow up to $80,000 under this part. The amount received 
may not exceed $20,000 in any academic year.
    (2) A student enrolled in a school of public health, pharmacy, 
chiropractic, or a graduate program in health administration, clinical 
psychology, or allied health may borrow up to $50,000 under this part. 
The amount received may not exceed $12,500 per academic year.
    (3) For purposes of this paragraph, an academic year means the 
traditional approximately 9-month September-to-June annual session. For 
the purpose of computing academic year equivalents for students who, 
during a 12-month period, attend for a longer period than the 
traditional academic year, the academic year will be considered to be 9 
months in length.
    (4) The student's estimated cost of attendance shall not exceed the 
estimated cost of attendance of all students in like circumstances 
pursuing a similar curriculum at that school.
    (b) Non-student borrower. An eligible nonstudent may borrow amounts 
under this authority with the following restrictions:
    (1) In no case may an eligible nonstudent borrower receive a loan 
that is greater than the sum of the HEAL insurance premium plus the 
interest that is expected to accrue and must be paid on the borrower's 
HEAL loans during the period for which the new loan is intended.
    (2) An eligible nonstudent in the field of medicine, ostepathic 
medicine, dentistry, veterinary medicine, optometry, or podiatric 
medicine may borrow up to $80,000 under this part including loans 
obtained while the borrower was a student. The loan amount may not 
exceed $20,000 in any 12-month period.
    (3) An eligible nonstudent in the field of pharmacy, public health, 
chiropractic, health administration, or clinical psychology may borrow 
up to $50,000 under this part including loans obtained while the 
borrower was a student. The loan amount received under this part may not 
exceed $12,500 in any 12-month period.

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30644, Aug. 28, 1986; 
52 FR 746, Jan. 8, 1987; 57 FR 28794, June 29, 1992]

[[Page 420]]



Sec. 60.11  Terms of repayment.

    (a) Commencement of repayment. (1) The borrower's repayment period 
must begin the first day of the 10th month after the month he or she 
ceases to be a full-time student at a HEAL school. The 9-month period 
before the repayment period begins is popularly called the ``grace 
period.''
    (i) Postponement for internship or residency program. However, if 
the borrower becomes an intern or resident in an accredited program 
within 9 full months after leaving school, then the borrower's repayment 
period must begin the first day of the 10th month after the month he or 
she ceases to be an intern or resident. For a borrower who receives his 
or her first HEAL loan on or after October 22, 1985, this postponement 
of the beginning of the repayment period for participation in an 
internship or residency program is limited to 4 years.
    (ii) Postponement for fellowship training or educational activity. 
For any HEAL loan received on or after October 22, 1985, if the borrower 
becomes an intern or resident in an accredited program within 9 full 
months after leaving school, and subsequently enters into a fellowship 
training program or an educational activity, as described in 
Sec. 60.12(b)(1) and (2), within 9 months after the completion of the 
accredited internship or residency program or prior to the completion of 
such program, the borrower's repayment period begins on the first day of 
the 10th month after the month he or she ceases to be a participant in 
the fellowship training program or educational activity. Postponement of 
the commencement of the repayment period for either activity is limited 
to 2 years.
    (iii) Non-student borrower. If a nonstudent borrower obtains another 
HEAL loan during the grace period or period of internship, residency, or 
deferment (as defined in Sec. 60.12), the borrower must begin to repay 
this loan when repayment on the borrower's other HEAL loans begins or 
resumes.
    (2) An accredited internship or residency program must be approved 
by one of the following accrediting agencies:
    (i) Accreditation Council for Graduate Medical Education.
    (ii) Council on Optometric Education.
    (iii) Commission on Accreditation of Dental and Dental Auxiliary 
Programs.
    (iv) American Osteopathic Association.
    (v) Council on Podiatry Education.
    (vi) American Council on Pharmaceutical Education.
    (vii) Council on Education for Public Health.
    (viii) American College of Veterinary Surgeons.
    (ix) Council on Chiropractic Education.
    (b) Length of repayment period. In general, a lender or holder must 
allow a borrower at least 10 years, but not more than 25 years, to repay 
a loan calculated from the beginning of the repayment period. A borrower 
must fully repay a loan within 33 years from the date that the loan is 
made.
    (1) For a HEAL borrower who received any HEAL loan prior to October 
22, 1985, periods of deferment (as described in Sec. 60.12) are not 
included when calculating the 10 to 25 or 33 year limitations.
    (2) For a borrower who receives his or her first HEAL loan on or 
after October 22, 1985, periods of deferment (as described in 
Sec. 60.12) are included when calculating the 33 year limitation, but 
are not included when calculating the 10 to 25 year limitation.
    (c) Prepayment. The borrower may prepay the whole or any part of the 
loan at any time without penalty.
    (d) Minimum annual payment. During each year of repayment, a 
borrower's payments to all holders of his or her HEAL loans must total 
the interest that accrues during the year on all of the loans, unless 
the borrower, in the promissory note or other written agreement, agrees 
to make payments during any year or any repayment period in a lesser 
amount.
    (e) Repayment schedule agreement. At least 30 and not more than 60 
days before the commencement of the repayment period, a borrower must 
contact the holder of the loan to establish the precise terms of 
repayment. The borrower may select a monthly repayment

[[Page 421]]

schedule with substantially equal installment payments or a monthly 
repayment schedule with graduated installment payments that increase in 
amount over the repayment period. If the borrower does not contact the 
lender or holder and does not respond to contacts from the lender or 
holder, the lender or holder may establish a monthly repayment schedule 
with substantially equal installment payments, subject to the terms of 
the borrower's HEAL note.
    (f) Supplemental repayment agreement. (1) A lender or holder and a 
borrower may enter into an agreement supplementing the regular repayment 
schedule agreement. Under a supplemental repayment agreement, the lender 
or holder agrees to consider that the borrower has met the terms of the 
regular repayment schedule as long as the borrower makes payments in 
accordance with the supplemental schedule.
    (2) The purpose of a supplemental repayment agreement is to permit a 
lender or holder, at its option, to offer a borrower a repayment 
schedule based on other than equal or graduated payments. (For example, 
a supplemental repayment agreement may base the amount of the borrower's 
payments on his or her income.)
    (3) The supplemental schedule must contain terms which, according to 
the Secretary, do not unduly burden the borrower and do not extend the 
Secretary's insurance liability beyond the number of years specified in 
paragraph (b) of this section. The supplemental schedule must be 
approved by the Secretary prior to the start of repayment.
    (4) The lender or holder may establish a supplemental repayment 
agreement over the borrower's objection only if the borrower's written 
consent to enter into a supplemental agreement was obtained by the 
lender at the time the loan was made.
    (5) A lender or holder may assign a loan subject to a supplemental 
repayment agreement only if it specifically notifies the buyer of the 
terms of the supplemental agreement. In such cases, the loan and the 
supplemental agreement must be assigned together.

(Approved by the Office of Management and Budget under control numbers 
0915-0043 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30644, Aug. 28, 1986; 
53 FR 6097, Feb. 29, 1988; 57 FR 28794, June 29, 1992]



Sec. 60.12  Deferment.

    (a) After the repayment period has commenced, installments of 
principal and interest need not be paid during any period:
    (1) During which the borrower is pursuing a full-time course of 
study at a HEAL school or at an institution of higher education that is 
a ``participating school'' in the Guaranteed Student Loan Program;
    (2) Up to 4 years during which the borrower is a participant in an 
accredited internship or residency program, as described in 
Sec. 60.11(a)(2). For a borrower who receives his or her first HEAL loan 
on or after October 22, 1985, this total of 4 years for an internship or 
residency program includes any period of postponement of the repayment 
period, as described in Sec. 60.11(a)(1);
    (3) Up to 3 years during which the borrower is a member of the Armed 
Forces of the United States;
    (4) Up to 3 years during which the borrower is in service as a 
volunteer under the Peace Corps Act;
    (5) Up to 3 years during which the borrower is a member of the 
National Health Service Corps; or
    (6) Up to 3 years during which the borrower is a full-time volunteer 
under title I of the Domestic Volunteer Service Act of 1973.
    (b) For any HEAL loan received on or after October 22, 1985, after 
the repayment period has commenced, installments of principal and 
interest need not be paid during any period for up to 2 years during 
which the borrower is a participant in:
    (1) A fellowship training program, which:
    (i) Is directly related to the discipline for which the borrower 
received the HEAL loan;
    (ii) Begins within 12 months after the borrower ceases to be a 
participant in

[[Page 422]]

an accredited internship or residency program, as described in 
Sec. 60.11(a)(2), or prior to the completion of the borrower's 
participation in such program;
    (iii) Is a full-time activity in reasearch or reserch training or 
health care policy;
    (iv) Is not a part of, an extension of, or associated with an 
internship or residency program, as described in Sec. 60.11(a)(2);
    (v) Pays no stipend or one which is not more than the annual stipend 
level established by the Public Health Service for the payment of 
uniform levels of financial support for trainees receiving graduate and 
professional training under Public Health Service grants, as in effect 
at the time the borrower requests the deferment; and
    (vi) Is a formally established fellowship program which was not 
created for a specific individual; or
    (2) A full-time educational activity at an institution defined by 
section 435(b) of the Higher Education Act of 1965 which:
    (i) Is directly related to the discipline for which the borrower 
received the HEAL loan;
    (ii) Begins within 12 months after the borrower ceases to be a 
participant in an accredited internship or residency program, as 
described in Sec. 60.11(a)(2), or prior to the completion of the 
borrower's participation in such program;
    (iii) Is not a part of, an extension of, or associated with an 
internship or residency program, as described in Sec. 60.11(a)(2); and
    (iv) Is required for licensure, registration, or certification in 
the State in which the borrower intends to practice the discipline for 
which the borrower received the HEAL program loan.
    (c) (1) To receive a deferment, including a deferral of the onset of 
the repayment period (see Sec. 60.11(a)), a borrower must at least 30 
days prior to, but not more than 60 days prior to, the onset of the 
activity and annually thereafter, submit to the lender or holder 
evidence of his or her status in the deferment activity and evidence 
that verifies deferment eligibility of the activity (with the full 
expectation that the borrower will begin the activity). It is the 
responsibility of the borrower to provide the lender or holder with all 
required information or other information regarding the requested 
deferment. If written evidence that verifies eligibility of the activity 
and the borrower for the deferment, including a certification from an 
authorized official (e.g., the director of the fellowship activity, the 
dean of the school, etc.), is received by the lender or holder within 
the required time limit, the lender or holder must approve the 
deferment. The lender or holder may rely in good faith upon statements 
of the borrower and the authorized official, except where those 
statements or other information conflict with information available to 
the lender or holder. When those verification statements or other 
information conflict with information available to the lender or holder, 
to indicate that the applicant fails to meet the requirements for 
deferment, the lender or holder may not approve the deferment until 
those conflicts are resolved.
    (2) For those activities described in paragraphs (b)(1) or (b)(2) of 
this section, the borrower may request that the Secretary review a 
decision by the lender or holder denying the deferment by sending to the 
Secretary copies of the application for deferment and the lender's or 
holder's denial of the request. However, if information submitted to the 
lender or holder conflicts with other information available to the 
lender or holder, to indicate that the borrower fails to meet the 
requirements for deferment, the borrower may not request a review until 
such conflicts have been resolved. During the review process, the lender 
or holder must comply with any requests for information made by the 
Secretary. If the Secretary determines that the fellowship or 
educational activity is eligible for deferment and so notifies the 
lender or holder, the lender or holder must approve the deferment.

(Approved by the Office of Management and Budget under control numbers 
0915-0034 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30644, Aug. 28, 1986; 
53 FR 6097, Feb. 29, 1988; 57 FR 28795, June 29, 1992]

[[Page 423]]



Sec. 60.13  Interest.

    (a) Rate. At the lender's option, the interest rate on the HEAL loan 
may be calculated on a fixed rate or on a variable rate basis. However, 
whichever method is selected must continue over the life of the loan, 
except where the loan is consolidated with another HEAL loan.
    (1) For all loans made on or after October 22, 1985, for each 
calendar quarter, the Secretary determines the maximum annual HEAL 
interest rate by determining the average of the bond equivalent rates 
reported for the 91-day U.S. Treasury bills auctioned for the preceding 
calendar quarter, adding 3 percentage points, and rounding that amount 
to the next higher one-eighth of 1 percent.
    (2) Interest that is calculated on a fixed rate basis is determined 
for the life of the loan during the calendar quarter in which the loan 
is executed. It may not exceed the rate determined for that quarter by 
the Secretary under paragraph (a)(1) of this section.
    (3) Interest that is calculated on a variable rate basis varies 
every calendar quarter throughout the life of the loan as the market 
price of U.S. Treasury bills changes. For any quarter it may not exceed 
the rate determined by the Secretary under paragraph (a)(1) of this 
section.
    (4) The Secretary announces the rate determined under paragraph 
(a)(1) of this section on a quarterly basis through a notice published 
in the Federal Register.
    (b) Compounding of interest. Interest accrues from the date the loan 
is disbursed until the loan is paid in full. Unpaid accrued interest 
shall be compounded not more frequently than semiannually and added to 
principal. However, a lender or holder may postpone the compounding of 
interest before the beginning of the repayment period or during periods 
of deferment or forbearance and add interest to principal at the time 
repayment of principal begins or resumes.
    (c) Payment. Repayment of principal and interest is due when the 
repayment period begins. A lender or holder must permit a borrower to 
postpone paying interest before the beginning of the repayment period or 
during a period of deferment or forbearance. In these cases, payment of 
interest begins or resumes on the date repayment of principal begins or 
resumes.
    (d) Usury laws. No provision of any Federal or State law that limits 
the rate or amount of interest payable on loans shall apply to a HEAL 
loan.

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30644, Aug. 28, 1986; 
57 FR 28795, June 29, 1992]



Sec. 60.14  The insurance premium.

    (a) General. (1) The Secretary insures each lender or holder for the 
losses of principal and interest it may incur in the event that a 
borrower dies; becomes totally and permanently disabled; files for 
bankruptcy under chapter 11 or 13 of the Bankruptcy Act; files for 
bankruptcy under chapter 7 of the Bankruptcy Act and files a complaint 
to determine the dischargeability of the HEAL loan; or defaults on his 
or her loan. For this insurance, the Secretary charges the lender an 
insurance premium. The insurance premium is due to the Secretary on the 
date of disbursement of the HEAL loan.
    (2) The lender may charge the borrower an amount equal to the cost 
of the insurance premium. The cost of the insurance premium may be 
charged to the borrower by the lender in the form of a one-time special 
charge with no subsequent adjustments required. The lender may bill the 
borrower separately for the insurance premium or may deduct an amount 
attributable to it from the loan proceeds before the loan is disbursed. 
In either case, the lender must clearly identify to the borrower the 
amount of the insurance premium and the method of calculation.
    (3) If the lender does not pay the insurance premium on or before 30 
days after disbursement of the loan, a late fee will be charged on a 
daily basis at the same rate as the interest rate that the lender 
charges for the HEAL loan for which the insurance premium is past due. 
The lender may not pass on this late fee to the borrower.
    (4) HEAL insurance coverage ceases to be effective if the insurance 
premium is not paid within 60 days of the disbursement of the loan.
    (5) Except in cases of error, premiums are not refundable by the 
Secretary,

[[Page 424]]

and need not be refunded by the lender to the borrower, even if the 
borrower graduates or withdraws from the school, defaults, dies or 
becomes totally and permanently disabled.
    (b) Rate. The rate of the insurance premium shall not exceed the 
statutory maximum. The Secretary announces changes in the rate of the 
insurance premium through a notice published in the Federal Register.
    (c) Method of calculation--(1) Student borrowers. For loans 
disbursed prior to July 22, 1986, the lender must calculate the 
insurance premium on the basis of the number of months beginning with 
the month following the month in which the loan proceeds are disbursed 
to the student borrower and ending 9 full months after the month of the 
student's anticipated date of graduation. For loans disbursed on or 
after July 22, 1986, the insurance premium shall be calculated as a one-
time flat rate on the principal of the loan at the time of disbursement.
    (2) Non-student borrowers. For loans disbursed prior to July 22, 
1986, the lender must calculate the insurance premium for nonstudent 
borrowers on the basis of the number of months beginning with the month 
following the month in which the loan proceeds are disbursed to the 
borrower and ending at the conclusion of the month preceding the month 
in which repayment of principal is expected to begin or resume on the 
borrower's previous HEAL loans. For loans disbursed on or after July 22, 
1986, the insurance premium shall be calculated as a one-time flat rate 
on the principal of the loan at the time of disbursement.
    (3) Multiple installments. In cases where the lender disburses the 
loan in multiple installments, the insurance premium is calculated for 
each disbursement.

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30644 Aug. 28, 1986; 52 
FR 746, Jan. 8, 1987; 56 FR 42700, Aug. 29, 1991; 57 FR 28795, June 29, 
1992]



Sec. 60.15  Other charges to the borrower.

    (a) Late charges. If the borrower fails to pay all of a required 
installment payment or fails to provide written evidence that verifies 
eligibility for the deferment of the payment within 30 days after the 
payment's due date, the lender or holder will require that the borrower 
pay a late charge. A late charge must be equal to 5 percent of the 
unpaid portion of the payment due.
    (b) Collection charges. The lender or holder may also require that 
the borrower pay the holder of the note for reasonable costs incurred by 
the holder or its agent in collecting any installment not paid when due. 
These costs may include attorney's fees, court costs, telegrams, and 
long-distance phone calls. The holder may not charge the borrower for 
the normal costs associated with preparing letters and making personal 
and local telephone contacts with the borrower. A service agency's fee 
for normal servicing of a loan may not be passed on to the borrower, 
either directly or indirectly. No charges, other than those authorized 
by this section, may be passed on to the borrower, either directly or 
indirectly, without prior approval of the Secretary.
    (c) Other loan making costs. A lender may not pass on to the 
borrower any cost of making a HEAL loan other than the costs of the 
insurance premium.

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 747, Jan. 8, 1987; 57 
FR 28795, June 29, 1992]



Sec. 60.16  Power of attorney.

    Neither a lender nor a school may obtain a borrower's power of 
attorney or other authorization to endorse a disbursement check on 
behalf of a borrower. The borrower must personally endorse the check and 
may not authorize anyone else to endorse it on his or her behalf.



Sec. 60.17  Security and endorsement.

    (a) A HEAL loan must be made without security.
    (b) With one exception, it must also be made without endorsement. If 
a borrower is a minor and cannot under State law create a legally 
binding obligation by his or her own signature, a lender may require an 
endorsement by another person on the borrower's HEAL note. For purposes 
of this paragraph, an ``endorsement'' means a signature of anyone other 
than the borrower who is to assume either primary or secondary liability 
on the note.

[[Page 425]]



Sec. 60.18  Consolidation of HEAL loans.

    HEAL loans may be consolidated as follows provided that the lender 
or holder must first inform the borrower of the effect of the 
consolidation on the interest rate and explain to the borrower that he 
or she is not required to agree to the consolidation:
    (a) If a lender or holder holds two or more HEAL loans made to the 
same borrower, the lender or holder and the borrower may agree to 
consolidate the loans into a single HEAL loan obligation evidenced by 
one promissory note.
    (b) A HEAL loan may be consolidated with any other loan only if:
    (1) The consolidation will not result in terms less favorable to the 
borrower than if no consolidation had occurred, and
    (2) The Federal Government does not, as a result of the 
consolidation, become liable for any payment of principal or interest 
for a Guaranteed Student Loan under the provisions of section 439(o) of 
the Higher Education Act of 1965.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 57 FR 28795, June 29, 1992]



Sec. 60.19  Forms.

    All HEAL forms are approved by the Secretary and may not be changed 
without prior approval by the Secretary. HEAL forms shall not be signed 
in blank by a borrower, a school, a lender or holder, or an agent of any 
of these. The Secretary may prescribe who must complete the forms, and 
when and to whom the forms must be sent. All HEAL forms must contain a 
statement that any person who knowingly makes a false statement or 
misrepresentation in a HEAL loan transaction, bribes or attempts to 
bribe a Federal official, fraudulently obtains a HEAL loan, or commits 
any other illegal action in connection with a HEAL loan is subject to 
possible fine and imprisonment under Federal statute.

[52 FR 747, Jan. 8, 1987, as amended at 57 FR 28795, June 29, 1992]



Sec. 60.20  The Secretary's collection efforts after payment of a default claim.

    After paying a default claim on a HEAL loan, the Secretary attempts 
to collect from the borrower and any valid endorser in accordance with 
the Federal Claims Collection Standards (4 CFR parts 101 through 105), 
the Office of Management and Budget Circular A-129, issued May 9, 1985, 
and the Department's Claims Collection Regulation (45 CFR part 30). The 
Secretary attempts collection of all unpaid principal, interest, 
penalties, administrative costs, and other charges or fees, except in 
the following situations:
    (a) The borrower has a valid defense on the loan. The Secretary 
refrains from collection against the borrower or endorser to the extent 
of any defense that the Secretary concludes is valid. Examples of a 
valid defense include expiration of the statute of limitations and 
infancy.
    (b) A school owes the borrower a refund for the period covered by 
the loan. In this situation, the Secretary refrains from collection to 
the extent of the unpaid refund if the borrower assigns to the Secretary 
the right to receive the refund.
    (c) The school or lender or holder is the subject of a lawsuit or 
Federal administrative proceeding. In this situation, if the Secretary 
determines that the proceeding involves allegations that, if proven, 
would provide the borrower with a full or partial defense on the loan, 
then the Secretary may suspend collection activity on all or part of a 
loan until the proceeding ends. The Secretary suspends collection 
activity only for so long as the proceeding is being energetically 
prosecuted in good faith and the allegations that relate to the 
borrower's defense are reasonably likely to be proven.
    (d) The borrower dies or becomes totally and permanently disabled. 
In this situation, the Secretary terminates all collection activity 
against the borrower. If the borrower dies or becomes totally and 
permanently disabled, the Secretary also terminates all collection 
activity against any endorser.

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 747, Jan. 8, 1987; 57 
FR 28795, June 29, 1992]

[[Page 426]]



Sec. 60.21  Refunds.

    (a) Student authorization. By applying for a HEAL loan, a student 
authorizes a participating school to make payment of a refund that is 
allocable to a HEAL loan directly to the original lender (or to a 
subsequent holder of the loan note, if the school has knowledge of the 
holder's identity).
    (b) Treatment by lenders or holders. (1) A holder of a HEAL loan 
must treat a refund payment received from a HEAL school as a downward 
adjustment in the principal amount of the loan.
    (2) When a lender receives a school refund check for a loan it no 
longer holds, the lender must transfer that payment to the holder of the 
loan and either inform the borrower about the refund check and where it 
was sent or, if the borrower's address is unknown, notify the current 
holder that the borrower was not informed. The current holder must 
provide the borrower with a written notice of the refund payment.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 57 FR 28795, June 29, 1992]



                    Subpart D--The Lender and Holder



Sec. 60.30  Which organizations are eligible to apply to be HEAL lenders and holders?

    (a) A HEAL lender may make and hold loans under the HEAL program.
    (b) The following types of organizations are eligible to apply to 
the Secretary to be HEAL lenders:
    (1) A financial or credit institution (including a bank, savings and 
loan association, credit union, or insurance company) which is subject 
to examination and supervision in its capacity as a lender by an agency 
of the United States or of the State in which it has its principal place 
of business;
    (2) A pension fund approved by the Secretary;
    (3) An agency or instrumentality of a State;
    (4) A HEAL school; and
    (5) A private nonprofit entity, designated by the State, regulated 
by the State, and approved by the Secretary.
    (c) The following types of organizations are eligible to apply to 
the Secretary to be HEAL holders:
    (1) Public entities in the business of purchasing student loans;
    (2) The Student Loan Marketing Association (popularly known as 
``Sallie Mae''); and
    (3) Other eligible lenders.
    (d) HEAL holders must comply with any provisions in the regulations 
required of HEAL lenders including, but not limited to, provisions 
regarding applications, contracts, and due diligence.

[48 FR 38988, Aug. 26, 1983, as amended at 57 FR 28795, June 29, 1992]



Sec. 60.31  The application to be a HEAL lender or holder.

    (a) In order to be a HEAL lender or holder, an eligible organization 
must submit an application to the Secretary annually.
    (b) In determining whether to enter into an insurance contract with 
an applicant and what the terms of that contract should be, the 
Secretary may consider the following criteria:
    (1) Whether the applicant is capable of complying with the 
requirements in the HEAL regulations applicable to lenders and holders;
    (2) The amount and rate of loans which are currently delinquent or 
in default, if the applicant has had prior experience with similar 
Federal or State student loan programs; and
    (3) The financial resources of the applicant.
    (c) The applicant must develop and follow written procedures for 
making, servicing and collecting HEAL loans. These procedures must be 
reviewed during the biennial audit required by Sec. 60.42(d). If the 
applicant uses procedures more stringent than those required by 
Secs. 60.34 and 60.35 for its other loans of comparable dollar value, on 
which it has no Federal, State, or other third party guarantee, it must 
include those more stringent procedures in its written procedures for 
servicing and collecting its HEAL loans.
    (d) The applicant must submit sufficient materials with his or her 
application to enable the Secretary to fairly

[[Page 427]]

evaluate the application in accordance with these criteria.

(Approved by the Office of Management and Budget under control numbers 
0915-0034 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 747, Jan. 8, 1987; 57 
FR 28796, June 29, 1992]



Sec. 60.32  The HEAL lender or holder insurance contract.

    (a)(1) If the Secretary approves an application to be a HEAL lender 
or holder, the Secretary and the lender or holder must sign an insurance 
contract. Under this contract, the lender or holder agrees to comply 
with all the laws, regulations, and other requirements applicable to its 
participation in the HEAL program and the Secretary agrees to insure 
each eligible HEAL loan held by the lender or holder against the 
borrower's default, death, total and permanent disability, bankruptcy 
under chapter 11 or 13 of the Bankruptcy Act, or bankruptcy under 
chapter 7 of the Bankruptcy Act when the borrower files a complaint to 
determine the dischargeability of the HEAL loan. The Secretary's 
insurance covers 100 percent of the lender's or holder's losses on both 
unpaid principal and interest, except to the extent that a borrower may 
have a defense on the loan other than infancy.
    (2) HEAL insurance, however, is not unconditional. The Secretary 
issues HEAL insurance on the implied representations of the lender that 
all the requirements for the initial insurability of the loan have been 
met. HEAL insurance is further conditioned upon compliance by the holder 
of the loan with the HEAL statute and regulations, the lender's or 
holder's insurance contract, and its own loan management procedures set 
forth in writing pursuant to Sec. 60.31(c). The contract may contain a 
limit on the duration of the contract and the number or amount of HEAL 
loans a lender may make or hold. Each HEAL lender has either a standard 
insurance contract or a comprehensive insurance contract with the 
Secretary, as described below.
    (b) Standard insurance contract. A lender with a standard insurance 
contract must submit to the Secretary a borrower's loan application for 
HEAL insurance on each loan that the lender determines to be eligible. 
The Secretary notifies the lender whether the loan is or is not 
insurable, the amount of the insurance, and the expiration date of the 
insurance commitment. A loan which has been disbursed under a standard 
contract of insurance prior to the Secretary's approval of the 
application is considered not to have been insured.
    (c)(1) Comprehensive insurance contract. A lender with a 
comprehensive insurance contract may disburse a loan without submitting 
an individual borrower's loan application to the Secretary for approval. 
All eligible loans made by a lender with this type of contract are 
insured immediately upon disbursement.
    (2) The Secretary will revoke the comprehensive contract of any 
lender who utilizes procedures which are inconsistent with the HEAL 
statute and regulations, the lender's insurance contract, or its own 
loan management procedures set forth in writing pursuant to 
Sec. 60.31(c), and require that such lenders disburse HEAL loans only 
under a standard contract. When the Secretary determines that the lender 
is in compliance with the HEAL statute and regulations and its own loan 
management procedures set forth in writing pursuant to Sec. 60.31(c), 
the lender may reapply for a comprehensive contract.
    (3) In providing comprehensive contracts, the Secretary shall give 
priority to eligible lenders that:
    (i) Make loans to students at interest rates below the rates 
prevailing during the period involved; or
    (ii) Make loans under terms that are otherwise favorable to the 
student relative to the terms under which eligible lenders are generally 
making loans during the period involved.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 747, Jan. 8, 1987; 56 
FR 42701, Aug. 29, 1991; 57 FR 28796, June 29, 1992]



Sec. 60.33  Making a HEAL loan.

    The loan-making process includes the processing of necessary forms, 
the approval of a borrower for a loan, determination of a borrower's 
creditworthiness, the determination of the loan

[[Page 428]]

amount (not to exceed the amount approved by the school), the 
explanation to a borrower of his or her responsibilities under the loan, 
the execution of the promissory note, and the disbursement of the loan 
proceeds. A lender may rely in good faith upon statements of an 
applicant and the HEAL school contained in the loan application papers, 
except where those statements are in conflict with information obtained 
from the report on the applicant's credit history, or other information 
available to the lender. Except where the statements are in conflict 
with information obtained from the applicant's credit history or other 
information available to the lender, a lender making loans to nonstudent 
borrowers may rely in good faith upon statements by the borrower and 
authorizing officials of internship, residency, or other programs for 
which a borrower may receive a deferment.
    (a) Processing of forms. Before making a HEAL loan, a lender must 
determine that all required forms have been completed by the borrower, 
the HEAL school, the lender, and the authorized official for an 
internship, a residency, or other deferment activity.
    (b) Approval of borrower. A lender may make a HEAL loan only to an 
eligible student or nonstudent borrower.
    (c) Lender determination of the borrower's creditworthiness. The 
lender may make HEAL loans only to an applicant that the lender has 
determined to be creditworthy. This determination must be made at least 
once for each academic year during which the applicant applies for a 
HEAL loan. An applicant will be determined to be ``creditworthy'' if he 
or she has a repayment history that has been satisfactory on any loans 
on which payments have become due. The lender may not determine that an 
applicant is creditworthy if the applicant is currently in default on 
any loan (commercial, consumer, or educational) until the delinquent 
account is made current or satisfactory arrangements are made between 
the affected lender(s) and the HEAL applicant. The lender must obtain 
documentation, such as a letter from the authorized official(s) of the 
affected lender(s) or a corrected credit report indicating that the HEAL 
applicant has taken satisfactory actions to bring the account into good 
standing. It is the responsibility of the HEAL loan applicant to assure 
that the lender receives each such documentation. No loan may be made to 
an applicant who is delinquent on any Federal debt until the delinquent 
account is made current or satisfactory arrangements are made between 
the affected agency and the HEAL applicant. The lender must receive a 
letter from the authorized Federal official of the affected Federal 
agency stating that the borrower has taken satisfactory actions to bring 
the account into good standing. It is the responsibility of the loan 
applicant to assure that the lender has received each such letter. The 
absence of any previous credit, however, is not an indication that the 
applicant is not creditworthy and is not to be used as a reason to deny 
the status of creditworthy to an applicant. The lender must determine 
the creditworthiness of the applicant using, at a minimum, the 
following:
    (1) A report of the applicant's credit history obtained from an 
appropriate consumer credit reporting agency, which must be used in 
making the determinations required by paragraph (c) of this section; and
    (2) For student applicants only, the certification made by the 
applicant's school under Sec. 60.51(e).
    (d) Determination of loan amount. A lender may not make a HEAL loan 
in an amount that exceeds the permissible annual and aggregate maximums 
described in Sec. 60.10.
    (e) Promissory note. (1) Each loan must be evidenced by a promissory 
note approved by the Secretary. A lender must obtain the Secretary's 
prior approval of the note form before it makes a HEAL loan evidenced by 
a promissory note containing any deviation from the provisions of the 
form most currently approved by the Secretary. The lender must give the 
borrower a copy of each executed note.
    (2) The lender must explain to the borrower that the loan must be 
repaid and that the loan proceeds may be applied toward educational 
expenses only.

[[Page 429]]

    (f) Disbursement of HEAL loan. (1) A lender must disburse HEAL loan 
proceeds:
    (i) To a student borrower, by means of a check or draft payable 
jointly to the student borrower and the HEAL school. Except where a 
lender is also a school, a lender must mail the check or draft to the 
school. A lender may not disburse the loan proceeds earlier than is 
reasonably necessary to meet the cost of education for the period for 
which the loan is made.
    (ii) To a nonstudent borrower, by means of a check or draft payable 
to the borrower. However, when a previous loan is held by a different 
lender, the current lender must make the HEAL loan disbursement check or 
draft payable jointly to the borrower and the holder of the previous 
HEAL loan for which interest is payable.
    (2) Effective July 1, 1987, a lender must disburse the HEAL loan 
proceeds in two or more installments unless the loan is intended to 
cover a period of no more than one-half an academic year. The amount 
disbursed at one time must correspond to the borrower's educational 
expenses for the period for which the disbursement is made, and must be 
indicated by the school on the borrower's application. If the loan is 
intended for more than one-half an academic year, the school must 
indicate on the borrower's application both the approximate dates of 
disbursement and the amount the borrower will need on each such date. In 
no case may the lender disburse the proceeds earlier than is reasonably 
necessary to meet the costs of education for the period for which the 
disbursement or the loan is made.
    (g) If the lender determines that the applicant is not creditworthy, 
pursuant to paragraph (c) of this section, the lender must not approve 
the HEAL loan request. If the applicant is a student, the lender must 
notify the applicant and the applicant's school named on the application 
form of the denial of a HEAL loan, stating the reason for the denial.
    (h) The lender must report a borrower's HEAL indebtedness to one or 
more national credit bureaus within 120 days of the date the final 
disbursement on the loan is made.

(Approved by the Office of Management and Budget under control numbers 
0915-0043, 0915-0108, and 0915-0144)

[48 FR 38988, Aug. 26, 1983, as amended at 51 FR 30645, Aug. 28, 1986; 
52 FR 748, Jan. 8, 1987; 57 FR 28796, June 29, 1992; 58 FR 67349, Dec. 
21, 1993]



Sec. 60.34  HEAL loan account servicing.

    HEAL loan account servicing involves the proper maintenance of 
records, and the proper review and management of accounts. Generally 
accepted account servicing standards ensure that collections are 
received and accounted for, delinquent accounts are identified promptly, 
and reports are produced comparing actual results to previously 
established objectives.
    (a) Borrower inquiries. A lender or holder must respond on a timely 
basis to written inquiries and other communications from a borrower and 
any endorser of a HEAL loan.
    (b) Conversion of loan to repayment status. (1) At least 30 and not 
more than 60 days before the commencement of the repayment period, the 
lender or holder must contact the borrower in writing to establish the 
terms of repayment. Lenders or holders may not charge borrowers for the 
additional interest or other charges, penalties, or fees that accrue 
when a lender or holder does not contact the borrower within this time 
period and a late conversion results.
    (2) Terms of repayment are established in a written schedule that is 
made a part of, and subject to the terms of, the borrower's original 
HEAL note.
    (3) The lender or holder may not surrender the original promissory 
note to the borrower until the loan is paid in full. At that time, the 
lender or holder must give the borrower the original promissory note.
    (c) Borrower contacts. The lender or holder must notify each 
borrower by a written contact, which has an address correction request 
on the envelope, of the balance owed for principal, interest, insurance 
premiums, and any other charges or fees owed to the lender, at least 
every 6 months from the time the loan is disbursed. The lender or holder

[[Page 430]]

must use this notice to remind the borrower of the option, without 
penalty, to pay all or part of the principal and accrued interest at any 
time.
    (d) Skip-tracing. If, at any time, the lender or holder is unable to 
locate a borrower, the lender or holder must initiate skip-tracing 
procedures as described in Sec. 60.35(a)(2).

(Approved by the Office of Management and Budget under control numbers 
0915-0043 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 748, Jan. 8, 1987; 57 
FR 28796, June 29, 1992]



Sec. 60.35  HEAL loan collection.

    A lender or holder must exercise due diligence in the collection of 
a HEAL loan with respect to both a borrower and any endorser. In order 
to exercise due diligence, a lender or holder must implement the 
following procedures when a borrower fails to honor his or her payment 
obligations:
    (a)(1) When a borrower is delinquent in making a payment, the lender 
or holder must remind the borrower within 15 days of the date the 
payment was due by means of a written contact. If payments do not 
resume, the lender or holder must contact both the borrower and any 
endorser at least 3 more times at regular intervals during the 120-day 
delinquent period following the first missed payment of that 120-day 
period. The second demand notice for a delinquent account must inform 
the borrower that the continued delinquent status of the account will be 
reported to consumer credit reporting agencies if payment is not made. 
Each of the required four contacts must consist of at least a written 
contact which has an address correction request on the envelope. The 
last contact must consist of a telephone contact, in addition to the 
required letter, unless the borrower cannot be contacted by telephone. 
The lender or holder may choose to substitute a personal contact for a 
telephone contact. A record must be made of each attempt to contact and 
each actual contact, and that record must be placed in the borrower's 
file. Each contact must become progressively firmer in tone. If the 
lender or holder is unable to locate the borrower and any endorser at 
any time during the period when the borrower is delinquent, the lender 
or holder must initiate the skip-tracing procedures described in 
paragraph (a)(2) of this section.
    (2) If the lender or holder is unable to locate either the borrower 
or the endorser at any time, the lender or holder must initiate and use 
skip-tracing activities which are at least as extensive and effective as 
those it uses to locate borrowers delinquent in the repayment of its 
other loans of comparable dollar value. To determine the correct address 
of the borrower, these skip-tracing procedures should include, but need 
not be limited to, contacting any other individual named on the 
borrower's HEAL application or promissory note, using such sources as 
telephone directories, city directories, postmasters, drivers license 
records in State and local government agencies, records of members of 
professional associations, consumer credit reporting agencies, skip 
locator services, and records at any school attended by the borrower. 
All skip-tracing activities used must be documented. This documentation 
must consist of a written record of the action taken and its date and 
must be presented to the Secretary when requesting preclaim assistance 
or when filing a default claim for HEAL insurance.
    (b) When a borrower is 90 days delinquent in making a payment, the 
lender or holder must immediately request preclaim assistance from the 
Public Health Service. The Secretary does not pay a default claim if the 
lender or holder fails to request preclaim assistance.
    (c) Prior to the filing of a default claim, a lender or holder must 
use, at a minimum, collection practices that are at least as extensive 
and effective as those used by the lender or holder in the collection of 
its other loans. These practices must include, but need not be limited 
to:
    (1) Using collection agents, which may include its own collection 
department or other internal collection agents;
    (2) Immediately notifying an appropriate consumer credit reporting 
agency regarding accounts overdue by more than 60 days; and
    (3) Commencing and prosecuting an action for default unless:

[[Page 431]]

    (i) In the determination of the Secretary that:
    (A) The lender or holder has made reasonable efforts to serve 
process on the borrower involved and has been unsuccessful in these 
efforts; or
    (B) Prosecution of such an action would be fruitless because of the 
financial or other circumstances of the borrower;
    (ii) For loans made before November 4, 1988, the loan involved was 
made in an amount of less than $5,000; or
    (iii) For loans made on or after November 4, 1988, the loan involved 
was made in an amount of less than $2,500.
    (d) If the Secretary's preclaim assistance locates the borrower, the 
lender or holder must implement the loan collection procedures described 
in this section. When the Secretary's preclaim assistance is unable to 
locate the borrower, a default claim may be filed by the lender as 
described in Sec. 60.40. The Secretary does not pay a default claim if 
the lender or holder has not complied with the HEAL statute and 
regulations or the lender's or holder's insurance contract.
    (e) If a lender or holder does not sue the borrower, it must send a 
final demand letter to the borrower and any endorser at least 30 days 
before a default claim is filed.
    (f) If a lender or holder sues a defaulted borrower or endorser, it 
may first apply the proceeds of any judgment against its reasonable 
attorney's fees and court costs, whether or not the judgment provides 
for these fees and costs.
    (g) Collection of chapter 7 bankruptcies. (1) If a borrower files 
for bankruptcy under chapter 7 of the Bankruptcy Act and does not file a 
complaint to determine the dischargeability of the HEAL loan, the lender 
or holder is responsible for monitoring the bankruptcy case in order to 
pursue collection of the loan after the bankruptcy proceedings have been 
completed.
    (i) For any loan for which the lender or holder had not begun to 
litigate against the borrower prior to the imposition of the automatic 
stay, the period of the automatic stay is to be considered as an 
extended forbearance authorized by the Secretary, in addition to the 2-
year period of forbearance which lenders and holders are authorized to 
grant without prior approval from the Secretary. Only periods of 
delinquency following the date of receipt (as documented by a date 
stamp) of the discharge of debtor notice (or other written notification 
from the court or the borrower's attorney of the end of the automatic 
stay imposed by the Bankruptcy Court) can be included in determining 
default, as described in Sec. 60.40(c)(1)(i). The lender or holder must 
attempt to reestablish repayment terms with the borrower in writing no 
more than 30 days after receipt of the discharge of debtor notice (or 
other written notification from the court or the borrower's attorney of 
the end of the automatic stay imposed by the Bankruptcy Court), in 
accordance with the procedures followed at the end of a forbearance 
period. If the borrower fails to make a payment as scheduled, the lender 
or holder must attempt to obtain repayment through written and telephone 
contacts in accordance with the intervals established in paragraph 
(a)(1) of this section, and must perform the other HEAL loan collection 
activities required in this section, before filing a default claim.
    (ii) For any loan for which the lender or holder had begun to 
litigate against the borrower prior to the imposition of the automatic 
stay, the lender or holder must, upon written notification from the 
court or the borrower's attorney that the bankruptcy proceedings have 
been completed, either resume litigation or treat the loan in accordance 
with paragraph (g)(1)(i) of this section.
    (2) If the lender or holder has not received written notification of 
discharge within 12 months of the date that the borrower filed for 
bankruptcy, the lender or holder must contact the court and the 
borrower's attorney (if known) within 30 days to determine if the 
bankruptcy proceedings have been completed. If no response is received 
within 30 days of the date of these contacts, the lender or holder must 
resume its collection efforts, in accordance with paragraph (g)(1) of 
this section. If a written response from the court or the borrower's 
attorney indicates that the bankruptcy proceedings are still underway, 
the lender or holder is not

[[Page 432]]

to pursue further collection efforts until receipt of written notice of 
discharge, except that follow-up in accordance with this paragraph must 
be done at least once every 12 months until the bankruptcy proceedings 
have been completed.
    (3) If, despite the lender or holder's compliance with required 
procedures, a loan subject to the requirements of paragraph (g)(1) of 
this section is discharged, the lender or holder must file a claim with 
the Secretary within 10 days of the initial date of receipt (as 
documented by a date stamp) of written notification of the discharge 
from the court or the borrower's attorney, in accordance with the 
procedures set forth in Sec. 60.40(c)(4). The lender or holder also must 
file with the bankruptcy court an objection to the discharge of the HEAL 
loan, and must include with the claim documentation showing that the 
bankruptcy proceedings were handled properly and expeditiously (e.g., 
all documents sent to or received from the bankruptcy court, including 
evidence which shows the period of the bankruptcy proceedings).

(Approved by the Office of Management and Budget under control numbers 
0915-0100 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 749, Jan. 8, 1987; 57 
FR 28796, June 29, 1992]



Sec. 60.36  Consequence of using an agent.

    The delegation of functions to a servicing agency or other party 
does not relieve a lender or holder of its responsibilities under the 
HEAL program.

[57 FR 28797, June 29, 1992]



Sec. 60.37  Forbearance.

    (a) Forbearance means an extension of time for making loan payments 
or the acceptance of smaller payments than were previously scheduled to 
prevent a borrower from defaulting on his or her payment obligations. A 
lender or holder must notify each borrower of the right to request 
forbearance.
    (1) Except as provided in paragraph (a)(2) of this section, a lender 
or holder must grant forbearance whenever the borrower is temporarily 
unable to make scheduled payments on a HEAL loan and the borrower 
continues to repay the loan in an amount commensurate with his or her 
ability to repay the loan. Any circumstance which affects the borrower's 
ability to repay the loan must be fully documented.
    (2) If the lender or holder determines that the default of the 
borrower is inevitable and that forbearance will be ineffective in 
preventing default, the lender or holder may submit a claim to the 
Secretary rather than grant forbearance. If the Secretary is not in 
agreement with the determination of the lender or holder, the claim will 
be returned to the lender or holder as disapproved and forbearance must 
be granted.
    (b) A lender or holder must exercise forbearance in accordance with 
terms that are consistent with the 25- and 33-year limitations on the 
length of repayment (described in Sec. 60.11) if the lender or holder 
and borrower agree in writing to the new terms. Each forbearance period 
may not exceed 6 months.
    (c) A lender or holder may also exercise forbearance for periods of 
up to 6 months in accordance with terms that are inconsistent with the 
minimum annual payment requirement if the lender or holder complies with 
the requirements listed in paragraphs (c) (1) through (4) of this 
section. Subsequent renewals of the forbearance must also be documented 
in accordance with the following requirements:
    (1) The lender or holder must reasonably believe that the borrower 
intends to repay the loan but is currently unable to make payments in 
accordance with the terms of the loan note. The lender or holder must 
state the basis for its belief in writing and maintain that statement in 
its loan file on that borrower.
    (2) Both the borrower and an authorized official of the lender or 
holder must sign a written agreement of forbearance.
    (3) If the agreement between the borrower and lender or holder 
provides for deferment of all payments, the lender or holder must 
contact the borrower at least every 3 months during the period of 
forbearance in order to remind the borrower of the outstanding 
obligation to repay.
    (4) The total period of forbearance (with or without interruption) 
granted

[[Page 433]]

by the lender or holder to any borrower must not exceed 2 years. 
However, when the borrower and the lender or holder believe that there 
are bona fide reasons why this period should be extended, the lender or 
holder may request a reasonable extension beyond the 2-year period from 
the Secretary. This request must document the reasons why the extension 
should be granted. The lender or holder may grant the extension for the 
approved time period if the Secretary approves the extension request.

(Approved by the Office of Management and Budget under control number 
915-0108)

[57 FR 28797, June 29, 1992]



Sec. 60.38  Assignment of a HEAL loan.

    A HEAL note may not be assigned except to another HEAL lender, the 
Student Loan Marketing Association (popularly known as ``Sallie Mae''), 
or a public entity in the business of purchasing student loans, and 
except as provided in Sec. 60.40. In this section ``seller'' means any 
kind of assignor and ``buyer'' means any kind of assignee.
    (a) Procedure. A HEAL note assigned from one lender or holder to 
another must be subject to a blanket endorsement together with other 
HEAL notes being assigned or must individually bear effective words of 
assignment. Either the blanket endorsement or the HEAL note must be 
signed and dated by an authorized official of the seller. Within 30 days 
of the transaction, the buyer must notify the following parties of the 
assignment:
    (1) The Secretary;
    (2) The borrower. The notice to the borrower must contain a clear 
statement of all the borrower's rights and responsibilities which arise 
from the assignment of the loan, including a statement regarding the 
consequences of making payments to the seller subsequent to receipt of 
the notice; and
    (3) The borrower's school, as shown on the application form 
supporting the loan purchased by the buyer, if the borrower is enrolled 
in school.
    (b) Risks assumed by the buyer. Upon acquiring a HEAL loan, a new 
holder assumes responsibility for the consequences of any previous 
violations of applicable statutes, regulations, or the terms of the note 
except for defects under Sec. 60.41(d). A HEAL note is not a negotiable 
instrument, and a subsequent holder is not a holder in due course. If 
the borrower has a valid legal defense that could be asserted against 
the previous holder, the borrower can also assert the defense against 
the new holder. In this situation, if the new holder files a default 
claim on a loan, the Secretary denies the default claim to the extent of 
the borrower's defense. Furthermore, when a new holder files a claim on 
a HEAL loan, it must provide the Secretary with the same documentation 
that would have been required of the original lender.
    (c) Warranty. Nothing in this section precludes the buyer of a HEAL 
loan from obtaining a warranty from the seller covering certain future 
reductions by the Secretary in computing the amount of insurable loss, 
if any, on a claim filed on the loan. The warranty may only cover 
reductions which are attributable to an act or failure to act of the 
seller or other previous holder. The warranty may not cover matters for 
which the buyer is charged with responsibility under the HEAL 
regulations.
    (d) Bankruptcy. If a lender or holder assigns a HEAL loan to a new 
holder, or a new holder acquires a HEAL loan under 20 U.S.C. 1092a (the 
Combined Payment Plan authority), and the previous holder(s) 
subsequently receives court notice that the borrower has filed for 
bankruptcy, the previous holder(s) must forward the bankruptcy notice to 
the purchaser within 10 days of the initial date of receipt, as 
documented by a date stamp, except that if it is a chapter 7 bankruptcy 
with no complaint for dismissal, the previous holder(s) must file the 
notice with the purchaser within 30 days of the initial date of receipt, 
as documented by a date stamp. The previous holder(s) also must file a 
statement with the court notifying it of the change of ownership. 
Notwithstanding the above, the current holder will not be held 
responsible for any loss due to the failure of the prior holder(s) to 
meet the deadline for giving notice if such failure occurs

[[Page 434]]

after the current holder purchased the loan.

(Approved by the Office of Management and Budget under control numbers 
0915-0034 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 749, Jan. 8, 1987; 56 
FR 42701, Aug. 29, 1991; 57 FR 28797, June 29, 1992]



Sec. 60.39  Death and disability claims.

    (a) Death. The Secretary will discharge a borrower's liability on 
the loan in accordance with section 738 of the Act upon the death of the 
borrower. The holder of the loan may not attempt to collect on the loan 
from the borrower's estate or any endorser. The holder must secure a 
certification of death or whatever official proof is conclusive under 
State law. The holder must return to the sender any payments, except for 
refunds under Sec. 60.21, received from the estate of the borrower or 
paid on behalf of the borrower after the date of death.
    (b) Disability. (1) The Secretary will discharge a borrower's 
liability on the loan in accordance with section 738 of the Act if the 
borrower is found to be permanently and totally disabled on 
recommendation of the holder of the loan and as supported by whatever 
medical certification the Secretary may require. A borrower is totally 
and permanently disabled if he or she is unable to engage in any 
substantial gainful activity because of a medically determinable 
impairment, which the Secretary expects to continue for a long and 
indefinite period of time or to result in death.
    (2) After being notified by the borrower or the borrower's 
representative that the borrower claims to be totally and permanently 
disabled, the holder of the loan may not attempt to collect on the loan 
from the borrower or any endorser. The holder must promptly request that 
the Secretary determine whether a borrower has become totally and 
permanently disabled. With its request, the holder must submit medical 
evidence no more than 4 months old that it has obtained from the 
borrower or the borrower's representative.
    (3) If the Secretary determines that the borrower is totally and 
permanently disabled, the lender or holder must return to the borrower 
any payments, except for refunds under Sec. 60.21, that it receives 
after being notified that the borrower claims to be totally and 
permanently disabled.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 57 FR 28797, June 29, 1992]



Sec. 60.40  Procedures for filing claims.

    (a) A lender or holder must file an insurance claim on a form 
approved by the Secretary. The lender or holder must attach to the claim 
all documentation necessary to litigate a default, including any 
documents required to be submitted by the Federal Claims Collection 
Standards, and which the Secretary may require. Failure to submit the 
required documentation and to comply with the HEAL statute and 
regulations or the lender's or holder's insurance contract will result 
in a claim not being honored. The Secretary may deny a claim that is not 
filed within the period specified in this section. The Secretary 
requires for all claims at least the following documentation:
    (1) The original promissory note;
    (2) An assignment to the United States of America of all right, 
title, and interest of the lender or holder in the note;
    (3) The loan application;
    (4) The history of the loan activities from the date of loan 
disbursement through the date of claim, including any payments made; and
    (5) A Borrower Status Form (HRSA-508), documenting each deferment 
granted under Sec. 60.12 or a written statement from an appropriate 
official stating that the borrower was engaged in an activity for which 
he or she was entitled to receive a deferment at the time the deferment 
was granted.
    (b) The Secretary's payment of a claim is contingent upon receipt of 
all required documentation and an assignment to the United States of 
America of all right, title, and interest of the lender or holder in the 
note underlying the claim. The lender or holder must warrant that the 
loan is eligible for HEAL insurance.
    (c) In addition, the lender or holder must comply with the following 
requirements for the filing of default,

[[Page 435]]

death, disability, and bankruptcy claims:
    (1) Default claims. Default means the persistent failure of the 
borrower to make a payment when due or to comply with other terms of the 
note or other written agreement evidencing a loan under circumstances 
where the Secretary finds it reasonable to conclude that the borrower no 
longer intends to honor the obligation to repay the loan. In the case of 
a loan repayable (or on which interest is payable) in monthly 
installments, this failure must have persisted for 120 days. In the case 
of a loan repayable (or on which interest is payable) in less frequent 
installments, this failure must have persisted for 180 days. If, for a 
particular loan, an automatic stay is imposed on collection activities 
by a Bankruptcy Court, and the lender or holder receives written 
notification of the automatic stay prior to initiating legal proceedings 
against the borrower, the 120- or 180-day period does not include any 
period prior to the end of the automatic stay.
    (i) If a lender or holder determines that it is not appropriate to 
commence and prosecute an action against a default borrower pursuant to 
Sec. 60.35(c)(3), it must file a default claim with the Secretary within 
30 days after a loan has been determined to be in default.
    (ii) If a lender files suit against a defaulted borrower and does 
not pursue collection of the judgment obtained as a result of the suit, 
it must file a default claim with the Secretary within 60 days of the 
date of issuance of the judgment. If a lender or holder files suit 
against a defaulted borrower, and pursues collection of the judgment 
obtained as a result of the suit, these collection activities must begin 
within 60 days of the date of issuance of the judgment. If the lender or 
holder is unable to collect the full amount of principal and interest 
owed, a claim must be filed within 30 days of completion of the post-
judgment collection activities. In either case, the lender or holder 
must assign the judgment to the Secretary as part of the default claim.
    (iii) In addition to the documentation required for all claims, the 
lender or holder must submit with its default claim at least the 
following:
    (A) Repayment schedule(s);
    (B) A collection history, if any;
    (C) A final demand letter;
    (D) The original or a copy of all correspondence relevant to the 
HEAL loan to or from the borrower (whether received by the original 
lender, a subsequent holder, or an independent servicing agent);
    (E) A claims collection litigation report; and
    (F) If the defaulted borrower filed for bankruptcy under chapter 7 
of the Bankruptcy Act and did not file a complaint to determine the 
dischargeability of the loan, all documents sent to or received from the 
bankruptcy court, including evidence which shows the period of the 
bankruptcy proceedings.
    (iv) If a lender or holder files a default claim on a loan and 
subsequently receives written notice from the court or the borrower's 
attorney that the borrower has filed for bankruptcy under chapter 11 or 
13 of the Bankruptcy Act, or under chapter 7 with a complaint to 
determine the dischargeability of the loan, the lender or holder must 
file that notice with the Secretary within 10 days of the lender or 
holder's initial date of receipt, as documented by a date stamp. If the 
borrower is declaring bankruptcy under chapter 7 of the Bankruptcy Act, 
and has not filed a complaint to determine the dischargeability of the 
loan, the lender or holder must file the written notice with the 
Secretary within 30 days of the lender's or holder's initial date of 
receipt, as documented by a date stamp. If the Secretary has not paid 
the claim at the time the lender or holder receives that notice, upon 
receipt of the notice, the lender or holder must file with the 
bankruptcy court a proof of claim, if applicable, and an objection to 
the discharge or compromise of the HEAL loan. If the Secretary has paid 
the claim, the lender or holder must file a statement with the court 
notifying it that the loan is owned by the Secretary.
    (2) Death claims. A lender or holder must file a death claim with 
the Secretary within 30 days after the lender or holder obtains 
documentation that a borrower is dead. In addition to the documentation 
required for all claims,

[[Page 436]]

the lender or holder must submit with its death claim those documents 
which verify the death, including an official copy of the Death 
Certificate.
    (3) Disability claims. A lender or holder must file a disability 
claim with the Secretary within 30 days after it has been notified that 
the Secretary has determined a borrower to be totally and permanently 
disabled. In addition to the documentation required for all claims, the 
lender or holder must submit with its claim evidence of the Secretary's 
determination that the borrower is totally and permanently disabled.
    (4) Bankruptcy claims. For a bankruptcy under chapter 11 or 13 of 
the Bankruptcy Act, or a bankruptcy under chapter 7 of the Bankruptcy 
Act when the borrower files a complaint to determine the 
dischargeability of the HEAL loan, the current holder must file a claim 
with the Secretary within 10 days of the initial date of receipt of 
court notice or written notice from the borrower's attorney that the 
borrower has filed for bankruptcy under chapter 11 or chapter 13, or has 
filed a complaint to determine the dischargeability of the HEAL loan 
under chapter 7. The initial date of receipt of the written notice must 
be documented by a date stamp. The lender or holder must file with the 
bankruptcy court a proof of claim, if applicable, and an objection to 
the discharge or compromise of the HEAL loan. In addition to the 
documentation required for all claims, with its claim the lender or 
holder must submit to the Secretary at least the following:
    (i) Repayment schedule(s);
    (ii) A collection history, if any;
    (iii) A proof of claim, where applicable;
    (iv) An assignment to the United States of America of its proof of 
claim, where applicable;
    (v) All pertinent documents sent to or received from the bankruptcy 
court; and
    (vi) A statement of any facts of which the lender is aware that may 
form the basis for an objection to the bankrupt's discharge or an 
exception to the discharge.
    (vii) The notice of the first meeting or creditors, or an 
explanation as to why this is not included;
    (viii) In cases where there is defective service, a declaration or 
affidavit attesting to the fact that the lender or holder was not 
directly served with the notice of meeting of creditors. This 
declaration or affidavit must also indicate when and how the lender or 
holder learned of the bankruptcy; and
    (ix) In cases where there is defective service due to the borrower's 
failure to list the proper creditor, a copy of the letter sent to the 
borrower at the time of purchase of the HEAL loan by the current holder, 
or a sample letter with documentation indicating when the letter was 
sent to the borrower.

(Approved by the Office of Management and Budget under control numbers 
0915-0036 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 750, Jan. 8, 1987; 56 
FR 42701, Aug. 29, 1991; 57 FR 28798, June 29, 1992]



Sec. 60.41  Determination of amount of loss on claims.

    (a) General rule. HEAL insurance covers the unpaid balance of 
principal and interest on an eligible HEAL loan, less the amount of any 
judgment collected pursuant to default proceedings commenced by the 
eligible lender or holder involved. In determining whether to approve an 
insurance claim for payment, the Secretary considers legal defects 
affecting the initial validity or insurability of the loan. The 
Secretary also deducts from a claim any amount that is not a legally 
enforceable obligation of the borrower except to the extent that the 
defense of infancy applies. The Secretary further considers whether all 
holders of the loan have complied with the requirements of the HEAL 
regulations, including those concerned with the making, servicing, and 
collecting of the loan, the timely filing of claims, and the submission 
of documents with a claim.
    (b) Special rules for loans acquired by assignment. If a claim is 
filed by a lender or holder that obtained a loan by assignment, that 
lender or holder is not entitled to any payment under this section 
greater than that to which a previous holder would have been entitled. 
In particular, the Secretary deducts

[[Page 437]]

from the claim any amounts that are attributable to payments made by the 
borrower to a prior holder of the loan before the borrower received 
proper notice of the assignment of the loan.
    (c) Special rules for loans made by school lenders. (1) If the loan 
for which a claim is filed was originally made by a school and the claim 
is filed by that school, the Secretary deducts from the claim an amount 
equal to any unpaid refund that the school owes the borrower.
    (2) If the loan for which a claim is filed was originally made by a 
school but the claim is filed by another lender of holder that obtained 
the note by assignment, the Secretary deducts from the claim an amount 
equal to any unpaid refund that the school owed the borrower prior to 
the assignment.
    (d) Circumstances under which defects in claims may be cured or 
excused. The Secretary may permit a lender or holder to cure certain 
defects in a specified manner as a condition for payment of a default 
claim. The Secretary may excuse certain defects if the holder submitting 
the default claim satisfies the Secretary that the defect did not 
contribute to the default or prejudice the Secretary's attempt to 
collect the loan from the borrower. The Secretary may also excuse 
certain defects if the defect arose while the loan was held by another 
lender or holder and the holder submitting the default claim satisfies 
the Secretary that the assignment of the loan was an arm's length 
transaction, that the present holder did not know of the defect at the 
time of the sale and that the present holder could not have become aware 
of the defect through an examination of the loan documents.
    (e) Payment of insured interest. The payment on an approved claim 
covers the unpaid principal balance and interest that accrues through 
the date the claim is paid, except:
    (1) If the lender or holder failed to submit a claim within the 
required period after the borrower's default; death; total and permanent 
disability; or filing of a petition in bankrupty under chapter 11 or 13 
of the Bankruptcy Act, or under chapter 7 where the borrower files a 
complaint to determine the dischargeability of the HEAL loan; the 
Secretary does not pay interest that accrued between the end of that 
period and the date the Secretary received the claim.
    (2) If the Secretary returned the claim to the lender or holder for 
additional documentation necessary for the approval of the claim, the 
Secretary pays interest only for the first 30 days following the return 
of the claim to the lender or holder.

[48 FR 38988, Aug. 26, 1983, as amended at 56 FR 42702, Aug. 29, 1991; 
57 FR 28798, June 29, 1992]



Sec. 60.42  Records, reports, inspection, and audit requirements for HEAL lenders and holders.

    (a) Records. (1) A lender or holder must keep complete and accurate 
records of each HEAL loan which it holds. The records must be organized 
in a way that permits them to be easily retrievable and allows the ready 
identification of the current status of each loan. The required records 
include:
    (i) The loan application;
    (ii) The original promissory note;
    (iii) The repayment schedule agreement;
    (iv) Evidence of each disbursement of loan proceeds;
    (v) Notices of changes in a borrower's address and status as a full-
time student;
    (vi) Evidence of the borrower's eligibility for a deferment;
    (vii) The borrower's signed statement describing his or her rights 
and responsibilities in connection with a HEAL loan;
    (viii) The documents required for the exercise of forbearance;
    (ix) Documentation of the assignment of the loan; and
    (x) Evidence of a borrower's creditworthiness, including the 
borrower's credit report.
    (2) The lender or holder must maintain for each borrower a payment 
history showing the date and amount of each payment received on the 
borrower's behalf, and the amounts of each payment attributable to 
principal and interest. A lender or holder must

[[Page 438]]

also maintain for each loan a collection history showing the date and 
subject of each communication with a borrower or endorser for collection 
of a delinquent loan. Furthermore, a lender or holder must keep any 
additional records which are necessary to make any reports required by 
the Secretary.
    (3) A lender or holder must retain the records required for each 
loan for not less than 5 years following the date the loan is repaid in 
full by the borrower. However, in particular cases the Secretary may 
require the retention of records beyond this minimum period. A lender or 
holder must keep the original copy of an unpaid promissory note, but may 
store all other records in microform or computer format.
    (4) The lender or holder must maintain accurate and complete records 
on each HEAL borrower and related school activities required by the HEAL 
program. All HEAL records shall be maintained under security and 
protected from fire, flood, water leakage, other environmental threats, 
electronic data system failures or power fluctuations, unauthorized 
intrusion for use, and theft.
    (b) Reports. A lender or holder must submit reports to the Secretary 
at the time and in the manner required by the Secretary.
    (c) Inspections. Upon request, a lender or holder must afford the 
Secretary, the Comptroller General of the United States, and any of 
their authorized representatives access to its records in order to 
assure the correctness of its reports.
    (d) The lender or holder must comply with the Department's biennial 
audit requirements of section 705 of the Act.
    (e) Any lender or holder who has information which indicates 
potential or actual commission of fraud or other offenses against the 
United States, involving these loan funds, must promptly provide this 
information to the appropriate Regional Office of Inspector General for 
Investigations.

(Approved by the Office of Management and Budget under control numbers 
0915-0043 and 0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 750, Jan. 8, 1987; 57 
FR 28798, June 29, 1992]



Sec. 60.43  Limitation, suspension, or termination of the eligibility of a HEAL lender or holder.

    (a) The Secretary may limit, suspend, or terminate the eligibility 
under the HEAL program of an otherwise eligible lender or holder that 
violates or fails to comply with any provision of title VII, part A, 
subpart I of the Act as amended (42 U.S.C. 292-292p), these regulations, 
or agreements with the Secretary concerning the HEAL program. Prior to 
terminating a lender or holder's participation in the program, the 
Secretary will provide the entity an opportunity for a hearing in 
accordance with the procedures under paragraph (b) of this section.
    (b) The Secretary will provide any lender or holder subject to 
termination with a written notice, sent by certified mail, specifying 
his or her intention to terminate the lender or holder's participation 
in the program and stating that the entity may request, within 30 days 
of the receipt of this notice, a formal hearing. if the entity requests 
a hearing, it must, within 90 days of the receipt of the notice, submit 
material, factual issues in dispute to demonstrate that there is cause 
for a hearing. These issues must be both substantive and relevant. The 
hearing will be held in the Washington, DC metropolitan area. The 
Secretary will deny a hearing if:
    (1) The request for a hearing is untimely (i.e., fails to meet the 
30-day requirement);
    (2) The lender or holder does not provide a statement of material, 
factual issues in dispute within the 90-day required period; or
    (3) The statement of factual issues in dispute is frivolous or 
inconsequential.

In the event that the Secretary denies a hearing, the Secretary will 
send a written denial, by certified mail, to the lender or holder 
setting forth the reasons for denial. If a hearing is denied, or if as a 
result of the hearing, termination is still determined to be necessary, 
the lender or holder will be terminated from participation in the 
program. An entity will be permitted to reapply for participation in the 
program when it demonstrates, and the Secretary agrees, that it is in 
compliance with all HEAL requirements.

[[Page 439]]

    (c) This section does not apply to a determination that a HEAL 
lender fails to meet the statutory definition of an ``eligible lender.''
    (d) This section also does not apply to administrative action by the 
Department of Health and Human Services based on any alleged violation 
of:
    (1) Title VI of the Civil Rights Act of 1964, which is governed by 
45 CFR part 80;
    (2) Title IX of the Education Amendments of 1972, which is governed 
by 45 CFR part 86;
    (3) The Family Educational Rights and Privacy Act of 1974 (section 
438 of the General Education Provisions Act, as amended), which is 
governed by 34 CFR part 99; or
    (4) Title XI of the Right to Financial Privacy Act of 1978, Pub. L. 
95-630 (12 U.S.C. 3401-3422).

(Approved by the Office of Management and Budget under control number 
0915-0144)

[48 FR 38988, Aug. 26, 1983, as amended at 57 FR 28799, June 29, 1992; 
58 FR 67349, Dec. 21, 1993]



                          Subpart E--The School



Sec. 60.50  Which schools are eligible to be HEAL schools?

    (a) In order to participate in the HEAL program, a school must enter 
into a written agreement with the Secretary. In the agreement, the 
school promises to comply with provisions of the HEAL law and the HEAL 
regulations. For initial entry into this agreement and for the agreement 
to remain in effect, a school must satisfy the following requirements:
    (1) The school must be legally authorized within a State to conduct 
a course of study leading to one of the following degrees:

Doctor of Medicine
Doctor of Osteopathic Medicine
Doctor of Dentistry or equivalent degree
Bachelor or Master of Science in Pharmacy or equivalent degree
Doctor of Optometry or equivalent degree
Doctor of Veterinary Medicine or equivalent degree
Doctor of Podiatric Medicine or equivalent degree
Graduate or equivalent degree in Public Health
Doctor of Chiropractic or equivalent degree
Doctoral degree of Clinical Psychology
Masters or doctoral degree in Health Administration


For the purposes of this section, the term ``State'' includes, in 
addition to the several States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana 
Islands, the Virgin Islands, Guam, American Samoa, the Trust Territory 
of the Pacific Islands (the Republic of Palau), the Republic of the 
Marshall Islands, and the Federated States of Micronesia.
    (2)(i) The school must be accredited by a recognized agency approved 
for that course of study by the Secretary of Education, as described in 
paragraph (a)(2)(ii) of this section, except where a school is not 
eligible for accreditation solely because it is too new. A new school is 
eligible if the Secretary of Education determines that it can reasonably 
expect to be accredited before the beginning of the academic year 
following the normal graduation date of its first entering class. The 
Secretary of Education makes this determination after consulting with 
the appropriate accrediting agency and receiving reasonable assurance to 
that effect.
    (ii) The approved accrediting agencies are:
    (A) Liaison Committee on Medical Education.
    (B) American Osteopathic Association.
    (C) Commission on Dental Accreditation.
    (D) Council on Education of American Veterinary Medical Association.
    (E) Council on Optometric Education.
    (F) Council on Podiatric Medical Education.
    (G) American Council on Pharmaceutical Education.
    (H) Council on Education for Public Health.
    (I) Council on Chiropractic Education.
    (J) Accrediting Commission on Education for Health Services 
Administration.
    (K) Committee on Accreditation of American Psychological 
Association.
    (b) If a HEAL school undergoes a change of controlling ownership or 
form of control, its agreement automatically expires at the time of that 
change. The school must enter into a

[[Page 440]]

new agreement with the Secretary in order to continue its participation 
in the HEAL program.

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 751, Jan. 8, 1987; 57 
FR 28799, June 29, 1992]



Sec. 60.51  The student loan application.

    When the student completes his or her portion of the student loan 
application and submits it to the school, the school must do the 
following:
    (a) Accurately and completely fill out its portion of the HEAL 
application;
    (b) Verify, to the best of its ability, the information provided by 
the student on the HEAL application, including, but not limited to, 
citizenship status and Social Security number. To comply with this 
requirement, the school may request that the student provide a certified 
copy of his or her birth certificate, his or her naturalization papers, 
and an original Social Security card or copy issued by the Federal 
Government, or other documentation that the school may require. The 
school must assure that the applicant's I-151 or I-551 is attached to 
the application, if the applicant is required to possess such 
identification by the United States;
    (c) Certify that the student is eligible to receive a HEAL loan, 
according to the requirements of Sec. 60.5;
    (d) Review the financial aid transcript from each institution 
previously attended by the applicant on at least a half-time basis to 
determine whether the applicant is in default on any loans or owes a 
refund on any grants. The school may not approve the HEAL application or 
disburse HEAL funds if the borrower is in default on any loans or owes a 
refund on any educational grants, unless satisfactory arrangements have 
been made between the borrower and the affected lender or school to 
resolve the default or the refund on the grant. If the financial aid 
transcript has been requested, but has not been received at the time the 
applicant submits his or her first HEAL application, the school may 
approve the application and disburse the first HEAL installment prior to 
receipt of the transcript. Each financial aid transcript must include at 
least the following data:
    (1) Student's name;
    (2) Amounts and sources of loans and grants previously received by 
the student for study at an institution of higher education;
    (3) Whether the student is in default on any of these loans, or owes 
a refund on any grants;
    (4) Certification from each institution attended by the student that 
the student has received no financial aid, if applicable; and
    (5) From each institution attended, the signature of an official 
authorized by the institution to sign such transcripts on behalf of the 
institution.
    (e) State that it has no reason to believe that the borrower may not 
be willing to repay the HEAL loan;
    (f) Make reasonable determinations of the maximum loan amount 
approvable, based on the student's circumstances. The student applicant 
determines the amount he or she wishes to borrow, up to this maximum 
amount. Only then may the school certify an eligible application. In 
determining the maximum loan amount approvable, the school will 
calculate the difference between:
    (1) The total financial resources available to the applicant for his 
or her costs of education for the period covered by the proposed HEAL 
loan, and other student aid that the applicant has received or will 
receive during the period covered by the proposed HEAL loan. To 
determine the total financial resources available to the applicant for 
his or her costs of education for the period covered by the proposed 
HEAL loan (including familial, spousal, or personal income or other 
financial assistance that the applicant has received or will receive), 
the school must consider information provided through one of the 
national need analysis systems or any other procedure approved by the 
Secretary of Education, in addition to any other information which the 
school has regarding the student's financial situation. The school may 
make adjustments to the need analysis information only when necessary to 
accurately reflect the applicant's actual resources, and must maintain 
in the borrower's record documentation to support the basis for any 
adjustments to the need analysis information; and

[[Page 441]]

    (2) The costs reasonably necessary for each student to pursue the 
same or similar curriculum or program within the same class year at the 
school for the period covered by the proposed HEAL loan, using a 
standard student budget. The school must maintain in its general office 
records the criteria used to develop each standard student budget. 
Adjustments to the standard student budget may be made only to the 
extent that they are necessary for the student to complete his or her 
education, and documentation must be maintained in the borrower's record 
to support the basis for any adjustments to the standard student budget.
    (g) Comply with the requirements of Sec. 60.61.

(Approved by the Office of Management and Budget under control numbers 
0915-0038 and 0915-0108)

[52 FR 751, Jan. 8, 1987, as amended at 57 FR 28799, June 29, 1992]



Sec. 60.52  The student's loan check.

    (a) When a school receives from a HEAL lender a loan disbursement 
check or draft payable jointly to the school and to one of its students, 
it must:
    (1) If the school receives the instrument after the student is 
enrolled, obtain the student's endorsement, retain that portion of funds 
due the school, and disburse the remaining funds to the student.
    (2) If the school receives the instrument before the student is 
enrolled, it must, prior to endorsing the instrument, send the 
instrument to the student to endorse and return to the school. The 
school may then retain that portion of funds then due the school but 
must hold the remaining funds for disbursement to the student at the 
time of enrollment. However, if the student is unable to meet other 
educational expenses due before the time of enrollment, the school may 
obtain the student's endorsement and disburse to the student that 
portion of funds required to meet these other educational expenses.
    (b) If a school determines that a student does not plan to enroll, 
the school must return a loan disbursement check or draft to the lender 
within 30 days of this determination.

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 751, Jan. 8, 1987]



Sec. 60.53  Notification to lender or holder of change in enrollment status.

    Each school must notify the holder of a HEAL loan of any change in 
the student's enrollment status within 30 days following the change in 
status. Each notice must contain the student's full name under which the 
loan was received, the student's current name (if different), the 
student's Social Security number, the date of the change in the 
enrollment status, or failure to enroll as scheduled for any academic 
period as a full-time student, the student's latest known permanent and 
temporary addresses, and other information which the school may decide 
is necessary to identify or locate the student. If the school does not 
know the identity of the current holder of the HEAL loan, it must notify 
the HEAL Program Office of a change in the student's enrollment status. 
This notification is not required for vacation periods and leaves of 
absence or other temporary interruptions which do not exceed one 
academic term.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[52 FR 751, Jan. 8, 1987, as amended at 57 FR 28799, June 29, 1992]



Sec. 60.54  Payment of refunds by schools.

    A participating school must pay that portion of a refund that is 
allocable to a HEAL loan directly to the original lender (or to a 
subsequent holder of the loan note, if the school has knowledge of the 
holder's identity). At the same time, the school must provide to the 
borrower written notice that it is doing so.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 57 FR 28799, June 26, 1992]



Sec. 60.55  Administrative and fiscal procedures.

    Each school must establish and maintain administrative and fiscal 
procedures necessary to achieve the following objectives:

[[Page 442]]

    (a) Proper and efficient administration of the funds received from 
students who have HEAL loans;
    (b) Protection of the rights of students under the HEAL program;
    (c) Protection of the United States from unreasonable risk of loss 
due to defaults; and
    (d) Compliance with applicable requirements for HEAL schools.



Sec. 60.56  Records.

    (a) In addition to complying with the requirements of section 739(b) 
of the Act, each school must maintain an accurate, complete, and easily 
retrievable record with respect to each student who has a HEAL loan. The 
record must contain all of the following information:
    (1) Student's name, address, academic standing and period of 
attendance;
    (2) Name of the HEAL lender, amount of the loan, and the period for 
which the HEAL loan was intended;
    (3) If a noncitizen, documentation of the student's alien 
registration status.
    (4) Amount and source of other financial assistance received by the 
student during the period for which the HEAL loan was made;
    (5) Date the school receives the HEAL check or draft and the date it 
either gives it to the student or returns it to the lender (if the 
school is not the lender);
    (6) Date the school disburses the loan to a student (if the school 
is the lender);
    (7) Date the school signs the loan check or draft (if the school is 
a copayee);
    (8) Amount of tuition, fees and other charges paid by the student to 
the school for the academic period covered by the loan and the dates of 
payment;
    (9) Photocopy of each HEAL check or draft received by the student;
    (10) Documentation of each entrance interview, including the date of 
the entrance interview and the signature of the borrower indicating that 
the entrance interview was conducted;
    (11) Documentation of the exit interview, including the date of the 
exit interview and the signature of the borrower indicating that the 
exit interview was conducted, or documentation of the date that the 
school mailed exit interview materials to the borrower if the borrower 
failed to report for the exit interview;
    (12) A photocopy made by the school of the borrower's I-151 or I-
551, if the borrower is required to possess such identification by the 
United States, or other documentation, if obtained by the school, to 
verify citizenship status and Social Security number (e.g., a certified 
copy of the borrower's birth certificate or a photocopy made by the 
school of the borrower's original Social Security card or copy issued by 
the Federal government);
    (13) Documentation of the calculations made which compare the 
financial resources of the applicant with the cost of his or her 
education at the school;
    (14) Copy(s) of the borrower's financial aid transcript(s);
    (15) The standard budget used for the student, and documentation to 
support the basis for any deviations made to the standard budget;
    (16) Copies of all correspondence between the school and the 
borrower or between the school and the lender or its assignee regarding 
the loan;
    (17) Copy of each form used by the school in connection with the 
loan; and
    (18) Expected postgraduate destination of borrower.
    (b) The school must maintain the record for not less than 5 years 
following the date the student graduates, withdraws or fails to enroll 
as a full-time student. The school may store the records in microform or 
computer format.
    (c) The school must comply with the Department's biennial audit 
requirements of section 705 of the Act.
    (d) The school must develop and follow written procedures for the 
receipt, verification of amount, and disbursement of HEAL checks or 
drafts. These procedures must be maintained in the school's policies and 
procedures manuals or other general office records.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[48 FR 38988, Aug. 26, 1983, as amended at 52 FR 751, Jan. 8, 1987; 57 
FR 28799, June 29, 1992]

[[Page 443]]



Sec. 60.57  Reports.

    A school must submit reports to the Secretary at the times and in 
the manner the Secretary may reasonably prescribe. The school must 
retain a copy of each report for not less than 5 years following the 
report's completion, unless otherwise directed by the Secretary. A 
school must also make available to a HEAL lender or holder, upon the 
lender's or holder's request, the name, address, postgraduate 
destination and other reasonable identifying information for each of the 
school's students who has a HEAL loan.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[57 FR 28799, June 29, 1992]



Sec. 60.58  Federal access to school records.

    For the purposes of audit and examination, a HEAL school must 
provide the Secretary of Health and Human Services, the Comptroller 
General of the United States, and any of their authorized 
representatives access to the records that the school is required to 
keep and to any documents and records pertinent to the administration of 
the HEAL Program.



Sec. 60.59  Records and Federal access after a school is no longer a HEAL school.

    In the event a school ceases to participate in the HEAL program, the 
school (or its successor, in the case of a school which undergoes a 
change in ownership) must retain all required HEAL records and provide 
the Secretary of Health and Human Services, the Comptroller General of 
the United States, and any of their authorized representatives access to 
them.



Sec. 60.60  Limitation, suspension, or termination of the eligibility of a HEAL school.

    (a) The Secretary may limit, suspend, or terminate the eligibility 
under the HEAL program of an otherwise eligible school that violates or 
fails to comply with any provision of title VII, part A, subpart I of 
the Act as amended (42 U.S.C. 292-292p), these regulations, or 
agreements with the Secretary concerning the HEAL program. Prior to 
terminating a school's participation in the program, the Secretary will 
provide the school an opportunity for a hearing in accordance with the 
procedures under paragraph (b) of this section.
    (b) The Secretary will provide any school subject to termination 
with a written notice, sent by certified mail, specifying his or her 
intention to terminate the school's participation in the program and 
stating that the school may request, within 30 days of the receipt of 
this notice, a formal hearing. If the school requests a hearing, it 
must, within 90 days of the receipt of the notice, submit material, 
factual issues in dispute to demonstrate that there is cause for a 
hearing. These issues must be both substantive and relevant. The hearing 
will be held in the Washington, DC metropolitan area. The Secretary will 
deny a hearing if:
    (1) The request for a hearing is untimely (i.e., fails to meet the 
30-day requirement);
    (2) The school does not provide a statement of material, factual 
issues in dispute within the 90-day required period; or
    (3) The statement of factual issues in dispute is frivolous or 
inconsequential.

In the event that the Secretary denies a hearing, the Secretary will 
send a written denial, by certified mail, to the school setting forth 
the reasons for denial. If a hearing is denied, or if as a result of the 
hearing, termination is still determined to be necessary, the school 
will be terminated from participation in the program. A school will be 
permitted to reapply for participation in the program when it 
demonstrates, and the Secretary agrees, that it is in compliance with 
all HEAL requirements.
    (c) This section does not apply to a determination that a HEAL 
school fails to meet the statutory definition of an ``eligible school.''
    (d) This section does not apply to administrative action by the 
Department of Health and Human Services based on any alleged violation 
of The Family Educational Rights and Privacy Act of

[[Page 444]]

1974 (section 438 of the General Education Provisions Act, as amended), 
as governed by 34 CFR part 99.

(Approved by the Office of Management and Budget under control number 
0915-0144)

[48 FR 38988, Aug. 26, 1983, as amended at 52 752, Jan. 8, 1987; 58 FR 
67350, Dec. 21, 1993]



Sec. 60.61  Responsibilities of a HEAL school.

    (a) A HEAL school is required to carry out the following activities 
for each HEAL applicant or borrower:
    (1) Conduct and document an entrance interview with each student 
(individually or in groups) no later than prior to the loan recipient's 
first HEAL disbursement in each academic year that the loan recipient 
obtains a HEAL loan. The school must inform the loan recipient during 
the entrance interview of his or her rights and responsibilities under a 
HEAL loan, including the consequences for noncompliance with those 
responsibilities, and must gather personal information which would 
assist in locating the loan recipient should he or she depart from the 
school without receiving an exit interview. A school may meet this 
requirement through correspondence where the school determines that a 
face-to-face meeting is impracticable.
    (2) Conduct and document an exit interview with each HEAL loan 
recipient (individually or in groups) within the final academic term of 
the loan recipient's enrollment prior to his or her anticipated 
graduation date or other departure date from the school. The school must 
inform the loan recipient in the exit interview of his or her rights and 
responsibilities under each HEAL loan, including the consequences for 
noncompliance with those responsibilities. The school must also collect 
personal information from the loan recipient which would assist the 
school or the lender or holder in skiptracing activities and to direct 
the loan recipient to contact the lender or holder concerning specific 
repayment terms and options. A copy of the documentation of the exit 
interview, including the personal information collected for skiptracing 
activities, and any other information required by the Secretary 
regarding the exit interview must be sent to the lender or holder of 
each HEAL loan within 30 days of the exit interview. If the loan 
recipient departs from the school prior to the anticipated date or does 
not receive an exit interview, the exit interview information must be 
mailed to the loan recipient by the school within 30 days of the 
school's knowledge of the departure or the anticipated departure date, 
whichever is earlier. The school must request that the loan recipient 
forward any required information (e.g., skiptracing information, request 
for deferment, etc.) to the lender or holder. The school must notify the 
lender or holder of the loan recipient's departure at the same time it 
mails the exit interview material to the loan recipient.
    (3) Verify the accuracy and completeness of information provided by 
each student on the HEAL loan application, particularly in regard to the 
HEAL eligibility requirements, by comparing the information with 
previous loan applications or other records or information provided by 
the student to the school. Notify the potential lender of any 
discrepancies which were not resolved between the school and the 
student.
    (4) Develop and implement procedures relating to check receipt and 
release which keep these functions separate from the application 
preparation and approval process and assure that the amount of the HEAL 
loan check(s) does(do) not exceed the approved total amount of the loan 
and the statutory maximums. Checks must not be cashed without the 
borrower's personal endorsement. Documentation of these procedures and 
their usage shall be maintained by the school.
    (5) Maintain accurate and complete records on each HEAL borrower and 
related school activities required by the HEAL program. All HEAL records 
shall be properly safeguarded and protected from environmental threats 
and unauthorized intrusion for use and theft.
    (6) Maintain documentation of the criteria used to develop the 
school's standard student budgets in the school's general records, 
readily available for audit purposes, and maintain in each HEAL 
borrower's record a copy of the standard budget which was actually used 
in the determination of the

[[Page 445]]

maximum loan amount approvable for the student, as described in 
Sec. 60.51.
    (7) Notify the lender or its assignee of any changes in the 
student's name, address, status, or other information pertinent to the 
HEAL loan not more than 30 days after receiving information indicating 
such a change.
    (b) Any school which has information which indicates potential or 
actual commission of fraud or other offenses against the United States 
involving these loan funds must promptly provide this information to the 
appropriate Regional Office of Inspector General for Investigations.
    (c) The school will be considered responsible and the Secretary may 
seek reimbursement from any school for the amount of a loan in default 
on which the Secretary has paid an insurance claim, if the Secretary 
finds that the school did not comply with the applicable HEAL statute 
and regulations, or its written agreement with the Secretary. The 
Secretary may excuse certain defects if the school satisfies the 
Secretary that the defect did not contribute to the default or prejudice 
the Secretary's attempt to collect the loan from the borrower.
    (d) A school is authorized to withhold services from a HEAL borrower 
who is in default on a HEAL loan received while enrolled in that school, 
except in instances where the borrower has filed for bankruptcy. Such 
services may include, but are not limited to academic transcripts and 
alumni services. Defaulted HEAL borrowers who have filed for bankruptcy 
shall provide court documentation that verifies the filing for 
bankruptcy upon the request of the school. Schools will also supply this 
information to the Secretary upon request. All academic and financial 
aid transcripts that are released on a defaulted HEAL borrower must 
indicate on the transcript that the borrower is in default on a HEAL 
loan. It is the responsibility of the borrower to provide the school 
with documentation from the lender, holder, or Department when a default 
has been satisfactorily resolved, in order to obtain access to services 
that are being withheld, or to have the reference to default removed 
from the academic and financial aid transcripts.

(Approved by the Office of Management and Budget under control number 
0915-0108)

[52 FR 752, Jan. 8, 1987, as amended at 57 FR 28799, June 29, 1992; 58 
FR 67350, Dec. 21, 1993]

[[Page 446]]



            SUBCHAPTER E--FELLOWSHIPS, INTERNSHIPS, TRAINING





PART 61--FELLOWSHIPS--Table of Contents




                     Subpart A--Regular Fellowships

Sec.
61.1  Definitions.
61.2  Applicability.
61.3  Purpose of regular fellowships.
61.4  Establishment and conditions.
61.5  Qualifications.
61.6  Method of application.
61.7  Review of applications; committees; awards.
61.8  Benefits: Stipends; dependency allowances; travel allowances; 
          vacation.
61.9  Payments: Stipends; dependency allowances; travel allowances.
61.10  Benefits: Tuition and other expenses.
61.11  Payments: Tuition and other expenses.
61.12  Accountability.
61.13  Duration and continuation.
61.14  Separate consideration of information concerning moral character 
          or loyalty.
61.15  Moral character or loyalty; reference to Special Review 
          Committee; review and recommendation.
61.16  Termination of or refusal to continue award on grounds relating 
          to moral character or loyalty; hearing.
61.17  Termination on grounds other than those relating to moral 
          character or loyalty.
61.18  Publications.
61.19  Copyright and reproduction.
61.20  Inventions or discoveries.
61.21  Interest.
61.22  Nondiscrimination.

                     Subpart B--Service Fellowships

61.30  Definitions.
61.31  Applicability.
61.32  Purpose of service fellowships.
61.33  Establishment of service fellowships.
61.34  Qualifications.
61.35  Method of application.
61.36  Selection and appointment of service fellows.
61.37  Stipends, allowances, and benefits.
61.38  Duration of service fellowships.



                     Subpart A--Regular Fellowships

    Authority: Sec. 215, 58 Stat. 690, as amended, sec. 8, 77 Stat. 400; 
42 U.S.C. 216, 1857g; secs. 301, 402, 58 Stat. 691, as amended, 707, 
secs. 412, 422, 62 Stat. 464, 598, sec. 433, 64 Stat. 444, as amended, 
sec. 308, 74 Stat. 364, sec. 444, 76 Stat. 1073, sec. 3, 77 Stat. 394, 
secs. 394, 395, 79 Stat. 1062; 42 U.S.C. 241, 282, 287a, 288a, 289c, 
242f, 289g, 1857b, 280b-4, 280b-5.

    Source: 31 FR 12096, Sept. 16, 1966, unless otherwise noted.



Sec. 61.1  Definitions.

    As used in this part:
    (a) Continuation award is an award made by the Surgeon General, 
within the period of support recommended by a fellowship committee, 
without necessity for further action by the committee.
    (b) Noncitizen national means any person who, though not a citizen 
of the United States, owes permanent allegiance to the United States.
    (c) Regular fellowship means an award to support activity not 
requiring performance of services for the Public Health Service.
    (d) Surgeon General means the Surgeon General of the U.S. Public 
Health Service or his delegate.
    (e) Continental United States does not include Hawaii or Alaska.



Sec. 61.2  Applicability.

    The regulations in this subpart apply to the establishment, award, 
and operation of all regular fellowships awarded under the Public Health 
Service Act and the Clean Air Act.



Sec. 61.3  Purpose of regular fellowships.

    Regular fellowships are provided to encourage and promote:
    (a) Research and training for research relating to (1) the physical 
and mental diseases and impairments of man, (2) the organization, 
provision, and financing of health services, (3) the causes, prevention, 
and control of air pollution, and (4) medical library and related health 
sciences and communication of information.
    (b) Special scientific projects for the compilation of existing, or 
writing of original, contributions relating to scientific, social, or 
cultural advancements in sciences related to health.



Sec. 61.4  Establishment and conditions.

    All regular fellowships in the Public Health Service shall be 
established by the Surgeon General. In establishing a fellowship or 
series of fellowships, the Surgeon General shall prescribe in

[[Page 447]]

writing the conditions (in addition to those provided in the regulations 
in this part) under which the fellowships are to be awarded and held.



Sec. 61.5  Qualifications.

    In order to qualify for a regular fellowship, an applicant must:
    (a) Meet the Public Health Service requirements of general 
suitability, including professional and personal fitness.
    (b) Have been accepted by a public or other nonprofit institution 
for the purpose of the activity for which the fellowship is sought.
    (c) Be free from any disease or disability that would interfere with 
the accomplishment of the fellowship purpose.
    (d) If a citizen or noncitizen national of the United States, sign 
and file with the Surgeon General the following statement:

    I do solemnly swear (or affirm) that I bear true faith and 
allegiance to the United States of America and will support and defend 
the Constitution and laws of the United States against all its enemies, 
foreign and domestic.

    (e) Comply with such other requirements as may be prescribed by the 
Surgeon General.



Sec. 61.6  Method of application.

    Application for a regular fellowship shall be made on forms 
prescribed by the Surgeon General. In addition to the information 
supplied by the applicant in his application, such further information 
may be required as is necessary to determine his qualifications and 
fitness.



Sec. 61.7  Review of applications; committees; awards.

    The Surgeon General shall appoint one or more fellowship committees 
to examine the qualifications of applicants for fellowships and the 
merits of their proposals for research, training, or special scientific 
projects. A fellowship committee shall submit to the Surgeon General its 
recommendations concerning appointments. Awards of regular fellowships 
shall be made in writing by the Surgeon General.



Sec. 61.8  Benefits: Stipends; dependency allowances; travel allowances; vacation.

    Individuals awarded regular fellowships shall be entitled to such of 
the following benefits as are authorized for the particular series of 
fellowship:
    (a) Stipend.
    (b) Dependency allowances.
    (c) When authorized in advance, separate allowances for travel. Such 
allowances may not exceed amounts prescribed by the Surgeon General for
    (1) Travel to the place where the fellow is to be located during the 
fellowship term, and
    (2) Travel to return the fellow at the end of the fellowship term to 
his home or other place he left to carry out the fellowship, provided 
that (unless otherwise prescribed by the Surgeon General) such return 
travel is to or from a place outside the continental United States.

No allowances will be granted for shipping personal effects or household 
goods and no allowances will be granted for transporting dependents, 
except as authorized by the Surgeon General for travel undertaken by 
dependents (spouse and/or dependent children only) to or from a place 
outside the continental United States where the fellow is to be located 
during the fellowship term and for return from such place or except as 
otherwise prescribed by the Surgeon General for a particular series of 
fellowships.
    (d) Vacation. Stipends and allowances will not be increased, or be 
paid beyond the term of a fellowship, on account of vacation an 
individual might have been entitled to but did not take.



Sec. 61.9  Payments: Stipends; dependency allowances; travel allowances.

    Payments for stipends, dependency allowances, and the travel 
allowances specified in Sec. 61.8 may be made directly to the fellow or 
to the sponsoring institution for payment to the fellow.



Sec. 61.10  Benefits: Tuition and other expenses.

    The Surgeon General may authorize allowances for payment of 
expenses, in whole or in part, of tuition, fees, equipment, supplies, 
attendance at meetings required to carry out the purposes of

[[Page 448]]

the fellowship, or other expenses of the activities of the fellow.



Sec. 61.11  Payments: Tuition and other expenses.

    (a) Tuition and fees. Allowances for tuition and fees may be made to 
the fellow or sponsoring institution.
    (b) Other expenses; standard or maximum allowances. Any allowances 
for equipment, supplies, attendance at meetings, and other expenses 
shall, except as may otherwise be prescribed herein or by the Surgeon 
General, be paid to the sponsoring institution. The Surgeon General may 
establish a standard allowance or a maximum allowance for payment to the 
sponsoring institution for such expenses.
    (c) Attendance at meetings--fellows sponsored by Federal agencies. 
Allowances for expenses of attendance at meetings by fellows who are 
sponsored by Federal agencies may be paid directly to such fellows.
    (d) Installments. Payments to sponsoring institutions and to fellows 
under this section or under Sec. 61.9 may be made in advance or by way 
of reimbursement and, except as may otherwise be prescribed by the 
Surgeon General, in monthly installments.



Sec. 61.12  Accountability.

    Payments shall be subject to such requirements relating to 
accountability as may be specified by the Surgeon General.



Sec. 61.13  Duration and continuation.

    An award period may be any period not in excess of 2 years. The 
Surgeon General may make one or more continuation awards for an 
additional period upon a finding of satisfactory progress toward 
accomplishment of the purposes of the initial fellowship award. 
Additional support may be provided on appropriate justification after 
expiration of the period of support involved in the previous award.



Sec. 61.14  Separate consideration of information concerning moral character or loyalty.

    No information in the records or possession of the Public Health 
Service concerning the moral character or loyalty of a fellow will be 
made available to any fellowship committee involved in recommending 
appointments of fellows.



Sec. 61.15  Moral character or loyalty; reference to Special Review Committee; review and recommendation.

    (a) Moral character or loyalty; reference to Special Review 
Committee. Whenever the Surgeon General has substantial evidence with 
respect to any fellow (1) that the statement filed pursuant to 
Sec. 61.5(d) was not made in good faith; or (2) that a fellow has (i) 
been convicted of a crime involving moral turpitude or (ii) engaged in 
conduct involving moral turpitude (unless in the case of either 
paragraph (a)(2) (i) or (ii) of this section, it is established that the 
fellow is, nevertheless, then a person of good moral character), the 
Surgeon General shall refer the pertinent records to a Special Review 
Committee established as prescribed in paragraph (b) of this section.
    (b) Special Review Committee; composition. The Special Review 
Committee shall be composed of a representative of the Office of the 
Surgeon General designated by the Surgeon General as chairman but 
nonvoting member, the appropriate Associate Director or comparable 
official of the bureau involved, the Chief of the Division of Research 
Grants, the Director of the Institute or the Chief of the Division which 
awarded the fellowship in question, or their delegates, and two 
additional members appointed by the Surgeon General.
    (c) Information; supplementation. The Committee may supplement the 
information referred to it by such correspondence, personal interviews, 
or other informal methods as necessary in order to make its 
recommendation as provided in paragraph (d) of this section.
    (d) Review and recommendation. The Committee shall review the 
pertinent records, determine whether there is substantial reason to 
believe that the award should be terminated or not continued either on 
grounds relating to moral character or on the ground that the statement 
filed pursuant to Sec. 61.5(d) was not made in good faith, and make its 
recommendation to the Surgeon

[[Page 449]]

General in writing, with reasons therefor, accordingly.



Sec. 61.16  Termination of or refusal to continue award on grounds relating to moral character or loyalty; hearing.

    If, after review of the recommendation of the Special Review 
Committee, the Surgeon General believes that the award should be 
terminated or should not be continued, he shall notify the fellow and 
sponsoring institution in writing that unless a request for a hearing is 
made by the fellow within 20 days after the fellow's receipt of such 
notice, his fellowship will be terminated or his application for 
continuation of the award denied. A copy of the regulations under this 
subpart and a copy of part 10 of title 45, Code of Federal Regulations, 
shall be enclosed with the notice. The notice shall set forth, as 
specifically as security permits, the grounds for the questions 
pertaining to moral character or loyalty. Any such request for a hearing 
shall be promptly submitted by the Surgeon General to the Chairman of 
the Departmental Fellowship Review Panel for handling in accordance with 
such part 10.



Sec. 61.17  Termination on grounds other than those relating to moral character or loyalty.

    The Surgeon General may terminate a fellowship upon receipt from the 
fellow of a written request for termination. The Surgeon General shall 
terminate any fellowship prior to the date it would otherwise expire if 
he determines that the fellow's performance is unsatisfactory or that 
the fellow or the sponsoring institution is unfit or unable to carry out 
the purpose of the fellowship. The fellow and the sponsoring institution 
shall be notified in writing of such termination.



Sec. 61.18  Publications.

    Publication, distribution, and disposition of all manuscripts and 
other materials resulting from a fellowship awarded hereunder shall be 
subject to the conditions that all such materials shall bear appropriate 
acknowledgment of Public Health Service support, that fellows shall 
furnish copies of such publications or other materials as may be 
requested by the Surgeon General, and to such other conditions as the 
Surgeon General may prescribe.



Sec. 61.19  Copyright and reproduction.

    Where the work accomplished under a fellowship award results in a 
book or other copyrightable material, the author is free to copyright 
the work, but the Public Health Service reserves a royalty-free, 
nonexclusive, and irrevocable license to reproduce, publish, or 
otherwise use, and to authorize others to use, all copyrightable or 
copyrighted material resulting from the fellowship award.



Sec. 61.20  Inventions or discoveries.

    Any fellowship award made hereunder is subject to the regulations of 
the Department of Health and Human Services set forth in title 45 CFR 
parts 6 and 8, as amended. Such regulations shall apply to any activity 
for which fellowship funds are in fact used, whether within the scope of 
the fellowship as approved or otherwise. Appropriate measures shall be 
taken by the fellow, the sponsoring institution, and the Surgeon General 
to assure that no contracts, assignments, or other arrangements 
inconsistent with the fellowship obligation are entered into or 
continued and that all personnel involved in the supported activity are 
aware of and comply with such obligation. Laboratory notes, related 
technical data and information pertaining to inventions or discoveries 
shall be maintained for such periods, and filed with or otherwise made 
available to the Surgeon General or those whom he may designate at such 
times and in such manner as he may determine necessary to comply with 
such Department regulations.



Sec. 61.21  Interest.

    Any interest earned through deposit or investment by the sponsoring 
institution of funds paid pursuant to the provisions of this subpart 
shall be paid to the United States as such interest is received by the 
sponsoring institution.



Sec. 61.22  Nondiscrimination.

    Attention is called to the fact that funds paid to a sponsoring 
institution

[[Page 450]]

pursuant to Sec. 61.11 in order to meet the expenses of the activities 
of a fellow are considered Federal financial assistance to such 
institution. The institution is thus subject in this respect to the 
prohibition against discrimination on the basis of race, color, or 
national origin imposed by title VI, Civil Rights Act of 1964, and the 
implementing Regulation of the Department of Health and Human Services 
(45 CFR part 80).



                     Subpart B--Service Fellowships

    Authority: 42 U.S.C. 209, 210, 216.

    Source: 31 FR 12098, Sept. 16, 1966, unless otherwise noted.



Sec. 61.30  Definitions.

    As used in this part:
    Continental United States does not include Hawaii or Alaska.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved may be delegated.
    Service Fellowship is one which requires the performance of 
services, either full or part time, for the Public Health Service.

[63 FR 9950, Feb. 27, 1998]



Sec. 61.31  Applicability.

    The regulations in this part apply to the establishment of service 
fellowships in the Public Health Service, the designation of persons to 
receive such fellowships, and the appointment of service fellows under 
authority of section 207(g) of the Public Health Service Act.



Sec. 61.32  Purpose of service fellowships.

    Service fellowships in the Public Health Service are for the purpose 
of encouraging and promoting research, studies, and investigations 
related to health. Such fellowships may be provided to secure the 
services of talented scientists for a period of limited duration for 
health-related research, studies, and investigations where the nature of 
the work or the character of the individual's services render customary 
employing methods impracticable or less effective.



Sec. 61.33  Establishment of service fellowships.

    All service fellowships shall be established by the Secretary. In 
establishing a service fellowship, or a series of service fellowships, 
the Secretary shall prescribe in writing the conditions (in addition to 
those provided in the regulations in this part) under which service 
fellows will be appointed and will hold their fellowships.

[63 FR 9950, Feb. 27, 1998]



Sec. 61.34  Qualifications.

    Scholastic and other qualifications shall be prescribed by the 
Secretary for each service fellowship, or series of service fellowships. 
Each individual appointed to a service fellowship shall:
    (a) Have presented satisfactory evidence of general suitability, 
including professional and personal fitness; and
    (b) Possess any other qualifications as reasonably may be 
prescribed.

[63 FR 9950, Feb. 27, 1998]



Sec. 61.35  Method of application.

    Application for a service fellowship shall be made in accordance 
with procedures established by the Secretary.

[63 FR 9950, Feb. 27, 1998]



Sec. 61.36  Selection and appointment of service fellows.

    The Secretary shall:
    (a) Prescribe a suitable professional and personal fitness review 
and an examination of the applicant's qualifications;
    (b) Designate in writing persons to receive service fellowships; and
    (c) Establish procedures for the appointment of service fellows.

[63 FR 9950, Feb. 27, 1998]



Sec. 61.37  Stipends, allowances, and benefits.

    (a) Stipends. Service fellows shall be entitled to such stipend as 
is authorized by the Secretary for each service fellowship or series of 
service fellowships.
    (b) Travel and transportation allowances. Under conditions 
prescribed by the Secretary, an individual appointed as a service fellow 
may be authorized

[[Page 451]]

personal travel allowances or transportation and per diem, travel 
allowances or transportation for his or her immediate family, and 
transportation of household goods and personal effects, in conjunction 
with travel authorized by the Secretary.
    (1) From place of residence, within or outside the continental 
United States, to first duty station,
    (2) For any change of duty station ordered by the Service during the 
term of the fellowship, and
    (3) From last duty station to the place of residence which he left 
to accept the fellowship, or to some other place at no greater cost to 
the Government.
    (4) A service fellow shall be entitled to travel allowances or 
transportation and per diem while traveling on official business away 
from his or her permanent duty station during the term of the 
fellowship. Except as otherwise provided herein, a service fellow shall 
be entitled to travel and transportation allowances authorized in this 
part at the same rates as may be authorized by law and regulations for 
other civilian employees of the Public Health Service. If a service 
fellow dies during the term of a fellowship, and the place of residence 
that was left by the service fellow to accept the fellowship was outside 
the continental United States, the payment of expenses of preparing the 
remains for burial and transporting them to the place of residence for 
interment may be authorized. In the case of deceased service fellows 
whose place of residence was within the continental United States, 
payment of the expenses of preparing the remains and transporting them 
to the place of residence for interment may be authorized as provided 
for other civilian employees of the Public Health Service.
    (c) Benefits. In addition to other benefits provided herein, service 
fellows shall be entitled to benefits as provided by law or regulation 
for other civilian employees of the Public Health Service.
    (d) Training. Service fellows are eligible for training at 
Government expense on the same basis as other civilian employees.

[31 FR 12098, Sept. 16, 1966, as amended at 63 FR 9950, Feb. 27, 1998]



Sec. 61.38  Duration of service fellowships.

    Initial appointments to service fellowships may be made for varying 
periods not in excess of 5 years. Such an appointment may be extended 
for varying periods not in excess of 5 years for each period in 
accordance with procedures and requirements established by the 
Secretary.

[63 FR 9951, Feb. 27, 1998]



PART 62--NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS--Table of Contents




      Subpart A--National Health Service Corps Scholarship Program

Sec.
62.1  What is the scope and purpose of the National Health Service Corps 
          scholarship program?
62.2  Definitions.
62.3  Who is eligible to apply for a scholarship program award?
62.4  To whom will scholarship program awards be available in addition 
          to those individuals pursuing courses of study leading to 
          degrees in medicine, osteopathy or dentistry?
62.5  How is application made for a scholarship program award?
62.6  How will individuals be selected to participate in the scholarship 
          program?
62.7  What will an individual be awarded for participating in the 
          scholarship program?
62.8  What does an individual have to do in return for the scholarship 
          program award?
62.9  Under what circumstances can the period of obligated service be 
          deferred to complete approved graduate training?
62.10  What will happen if an individual does not comply with the terms 
          and conditions of participating in the scholarship program?
62.11  When can a scholarship program payment obligation be discharged 
          in bankruptcy?
62.12  Under what circumstances can the service or payment obligation be 
          canceled, waived or suspended?
62.13  What are the limitations on the receipt of concurrent benefits?
62.14  What are the special provisions relating to recipients of awards 
          under the PH/NHSC scholarship training program who will also 
          receive awards under the scholarship program?

[[Page 452]]

     Subpart B--National Health Service Corps Loan Repayment Program

62.21  What is the scope and purpose of the National Health Service 
          Corps Loan Repayment Program?
62.22  Definitions.
62.23  How will individuals be selected to participate in the Loan 
          Repayment Program?
62.24  Who is eligible to apply for the Loan Repayment Program?
62.25  What does the Loan Repayment Program provide?
62.26  What does an individual have to do in return for loan repayments 
          received under the Loan Repayment Program?
62.27  What will happen if an individual does not comply with the terms 
          and conditions of participation in the Loan Repayment Program?
62.28  Under what circumstances can the service or payment obligation be 
          canceled, waived or suspended?
62.29  Under what circumstances can the Loan Repayment Program 
          obligation be discharged in bankruptcy?
62.30  What other regulations and statutes apply?

           Subpart C--Grants for State Loan Repayment Programs

62.51  What is the scope and purpose of the State Loan Repayment 
          Program?
62.52  Definitions.
62.53  Who is eligible for this program?
62.54  What must applications for the State Loan Repayment Program 
          contain?
62.55  What State Program Elements are required to ensure similarity 
          with the NHSC Loan Repayment Program?
62.56  How are the Federal grant funds and State matching funds to be 
          used under this program?
62.57  How will States be selected to participate in this program?
62.58  What other regulations apply?

                  Subpart D--Special Repayment Program

62.71  What is the scope and purpose of the Special Repayment Program?
62.72  Definitions.
62.73  What are the procedures for participation in the Special 
          Repayment Program?
62.74  How much credit will a Program participant receive for monetary 
          repayments made, or approved service performed, before 
          beginning service under the Special Repayment Program?
62.75  Will individuals serving under the Special Repayment Program 
          receive credit for partial service?
62.76  How will amounts of money due under the option under section 
          204(c)(1) of Public Law 100-177 be required to be repaid?

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended, 63 Stat. 35 (42 U.S.C. 216); sec. 751 of the Public Health 
Service Act, 90 Stat. 2281 (42 U.S.C. 294t), unless otherwise noted.

    Source: 45 FR 55429, Aug. 20, 1980, unless otherwise noted.



      Subpart A--National Health Service Corps Scholarship Program



Sec. 62.1  What is the scope and purpose of the National Health Service Corps scholarship program?

    These regulations apply to the award of scholarships under the 
National Health Service Corps Scholarship Program authorized by section 
751 of the Public Health Service Act (42 U.S.C. 294t) to students 
receiving academic training in medicine, osteopathy, dentistry, and 
other health professions. The purpose of this program is to assure an 
adequate supply of trained health professionals for the National Health 
Service Corps which is used by the Secretary to improve the delivery of 
health services in health manpower shortage areas.



Sec. 62.2  Definitions.

    As used in this part:
    Acceptable level of academic standing means the level at which a 
full-time student retains eligibility to continue in attendance in 
school under the school's standards and practices.
    Act means the Public Health Service Act, as amended.
    Approved graduate training means those programs of graduate training 
in medicine, osteopathy, dentistry or other health professions which (a) 
lead to eligibility for board certification or which provide other 
evidence of completion, and (b) have been approved by the appropriate 
health professions body as determined by the Secretary.
    Full-time student means an individual pursuing a course of study 
leading to a degree in medicine, osteopathy, dentistry or an equivalent 
credential for a particular health profession who is enrolled for a 
sufficient number of credit hours in any academic term to complete the 
course of study within not more than the number of academic terms 
normally required at the school.

[[Page 453]]

If an individual is enrolled in a school and is pursuing a course of 
study which is designed to be completed in more than 4 years, the 
individual will be considered a full-time student for only the last 4 
years of the course of study.
    Health manpower shortage area means the geographic area, the 
population group, the public or nonprofit private medical facility, or 
other public facility which has been determined by the Secretary to have 
a shortage of health manpower under section 332 of the Act and its 
implementing regulations (42 CFR part 5).
    National of the United States means a citizen of the United States 
or a person who, though not a citizen of the United States, owes 
permanent allegiance to the United States.
    Public Health and National Health Service Corps Scholarship Training 
Program, or PH/NHSC Scholarship Training Program, means the program 
authorized by section 225 of the Act as in effect on September 30, 1977, 
and repealed on October 1, 1977.
    Scholarship Program means the National Health Service Corps 
Scholarship Program authorized by section 751 of the Act (42 U.S.C. 
294t).
    Scholarship Program participant or participant means an individual 
whose application to the Scholarship Program has been approved and whose 
contract has been accepted and signed by the Secretary.
    School means a school of medicine, osteopathy, dentistry, or other 
health profession which (a) provides training leading to a degree of 
doctor of medicine, doctor of osteopathy, doctor of dentistry, or an 
equivalent credential for a particular health profession, and (b) which 
is accredited by a body or bodies recognized for accreditation purposes 
by the Secretary of Education.
    School year means all or part of the 12-month period from July 1 
through June 30 during which an applicant is enrolled in a school as a 
full-time student.
    Service means the United States Public Health Service.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State means one of the several States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin 
Islands, Guam, American Samoa, and the Trust Territory of the Pacific 
Islands.



Sec. 62.3  Who is eligible to apply for a scholarship program award?

    (a) To be eligible for a scholarship under this part an applicant 
must:
    (1) Be accepted for enrollment, or be enrolled, as a full-time 
student in a school located in a State;
    (2) Be pursuing a course of study or program offered by the school 
leading to a degree in medicine, osteopathy, dentistry, or an equivalent 
credential for a particular health profession;
    (3) Be eligible for, or hold, an appointment as a commissioned 
officer in the Regular or Reserve Corps of the Service or be eligible 
for selection for civilian service in the National Health Service Corps;
    (4) Be a National of the United States; and
    (5) Submit an application to participate in the Scholarship Program 
together with a signed contract as described in section 751(f) of the 
Act.
    (b) Any applicant who owes an obligation for professional practice 
to a State or other entity under an agreement entered into before filing 
an application under this part is ineligible for an award unless a 
written statement satisfactory to the Secretary is submitted from the 
State or entity that (1) there is no potential conflict in fulfilling 
the service obligation to the State or entity and the Scholarship 
Program, and that (2) the Scholarship Program service obligation will be 
served before the service obligation for professional practice owed to 
the State or entity.
    (c) Any individual who receives a scholarship under the Indian 
Health Service Scholarship Program (section 757 of the Act) or the 
Scholarship Program for First-Year Students of Exceptional Financial 
Need (section 758 of the Act) is ineligible to participate in the 
Scholarship Program during the

[[Page 454]]

School year(s) for which the scholarships under sections 757 or 758 of 
the Act were awarded.



Sec. 62.4  To whom will scholarship program awards be available in addition to those individuals pursuing courses of study leading to degrees in medicine, 
          osteopathy, or dentistry?

    The Secretary will, from time-to-time, publish in the Federal 
Register a list of those health professions in addition to medicine, 
osteopathy, and dentistry for which the National Health Service Corps 
has need and for which support is available. The Secretary will also 
publish any other eligibility criteria, in addition to those in 
Sec. 62.3, that may be required to assure that participants can be 
utilized during their periods of obligated service in a manner that will 
best meet the needs of the National Health Service Corps.



Sec. 62.5  How is application made for a scholarship program award?

    Each individual desiring a scholarship under this part must submit 
an application (including a signed contract as required under section 
751(f) of the Act) in the form and at the time prescribed by the 
Secretary.



Sec. 62.6  How will individuals be selected to participate in the scholarship program?

    (a) General. In deciding which applications for participation in the 
Scholarship Program will be approved, the Secretary will place the 
applications into categories based upon the selection priorities 
described in paragraph (b) of this section. Except for continuation 
awards (see paragraph (e) of this section) the Secretary will then 
evaluate each applicant under paragraph (c) of this section.
    (b) Priorities. (1) First priority will be given to individuals who 
have previously received a scholarship under the PH/NHSC Scholarship 
Training Program, a scholarship under this Scholarship Program, or a 
scholarship under section 758 of the Act, authorizing scholarships for 
first-year students of exceptional financial need. (2) Second priority 
will be given to applicants who are entering their first year of study.
    (c) Selection. (1) In selecting participants, the Secretary will 
take into consideration those factors which he or she determines 
necessary to assure effective participation in the Scholarship Program. 
These factors may include, but not be limited to (i) work experience, 
(ii) community background, (iii) career goals, (iv) faculty 
recommendation, and (v) academic performance.
    (2) Special consideration will be given to (i) medical and 
osteopathic students who indicate their intention to enter family 
practice, internal medicine, pediatrics, or osteopathic general practice 
residencies, (ii) dental students who indicate their intention to 
undertake general practice training following graduation or who plan no 
postgraduate training, and (iii) those individuals who indicate an 
intent to pursue other types of clinical practice or specialized 
training for which the National Health Service Corps has a particular 
need.
    (d) Duration of Scholarship award. Subject to the availability of 
funds for the Scholarship Program, the Secretary will award a 
participant a scholarship under this part for a period of 1 school year.
    (e) Continuation awards. Subject to the availability of funds for 
the Scholarship Program, the Secretary will award a continuation 
scholarship if (1) the participant requests a continuation, (2) the 
award will not extend the total period of Scholarship Program support 
beyond 4 years, and (3) the participant is eligible for continued 
participation in the Scholarship Program.



Sec. 62.7  What will an individual be awarded for participating in the scholarship program?

    (a) Amount of scholarship. (1) A scholarship award for each school 
year will consist of (i) tuition, (ii) reasonable educational expenses, 
including required fees, books, supplies, and required educational 
equipment, and (iii) a monthly stipend for the 12-month period beginning 
with the first month of each school year in which the individual is a 
participant. For purposes of this section ``required fees'' means those 
fees which are charged by the

[[Page 455]]

school to all students pursuing a similar curriculum and ``required 
educational equipment'' means educational equipment which must be rented 
or purchased by all students pursuing a similar curriculum at that 
school.
    (2) The Secretary may enter into a contract with the school in which 
the participant is enrolled for the direct payment of tuition and 
reasonable educational expenses in the participant's behalf.
    (b) Payment of scholarship: Leave-of-absence; repeated course work. 
The Secretary will suspend scholarship payments to or on behalf of a 
participant if the school (1) approves a leave-of-absence for the 
participant for health, personal, or other reasons, or (2) requires the 
participant to repeat course work for which the Secretary has previously 
made scholarship payments under Sec. 62.7. However, if the repeated 
course work does not delay the participant's graduation date, 
scholarship payments will continue except for any additional costs 
relating to the repeated course work. Any scholarship payments suspended 
under this paragraph will be resumed by the Secretary upon notification 
by the school that the participant has returned from the leave-of-
absence or has completed the repeated course work and is pursuing as a 
full-time student the course of study for which the scholarship was 
awarded.



Sec. 62.8  What does an individual have to do in return for the scholarship program award?

    (a) General. Except as provided in paragraphs (d), (f), and (g) of 
this section, each participant is obligated to (1) become a member of 
the National Health Service Corps employed as a Commissioned Officer in 
the Regular or Reserve Corps of the Service or as a Federal civilian in 
the full-time clinical practice of the participant's profession and (2) 
serve in the health manpower shortage area to which the participant is 
assigned by the National Health Service Corps.
    (b) Beginning of service. (1) The period of obligated service will 
begin when the Scholarship Program participant begins to provide 
services in the health manpower shortage area to which he or she is 
assigned by the Secretary. Except for those participants who receive a 
deferral under Sec. 62.9 (a) or (b), this assignment will be made by the 
Secretary as soon as possible following: (i) the completion of the 
participant's course of study leading to a degree in medicine, 
osteopathy, dentistry, or an equivalent credential for a particular 
health profession, and (ii) appointment of the participant as a 
Commissioned Officer in the Regular or Reserve Corps of the Service or 
as a civilian member of the National Health Service Corps.
    (2) For purposes of this paragraph, ``appointment'' means only those 
appointments as Commissioned Officers in the Regular or Reserve Corps of 
the Service or as civilian members of the National Health Service Corps 
made specifically for the purpose of serving a participant's period of 
obligated service.
    (c) Duration of service. Except as provided in Sec. 62.14(b)(1), the 
period for which the Scholarship Program participant is obligated to 
serve is equal to 1 year for each school year for which the participant 
receives a scholarship award under this part, or 2 years, whichever is 
greater.
    (d) Service by detail. If the Secretary determines that there is no 
need in a health manpower shortage area for a member of the profession 
in which the Scholarship Program participant is obligated to provide 
service, the Scholarship Program participant may be detailed to serve 
the period of obligated service as a full-time member of the profession 
for which the participant has been trained, in any unit of the 
Department of Health and Human Services as the Secretary may determine.
    (e) Creditability of approved graduate training. Except as provided 
in Sec. 62.14(b)(2), no period of approved graduate training will be 
credited toward satisfying the period of obligated service incurred 
under the Scholarship Program.
    (f) Service under the National Research Service Award Program. (1) A 
Scholarship Program participant who demonstrates exceptional promise for 
medical research may perform the period of obligated service owed under 
this section by participating in the National

[[Page 456]]

Research Service Award Program for individual postdoctoral fellows 
authorized under section 472 of the Act.
    (2) Exceptional promise for medical research will be demonstrated if 
the participant applies for a National Research Service Award for 
individual postdoctoral fellows, is selected to participate in this 
research program, and accepts the offer of participation. A Scholarship 
Program participant in the National Research Service Award Program will 
receive credit toward satisfying the period of obligated service 
incurred under this section for any period of time he or she is engaged 
in activities which meet the service requirements of the National 
Research Service Award Program.
    (3) If the time served under the National Research Service Award 
Program is less than the total period of obligated service owed under 
the Scholarship Program, the participant will serve the remainder of the 
Scholarship Program service obligation (i) in activities which meet the 
criteria for service under the National Research Service Award Program, 
as approved by the Secretary or (ii) as a member of the National Health 
Service Corps providing health services in the full-time clinical 
practice of his or her health profession. A participant who fails to 
begin or complete the service requirements under the National Research 
Service Award Program may be subject to the default penalty under 
Sec. 62.10(c) of this part and the default penalties under the National 
Research Service Award Program.
    (g) Release from service obligation to engage in private practice. 
The Secretary will release a participant from all or part of the service 
obligation if the participant applies for a release under section 753 of 
the Act and agrees in writing to engage for a period equal to the 
remaining period of the participant's service obligation in the full-
time private clinical practice of the participant's health profession, 
under the requirements of section 753 of the Act.



Sec. 62.9  Under what circumstances can the period of obligated service be deferred to complete approved graduate training?

    (a) Requested deferment. Upon the request of any participant 
receiving a degree from a school of medicine, osteopathy, or dentistry, 
veterinary medicine, optometry, podiatry or pharmacy, the Secretary will 
defer the beginning date of the obligated service to allow the 
participant to complete an approved graduate training program. The 
period of this deferment may not exceed (1) three years for any 
participant receiving a degree from a school of medicine, osteopathy or 
dentistry, or (2) one year for any participant recieving a degree from a 
school of veterinary medicine, optometry, podiatry or pharmacy. The 
Secretary may, however, extend this period of deferment if the Secretary 
determines that the extension is consistent with the needs of the 
National Health Service Corps.
    (b) Required deferment. Each participant receiving a degree in 
medicine or osteopathy who does not intend to enter training which can 
be completed within the deferment period granted under paragraph (a) of 
this section must complete at least one year of approved graduate 
training before beginning the period of obligated service. This one year 
of training must be in (1) an allopathic flexible first-year program 
whose sponsorship includes approved residencies in family practice, 
internal medicine, pediatrics, or a categorical first-year program in 
family practice, internal medicine, or pediatrics; (2) a rotating 
internship in osteopathic medicine; or (3) such other programs as the 
Secretary determines provides comparable experience. Any participant 
receiving a degree in medicine or osteopathy who fails to complete the 
one year of required training or an approved graduate training program 
for which a deferment was granted under paragraph (a) of this section 
will be subject to the default penalties of Sec. 62.10(c).
    (c) Altering deferment. Before altering the length or type of 
approved graduate training for which the period of obligated service was 
deferred under

[[Page 457]]

paragraphs (a) or (b) of this section, the participant must request and 
obtain the Secretary's approval of the alteration.
    (d) Additional terms of deferment. The Secretary may prescribe 
additional terms and conditions for deferment under paragraphs (a), (b), 
and (c) of this section as necessary to carry out the purposes of the 
Scholarship Program.
    (e) Beginning of service after deferment. Any participant whose 
period of obligated service has been deferred under paragraphs (a) or 
(b) of this section must begin the obligated service when the 
participant begins to provide health services in the health manpower 
shortage area to which he or she is assigned by the Secretary. This 
assignment will be made by the Secretary as soon as possible following 
(1) the completion of the requested or required graduate training for 
which the deferment was granted, and (2) appointment as a Commissioned 
Officer in the Regular or Reserve Corps of the Service or as a civilian 
member of the National Health Service Corps.



Sec. 62.10  What will happen if an individual does not comply with the terms and conditions of participating in the scholarship program?

    (a) If a participant, other than one described in paragraph (b) of 
this section, fails to accept payment or instructs the school not to 
accept payment of the scholarship provided by the Secretary, the 
participant must, in addition to any service or other obligation 
incurred under the contract, pay to the United States the amount of 
$1,500 liquidated damages. Payment of this amount must be made within 30 
days of the date on which the participant fails to accept payment of the 
scholarship award or instructs the school not to accept payment.
    (b) When a participant fails to maintain an acceptable level of 
academic standing, is dismissed from the school for disciplinary 
reasons, or voluntarily terminates the course of study or program for 
which the scholarship was awarded before completing the course of study 
or program, the participant must, instead of performing any service 
obligation, pay to the United States an amount equal to all scholarship 
funds awarded under Sec. 62.7. Payment of this amount must be made 
within 3 years of the date the participant becomes liable to make 
payment under this paragraph.
    (c) If a participant fails to begin or complete the period of 
obligated service incurred under Sec. 62.8, including failing to comply 
with the applicable terms and conditions of a deferment granted by the 
Secretary, the participant must pay to the United States an amount 
determined by the formula set forth in section 754(c) of the Act. 
Payment of this amount shall be made within 1 year of the date that the 
participant failed to begin or complete the period of obligated service, 
as determined by the Secretary.



Sec. 62.11  When can a scholarship program payment obligation be discharged in bankruptcy?

    In accordance with section 754(d)(3) of the Act, any payment 
obligation incurred under Sec. 62.10 may not be discharged in bankruptcy 
under title XI of the United States Code until 5 years after the date on 
which the payment obligation is due.



Sec. 62.12  Under what circumstances can the service or payment obligation be canceled, waived or suspended?

    (a) Any obligation of a participant for service or payment will be 
canceled upon the death of the participant.
    (b)(1) A participation may seek a waiver or suspension of the 
service or payment obligations incurred under this part by written 
request to the Secretary setting forth the bases, circumstances, and 
causes which support the requested action. The Secretary may approve a 
request for a suspension for a period of 1 year. A renewal of this 
suspension may also be granted.
    (2) The Secretary may waive or suspend any service or payment 
obligation incurred by a participant whenever compliance by the 
participant (i) is impossible, or (ii) would involve extreme hardship to 
the participant and if enforcement of the service or payment obligation 
would be against equity and good conscience.
    (c) Compliance by a participant with a service or payment obligation 
will be considered impossible if the Secretary

[[Page 458]]

determines, on the basis of information and documentation as may be 
required, that the participant suffers from a physical or mental 
disability resulting in the permanent inability of the participant to 
perform the service or other activities which would be necessary to 
comply with the obligation.
    (d) In determining whether to waive or suspend any or all of the 
service or payment obligations of a participant as imposing an undue 
hardship and being against equity and good conscience, the Secretary, on 
the basis of information and documentation as may be required, will 
consider:
    (1) The participant's present financial resources and obligations;
    (2) The participant's estimated future financial resources and 
obligations; and
    (3) The extent to which the participant has problems of a personal 
nature, such as physical or mental disability, terminal illness in the 
immediate family which so intrude on the participant's present and 
future ability to perform as to raise a presumption that the individual 
will be unable to perform the obligation incurred.



Sec. 62.13  What are the limitations on the receipt of concurrent benefits?

    Under section 741(f) or 836(h) of the Act, the Secretary may agree 
to repay a portion of an individual's educational loans in return for 
the individual's agreement to practice his or her profession in an area 
in need of health manpower. However, a Scholarship Program participant 
may not enter into an agreement with the Secretary under section 741(f) 
or 836(h) of the Act, until either:
    (a) The participant has completed the service obligation under the 
Scholarship Program,
    (b) The Secretary has recovered from the participant an amount 
determined under Sec. 62.10, or
    (c) Any service or payment obligation has been waived under 
Sec. 62.12.

In no case shall a scholarship received under these regulations be 
considered an educational loan for the purposes of section 741(f) or 
836(h) of the Act.



Sec. 62.14  What are the special provisions relating to recipients of awards under the PH/NHSC scholarship training program who will also receive awards under 
          the scholarship program?

    (a) Except as provided in paragraph (b) of this section, if a 
participant has previously received an award under the PH/NHSC 
Scholarship Training Program and also receives an award under the 
Scholarship Program, the terms and conditions of these regulations will 
apply to the participant's entire obligation incurred under both the PH/
NHSC Scholarship Training Program and the Scholarship Program.
    (b) If a participant has received an award under the PH/NHSC 
Scholarship Training Program and also receives an award under the 
Scholarship Program, the following conditions apply:
    (1) Period of obligated service--carry over. The period of obligated 
service owed by the participant is equal to the total number of school 
years for which scholarship support was awarded under both the PH/NHSC 
Scholarship Training Program and the Scholarship Program without regard 
to either Program's minimum support requirement under 42 CFR 62.7(a) 
(1976) as adopted on May 22, 1974 (see 39 FR 17962), and under 
Sec. 62.8(c) of this part.
    (2) Credit for internship and residency training. (i) If a 
participant received a scholarship under the PH/NHSC Scholarship 
Training Program for any school year beginning before October 12, 1976, 
the participant will receive credit toward satisfying the periods of 
obligated service incurred under the PH/NHSC Scholarship Training 
Program and under Sec. 62.8 of this part for any periods of internship 
or residency training served in a Service or National Health Service 
Corps facility.
    (ii) If a participant received a scholarship for the first time 
during the 1977-78 school year under the PH/NHSC Scholarship Training 
Program, the participant will only receive 1 year of credit toward 
satisfying the period of obligated service incurred under the PH/NHSC 
Scholarship Training Program for internship or residency training served 
in a Service or National Health Service Corps facility.

[[Page 459]]

    (3) Default penalties. The PH/NHSC Scholarship Training Program 
default penalty will apply to a participant who fails to begin or 
complete the active duty service obligation incurred under that Program, 
and the Sec. 62.10 default penalties will apply to a participant who 
fails to begin or complete the service obligation incurred under 
Sec. 62.8 of these regulations. In determining which default penalty to 
apply when an individual who has received a Scholarship award under both 
the PH/NHSC Scholarship Training Program and the Scholarship Program 
fails to begin or complete his service obligation, the service 
obligations will be considered to have been served in the order in which 
they were incurred.



     Subpart B--National Health Service Corps Loan Repayment Program

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690, 
as amended, 63 Stat. 35 (42 U.S.C. 216); sec. 338B of the Public Health 
Service Act, 101 Stat. 992 (42 U.S.C. 2541-1).

    Source: 54 FR 13462, Apr. 3, 1989, unless otherwise noted.



Sec. 62.21  What is the scope and purpose of the National Health Service Corps Loan Repayment Program?

    The regulations of this subpart apply to the award of health 
professions educational loan payments under the National Health Service 
Corps Loan Repayment Program authorized by section 338B of the Public 
Health Service Act (42 U.S.C. 2541-1). The purpose of the Program is to 
assure an adequate supply of trained health professionals for the 
National Health Service Corps. These professionals will be assigned by 
the Secretary to provide necessary health services to persons living in 
designated health manpower shortage areas.



Sec. 62.22  Definitions.

    The definitions in Sec. 62.2 of this part will apply for the purpose 
of this subpart, except for the definition of approved graduate 
training. The following definitions will also apply for purposes of this 
subpart:
    Approved graduate training means a program of graduate training in 
allopathic or osteopathic medicine, dentistry or other health profession 
which (a) leads to eligibility for board certification or which provides 
other evidence of completion, (b) has been approved by the appropriate 
health professions body as determined by the Secretary and (c) is in the 
specialty or type of training specified by the Program participant in 
the Loan Repayment Program Contract or, at the Program participant's 
request and at the Secretary's option, is in a specialty or area of 
training determined by the Secretary to be consistent with the needs of 
the National Health Service Corps.
    Commercial loans means loans made by banks, credit unions, savings 
and loan associations, insurance companies, schools, and other financial 
or credit institutions which are subject to examination and supervision 
in their capacity as lenders by an agency of the United States or of the 
State in which the lender has its principal place of business.
    Educational expenses means the costs of the health professions 
education, exclusive of the tuition, such as fees, books, supplies, and 
educational equipment and materials.
    Government loans means loans which are made by Federal, State, 
county or city agencies which are authorized by law to make such loans.
    Living expenses means the costs of room and board, transportation 
and commuting costs and other costs incurred during an individual's 
attendance at a health professions school.
    Loan Repayment Program means the National Health Service Corps Loan 
Repayment Program authorized by section 338B of the Act (42 U.S.C. 2541-
1).
    Loan Repayment Program Contract means the agreement, which is signed 
by an applicant and the Secretary, for the Loan Repayment Program 
wherein the applicant agrees to accept repayment of health professions 
educational loans and to serve in accordance with the provisions of 
section 338B of the Act and this subpart for a prescribed period of 
obligated service.
    Medically underserved area means health manpower shortage area as 
defined in Sec. 62.2.

[[Page 460]]

    Program participant means an individual whose application to the 
Loan Repayment Program has been approved and whose contract has been 
accepted and signed by the Secretary.
    Qualifying loans means government and commercial loans for actual 
costs paid for tuition, reasonable educational expenses, and reasonable 
living expenses relating to the obtainment of a degree in allopathic or 
osteopathic medicine, dentistry, or other health profession. Such loans 
must have documentation which is contemporaneous with the training 
received in a health professions school. If health professions 
educational loans are refinanced, the original documentation of the 
loan(s) will be required to be submitted to the Secretary to establish 
the contemporaneous nature of such loans.
    Reasonable educational and living expenses means those educational 
and living expenses which are equal to or less than the sum of the 
school's estimated standard student budgets for educational and living 
expenses for the degree program and for the year(s) during which the 
Program participant is/was enrolled in the school. However, if the 
school attended by the Program participant does/did not have a standard 
student budget or if a Program participant requests repayment for 
educational and living expenses which are in excess of the standard 
student budgets described in the preceding sentence, the Program 
participant must submit documentation, as required by the Secretary, to 
substantiate the reasonableness of all educational and living expenses 
incurred by the Program participant. To the extent that the Secretary 
determines, upon review of the Program participant's documentation, that 
all or a portion of the educational and living expenses are reasonable, 
these expenses will qualify for repayment.



Sec. 62.23  How will individuals be selected to participate in the Loan Repayment Program?

    (a) In determining which applications from eligible individuals for 
participation in the Loan Repayment Program will be accepted for 
consideration, the Secretary will apply the following criteria:
    (1) The extent to which an individual's training is in a health 
profession or specialty determined by the Secretary to be needed by the 
National Health Service Corps;
    (2) The individual's commitment to serve in medically underserved 
areas;
    (3) The availability of the individual for service, with highest 
consideration being given to individuals who will be available for 
service at the earliest dates;
    (4) The length of the individual's proposed service obligation, with 
greatest consideration being given to persons who agree to serve for 
longer periods of time; and
    (5) The individual's academic standing, prior professional 
experience in a health manpower shortage area, board certification, 
residency achievements, peer recommendations, depth of past residency 
practice experience and other criteria related to professional 
competence or conduct.
    (b) Among qualified applicants, the Secretary will give priority to 
applications from individuals whose health professions or specialties 
are most needed by the NHSC and who are, in the Secretary's judgement, 
most committed to practice in medically underserved areas.
    (c) By notice published in the Federal Register from time to time, 
the Secretary will specify the professions and specialties most needed 
by the National Health Service Corps.



Sec. 62.24  Who is eligible to apply for the Loan Repayment Program?

    (a) To be eligible to participate in the Loan Repayment Program an 
individual must:
    (1)(i) Be enrolled as a full-time student in the final year of a 
course of study or program approved by the Secretary which leads to a 
degree in allopathic or osteopathic medicine, dentistry or other health 
profession and which is offered by an accredited school in a State or
    (ii) Be enrolled in an approved graduate training program in 
allopathic or osteopathic medicine or dentistry or other health 
profession in a State, or
    (iii) Have a degree in allopathic or osteopathic medicine or 
dentistry or

[[Page 461]]

other health profession and have completed an approved graduate training 
program in a State (or received a waiver of the completion requirement 
under Sec. 62.26(d) of this subpart) and have a current and valid 
license to practice such health profession in a State;
    (2) Be eligible for, or hold, an appointment as a commissioned 
officer in the Regular or Reserve Corps of the Public Health Service or 
be eligible for selection for civilian service in the National Health 
Service Corps;
    (3) Submit an application to participate in the Loan Repayment 
Program; and
    (4) Sign and submit to the Secretary, at the time of the submission 
of such application, a written contract agreeing to accept repayment of 
health professions educational loans and to serve (in accordance with 
this subpart) for the applicable period of obligated service in a health 
manpower shortage area as determined by the Secretary.
    (b) Any individual who owes an obligation for health professional 
service to the Federal Government or a State or other entity under an 
agreement with such Federal, State or other entity is ineligible for the 
Loan Repayment Program unless such obligation will be completely 
satisfied prior to the beginning of service under this Program.
    (c) Individuals in breach of a written contract entered into under 
section 338A of the Act and liable to the United States under section 
338E(b) of the Act, in breach of a written contract entered into under 
section 225 of the Act (as in effect on September 30, 1977) and liable 
to the United States under section 225(f)(1) of the Act (as in effect on 
September 30, 1977) or in breach of any other obligation for health 
professional service to a Federal, State or local government entity are 
not eligible for participation in the Loan Repayment Program.

(Approved by the Office of Management and Budget under control number 
0915-0127)



Sec. 62.25  What does the Loan Repayment Program provide?

    (a) Loan repayment. For each year of service the individual agrees 
to serve, with a minimum of 2 years of obligated service, the Secretary 
may pay:
    (1) Except as provided in paragraph (a)(2) of this section, up to 
$20,000 per year of a Program participant's qualifying loans or
    (2) Up to $25,000 per year for a Program participant's qualifying 
loans if the Program participant agrees to provide obligated service in 
the Indian Health Service or a health facility or program operated by a 
tribe or tribal organization under the Indian Self-Determination Act.

The Secretary may establish different levels of annual loan repayment to 
encourage Program participants to serve in a manner which is in the best 
interest of the Loan Repayment Program. No loan repayments will be made 
for any professional practice performed prior to the effective date of 
the Loan Repayment Program Contract. Once a loan repayment contract has 
been signed by both parties, the Secretary will obligate such funds as 
will be necessary to ensure that sufficient funds will be available to 
make loan repayments for the duration of the period of obligated 
service.
    (b) Site visit. The Secretary may reimburse an individual for the 
actual and reasonable travel expenses associated with one trip from the 
individual's residence to a site for the purpose of evaluating such site 
for service under the the Loan Repayment Program.
    (c) Tax liability payments. The Secretary may, upon a Program 
participant's written request, make payments in a reasonable amount, as 
determined by the Secretary, to reimburse the Program participant for 
all or part of the increased Federal, State and local tax liability 
resulting from loan repayments received under the Loan Repayment 
Program. To maximize the Federal resources available for placing 
participants in HMSAs, supplementary payments for increased tax 
liability will only be made under unusual circumstances, and in no cases 
will these tax liability payments exceed 20% of the annual amounts of 
the loans being repaid. Program participants wishing to receive tax 
liability payments must submit their requests for such payments in a 
manner prescribed by the Secretary and must provide the Secretary with 
any documentation the Secretary determines is necessary to

[[Page 462]]

establish a Program participant's increased tax liability. The Secretary 
will determine, based on the availability of funds and such other 
factors as the Secretary determines, the amounts of any such payments 
that may be made.

(Information collection requirements contained in paragraph (c) were 
approved by the Office of Management and Budget under control number 
0915-0131)

[54 FR 13462, Apr. 3, 1989, as amended at 57 FR 56996, Dec. 2, 1992]



Sec. 62.26  What does an individual have to do in return for loan repayments received under the Loan Repayment Program?

    (a) A Program participant whose eligibility for the Loan Repayment 
Program is based on Sec. 62.24(a)(1)(i) of this subpart must maintain 
full-time enrollment, at an acceptable level of academic standing, in 
that course of study until its completion. Upon completion of that 
course of study, a Program participant who received a degree in 
allopathic or osteopathic medicine must enter approved graduate training 
and a Program participant who received a degree in a health profession 
other than allopathic or osteopathic medicine may enter approved 
graduate training. Once a Program participant enters approved graduate 
training, he or she must also meet the requirements set forth in 
paragraphs (b) (1), (2), (3), and (4) of this section. If a Program 
participant who received a degree in a health profession other than 
allopathic or osteopathic medicine does not enter approved graduate 
training; service, in accordance with paragraph (e) of this section, 
must commence as soon as possible upon the Program participant's 
completion of the course of study leading to his or her health 
professions degree.
    (b) A Program participant whose eligibility for the Loan Repayment 
Program is based on Sec. 62.24(a)(1)(ii) of this subpart must: (1) 
Continue in his or her approved graduate training program at an 
acceptable level of academic standing; (2) provide the Secretary with 
annual documentation of continued participation in that approved 
graduate training program at an acceptable level of academic standing; 
(3) successfully complete that approved graduate training program; and 
(4) commence service, in accordance with paragraph (e) of this section, 
as soon as possible upon completion of approved graduate training.
    (c) A Program participant whose eligibility for the Loan Repayment 
Program is based on Sec. 62.24(a)(1)(iii) of this subpart must commence 
service, in accordance with paragraph (e) of this section, as soon as 
possible after the effective date of the Loan Repayment Program 
Contract.
    (d) If a Program participant fails to complete approved graduate 
training, the Secretary may, on his or her own initiative or at the 
Program participant's request, waive, for good cause, the completion 
requirement. Good cause will be deemed to exist if the Secretary 
determines that the Program participant has sufficient health 
professions training to be utilized by and make a substantial 
contribution to the National Health Service Corps. If waiver of the 
completion requirement in paragraph (b) of this section is granted; 
service, in accordance with paragraph (e) of this section, must commence 
as soon as possible after the granting of the waiver.
    (e) Except for Program participants who fail to complete their 
course of study leading to a health professions degree or who fail to 
complete approved graduate training and do not receive a waiver pursuant 
to paragraph (d) of this section, each program participant must:
    (1) Serve in a health manpower shortage area to which he or she is 
assigned by the Secretary as a member of the National Health Service 
Corps or serve pursuant to section 338D of the Act in a health manpower 
shortage area selected by the Secretary and
    (2) Accept employment in a full-time clinical practice of the 
Program participant's profession, as
    (i) A commissioned officer in the Regular or Reserve Corps of the 
Public Health Service,
    (ii) A civilian member of the National Health Service Corps who is 
an employee of the United States,
    (iii) A member of the National Health Service Corps who is not an 
employee of the United States, or

[[Page 463]]

    (iv) A private practitioner who is providing obligated service under 
the provisions of section 338D of the Act.
    (f) The minimum length of obligated service is two years, or such 
longer period as the Program participant may agree to. The maximum 
length of obligated service is four years. If a Program participant 
agrees to an original contract of two or three years, such contract may 
be extended, subject to the availability of appropriated funding, for 
one year or two years (up to the four-year maximum). A one-year 
extension will not reactivate the statutory minimum requirement of two 
years of service.

(Information collection requirements contained in paragraph (b)(2) were 
approved by the Office of Management and Budget under control number 
0915-0131)



Sec. 62.27  What will happen if an individual does not comply with the terms and conditions of participation in the Loan Repayment Program?

    Program participants who default on their Loan Repayment Program 
Contracts will be subject to the applicable monetary payment provisions 
set forth at section 338E of the Act. Payment of any amount owed under 
section 338E of the Act shall be made within one year of the date the 
participant breached his or her Loan Repayment Contract, as determined 
by the Secretary.



Sec. 62.28  Under what circumstances can the service or payment obligation be canceled, waived or suspended?

    A service or payment obligation under the Loan Repayment Program 
will be canceled or may be waived or suspended as provided in Sec. 62.12 
of this part of the regulations.



Sec. 62.29  Under what circumstances can the Loan Repayment Program obligation be discharged in bankruptcy?

    Any payment obligation incurred under Sec. 62.27 of this subpart may 
be released by a discharge in bankruptcy under title 11 of the United 
States Code only if such discharge is granted after the expiration of 
the five-year period beginning on the first date that payment was 
required, and only if the bankruptcy court finds that nondischarge of 
the obligation would be unconscionable.



Sec. 62.30  What other regulations and statutes apply?

    Other regulations and statutes which apply to this subpart include 
but are not limited to:

    Debt Collection Act of 1982, Pub. L. 97-365 (5 U.S.C. 5514) 
including Section 4, Requirement that Applicant Furnish Taxpayer 
Identifying Number;
    Fair Credit Reporting Act (15 U.S.C. 1681 et seq.);
    Privacy Act of 1974 (5 U.S.C. 552a);
    Section 215(a) of the Public Health Service Act, as amended (42 
U.S.C. 216(a)), for PHS commissioned officers, and 5 U.S.C. 3301 for 
civil service employees both of which authorize verification of an 
individual's suitability for employment;
    Privacy Act of 1974; Alteration of System of Records, 52 FR 21622-
21627, June 8, 1987, regarding the collection, maintenance and allowable 
use of personal information requested from program applicants.



           Subpart C--Grants for State Loan Repayment Programs

    Authority: Sec. 215 of the Public Health Service Act, 58 Stat. 690 
as amended, 63 Stat. 35 (42 U.S.C. 216); sec. 338H of the Public Health 
Service Act, 101 Stat. 999 (42 U.S.C. 254q-1).

    Source: 54 FR 13464, Apr. 3, 1989, unless otherwise noted.



Sec. 62.51  What is the scope and purpose of the State Loan Repayment Program?

    The regulations of this subpart apply to the award of grants 
authorized by section 338H of the Public Health Service Act (42 U.S.C. 
254q-1) to support the establishment of State programs similar to the 
National Health Service Corps Loan Repayment Program authorized by 
section 338B of the Public Health Service Act (42 U.S.C. 2541-1). The 
purpose of this program is to improve the delivery of health services in 
medically underserved areas.



Sec. 62.52  Definitions.

    In addition to the definitions in Sec. 62.2 of this part, the 
following definitions will apply for purposes of this subpart:

[[Page 464]]

    The definitions of Qualifying loans, Commercial loans, Government 
loans, Educational expenses, and Living expenses as contained in 
Sec. 62.22 of this part will apply for purposes of this subpart.
    Medically underserved area means health manpower shortage area or an 
area which has been designated by a State pursuant to standards 
described in Sec. 62.54(b)(1) of this subpart which the Secretary has 
deemed acceptable.
    State Loan Repayment Program or program means a State loan repayment 
program authorized under section 338H (42 U.S.C. 254q-1) of the Act.



Sec. 62.53  Who is eligible for this program?

    Any State is eligible to apply for a grant under this subpart.



Sec. 62.54  What must applications for the State Loan Repayment Program contain?

    (a) An application for a grant under this subpart shall be submitted 
to the Secretary at such time and in such form and manner as the 
Secretary requires.
    (b) The application shall contain a budget and narrative statement 
describing the manner in which the applicant intends to conduct the 
project and carry out the requirements of this subpart. In addition, 
applications must include:
    (1) A description of the State's standards for the designation of 
medically underserved areas, except that no description of designation 
standards will be required if the State elects to use health manpower 
shortage areas designated by the Secretary;
    (2) An assessment of the need and demand in medically underserved 
areas within the State for health professions manpower with special 
emphasis on individuals whose training is in a health profession or 
specialty identified by the Secretary pursuant to Sec. 62.23(b) of this 
part. This assessment should include such demographic indicators of the 
need as the economic accessibility of health care services in the State 
as measured by poverty levels, the percentage of the service area 
population without health insurance, and the health status of the 
population as measured by the rates of infant mortality, low birth 
weight, geographic barriers and other indicators;
    (3) A proposal for the placement of the health profession providers 
in medically underserved areas with the greatest need and demand in 
accordance with the need/demand assessment completed in compliance with 
paragraph (b)(2) of this section;
    (4) Adequate assurances that sufficient current year State funds are 
available to cover the non-Federal share of State Loan Repayment Program 
costs;
    (5) A description of how the program would meet the requirements of 
Sec. 62.55 to demonstrate its similarity to the NHSC Loan Repayment 
program;
    (6) A description of the source of, and plans for the use of, State 
matching funds;
    (7) A description of how the program would be coordinated with 
Federal, State and other organized activities within the State which 
relate to health manpower services and resources;
    (8) Identification of the State entity and key personnel who would 
administer the grant and a description of the qualifications and 
experience of that entity and its personnel concerning the State's 
health service delivery system and health manpower needs;
    (9) A description of the State's plans for administration of the 
State's Loan Repayment Program which may include such provisions as 
annual levels of loan repayment to be made under the program, the number 
of health professionals to be funded, the frequency and timing of the 
loan repayments, program incentives for longer periods of service, 
procedures for monitoring the service of program participants and 
placing professionals in default for failure to complete their service 
obligation, penalties for default, provisions for waivers and 
suspensions, and a description of the contract/obligation process to be 
used by the State to obligate individuals receiving State loan 
repayments;
    (10) A description of the State's need for Federal assistance in 
obtaining health professions resources and demonstrated inability to 
obtain such resources without Federal assistance;

[[Page 465]]

    (11) A description of how the State will accord special 
consideration to medically underserved areas with large minority 
populations; and
    (12) The signature of an individual authorized to act for the State 
and to assume on behalf of the State the obligations imposed by the 
statute, the applicable regulations of this subpart and any additional 
conditions of the grant.

(Approved by the Office of Management and Budget under control number 
0915-0131)



Sec. 62.55  What State Program Elements are required to ensure similarity with the NHSC Loan Repayment Program?

    A State Loan Repayment Program supported under this subpart must:
    (a) Establish priorities for loan repayment applicants consistent 
with the provisions of Sec. 62.23 of this part;
    (b) Contract only with a person who is (1) enrolled as a full-time 
student in the final year of a course of study or program in an 
accredited school in a State leading to a degree in allopathic or 
osteopathic medicine, dentistry or other health profession, or (2) 
enrolled in an accredited graduate training program in a State in 
allopathic or osteopathic medicine or dentistry or other health 
profession, or (3) a practitioner licensed by a State who has completed 
training in an accredited graduate training program in allopathic or 
osteopathic medicine, dentistry or other health profession;
    (c) Provide that health professionals participating in a State Loan 
Repayment Program shall:
    (1) Serve for at least 2 years in a medically underserved area 
identified pursuant to Sec. 62.54(b)(3) of this subpart in the full-time 
clinical practice of their profession,
    (2) Charge for his or her professional services at the usual and 
customary rate prevailing in the area in which such services are 
provided, except that if a person is unable to pay such charge, such 
person shall be charged at a reduced rate or not charged any fee,
    (3) In providing health services, not discriminate against any 
person on the basis of such person's ability to pay for such services or 
because payment for the health services provided to such person will be 
made under the insurance program established under part A or B of title 
XVIII of the Social Security Act or under a State plan for medical 
assistance approved under title XIX of such Act, and
    (4) Agree to accept an assignment under section 1842(b)(3)(B)(ii) of 
such Act for all services for which payment may be made under part B of 
title XVIII of such Act and enter into an appropriate agreement with the 
State agency which administers the State plan for medical assistance 
under title XIX of such Act to provide service to individuals entitled 
to medical assistance under the plan;
    (d) Repay qualifying loans for participating health professionals;
    (e) Provide that the loans of health professionals will be repaid on 
a periodic basis after the receipt of obligated services by such 
participant for such period; and



Sec. 62.56  How are the Federal grant funds and State matching funds to be used under this program?

    The Federal share of any program shall not exceed 75 percent of the 
cost of the approved State program. The Federal share must be used to 
repay the qualifying loans of health professionals. No portion of the 
Federal share shall be used to pay for administrative costs of any State 
Loan Repayment Program. The State's share of the program may be used to 
repay qualifying loans of health professionals or administrative costs 
of the State's Loan Repayment Program, or a combination of both. All 
program administrative costs are to be borne by the State. No portion of 
the State's share of the program shall consist of Federal funds.



Sec. 62.57  How will States be selected to participate in this program?

    Within the limits of funds available under section 338H of the Act, 
the Secretary may award grants to State applicants whose proposed Loan 
Repayment Programs will, in his or her judgment, best promote the 
purposes of section 338H of the Act, taking into account, among other 
pertinent factors:
    (a) The need of the State for health professions manpower;

[[Page 466]]

    (b) The number and type of providers the State proposes to support 
through this program;
    (c) The acceptableness of the State's standards for the designation 
of medically underserved areas and the appropriateness of the proposed 
placements of obligated providers;
    (d) The degree of similarity between the proposed State Loan 
Repayment Program and the National Health Service Corps Loan Repayment 
Program;
    (e) The adequacy of the qualifications, the administrative and 
managerial ability and the experience of the State staff to administer 
and carry out the proposed project;
    (f) The suitability of the applicant's approach and the degree to 
which the applicant's project is coordinated with Federal, State and 
other organized activities for meeting the State's health professions 
manpower needs and resources, including mechanisms for an ongoing 
evaluation of the program's activities;
    (g) The source and plans for use of the State match (including the 
percentage of the State's match that is proposed to be used for loan 
repayments), the degree to which the State match exceeds 25% or has 
increased over time, and the amount of the match relative to the needs 
and resources of the States; and
    (h) The extent to which special consideration will be extended to 
medically underserved areas with large minority populations.



Sec. 62.58  What other regulations apply?

    Other regulations which apply to this subpart include but are not 
limited to:

45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services-
Effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in programs and 
activities receiving or benefiting from Federal financial assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 50--Policies of general applicability: Subpart D--Public 
Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 92--Administrative Requirements for grants and cooperative 
agreements to State and local governments (effective October 1, 1988)



                  Subpart D--Special Repayment Program

    Authority: Sec. 215 of the Public Health Service Act 58 Stat. 690, 
as amended, 63 Stat. 35 (42 U.S.C. 216); sec. 204, Pub. L. 100-177, 101 
Stat. 1000.

    Source: 56 FR 56597, Nov. 6, 1991, unless otherwise noted.



Sec. 62.71  What is the scope and purpose of the Special Repayment Program?

    These regulations apply to the Special Repayment Program authorized 
under section 204 of Pub. L. 100-177, which provides a time-limited 
opportunity for persons who were, on November 1, 1987, in breach of a 
written contract under the Public Health and National Health Service 
Corps Scholarship Training Program or the National Health Service Corps 
Scholarship Program to satisfy their scholarship obligations through 
full-time clinical service. These regulations do not apply to any Public 
Health and National Health Service Corps Scholarship Training Program or 
National Health Service Corps Scholarship Program obligation which the 
Secretary has determined was completely satisfied through service or 
monetary payment prior to November 1, 1987. The purpose of this program 
is to supply trained health professionals for the National Health 
Service Corps, which is used by the Secretary to improve the delivery of 
health services in health manpower shortage areas.



Sec. 62.72  Definitions.

    In addition to the definitions in Sec. 62.2 of this part, the 
following definitions will apply for purposes of this subpart:
    Eligible defaulters means those individuals who, as of November 1, 
1987, were:

[[Page 467]]

    (1) In breach of a written contract entered into under section 338A 
of the Act and liable to the United States under section 338E(b) of the 
Act and/or in breach of a written contract entered into under section 
225 of the Act (as in effect on September 30, 1977) and liable to the 
United States under section 225(f)(1) of the Act (as in effect on 
September 30, 1977); and
    (2) Not already serving their obligations on December 1, 1987, under 
a judgment, forbearance agreement, or other written agreement to serve.
    HPOL means the Health Manpower Shortage Area Placement Opportunity 
List described in section 204(b) of Pub. L. 100-177.
    Match means that the Secretary has received documentation of:
    (1) An offer of employment from a HPOL or SHPOL site which specifies 
at least the agreed upon salary and start date; and
    (2) The Program participant's acceptance of that offer. Provided, 
however, that if the Program participant would be self-employed, a match 
means that the Secretary has approved a program participant's private 
practice option application under section 338D(a) of the Act.
    Prior approved service means service performed prior to a Program 
participant's service start date under the Special Repayment Program:
    (1) As a member of the National Health Service Corps pursuant to an 
assignment by the Secretary under section 333 of the Act;
    (2) Under a written private practice option agreement signed by the 
Secretary pursuant to section 338D of the Act; or
    (3) In compliance with section 338C(e) of the Act.
    Program participant means an eligible defaulter whose contract under 
section 204 of Pub. L. 100-177 has been accepted and signed by the 
Secretary.
    Scholarship amount means the sum of any amounts paid to, or on the 
behalf of, a scholarship recipient under the PH/NHSC Scholarship 
Training Program and/or the Scholarship Program.
    SHPOL means the Supplemental Health Manpower Shortage Area Placement 
Opportunity List described in section 204(d) of Pub. L. 100-177.
    Special Repayment Program or Program means the program authorized by 
section 204 of Pub. L. 100-177.
    Total debt means the debt that would be owed by a Program 
participant under section 225(f)(1) of the Act, as in effect on 
September 30, 1977, and/or section 338E(b) of the Act, as if no payments 
had been made on the debt.



Sec. 62.73  What are the procedures for participation in the Special Repayment Program?

    (a) Notice of eligibility for participation in the program. On or 
before February 29, 1988, the Secretary will, subject to paragraph (h) 
of this section, send written notice to each eligible defaulter of the 
opportunity provided under this Program. The notice will be sent to the 
last known address of each eligible defaulter and will describe the 
special repayment options available under the Program.
    (b) Selection of repayment method. On or before May 29, 1988, 
eligible defaulters who wish to participate in this Program must sign 
and submit to the Secretary a written contract to provide service in 
accordance with either section 204(b) or section 204(c) of Pub. L. 100-
177. The election between section 204(b) and section 204(c) of Pub. L. 
100-177 is binding on the eligible defaulters.
    (c) Service sites. Program participants will receive a listing of 
approved sites appropriate to the service option they have selected. 
Program participants electing service under section 204(b) of Pub. L. 
100-177 will receive a HPOL. Program participants electing service under 
section 204(c) of Pub. L. 100-177 will receive a SHPOL. The HPOL or 
SHPOL sent to the Program participant will be specific to the Program 
participant's profession and his or her specialty training which is most 
needed by the National Health Service Corps. The Secretary is not 
required to identify placements for Program participants in a medical 
specialty for which the National Health service Corps has no need.
    (d) Time frames for matching and commencing service. If a program 
participant electing to serve under section 204(b) of Pub. L. 100-177 
chooses to serve at a remaining site on the 1988 HPOL, such participant 
must match to

[[Page 468]]

a site and must begin serving at the site by October 1, 1988. If a 
Program participant electing to serve under section 204(b) of Pub. L. 
100-177 chooses to serve at a site on the 1989 HPOL, such participant 
must match to a HPOL site by February 15, 1989, and must begin service 
at the site by October 1, 1989. If a Program participant has elected to 
serve under section 204(c) of Pub. L. 100-177, such participant must 
match to a SHPOL site by May 15, 1989, and must begin service at that 
site by October 1, 1989.
    (e) Site visits. The Program participant is responsible for the 
costs of any site visit(s) and any other contact with the site to obtain 
employment at the site.
    (f) Effect of failure to meet established time frames. If a Program 
participant does not match to a site or begin service at that site 
within the time frames described in paragraph (d) of this section, the 
Secretary will determine that such individual is not relieved of his or 
her liability to the United States under the PH/NHSC Scholarship 
Training Program and/or Scholarship Program (including accrued interest 
and/or damages).
    (g) Service. Service must be performed in accordance with subpart II 
of part D of title III of the Act. Service credit will begin after a 
Program participant has matched to a HPOL or SHPOL site and has 
commenced service at that site in accordance with subpart II of part D 
of title III of the Act.
    (h) Secretary's exclusion authority. The Secretary is authorized, at 
any time, to deny or terminate an individual's participation in the 
Program for reasons related to the individual's professional competence 
or conduct.



Sec. 62.74  How much credit will a Program participant receive for monetary repayments made, or for approved service performed, before beginning service under 
          the Special Repayment Program?

    (a) Prior approved service performed by a Program participant will 
be credited to the Program participant for the purpose of calculating 
the Program participant's remaining service obligation under this 
Program. Thus, the Program participant's remaining service obligation 
will be calculated by subtracting the number of days of the Program 
participant's prior approved service from the number of days of the 
Program participant's original service obligation under the PH/NHSC 
Scholarship Training Program and/or the Scholarship Program. If a 
Program participant has made monetary payments, his or her remaining 
service obligation will be reduced by converting the monetary payments 
into days of service credit as set forth in paragraph (b) or (c) of this 
section, whichever is applicable.
    (b) Program participants who elect to serve pursuant to section 
204(b) and section 204(c)(2) of Pub. L. 100-177, will not receive a 
refund of any amounts previously paid but will receive service credit 
for those payments as follows:
    (1) The number of days of service credit will be calculated by 
dividing the total amount paid by the Program participant prior to the 
Program participant's service start date by the total debt as of the 
service start date and multiplying the result of that division by the 
number of days of the participant's remaining service obligation (as 
determined by the formula set forth in the second sentence of paragraph 
(a) of this section).
    (2) If the Program participant defaults on a contract under this 
Program, prior monetary payments will not be credited to service but 
will be applied to the monetary debt owed by the Program participant.
    (c) Program participants who elect to serve under section 204(c)(1) 
of Pub. L. 100-177 must pay an amount equal to the scholarship amount. 
Any amounts paid by the Program participant prior to or after entry into 
the Program, in accordance with Sec. 62.76 of this subpart, will be used 
to reduce the Program participant's financial obligation incurred under 
section 204(c)(1) of Pub. L. 100-177. In some cases, the amounts paid 
before or after entry into the Program will exceed the scholarship 
amount. These payments in excess of the scholarship amount will be 
converted into days of service credit under the formula set forth in 
paragraph (b)(1) of this section. If a Program participant defaults on a 
contract under this option, the monies paid in excess of the

[[Page 469]]

scholarship amount will not be credited to service but will be credited 
toward the monetary debt owed by the Program participant under section 
338E(b) of the Act or section 225(f)(1) of the Act, as in effect on 
September 30, 1977. The scholarship amount paid upon entering this 
option will be forfeited.



Sec. 62.75  Will individuals serving under the Special Repayment Program receive credit for partial service?

    (a) With respect to obligations under the Scholarship Program, a 
credit will be allowed for partial service under the Special Repayment 
Program and will result in a reduction of the Program participant's 
financial obligation in accordance with the following formula:
[GRAPHIC] [TIFF OMITTED] TC13NO91.003


In which:

`A' is the amount the United States is entitled to recover;
`0' is the sum of the amounts paid to or on behalf of the Program 
          participant under the Scholarship Program and the interest on 
          such amounts which would be payable if, at the time the 
          amounts were paid, they were loans bearing interest at the 
          maximum legal prevailing rate, as determined by the Treasurer 
          of the United States;
`t' is the sum of (1) the number of months of prior approved service 
          plus (2) the number of months of the Program participant's 
          period of obligated service under the Program including any 
          additional months of service incurred pursuant to section 
          204(c)(2) of Pub. L. 100-177;
`s' is the number of months of prior approved service performed by the 
          Program participant before commencing service under this 
          Program; and
`r' is the number of months of service performed by the Program 
          participant in compliance with this Program.

However, where a judgment has been entered against a Program 
participant, the formula will be revised such that:

`30' is the amount of the judgment representing the Program 
          participant's liability under the Scholarship Program, 
          including any accrued post judgment interest and excluding any 
          monetary payments on the judgment which may have been made by 
          the Program participant;
`t' is the sum of (1) the number of months of prior approved service 
          performed by the Program participant after entry of the 
          judgment but before commencing service under this Program plus 
          (2) the number of months of the Program participant's period 
          of obligated service under the Program including any 
          additional months of service incurred pursuant to section 
          204(c)(2) of Pub. L. 100-177; and
`s' is the number of months of prior approved service performed by the 
          Program participant after the entry of the judgment but before 
          commencing service under this Program.

    (b) With respect to obligations under the PH/NHSC Scholarship 
Training Program, if a Program participant fails to complete the period 
of obligated service under the Program (including any additional months 
of service incurred pursuant to section 204(c)(1) of Pub. L. 100-177), 
no credit for partial service under this Program will be allowed.
    (c) Where participants have obligations under both the Scholarship 
Program and the PH/NHSC Scholarship Training Program, credit for service 
will be applied against the scholarship obligations in the order in 
which they were incurred.



Sec. 62.76  How will amounts of money due under the option under section 204(c)(1) of Public Law 100-177 be required to be repaid?

    Program participants who elect to serve under section 204(c)(1) of 
Pub. L. 100-177 will be required to pay the full scholarship amount at 
least 60 days prior to the service start date specified in the 
documentation submitted to the Secretary.



PART 63--TRAINEESHIPS--Table of Contents




Sec.
63.1  To what programs do these regulations apply?
63.2  Definitions.
63.3  What is the purpose of traineeships?
63.4  What are the minimum qualifications for awards?
63.5  How will NIH make awards?
63.6  How to apply.
63.7  What are the benefits of awards?
63.8  What are the terms and conditions of awards?
63.9  How may NIH terminate awards?
63.10  Other HHS regulations and policies that apply.

    Authority: 42 U.S.C. 216, 283g(d), 284(b)(1)(C), 286b-3, 287c(b).

[[Page 470]]


    Source: 60 FR 10719, Feb. 27, 1995, unless otherwise noted.



Sec. 63.1  To what programs do these regulations apply?

    (a) The regulations in this part apply to research traineeships 
awarded by each Director of a national research institute of NIH, the 
Director of the National Library of Medicine (NLM), the Director of the 
National Center for Human Genome Research (NCHGR), the Director of the 
Office of Alternative Medicine, or designees pursuant to sections 
404E(d)(2), 405(b)(1)(C), 472, and 485B of the Public Health Service 
Act, as amended.
    (b) The regulations of this part do not apply to research training 
which is part of the National Research Service Award Program provided 
under 42 CFR part 66, the Mental Health Traineeship Program provided 
under 42 CFR part 64a, or residency training of physicians or other 
health professionals.



Sec. 63.2  Definitions.

    As used in this part:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.).
    Award means an award of funds under sections 404E(d)(2), 
405(b)(1)(C), 472, or 485B of the Act, or other sections of the Act 
which authorize research training or traineeships.
    Awardee means an individual awarded a traineeship under sections 
404E(d)(2), 405(b)(1)(C), 472, or 485B of the Act, or other sections of 
the Act which authorize research training or traineeships.
    Director means the director of one of the national research 
institutes of NIH specified in section 401(b)(1) of the Act, the 
Director of the National Library of Medicine, the Director of the 
National Center for Human Genome Research, the Director of the Office of 
Alternative Medicine, or any official of NIH to whom the authority 
involved has been delegated.
    HHS means the Department of Health and Human Services.
    NIH means the National Institutes of Health.
    PHS means the Public Health Service.
    Traineeship means an award of funds under section 404E(d)(2), 
405(b)(1)(C), 472, or 485B of the Act, or other sections of the Act 
authorizing research training or traineeships, and the regulations of 
this part, to a qualified individual for the person's subsistence and 
other expenses during a period in which the awardee is acquiring the 
research training approved under the award.



Sec. 63.3  What is the purpose of traineeships?

    The purpose of an NIH research traineeship is to provide support for 
financial subsistence to an individual during a period in which the 
awardee is acquiring training in:
    (a) Basic and/or clinical biomedical or behavioral research relating 
to human health, including extending healthy life and reducing the 
burdens of illness, or
    (b) Medical library science or related fields pertaining to sciences 
related to health or the communication of health sciences information.
    Traineeships are intended to make available in the United States an 
increased number of persons having special competence in these research 
fields through developmental training and practical research experience 
in the facilities of NIH, with supplemental training at other qualified 
institutions (see Sec. 63.8(a)).



Sec. 63.4  What are the minimum qualifications for awards?

    Minimum qualifications for any traineeship shall be established by 
the Director and shall be uniformly applicable to all applicants in each 
traineeship program. These minimum qualifications may include 
requirements as to citizenship, medical standards, academic degrees, 
professional or other training or experience, and other factors as may 
be necessary to the fulfillment of the purpose of the traineeship. The 
Director may, as a matter of general policy or, in individual cases, 
waive compliance with any minimum qualification so established to the 
extent that the applicant or applicants have substantially equivalent 
qualifications or have such special training, experience or opportunity 
for service as to make an award particularly appropriate, and to the 
extent the Director finds it is consistent

[[Page 471]]

with the fulfillment of the purpose of the traineeship.



Sec. 63.5  How will NIH make awards?

    Subject to the regulations of this part, the Director may award 
traineeships to those qualified applicants who are best able in that 
official's judgment to carry out the purpose of the traineeships. These 
awards may be made for a period of one (1) year or other period, 
including extensions or renewals, as may be specified.



Sec. 63.6  How to apply.

    (a) Application for a traineeship shall be made in writing as 
prescribed by the Director.
    (b) In addition to other pertinent information, the Director may 
require each applicant to submit the following information:
    (1) Certification of the applicant's citizenship status;
    (2) The applicant's educational background and other qualifications 
and experience, including previous academic and professional degrees, if 
any; and
    (3) The subject area of the proposed training.
    (c) By applying, eligible individuals agree to abide by HHS, PHS, 
and NIH regulations, and the terms and conditions of the traineeship 
award which may require compliance with policies and procedures that 
apply to the proper conduct of research, such as research involving 
human and animal subjects, patient care, hospital and laboratory 
procedures, handling of confidential information, and outside 
employment.



Sec. 63.7  What are the benefits of awards?

    (a) Subject to the availability of funds, each individual awarded a 
traineeship may receive a stipend fixed in an amount determined by the 
Director.
    (b) Additional allowances and benefits may be authorized by and at 
the discretion of the Director, taking into account the cost of living 
and other factors such as the requirements of the training program and 
availability of discretionary funds. Discretionary allowances and 
benefits may include: health benefits coverage; dependents' allowance; 
travel to pre-award interviews, to first duty station, and return to the 
place of origin upon conclusion of the traineeship; tuition and 
institution fees; and other specific costs as may be necessary to 
fulfill the purpose of the training program.



Sec. 63.8  What are the terms and conditions of awards?

    All traineeships shall be subject to the following terms and 
conditions:
    (a) Training must be carried out at a facility of the NIH, but may 
be supplemented by additional training acquired at another institution 
which is found by the Director to be directly related to the purpose of 
the traineeship and necessary to its successful completion.
    (b) Payments shall be made to the awardee or to the institution for 
payment to the awardee in accordance with payment schedules as 
prescribed by the Director for each traineeship program.
    (c) The awardee shall reimburse NIH for any overpayment of stipends 
or other allowances because of early termination of the traineeship or 
any other reason, unless waived for good cause shown by the awardee.
    (d) The Director may establish procedures and requirements 
applicable to traineeship awards, consistent with the regulations in 
this part, regarding: (1) The proper conduct of research investigations, 
including research involving human and animal subjects; (2) patient 
care; (3) hospital and laboratory procedures; (4) handling of 
confidential information; (5) outside employment; and (6) additional 
conditions the Director finds necessary to fulfill the purpose of the 
traineeship.
    (e) The awardee shall sign an agreement to comply with the terms and 
conditions of the traineeship.



Sec. 63.9  How may NIH terminate awards?

    The Director may terminate a traineeship at any time:
    (a) Upon written request of the awardee; or
    (b) If it is determined that the awardee is ineligible, has 
materially failed to comply with the terms and conditions of the award, 
or to carry out the purpose for which it was made.

[[Page 472]]



Sec. 63.10  Other HHS regulations and policies that apply.

    Several other policies and regulations apply to awards under this 
part. These include, but are not necessarily limited to:

45 CFR part 46--Protection of human subjects.
45 CFR part 76--Governmentwide debarment and suspension (nonprocurement) 
and governmentwide requirements for drug-free workplace (grants).
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services--
effectuation of title VI of the Civil Rights Act of 1964.
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title.
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving Federal financial assistance.
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance.
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance.
51 FR 16958 (May 7, 1986)--NIH Guidelines for Research Involving 
Recombinant DNA Molecules.
``Public Health Service Policy on Humane Care and Use of Laboratory 
Animals,'' Office for Protection from Research Risks, NIH (Revised 
September 1986).
59 FR 14508 (March 28, 1994)--NIH Guidelines on the Inclusion of Women 
and Minorities as Subjects in Clinical Research.



PART 63a--NATIONAL INSTITUTES OF HEALTH TRAINING GRANTS--Table of Contents




Sec.
63a.1  To what programs do these regulations apply?
63a.2  Definitions.
63a.3  What is the purpose of training grants?
63a.4  Who is eligible for a training grant?
63a.5  How to apply for a training grant.
63a.6  How are training grant applications evaluated?
63a.7  Awards.
63a.8  How long does grant support last?
63a.9  What are the terms and conditions of awards?
63a.10  How may training grant funds be spent?
63a.11  Other HHS regulations and policies that apply.

    Authority: 42 U.S.C. 216, 242l(b)(3), 284(b)(1)(C), 287c(b), 300cc-
15(a)(1), 300cc-41(a)(3)(C), 7403(h)(2).

    Source: 61 FR 55111, Oct. 24, 1996, unless otherwise noted.



Sec. 63a.1  To what programs do these regulations apply?

    (a) The regulations of this part apply to:
    (1) Grants awarded by the John E. Fogarty International Center for 
Advanced Study in the Health Sciences, NIH, for training in 
international cooperative biomedical research endeavors, as authorized 
under section 307(b)(3) of the Act;
    (2) Grants awarded by NIH for research training with respect to the 
human diseases, disorders, or other aspects of human health or 
biomedical research, for which the institute or other awarding component 
was established, for which fellowship support is not provided under 
section 487 of the Act and which is not residency training of physicians 
or other health professionals, as authorized by sections 405(b)(1)(C), 
485B(b), 2315(a)(1), and 2354(a)(3)(C) of the Act; and,
    (3) Grants awarded by the National Institute of Environmental Health 
Sciences, NIH, for the education and training of physicians in 
environmental health, as authorized under section 103(h)(2) of the Clean 
Air Act, as amended.
    (b) The regulations of this part also apply to cooperative 
agreements awarded to support the training specified in paragraph (a) of 
this section. References to ``grant(s)'' shall include ``cooperative 
agreement(s).''
    (c) The regulations of this part do not apply to:
    (1) Research training support under the National Research Service 
Awards Program (see part 66 of this chapter);
    (2) Research training support under the NIH Center Grants programs 
(see part 52a of this chapter);
    (3) Research training support under traineeship programs (see part 
63 of this chapter);
    (4) Research training support under the NIH AIDS Research Loan 
Repayment Program (see section 487A of the Act); or
    (5) Research training support under the National Library of Medicine 
training grant programs (see part 64 of this chapter).

[[Page 473]]



Sec. 63a.2  Definitions.

    As used in this part:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.).
    HHS means the Department of Health and Human Services.
    NIH means the National Institutes of Health and its organizational 
components that award training grants.
    Nonprofit as applied to any agency or institution, means an agency 
or institution which is a corporation or association, no part of the net 
earnings of which inures or may lawfully inure to the benefit of any 
private shareholder or individual.
    Program director means the single individual named by the grantee in 
the grant application and approved by the Secretary, who is responsible 
for the management and conduct of the training program.
    Project period See Sec. 63a.8(a).
    Secretary means the Secretary of Health and Human Services and any 
other official of HHS to whom the authority involved is delegated.
    Stipend means a payment to an individual to help meet that 
individual's subsistence expenses during the training period.
    Training grant means an award of funds to an eligible agency or 
institution for a training program authorized under Sec. 63a.1 to carry 
out one or more of the purposes set forth in Sec. 63a.3.



Sec. 63a.3  What is the purpose of training grants?

    The purpose of a training grant is to provide financial assistance 
to an eligible agency or institution to enable it to provide research 
training to individuals in the diagnosis, prevention, treatment, or 
control of human diseases or disorders, or other aspects of human health 
or biomedical research, or in environmental health, in order to increase 
the number of facilities which provide qualified training and the number 
of persons having special competence in these fields.



Sec. 63a.4  Who is eligible for a training grant?

    (a) General. Except as otherwise provided in this section or as 
prohibited by law, any public or private for-profit or nonprofit agency, 
institution, or entity is eligible for a training grant.
    (b) International training grants for AIDS research. Any 
international organization concerned with public health is eligible for 
a training grant to support individuals for research training relating 
to acquired immunodeficiency syndrome (AIDS), as authorized under 
section 2315(a)(1) of the Act. In awarding these grants, preference 
shall be given to:
    (1) Training activities conducted by, or in cooperation with, the 
World Health Organization and
    (2) With respect to training activities in the Western Hemisphere, 
activities conducted by, or in cooperation with, the Pan American Health 
Organization or the World Health Organization.



Sec. 63a.5  How to apply for a training grant.

    Any agency, institution, or entity interested in applying for a 
grant under this part must submit an application at the time and in the 
form and manner that the Secretary may require.



Sec. 63a.6  How are training grant applications evaluated?

    The Secretary shall evaluate applications through the officers and 
employees, experts, consultants, or groups engaged by the Secretary for 
that purpose, including review or consultation with the appropriate 
advisory council or other body as may be required by law. The 
Secretary's evaluation will be for merit and shall take into account, 
among other pertinent factors, the significance of the program, the 
qualifications and competency of the program director and proposed 
staff, the adequacy of the selection criteria for trainees under the 
program, the adequacy of the applicant's resources available for the 
program, and the amount of grant funds necessary for completion of its 
objectives.



Sec. 63a.7  Awards.

    Criteria. Within the limits of available funds, the Secretary may 
award training grants for training programs which:
    (a) Are determined to be meritorious, and

[[Page 474]]

    (b) Best carry out the purposes of the particular statutory program 
described in Sec. 63a.1 and the regulations of this part.



Sec. 63a.8  How long does grant support last?

    (a) The notice of the grant award specifies how long the Secretary 
intends to support the project without requiring the grantee to 
recompete for funds. This period, called the ``project period,'' will 
usually be for one to five years.
    (b) Generally, the grant will be initially for one year and 
subsequent continuation awards will be for one year at a time. A grantee 
must submit a separate application at the time and in the form and 
manner that the Secretary may require to have the support continued for 
each subsequent year. Decisions regarding continuation awards and the 
funding level of these awards will be made after consideration of such 
factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, continuation awards require 
determination by the Secretary that continued funding is in the best 
interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.
    (d) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward to the next budget period, for use as prescribed by the 
Secretary, provided that a continuation award is made. If at any time 
during a budget period it becomes apparent to the Secretary that the 
amount of Federal funds awarded and available to the grantee for that 
period, including any unobligated balance carried forward from prior 
periods, exceeds the grantee's needs for that period, the Secretary may 
adjust the amounts awarded by withdrawing the excess.



Sec. 63a.9  What are the terms and conditions of awards?

    In addition to the requirements imposed by law, grants awarded under 
this part are subject to any terms and conditions imposed by the 
Secretary to carry out the purpose of the grant or assure or protect 
advancement of the approved program, the interests of the public health, 
or the conservation of grant funds.



Sec. 63a.10  How may training grant funds be spent?

    (a) Authorized expenditures; general. A grantee shall expend funds 
it receives under this part solely in accordance with the approved 
application and budget, the regulations of this part, the terms and 
conditions of the grant award, and the applicable cost principles in 45 
CFR 74.27.
    (b) Authorized categories of expenditures. Subject to any 
limitations imposed in the approved application and budget or as a 
condition of the award, grant funds may be expended for the following 
costs:
    (1) Expenses of the grantee in providing training and instruction 
under the particular program, including salaries of faculty and support 
personnel, and the costs of equipment and supplies;
    (2) Stipends and allowances to individuals during the period of 
their training and instruction; and,
    (3) If separately justified and authorized under the particular 
program, tuition, fees, and trainee travel expenses which are necessary 
to carry out the purpose of the training grant.
    (c) Expenditures not authorized. Grant funds may not be expended 
for:
    (1) Compensation for employment or for the performance of personal 
services by individuals receiving training and instruction; or
    (2) Payments to any individual who does not meet the minimum 
qualifications for training and instruction established by the grantee 
and approved by the Secretary or who has failed to demonstrate 
satisfactory participation in the training in accordance with the usual 
standards and procedures of the grantee.

[[Page 475]]



Sec. 63a.11  Other HHS regulations and policies that apply.

    Several other HHS regulations and policies apply to this part. These 
include, but are not necessarily limited to:

42 CFR part 50, subpart A--Responsibility of PHS awardee and applicant 
institutions for dealing with and reporting possible misconduct in 
science
42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Uniform administrative requirements for awards and 
subawards to institutions of higher education, hospitals, other 
nonprofit organizations, and commercial organizations; and certain 
grants and agreements with states, local governments and Indian tribal 
governments
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide debarment and suspension (nonprocurement) 
and governmentwide requirements for drug-free workplace (grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 92--Uniform administrative requirements for grants and 
cooperative agreements to State and local governments
45 CFR part 93--New restrictions on lobbying
59 FR 14508 (March 28, 1994)--NIH Guidelines on the Inclusion of Women 
and Minorities as Subjects in Clinical Research. [Note: this policy is 
subject to change, and interested persons should contact the Office of 
Research on Women's Health, NIH, Room 201, Building 1, MSC 0161, 
Bethesda, MD 20892-0161 (301-402-1770; not a toll-free number) to obtain 
references to the current version and any amendments.]
59 FR 34496 (July 5, 1994)--NIH Guidelines for Research Involving 
Recombinant DNA Molecules. [Note: this policy is subject to change, and 
interested persons should contact the Office of Recombinant DNA 
Activities, NIH, Suite 323, 6000 Executive Boulevard, MSC 7010, 
Bethesda, MD 20892-7010 (301-496-9838; not a toll-free number) to obtain 
references to the current version and any amendments.]
``PHS Grants Policy Statement,'' DHHS Publication No. (OASH) 94-50,000 
(Revised April 1, 1994), as amended by the Addendum, dated January 24, 
1995. [Note: this policy is subject to change, and interested persons 
should contact the Extramural Outreach and Information Resources Office 
(EOIRO), Office of Extramural Research, 6701 Rockledge Drive, Room 6208, 
MSC 7910, Bethesda, MD 20892-7910 (301-435-0714; not a toll-free number) 
to obtain references to the current version and any amendments. 
Information may also be obtained by contacting the EOIRO via its e-mail 
address (ask [email protected]) and by browsing the NIH Home Page 
site on the World Wide Web (http://www.nih.gov).]
``Public Health Service Policy on Humane Care and Use of Laboratory 
Animals,'' Office for Protection from Research Risks, NIH (Revised 
September 1986).

    [Note: This policy is subject to change, and interested persons 
should contact the Office for Protection from Research Risks, NIH, Suite 
3B01, 6100 Executive Boulevard, MSC 7507, Rockville, MD 20852-7507 (301-
496-7005; not a toll-free number) to obtain references to the current 
version and any amendments.]



PART 64--NATIONAL LIBRARY OF MEDICINE TRAINING GRANTS--Table of Contents




Sec.
64.1  Programs to which these regulations apply.
64.2  Definitions.
64.3  Who is eligible for a grant?
64.4  How to apply for a grant.
64.5  How are grant applications evaluated?
64.6  Awards.
64.7  What other conditions apply?
64.8  How may funds be used?
64.9  Other HHS regulations that apply.

    Authority: 42 U.S.C. 216, 286b-3.

    Source: 56 FR 29192, June 26, 1991, unless otherwise noted.



Sec. 64.1  Programs to which these regulations apply.

    (a) The regulations of this part apply to grants under section 472 
of the Public Health Service Act (42 U.S.C. 286b-3) to public and 
private nonprofit institutions to assist in developing, expanding, and 
improving training programs (excluding training in a biomedical

[[Page 476]]

specialty and residency training) in library science and the field of 
communications of information pertaining to sciences relating to health.
    (b) The regulations of this part also apply to cooperative 
agreements awarded for these purposes. References to ``grant(s)'' shall 
include ``cooperative agreement(s).''
    (c) The regulations of this part do not apply to research training 
support under the National Research Service Awards Program (see part 66 
of this chapter).



Sec. 64.2  Definitions.

    As used in this part:
    HHS means the Department of Health and Human Services.
    Nonprofit private entity means an agency, organization, institution, 
or other entity which may not lawfully hold or use any part of its net 
earnings to the benefit of any private shareholder or individual which 
does not hold or use its net earnings for that purpose.
    Other trainee costs means those costs other than stipends, such as 
tuition, fees, and trainee travel, which are directly associated with 
and necessary for the training of individuals receiving stipends and 
which are incurred within the period of training.
    Project director means the single individual named by the grantee in 
the grant application and approved by the Secretary, who is responsible 
for the management and conduct of the project.
    Project period. See Sec. 64.6(b).
    Secretary means the Secretary of Health and Human Services and any 
other official of HHS to whom the authority involved is delegated.
    Stipend means a payment to an individual that is intended to help 
meet that individual's subsistence expenses during training.
    Training grant means an award of funds to an eligible entity for a 
project authorized under Sec. 64.1(a).



Sec. 64.3  Who is eligible for a grant?

    Except as otherwise prohibited by law, any public or private 
nonprofit entity is eligible for a training grant.



Sec. 64.4  How to apply for a grant.

    Applications for grants must include the following information:
    (a) Required information on the proposed project. (1) The nature, 
duration, and purpose of the training for which the application is 
filed.
    (2) The name and qualifications of the project director and any key 
personnel responsible for the proposed project.
    (3) A description of the facilities, staff, support services, and 
other organizational resources available to carry out the project.
    (4) The intended number of trainees and the minimum qualifications 
and criteria for their selection.
    (5) A description of the plan for evaluating the proposed project.
    (6) Other pertinent information the Secretary may require to 
evaluate the proposed project.
    (b) Required information on costs. (1) A budget for the proposed 
project and a justification of the amount of grant funds requested.
    (2) If institutional expenses are requested, a separate statement of 
the amounts requested for personal services, equipment, supplies, or 
other non-personal services.
    (3) If stipend costs are requested, a statement for each grant year 
of the estimated number of individuals to whom stipends will be provided 
and the length of time for which the stipend support will be provided. 
If other trainee costs are requested, they must be separately stated and 
justified.

(Approved by the Office of Management and Budget under control number 
0925-0276)



Sec. 64.5  How are grant applications evaluated?

    The Secretary shall evaluate applications through the officers and 
employees, experts, consultants, or groups engaged by the Secretary for 
that purpose. The Secretary's evaluation will be for technical merit and 
shall take into account, among other pertinent factors, the significance 
of the project, the qualifications and competency of the project 
director and proposed staff, the adequacy of selection criteria for 
trainees for the project, the adequacy of the applicant's resources 
available for the project, and the amount of

[[Page 477]]

grant funds necessary for completion of its objectives.



Sec. 64.6  Awards.

    (a) Criteria. Within the limits of available funds, the Secretary 
may award training grants to carry out those projects which:
    (1) Are determined by the Secretary to be technically meritorious; 
and
    (2) In the judgment of the Secretary best promote the purpose of the 
grant program as authorized by section 472 of the Act (42 U.S.C. 286b-
3), the regulations of this part (see Sec. 64.1), and address program 
priorities.
    (b) Project period. (1) The notice of grant award specifies how long 
the Secretary intends to support the project without requiring the 
project to recompete for funds. This period, called the project period, 
will usually be for one to five years.
    (2) Generally, the grant will initially be for one year and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit a separate application to have the support continued 
for each subsequent year. Decisions regarding continuation awards and 
the funding level of these awards will be made after consideration of 
such factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, continuation awards require a 
determination by the Secretary that continued funding is in the best 
interest of the Federal Government.
    (3) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.
    (4) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward to the next budget period, for use as prescribed by the 
Secretary, provided a continuation award is made. If at any time during 
a budget period it becomes apparent to the Secretary that the amount of 
Federal funds awarded and available to the grantee for that period, 
including any unobligated balance carried forward from prior periods, 
exceeds the grantee's needs for that period, the Secretary may adjust 
the amounts awarded by withdrawing the excess.



Sec. 64.7  What other conditions apply?

    (a) Grants awarded under this part are subject to the following 
conditions:
    (1) The grantee may not materially change the quality, nature, or 
duration of the project unless the written approval of the Secretary is 
obtained prior to the change.
    (2) The grantee must submit to the Secretary, in the manner 
prescribed by the Secretary, the name and other pertinent information 
regarding each individual who is awarded a stipend under a grant.
    (b) The Secretary may impose additional conditions prior to the 
award of any grant under this part if it is determined by the Secretary 
that the conditions are necessary to carry out the purpose of the grant.

(Approved by the Office of Management and Budget under control number 
0925-0276)



Sec. 64.8  How may funds be used?

    A grantee shall expend funds it receives under this part solely in 
accordance with the approved application and budget, the regulations of 
this part, the terms and conditions of the grant award, and the 
applicable cost principles in subpart Q of 45 CFR part 74. The funds may 
not be expended for:
    (a) Compensation for employment or for the performance of personal 
services by individuals receiving training and instruction; or
    (b) Payments to any individual who does not meet the minimum 
qualifications for training and instruction established by the grantee 
and approved by the Secretary or who has failed to demonstrate 
satisfactory participation in the training in accordance with the usual 
standards and procedures of the grantee.



Sec. 64.9  Other HHS regulations that apply.

    Several other regulations apply to grants under this part. These 
include, but are not necessarily limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals 
procedure.

[[Page 478]]

45 CFR part 16--Procedures of the Departmental Grant Appeals Board.
45 CFR part 74--Administration of grants.
45 CFR part 75--Informal grant appeals procedures.
45 CFR part 76--subparts A-F.
Governmentwide debarment and suspension (nonprocurement) and 
          requirements for drug-free workplace (grants).
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services--
effectuation of title VI of the Civil Rights Act of 1964.
45 CFR part 81--Practice and procedure for hearings under 45 CFR part 80 
of this title.
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial 
assistance.
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance.
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance.
45 CFR part 92--Uniform administrative requirements for grants and 
cooperative agreements to state and local governments.



PART 64a--OBLIGATED SERVICE FOR MENTAL HEALTH TRAINEESHIPS--Table of Contents




Sec.
64a.101  Purpose.
64a.102  To whom do these regulations apply?
64a.103  Definitions.
64a.104  What requirements are imposed upon grantees?
64a.105  What are the conditions of obligated service?

    Authority: Sec. 803, Pub. L. 96-398, 94 Stat. 1607-1608 (42 U.S.C. 
242a).

    Source: 46 FR 39979, Aug. 5, 1981, unless otherwise noted.



Sec. 64a.101  Purpose.

    This part establishes requirements to implement the service payback 
obligation of individuals who receive clinical traineeships in 
pyschology, psychiatry, social work, or nursing (that are not of limited 
duration or experimental nature) under section 303 of the Public Health 
Service Act.



Sec. 64a.102  To whom do these regulations apply?

    This part applies to any institution which receives a training grant 
under section 303 of the Public Health Service Act and to any individual 
who receives a stipend or other trainee allowances under such a grant 
for any period beginning on or after July 1, 1981, for clincial training 
in the field of psychology, psychiatry, nursing, or social work, except 
for training that is of a limited duration or experimental nature.



Sec. 64a.103  Definitions.

    As used in this part:
    Act means the Public Health Service Act as amended by Pub. L. 96-
398.
    Clinical traineeship means a stipend or other trainee allowances 
provided to an individual for clinical training in psychology, 
psychiatry, nursing, or social work, except for training that is of a 
limited duration or experimental nature, under a training grant 
authorized by section 303 of the Act.
    Community Mental Health Centers Act means the Community Mental 
Health Centers Act (42 U.S.C. 2689 et seq.) other than Part D thereof.
    Experimental nature refers to the training of undergraduates; the 
training of individuals in disciplines other than psychology, 
psychiatry, nursing, or social work; and any other training which the 
Secretary specifically designates as experimental in the notice of award 
for a training grant under section 303 of the Act.
    Limited duration means a period that is equal to or less than 180 
days, computed cumulatively over a two year period which begins on the 
first day of the clinical traineeship.
    Mental Health Systems Act means the Mental Health Systems Act (42 
U.S.C. 9401 et seq.).
    Nonprofit private entity means an agency, organization, institution 
or other entity which may not lawfully hold or use any part of its net 
earnings to the benefit of any private shareholder or individual and 
which does not hold or use its net earnings for that purpose.
    Other trainee allowances means financial assistance for those costs 
not covered by stipends, such as tuition, fees, and trainee travel, 
which are directly associated with and necessary to the

[[Page 479]]

training of individuals receiving stipends and are incurred within the 
period of training.
    Secretary means the Secretary of Health and Human Services or other 
official of the Department to whom the authority involved has been 
delegated.
    Stipend means financial assistance to an individual that is intended 
to help meet that individual's subsistence expenses during training.



Sec. 64a.104  What requirements are imposed upon grantees?

    Recipients of training grants under section 303 of the Act that 
provide a clinical traineeship to any individual must:
    (a) Give each such individual written notice of the service payback 
and recovery requirements of this part at the time the individual 
becomes a candidate for the traineeship;
    (b) Before awarding a clinical traineeship, conduct an entrance 
interview with the individual in order to explain and emphasize the 
service obligation the individual is incurring, obtain the individual's 
written assurance that he or she will satisfy the requirements of 
Sec. 64a.105, and document, in accordance with paragraph (d) of this 
section, the entrance interview on the form containing the individual's 
written assurance.
    (c) At the time of termination of the clinical traineeship,
    (1) Notify the Secretary in writing of the date on which the 
individual's traineeship is terminated;
    (2) Conduct an exit interview with the individual to remind the 
trainee of the service obligation, to fully explain the consequences 
that will incur should the trainee fail to satisfy the obligation, and, 
to tell the individual that the Secretary has been notified of the date 
of termination of the traineeship; and
    (3) Document, in accordance with paragraph (d) of this section, the 
exit interview on the form notifying the Secretary of the termination of 
the traineeship.
    (d) Document the entrance and exit interviews with at least the 
following information: The date of the interview, the names of the 
participants involved in the interview, and a statement that the 
interview included an explanation to the individual of the service 
payback requirement and the consequences of failing to fulfill the 
service payback requirement.

(Approved by the Office of Budget and Management under control number 
0930-0120)

[46 FR 39979, Aug. 5, 1981, as amended at 52 FR 18359, May 15, 1987]



Sec. 64a.105  What are the conditions of obligated service?

    In order to receive a clinical traineeship an individual must comply 
with the following conditions:
    (a) Written assurance. Prior to the award of a clinical traineeship, 
the individual must sign a written assurance (in such form and manner as 
the Secretary prescribes) that he or she will satisfy the requirements 
of this section.
    (b) Commencement and crediting of service. (1) An individual must 
start the obligated service within twenty-four months after termination 
of the clinical traineeship and carry out the service on a continuous 
basis unless, as specified in paragraph (e) of this section, the 
individual has requested and had approved, respectively, an extension of 
the time for beginning the service, or a break in service.
    (2) Following termination of the traineeship, the individual must 
annually provide (in such form and manner as the Secretary prescribes) a 
written report describing those previous years' activities which are 
related to service that fulfills the payback obligation. The Secretary 
will review this report and credit all service performed in those 
categories specified in paragraph (d) of this section toward the 
individual's payback obligation, except any service which is performed:
    (i) Before termination of the individual's clinical traineeship; and
    (ii) As part of any activity, such as course work, preparation of a 
dissertation or thesis, or practicum, which is needed to complete the 
training for which the individual received the traineeship.
    (c) Duration of obligation. The period of service payback must equal 
the period of support under the clinical traineeship on a month for 
month basis.

[[Page 480]]

    (d) Performance of the obligated service--(1) General requirements. 
The obligated service must consist of the provision of service for which 
the individual was trained (in the training program for which the 
clinical traineeship was received) and must be performed on a full-time 
basis (not less than 30 hours per week averaged over the obligated 
service period).
    (2) Preferred service. Except as provided under paragraph (d)(3) of 
this section, the individual must provide the obligated service in:
    (i) A public inpatient mental institution;
    (ii) Any entity which is receiving or has received a grant under the 
Mental Health Systems Act or the Community Mental Health Centers Act;
    (iii) A psychiatric manpower shortage area designated by the 
Secretary under section 332 of the Public Health Service Act and 42 CFR 
part 5;
    (iv) Any public or private nonprofit entity or in any nursing home 
(whether public, private nonprofit, or for profit) in which 50 percent 
or more of those served are within one or more of the following groups: 
Racial or ethnic minorities (American Indian or Alaskan Native, Asian or 
Pacific Islander, Black, Hispanic), chronically mentally ill, mentally 
retarded, criminal or delinquent populations, rape victims, physically 
handicapped, abusers of alcohol, or persons addicted to drugs or other 
substances, children and adolescents, the elderly, poverty populations, 
migrants, members of the armed forces (or veterans if seen in a Federal 
facility), residents of areas other than those defined as urbanized by 
the Department of Commerce, or any other special populations, such as 
groups of refugees or disaster victims, which are specifically 
designated by the Secretary for this purpose.
    (3) Alternate service. If the individual obtains the written 
approval of the Secretary, the individual may fulfill his or her 
obligation by:
    (i) Serving in any public or private nonprofit entity or in any 
nursing home (whether public, private nonprofit, or for profit) in which 
not less than 25 percent of those served are within one or more of the 
underserved population groups listed in paragraph (d)(2)(iv) of this 
section. The individual must demonstrate a service commitment of more 
than 50 percent of his or her time to the targeted populations.
    (ii) Teaching, conducting research, or conducting evaluation 
directed at improving alcohol, drug abuse or mental health services to 
one or more of the priority population groups listed in paragraph 
(d)(2)(iv) of this section, or working in a position which fosters the 
closer collaboration of health and alcohol, drug abuse or mental health 
services.
    (iii) Providing in a public or private nonprofit entity 
consultation, training and education, liaison, community support or 
other professional services for which the individual was trained when 
the individual's work is directed toward improving alcohol, drug abuse 
or mental health services to the priority populations listed in 
paragraph (d)(2)(iv) of this section.
    (e) Conditions for deferral or break in service, waiver, or 
cancellation. (1) Upon receipt of a written request showing good cause 
therefor by the individual having a payback obligation, the Secretary 
may:
    (i) Extend the period for beginning the obligated service (24 months 
after termination of the clinical traineeship), permit breaks in the 
required continuous service or extend the period for repayment under 
paragraph (g)(2) of this section, if it is determined that:
    (A) An extension or break in service is necessary for the completion 
of training;
    (B) Performance of the obligation must be delayed because a 
temporary disability makes present performance impossible; or
    (C) Performance of the obligation must be delayed because present 
performance would involve a substantial hardship and failure to extend 
the period would be against equity and good conscience.
    (ii) Waive, in whole or in part, the service payback and recovery 
requirements of this section if it is determined that fulfillment would 
be impossible because the individual is permanently and totally 
disabled.
    (iii) In making determinations under Sec. 64a.105(e)(1)(i)(C), the 
Secretary will

[[Page 481]]

take into consideration the following factors:
    (A) The individual's present financial resources and obligations;
    (B) The individual's estimated future financial resources and 
obligations;
    (C) The reasons for the individual's failure to complete the 
requirements within the prescribed period, such as problems of a 
personal nature;
    (D) The unavailability of employment opportunities appropriate to 
the individual's education and training; and
    (E) Any other extenuating circumstances.
    (2) Upon receipt of written notice giving evidence of a conflicting 
obligation under section 752 or 753 of the Act or of an election to 
fulfill an obligation under section 472 of the Act prior to an 
obligation under this section, the Secretary will extend the period for 
beginning service (24 months after termination of the clinical 
traineeship), permit breaks in the required continuous service or extend 
the period for repayment under paragraph (g)(1), as appropriate.
    (3) The service payback and recovery obligations of an individual 
will be cancelled upon the submission to the Secretary of a certificate 
of that individual's death or other evidence which the Secretary 
determines to be satisfactory.
    (f) Conflicting or multiple payback obligations. In any case where 
the individual has, in addition to a payback obligation incurred under 
this section, an obligation to perform service under section 752 or 753 
of the Act (because of receipt of a National Health Service Corps 
scholarship) or under section 472 of the Act (because of receipt of a 
National Research Service Award), or both, performance of the same 
activity may not be counted toward more than one of these obligations. 
In determining the order in which obligations must be fulfilled, 
obligations under section 752 or 753 take precedence over obligations 
incurred under this section. However, with respect to obligations under 
this section and 472, the individual may elect which obligation to 
fulfill first. Any individual who has an obligation under section 752 or 
753 or makes an election to fulfill an obligation under section 472 
prior to an obligation under this section, must give written notice to 
the Secretary as provided by paragraph (e)(3) of this section.
    (g) Recovery for failure to perform obligated service. (1) If an 
individual fails to begin or complete the obligated service in 
accordance with the requirements of paragraphs (a) through (f) of this 
section, that individual is obligated to repay the United States an 
amount equal to three times the cost of the award (including stipends 
and other trainee allowances) plus interest on that amount calculated 
for the total period since the trainee failed to perform the obligated 
service at the rate set by the Secretary of the Treasury for National 
Research Service Awards prevailing on the date on which the period of 
appointment begins, multiplied, in any case in which the service that 
was required has been performed in part, by the percentage which the 
length of service that was not performed is to the length of the service 
that was required to be performed. The amount will be determined under 
the following formula:
[GRAPHIC] [TIFF OMITTED] TC13NO91.004


where

A=the amount the United States is entitled to recover;
=the cost of the clinical traineeship (including stipends and 
          other trainee allowances);
m=the number of months since the trainee failed to perform obligated 
          service;
i=the National Research Service Award rate on the date which the period 
          of appointment begins divided by twelve;
t=the total number of months of the service obligation;
s=the number of months that have been served.

    (2) Unless the Secretary extends the repayment period as provided in 
paragraph (e) of this section, the individual shall pay to the United 
States the total amount which the United States is entitled to recover 
under paragraph (g)(1) of this section immediately upon the date that 
the individual fails to begin or complete the period of obligated 
service (including failing to comply

[[Page 482]]

with the applicable terms and conditions of an extension or break in 
service granted the individual) or upon the date that the individual 
indicates his or her intention not to fulfill the service obligation as 
determined by the Secretary. The amount is considered a debt owed to the 
United States, with interest accruing monthly upon the total debt as 
provided under paragraph (g)(1) of this section.

[46 FR 39979, Aug. 5, 1981, as amended at 52 FR 18359, May 15, 1987]



PART 65--NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES HAZARDOUS WASTE WORKER TRAINING--Table of Contents




Sec.
65.1  To what projects do these regulations apply?
65.2  Definitions.
65.3  Who is eligible to apply for a grant?
65.4  Project requirements.
65.5  How will applications be evaluated?
65.6  How long does grant support last?
65.7  For what purposes may grant funds be spent?
65.8  What additional Department regulations apply to grantees?
65.9  Additional conditions.

    Authority: 42 U.S.C. 9660a; 49 U.S.C. App. 1816.

    Source: 55 FR 42568, Oct. 22, 1990, unless otherwise noted.



Sec. 65.1  To what projects do these regulations apply?

    (a) The regulations in this part apply to:
    (1) The program of grants for the training and education of workers 
who are or are likely to be engaged in activities related to hazardous 
waste removal or containment, or emergency response that is authorized 
under section 126(g) of the SARA; and
    (2) The program of grants to support qualified non-profit 
organizations for the purpose of providing training and education to 
hazardous materials employees regarding: the safe unloading, loading, 
handling, storage, and transportation of hazardous materials; and, 
emergency preparedness for responding to accidents or incidents 
involving the transportation of hazardous materials that is authorized 
under section 118 of the HMTA.
    (b) Grants are available for curriculum and training materials 
development, technical support of training, direct student training, 
training program evaluation and related activities. Target populations 
for this training are workers and supervisors who are or are likely to 
be engaged in hazardous substance removal or other activities which 
expose or potentially expose these workers to hazardous substances in 
activities such as:
    (1) Waste handling and processing at waste generators and active and 
inactive hazardous substance treatment, storage, and disposal 
facilities;
    (2) Clean up, removal, containment, or remedial actions at waste 
sites;
    (3) Hazardous substance emergency response;
    (4) Hazardous substance disposal site risk assessment and 
investigation, clean up, or remedial actions; and
    (5) Transportation of hazardous wastes.
    Target populations may also be regulated under standards promulgated 
by the Secretary of Labor, the Secretary of Transportation, the 
Administrator of the Environmental Protection Agency, and other agencies 
under section 126(g) of the SARA or section 106(b) of the HMTA.
    (c) Two types of grants are available: Program grants covering the 
full range of activities, including program development, direct worker 
training and education, and program evaluation; and planning grants 
under the SARA.
    (1) Planning grants are intended to assist organizations which 
demonstrate potential for providing hazardous worker training, but need 
additional developmental efforts prior to initiation of full curriculum 
development and training activities. A limited number of one-year 
planning grants may be funded at a level determined appropriate by the 
Director. After successful completion of a one-year planning grant, a 
recipient may apply for a full program grant on a competitive basis.
    (2) Full program grants will be awarded to organizations with 
demonstrated capability to provide worker health and safety training and 
education and demonstrated ability to

[[Page 483]]

identify, describe, and access target populations. Full program grantees 
must be able to immediately initiate curriculum development and worker 
training activities.

[55 FR 42568, Oct. 22, 1990; 59 FR 64141, Dec. 13, 1994]



Sec. 65.2  Definitions.

    As used in this part:
    Award or grant means a grant or cooperative agreement made under 
section 126(g) of the SARA or section 118 of the HMTA.
    Director means the Director, National Institute of Environmental 
Health Sciences, or the Director's delegate.
    HHS means the Department of Health and Human Services.
    HMTA means the Hazardous Materials Transportation Act, as amended 
(49 U.S.C. App. 1801 et seq.).
    NIEHS means the National Institute of Environmental Health Sciences, 
an organizational component of the National Institutes of Health, as 
authorized by sections 401(b)(1)(L) and 463 of the Public Health Service 
Act (42 U.S.C. 281(b)(1)(L) and 285(l).
    NIH means the National Institutes of Health.
    Nonprofit as applied to any agency, organization, institution, or 
other entity means a corporation or association no part of the net 
earnings of which inures or may lawfully inure to the benefit of any 
private shareholder or individual.
    SARA means the Superfund Amendments and Reauthorization Act of 1986, 
Public Law 99-499, as amended (42 U.S.C. 9601 et seq.).
    Stipend means a payment to an organization that is intended to help 
meet that organization's subsistence expenses for trainees during the 
training period.
    Training grant means an award of funds to an eligible entity for a 
project authorized under Sec. 65.1.

[55 FR 42568, Oct. 22, 1990; 59 FR 64141, Dec. 13, 1994]



Sec. 65.3  Who is eligible to apply for a grant?

    Public and private nonprofit entities providing worker health and 
safety education and training may apply for grants under these 
regulations. Applicants for a grant may use services, as appropriate, of 
other public or private organizations necessary to develop, administer, 
or evaluate proposed worker training programs so long as the majority of 
the work is done by the applicant.



Sec. 65.4  Project requirements.

    In addition to meeting the requirements specified in the 
application, the instructions accompanying it, and the regulations 
referred to in Sec. 65.8, each applicant must meet the following 
requirements:
    (a) Two or more nonprofit organizations may join in a single 
application and share grant resources in order to maximize worker group 
coverage, enhance the effectiveness of training, and bring together 
appropriate academic disciplines and talents. Joint applications must 
describe the cooperative arrangements for program integration and 
effectiveness. Specific expertise, facilities, or services to be 
provided by each participating member must be identified.
    (b) Each applicant must detail the nature, duration, and purpose of 
the training for which the application is filed. The proposed training 
program must meet the standards promulgated by the Secretary of Labor 
and Secretary of Transportation under section 126(g) of the SARA or 
section 106(b) of the HMTA, and such additional requirements as the 
Director may prescribe to ensure appropriate health and safety training.
    (c) The applicant must provide assurance that the applicant will not 
discriminate in the selection of trainees or instructors on the basis of 
membership or nonmembership in a union.

[55 FR 42568, Oct. 22, 1990; 59 FR 64141, Dec. 13, 1994]



Sec. 65.5  How will applications be evaluated?

    (a) The Director shall evaluate applications through the officers 
and employees, and experts and consultants engaged by the Director for 
that purpose. The Director's first level of evaluation will be for 
technical merit and shall take into account, among other pertinent 
factors, the significance of the project, the qualifications and

[[Page 484]]

competency of the project director and proposed staff (including the 
ability to manage complex training programs), the adequacy of selection 
criteria for trainees for the project, the adequacy of the detailed 
training plan including provision for hands-on training, the adequacy of 
the applicant's resources available for the project, the amount of grant 
funds necessary for completion of its objectives, and how well the 
projects meet training criteria in OSHA's Hazardous Waste Operations and 
Emergency Response Regulation (29 CFR 1910.120) and/or how well they 
cover the target populations listed in Sec. 65.1(b). A second level of 
review will be conducted for program relevance.
    (b) Within the limits of funds available, the Director may award 
training grants to carry out those projects which have satisfied the 
requirements of the regulations of this part; are determined by the 
Director to be technically meritorious; and in the judgment of the 
Director best promote the purposes of the grant programs authorized by 
section 126(g) of the SARA or section 118 of the HMTA, the regulations 
of this part, and program priorities.

[55 FR 42568, Oct. 22, 1990; 59 FR 64141, Dec. 13, 1994]



Sec. 65.6  How long does grant support last?

    (a) The notice of grant award specifies how long NIEHS intends to 
support the project without requiring the project to recompete for 
funds. This period, called the project period, will usually be for 1-5 
years.
    (b) Generally, the grant will initially be for one year and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit a separate application to have the support continued 
for each subsequent year. Decisions regarding continuation awards and 
the funding level of such awards will be made after consideration of 
such factors as the grantee's progress and management practices and the 
availability of funds. In all cases, continuation awards require a 
determination by the NIEHS that continued funding is in the best 
interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.



Sec. 65.7  For what purposes may grant funds be spent?

    Individuals receiving training shall be entitled only to the 
stipends and allowances included in a budget approved by the Director, 
taking into account the cost of living and such other factors as the 
needs of the program and the availability of funds.



Sec. 65.8  What additional Department regulations apply to grantees?

    Several other regulations and policies apply to grants under this 
part. These include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals 
procedure.
45 CFR part 16--Procedures of the Departmental Grant Appeals Board.
45 CFR part 74--Administration of grants.
45 CFR part 75--Informal grant appeals procedures.
45 CFR part 76, subparts A-F--Government-wide debarment and suspension 
(nonprocurement) and government-wide requirements for drug-free 
workplace (grants).
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services--
Effectuation of title VI of the Civil Rights Act of 1964.
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title.
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial 
assistance.
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance.
45 CFR part 91--Nondiscrimination on the basis of age in Health and 
Human Services programs and activities receiving Federal financial 
assistance.
45 CFR part 92--Uniform Administrative Requirements for Grants and 
Cooperative Agreements to State and local Governments.
45 CFR part 93--New restrictions on lobbying.

[[Page 485]]



Sec. 65.9  Additional conditions.

    The Director may with respect to any award impose additional 
conditions prior to, or at the time of, any award when, in the 
Director's judgment, such conditions are necessary to assure the 
carrying out of the purposes of the award, the interest of the public 
health, or the conservation of funds awarded.



PART 65a--NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES HAZARDOUS SUBSTANCES BASIC RESEARCH AND TRAINING GRANTS--Table of Contents




Sec.
65a.1  To what programs do these regulations apply?
65a.2  Definitions.
65a.3  Who is eligible to apply for a grant?
65a.4  What are the program requirements?
65a.5  How to apply.
65a.6  How will applications be evaluated?
65a.7  Awards.
65a.8  How long does grant support last?
65a.9  What are the terms and conditions of award?
65a.10  For what purposes may grant funds be spent?
65a.11  Other HHS regulations and policies that apply.

    Authority: 42 U.S.C. 216, 9660(a).

    Source: 61 FR 55114, Oct. 24, 1996, unless otherwise noted.



Sec. 65a.1  To what programs do these regulations apply?

    (a) The regulations of this part apply to the award of grants to 
support programs for basic research and training directed towards 
understanding, assessing, and attenuating the adverse effects on human 
health resulting from exposure to hazardous substances, as authorized 
under section 311(a) of the Act (42 U.S.C. 9660(a)). The purpose of 
these programs is to carry out coordinated, multi-component, 
interdisciplinary research consisting of at least three or more 
biomedical research projects relating to hazardous substances and at 
least one non-biomedical research project in the fields of ecology, 
hydrogeology, and/or engineering, and including the training of 
investigators as part of the grantee's overall program.
    (b) The regulations of this part also apply to cooperative 
agreements awarded to support the programs described in paragraph (a) of 
this section. References to ``grant(s)'' shall include ``cooperative 
agreement(s).''
    (c) The regulations of this part do not apply to:
    (1) Research training support under the National Research Service 
Awards Program (see part 66 of this chapter),
    (2) Research, demonstration, and training support under the NIH 
Center Grants programs (see part 52a of this chapter),
    (3) Research training support under traineeship programs (see parts 
63 and 64a of this chapter), or
    (4) Research training support under the NIH AIDS Research Loan 
Repayment Program authorized under section 487A of the Public Health 
Service Act, as amended (42 U.S.C. 288-1).



Sec. 65a.2  Definitions.

    As used in this part:
    Act means the Comprehensive Environmental Response, Compensation, 
and Liability Act of 1980, as amended (42 U.S.C. 9601 et seq.).
    Award or grant means a grant or cooperative agreement awarded under 
section 311(a) of the Act (42 U.S.C. 9660(a)).
    Director means the Director of the National Institute of 
Environmental Health Sciences, or the Director's delegate.
    HHS means the Department of Health and Human Services.
    Institution of higher education means an educational institution in 
any state which (1) admits as regular students only persons having a 
certificate of graduation from a school providing secondary education, 
or the recognized equivalent of such a certificate, (2) is legally 
authorized within the state to provide a program of education beyond 
secondary education, (3) provides an educational program for which it 
awards a bachelor's degree or provides not less than a two-year program 
which is acceptable for full credit toward a bachelor's degree, (4) is a 
public or other nonprofit institution, and (5) is accredited by a 
nationally recognized accrediting agency or association

[[Page 486]]

or, if not so accredited, (i) is an institution with respect to which 
the Secretary of Education has determined that there is satisfactory 
assurance, considering the resources available to the institution, the 
period of time, if any, during which it has operated, the effort it is 
making to meet accreditation standards, and the purpose for which this 
determination is being made, that the institution will meet the 
accreditation standards of a nationally recognized accrediting agency or 
association within a reasonable time, or (ii) is an institution whose 
credits are accepted, on transfer, by not less than three institutions 
which are so accredited, for credit on the same basis as if transferred 
from an institution so accredited. The term also includes any school 
which provides not less than a one-year program of training to prepare 
students for gainful employment in a recognized occupation and which 
meets the provisions of paragraphs (1), (2), (4), and (5) of this 
definition. The term also includes a public or nonprofit private 
educational institution in any state which, in lieu of the requirement 
in paragraph (1), admits as regular students persons who are beyond the 
age of compulsory school attendance in the state in which the 
institution is located and who meet the requirements of section 1091(d) 
of title 20 U.S. Code, as amended. For purposes of this definition, the 
Secretary of Education publishes a list of nationally recognized 
accrediting agencies or associations which that official determines to 
be reliable authority as to the quality of training offered. This list 
is found in the brochure, ``Nationally Recognized Accrediting Agencies 
and Associations Criteria and Procedures for Listing by the U.S. 
Secretary of Education and Current List.''

    [Note: This brochure is subject to change, and interested persons 
should contact the U.S. Department of Education Office of Post-Secondary 
Education, Accreditation and State Liaison Division, ROB 3, 7th and D 
Streets, S.W., Room 37-15, Washington, DC 20202-5244 (202-708-7417; not 
a toll-free number) to obtain a current version of the brochure and any 
amendments.]

    NIEHS means the National Institute of Environmental Health Sciences, 
an organizational component of the National Institutes of Health, as 
authorized under sections 401(b) and 463 of the Public Health Service 
Act, as amended (42 U.S.C. 281(b) and 185l).
    NIH means the National Institutes of Health.
    Nonprofit, as applied to any agency, organization, institution, or 
other entity, means a corporation or association no part of the net 
earnings of which insures or may lawfully inure to the benefit of any 
private shareholder or individual.
    PHS means the Public Health Service.
    Program means the activity to carry out research and training 
supported by a grant under this part.
    Program director means the single individual designated by the 
grantee in the grant application and approved by the Director, who is 
responsible for the scientific and technical direction of the research 
component and the conduct of the training component under a program.
    Project period means the period of time, from one to five years, 
specified in the notice of grant award that NIEHS intends to support a 
proposed program without requiring the program awardee to recompete for 
funds.
    Secretary means, unless the context otherwise requires, the 
Secretary of Health and Human Services or other official of HHS to whom 
the authority involved is delegated.



Sec. 65a.3  Who is eligible to apply for a grant?

    (a) Except as otherwise prohibited by law, any public or private 
nonprofit institution of higher education may apply for an award under 
this part.
    (b) Awardee institutions may carry out portions of the research or 
training components of an award through contracts with appropriate 
organizations, including:
    (1) Generators of hazardous wastes;
    (2) Persons involved in the detection, assessment, evaluation, and 
treatment of hazardous substances;
    (3) Owners and operators of facilities at which hazardous substances 
are located; and
    (4) State and local governments.

[[Page 487]]



Sec. 65a.4  What are the program requirements?

    The applicant shall include the following in its proposed program 
for which support is requested under this part:
    (a) Basic research component. The program shall include three or 
more meritorious biomedical research projects, including epidemiologic 
studies relating to the study of the adverse effects of hazardous 
substances on human health, and at least one meritorious project 
involving hydrogeologic or ecologic research which shall cumulatively 
address:
    (1) Methods and technologies to detect hazardous substances in the 
environment;
    (2) Advanced techniques for the detection, assessment, and 
evaluation of the effects of these substances on human health;
    (3) Methods to assess the risks to human health presented by these 
substances; and
    (4) Basic biological, chemical, and/or physical methods to reduce 
the amount and toxicity of these substances.
    (b) Training component. The program shall include the following 
kinds of training, as part of or in conjunction with the basic research 
component:
    (1) Graduate training in environmental and occupational health and 
safety and in public health and engineering aspects of hazardous waste 
control; and/or
    (2) Graduate training in the geosciences, including hydrogeology, 
geological engineering, geophysics, geochemistry, and related fields, 
necessary to meet professional personnel needs in the public and private 
sectors and to carry out the purposes of the Act; and
    (3) Worker training relating to handling hazardous substances, which 
includes short courses and continuing education for state and local 
health and environmental agency personnel and other personnel engaged in 
the handling of hazardous substances, in the management of facilities at 
which hazardous substances are located, and in the evaluation of the 
hazards to human health presented by these facilities.



Sec. 65a.5  How to apply.

    Each institution desiring a grant under this part must submit an 
application at the time and in the form and manner as the Secretary may 
require.



Sec. 65a.6  How will applications be evaluated?

    The Director shall evaluate applications through the officers and 
employees, experts, consultants, or groups engaged by the Director for 
that purpose, including review by the National Advisory Environmental 
Health Sciences Council in accordance with peer review requirements set 
forth in part 52h of this chapter. The Director's first level of 
evaluation will be for technical merit and shall take into account, 
among other pertinent factors, the significance of the program, the 
qualifications and competency of the program director and proposed 
staff, the adequacy of the applicant's resources available for the 
program, and the amount of grant funds necessary for completion of its 
objectives. A second level of review will be conducted by the National 
Advisory Environmental Health Sciences Council.



Sec. 65a.7  Awards.

    Criteria. Within the limits of available funds, the Director may 
award grants to carry out those programs which:
    (a) Are determined by the Director to be meritorious; and
    (b) In the judgment of the Director, best promote the purposes of 
the grant program, as authorized under section 311(a) of the Act and the 
regulations of this part, and best address program priorities.



Sec. 65a.8  How long does grant support last?

    (a) The notice of grant award specifies how long NIEHS intends to 
support the project without requiring the grantee to recompete for 
funds. This period, called the project period, may be for 1-5 years.
    (b) Generally, the grant will initially be for one year, and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit a separate application at the time and

[[Page 488]]

in the form and manner as the Secretary may require to have the support 
continued for each subsequent year. Decisions regarding continuation 
awards and the funding level of these awards will be made after 
consideration of such factors as the grantee's progress and management 
practices, and the availability of funds. In all cases, continuation 
awards require a determination by the Director that continued funding is 
in the best interest of the Federal Government.
    (c) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation or other award with respect to 
any approved application or portion of an approved application.
    (d) Any balance of federally obligated grant funds remaining 
unobligated by the grantee at the end of a budget period may be carried 
forward to the next budget period, for use as prescribed by the 
Director, provided a continuation award is made. If at any time during a 
budget period it becomes apparent to the Director that the amount of 
Federal funds awarded and available to the grantee for that period, 
including any unobligated balance carried forward from prior periods, 
exceeds the grantee's needs for that period, the Director may adjust the 
amounts awarded by withdrawing the excess.



Sec. 65a.9  What are the terms and conditions of awards?

    In addition to being subject to other applicable regulations (see 
Sec. 65a.11), grants awarded under this part are subject to the 
following terms and conditions:
    (a) Material changes. Except as otherwise provided by 45 CFR 74.25, 
the grantee may not materially change the quality, nature, scope, or 
duration of the program unless the written approval of the Director is 
obtained prior to the change.
    (b) Additional conditions. The Director may impose additional 
conditions prior to the award of any grant under this part if it is 
determined by the Director that the conditions are necessary to carry 
out the purpose of the grant or assure or protect advancement of the 
approved program, the interests of the public health, or the 
conservation of grant funds.



Sec. 65a.10  For what purposes may grant funds be spent?

    A grantee shall spend funds it receives under this part solely in 
accordance with the approved application and budget, the regulations of 
this part, the terms and conditions of the award, and the applicable 
cost principles prescribed in 45 CFR 74.27.



Sec. 65a.11  Other HHS regulations and policies that apply.

    Several other HHS regulations and policies apply to awards under 
this part. These include but are not necessarily limited to:

42 CFR part 50, subpart A--Responsibility of PHS awardee and applicant 
institutions for dealing with and reporting possible misconduct in 
science
42 CFR part 50, subpart D--Public Health Service grant appeals procedure
42 CFR part 50, subpart F--Responsibility of applicants for promoting 
objectivity in research for which PHS funding is sought
42 CFR part 52h--Scientific peer review of research grant applications 
and research and development contract projects
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Uniform administrative requirements for awards and 
subawards to institutions of higher education, hospitals, other 
nonprofit organizations, and commercial organizations; and certain 
grants and agreements with states, local governments and Indian tribal 
governments
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Governmentwide debarment and suspension (nonprocurement) 
and governmentwide requirements for drug-free workplace (grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance

[[Page 489]]

45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
45 CFR part 92--Uniform administrative requirements for grants and 
cooperative agreements to state and local governments
45 CFR part 93--New restrictions on lobbying
59 FR 14508 (March 28, 1994)--NIH Guidelines on the Inclusion of Women 
and Minorities as Subjects in Clinical Research

    [Note: This policy is subject to change, and interested persons 
should contact the Office of Research on Women's Health, NIH, Room 201, 
Building 1, MSC 0161, Bethesda, MD 20892-0161 (301-402-1770; not a toll-
free number) to obtain references to the current version and any 
amendments.]

59 FR 34496 (July 5, 1994)--NIH Guidelines for Research Involving 
Recombinant DNA Molecules.

    Note: This policy is subject to change, and interested persons 
should contact the Office of Recombinant DNA Activities, NIH, Suite 323, 
6000 Executive Boulevard, MSC 7010, Bethesda, MD 20892-7010 (301-496-
9838; not a toll-free number) to obtain references to the current 
version and any amendments.]
    ``PHS Grants Policy Statement,'' DHHS Publication No. (OASH) 94-
50,000 (Revised April 1, 1994), as amended by Addendum, dated January 
24, 1995.

    Note: This policy is subject to change, and interested persons 
should contact the Extramural Outreach and Information Resources Office 
(EOIRO), Office of Extramural Research, 6701 Rockledge Drive, Room 6208, 
MSC 7910, Bethesda, MD 20892-7910 (301-435-0714; not a toll-free number) 
to obtain references to the current version and any amendments. 
Information may also be obtained by contacting the EOIRO via its e-mail 
address ([email protected]) and by browsing the NIH Home Page 
site on the World Wide Web (http://www.nih.gov).]

    ``Public Health service Policy on Humane Care and Use of Laboratory 
animals,'' Office for Protection from Research Risks, HIH (Revised 
September 1986).

    Note: This policy is subject to change, and interested persons 
should contact the Office for Protection for Research Risks, NIH, Suite 
3B01, 6100 Executive Boulevard, MSC 7507, Rockville, MD 20852-7507 (301-
496-7005; not a toll-free number) to obtain references to the current 
version and any amendments.]



PART 66--NATIONAL RESEARCH SERVICE AWARDS--Table of Contents




                        Subpart A--Direct Awards

Sec.
66.101  Applicability.
66.102  Definitions.
66.103  Eligibility.
66.104  Application.
66.105  Requirements.
66.106  Awards.
66.107  Payments to awardees.
66.108  Payments to institutions.
66.109  Termination.
66.110  Service, payback, and recovery requirements.
66.111  Suspension, waiver, and cancellation.
66.112  Other HHS regulations that apply.
66.113  Publications.
66.114  Copyright.
66.115  Additional conditions.

                     Subpart B--Institutional Grants

66.201  Applicability.
66.202  Definitions.
66.203  Eligibility.
66.204  Application.
66.205  Requirements.
66.206  Grant awards.
66.207  Other HHS regulations and policies that apply.
66.208  Additional conditions.

    Authority: Sec. 215, 58 Stat. 690, as amended (42 U.S.C 216); sec. 
472, 88 Stat. 342 (42 U.S.C. 289l-1).

    Source: 48 FR 24880, June 3, 1983, unless otherwise noted.



                        Subpart A--Direct Awards



Sec. 66.101  Applicability.

    The regulations in this subpart apply to National Research Service 
Awards made by the Secretary to individuals for research, and training 
to undertake research, under section 472(a)(1)(A) of the Public Health 
Service Act, as amended [42 U.S.C. 289l-1(a)(1)(A)].



Sec. 66.102  Definitions.

    As used in this subpart:
    (a) Act means the Public Health Service Act, as amended.
    (b) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (c) Nonprofit institution means a corporation or association in 
which no part of the net earnings inures or may lawfully inure to the 
benefit of any private shareholder or individual.
    (d) Award means a National Research Service Award under section 472 
of the Act (42 U.S.C. 289l-1).

[[Page 490]]

    (e) Residency means post-graduate training for doctors of medicine, 
osteopathy, dentistry, optometry, and podiatry, nurses, and other 
individuals providing health care directly to patients, in which the 
majority of the time is spent in non-research clinical training.
    (f) Noncitizen national of the United States means a person who, 
though not a citizen of the United States, owes permanent allegiance to 
the United States [8 U.S.C. 1101(a) (22)].
    (g) Predoctoral training means training at the post-baccalaureate 
level in a program leading to the award of a doctor of philosophy or 
science, or equivalent degree. For purposes of Awards under the Minority 
Access to Research Careers programs of the National Institute of General 
Medical Sciences and the Alcohol, Drug Abuse, and Mental Health 
Administration, predoctoral training also means training in a program 
leading to the award of a baccalaureate degree in science or equivalent 
degree.
    (h) Postdoctoral training means training of individuals holding a 
doctor of philosophy, science, medicine, dentistry, osteopathy, 
optometry, podiatry, veterinary medicine, engineering, nursing sciences, 
public health, or equivalent degree.



Sec. 66.103  Eligibility.

    To be eligible for a National Research Service Award an individual 
must:
    (a) Be a citizen, noncitizen national of the United States, or 
lawfully admitted to the United States for permanent residence at the 
time of application; and
    (b) Propose to engage on a full-time basis in research, or training 
to undertake research, in a program specified in section 472(a)(1)(A) of 
the Act.



Sec. 66.104  Application.

    (a) Eligible individuals may apply for an Award using the form and 
by the dates the Secretary prescribes.
    (b) In addition to any other pertinent information that the 
Secretary may require, each application shall detail:
    (1) The applicant's educational background and other qualifications 
and experience, including previous academic and professional degrees;
    (2) The subject area of the proposed research or training;
    (3) The proposed period of Award:
    (4) If the proposed period of Award would provide the individual 
with aggregate support in excess of five years at the predoctoral level 
or three years at the postdoctoral level, the justification for this 
request; and
    (5) The availability of necessary resources facilities at the 
institution where the research or training would be conducted.

(Approved by the Office of Management and Budget under control number 
0925-0002)



Sec. 66.105  Requirements.

    The Secretary shall make an Award to an individual under this 
subpart only if:
    (a) For any Award made for a period in excess of twelve months, 
other than an Award made for research training at the prebaccalaureate 
level, the individual has submitted to the Secretary a written assurance 
(in the manner the Secretary may prescribe) that he or she will satisfy 
the requirements of Sec. 66.110;
    (b) If the proposed research or training would take place at an 
institution other than one operated by the Public Health Service 
agencies listed in section 472(a)(1)(A) of the Act, the institution has 
submitted a written assurance (in the manner the Secretary may 
prescribe). The assurance shall indicate that:
    (1) The applicant has been accepted to the institution for the 
purpose of engaging in the research or training for which an Award is 
being sought;
    (2) The Award will not be used to support a residency; and
    (3) In the event an Award is made the institution will make 
available to the applicant any resources and facilities described in the 
application as necessary to carry out the research or training; and
    (c) The individual has submitted a written assurance (in the manner 
the Secretary may prescribe) that the Award to individuals will not be 
used to support a residency.

(Approved by the Office of Management and Budget under control number 
0925-0002)

[[Page 491]]



Sec. 66.106  Awards.

    (a) Within the limits of funds available, the Secretary shall make 
Awards to those applicants:
    (1) Who have satisfied the requirements of Sec. 66.105; and
    (2) Whose proposed research or training would, in the judgment of 
the Secretary, best promote the purposes of section 472(a)(1)(A) of the 
Act, taking into consideration among other pertinent factors:
    (i) The scientific, technical, or educational merit of the 
particular proposal;
    (ii) The availability of resources and facilities to carry it out;
    (iii) The qualifications and experience of the applicant; and
    (iv) The need for personnel in the subject area of the proposed 
research or training.
    (b) In making Awards, the Secretary shall take account of the 
Nation's overall need for biomedical research by giving special 
consideration to physicians who agree to undertake a minimum of two 
years of biomedical research.
    (c) All Awards shall be in writing. Each shall specify:
    (1) The period of the Award;
    (2) The total recommended stipends and allowances provided for the 
entire Award period;
    (3) The amount awarded for the intitial year of that period (see 
Sec. 66.107); and
    (4) The amount of the payments to the institution for the cost of 
services provided the awardee by the institution during the initial year 
of that period (see Sec. 66.108).
    (d) Neither the approval of any application nor any Award shall 
commit or obligate the United States in any way to make additional, 
supplemental, continuation, or other Award with respect to any approved 
application or portion thereof.
    (e) No individual may receive an aggregate of more than five years 
of support at the predoctoral level and three years at the postdoctoral 
level unless the Secretary waives, for good cause shown, this limitation 
for the individual. In determining what constitutes ``good cause,'' the 
Secretary shall take into account such factors as whether the applicant 
proposes to pursue a combined program leading to the degrees of doctor 
of medicine and doctor of philosophy.



Sec. 66.107  Payments to awardees.

    (a) Individuals receiving Awards shall be entitled to the stipends, 
tuition, fees, and allowances the Secretary may designate, taking into 
account the cost of living, and such other factors as the needs of the 
program and the availability of funds.
    (b) The Secretary shall pay stipends, tuition, fees and allowances 
to the awardee or the sponsoring institution for payment to the awardee.



Sec. 66.108  Payments to institutions.

    The institution shall be entitled to an allowance to help defray the 
cost of support services (including the cost of faculty salaries, 
supplies, equipment, general research support, and related items) 
provided to the individual by the institution. The Secretary shall 
determine the amount of payments based upon reasonable costs to the 
institution of establishing and maintaining the quality of research and 
training programs for which it receives support under this subpart. The 
Secretary may make payments to the institution either in advance or by 
way of reimbursement.



Sec. 66.109  Termination.

    (a) The Secretary may terminate an Award prior to its normal 
expiration date:
    (1) At the written request of the awardee; or
    (2) If the Secretary finds that the awardee has materially failed to 
comply with the terms and conditions of the Award or to carry out the 
purpose for which it was made.
    (b) In the event an Award is terminated, the Secretary shall notify 
the awardee in writing of this determination, the reasons for 
termination, the effective date, and any procedural rights available.



Sec. 66.110  Service, payback, and recovery requirements.

    (a) Each individual who receives an Award for more than twelve 
months

[[Page 492]]

other than an Award for research training at the prebaccalaureate level 
shall upon completion of the Award engage for a period equal to the 
period of support (in excess of twelve months) in health research or 
teaching or, when in academic employment, any combination of research or 
teaching which is in accordance with the usual patterns of such 
employment.
    (b) Except as provided in Sec. 66.111, an individual subject to the 
requirements for service in paragraph (a) of this section must begin to 
undertake the service on a continuous basis within two years after the 
termination of his or her Award.
    (c) If the individual fails to undertake or perform the service in 
accordance with the requirements of paragraph (a) of this section, the 
United States shall be entitled to recover from the individual an amount 
determined in accordance with the formula:
[GRAPHIC] [TIFF OMITTED] TC13NO91.005


In which
    A is the amount the United States is entitled to recover;
    0 is the sum of the total amount paid under one or more Awards to 
the individual less the amount paid for the initial twelve months;
    t is total number in months in the individual's sevice obligation;
    and s is the number of months of the obligation served by him or her 
in accordance with paragraph (a) of this section.

    (d) Except as provided in Sec. 66.111, the individual shall pay to 
the United States any amount which it is entitled to recover under 
paragraph (c) within a three-year period beginning on the date the 
United States becomes entitled to recover that amount. Interest shall 
accrue to the United States until any amount due it under paragraph (c) 
of this section is paid. The rate of interest will be fixed by the 
Secretary of the Treasury after taking into consideration private 
consumer rates of interest prevailing on the date the United States 
become entitled to recovery.

[48 FR 24880, June 3, 1983; 48 FR 33710, July 25, 1983]



Sec. 66.111  Suspension, waiver, and cancellation.

    (a) The Secretary may extend the period for undertaking service 
prescribed in Sec. 66.110(d), permit breaks in service under 
Sec. 66.110(b), or extend the period of repayment under Sec. 66.110(d) 
if the Secretary determines that:
    (1) An extension or break in service is necessary so the individual 
may complete his or her research training;
    (2) Completion during the period would be impossible because the 
individual is temporarily disabled; or
    (3) Completion during the period would involve a substantial 
hardship to the individual and failure to extend to the period would be 
against equity and good conscience.
    (b) The Secretary may waive, in whole or in part, the obligation of 
the individual to repay pursuant to Sec. 66.110(c) if the Secretary 
determines that:
    (1) Fulfillment would be impossible because the individual is 
permanently and totally disabled; or
    (2) Fulfillment would involve a substantial hardship to the 
individual and enforcement of the obligation would be against equity and 
good conscience.
    (c) In making determinations under Sec. 66.111 (a)(3) and (b)(2), 
the Secretary will take into consideration such factors as:
    (1) The individual's present financial resources and obligations;
    (2) The individual's estimated future financial resources and 
obligations;
    (3) The reasons for the individual's failure to complete the 
requirements within the prescribed period, such as problems of a 
personal nature;
    (4) The extent to which the individual has been engaged in 
activities encompassed by Sec. 66.110(a);
    (5) Whether the individual has received sufficient training to be 
qualified to perform any such activities;
    (6) The unavailability of employment opportunities appropriate to 
the individual's education and training; and
    (7) Any other extenuating circumstances.
    (d) Any obligations of any individual under this subpart will be 
cancelled upon the death of that individual.

[48 FR 24880, June 3, 1983; 48 FR 33710, July 25, 1983]

[[Page 493]]



Sec. 66.112  Other HHS regulations that apply.

    Several other regulations and policies may apply to individuals and 
institutions receiving payments under this subpart. These include, but 
are not limited to:

45 CFR parts 6 and 8--Inventions and patents
45 CFR part 46--Protection of human subjects
45 CFR part 76--Debarment and suspension from eligibility for financial 
assistance
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this Title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
48 FR 24556--Guidelines for Research Involving Recombinant DNA Molecules 
published by the National Institutes of Health

[49 FR 38116, Sept. 27, 1984]



Sec. 66.113  Publications.

    Publication, distribution, and disposition of all manuscripts and 
other materials resulting from an Award shall be subject to the 
conditions that all such materials shall bear appropriate 
acknowledgement of Department of Health and Human Services support and 
that the awardee shall furnish copies of these manuscripts or other 
materials as the Secretary may reasonably request.



Sec. 66.114  Copyright.

    Where the work accomplished under an Award results in a book or 
other copyrightable material, the author is free to copyright the work, 
but the United States reserves a royalty-free, nonexclusive, and 
irrevocable license to reproduce, publish, or otherwise use, and to 
authorize others to use, all copyrightable or copyrighted material 
resulting from the Award.



Sec. 66.115  Additional conditions.

    The Secretary may with respect to any Award or class of Awards 
impose additional conditions prior to or at the time of any Award when 
in the Secretary's judgment such conditions are necessary to assure the 
carrying out of the purposes of the Award, the interests of the public 
health, or the conservation of funds awarded.



                     Subpart B--Institutional Grants



Sec. 66.201  Applicability.

    The regulations in this subpart apply to grants under section 
472(a)(1)(B) of the Public Health Service Act, as amended [42 U.S.C. 
2891 -1(a)(1)(B)], to public institutions and to nonprofit private 
institutions to enable these institutions to make National Research 
Service Awards to individuals for research, and training to undertake 
research, in programs specified in section 472(a)(1)(B) of the Act.



Sec. 66.202  Definitions.

    The definitions in Sec. 66.102 of subpart A of this part apply to 
this subpart.

[48 FR 24880, June 3, 1983; 48 FR 33710, July 25, 1983]



Sec. 66.203  Eligibility.

    To be eligible for a grant under this subpart, an applicant must be:
    (a) A public or nonprofit private institution; and
    (b) Located in a State, the District of Columbia, Puerto Rico, the 
Virgin Islands, the Canal Zone, Guam, American Samoa, or the Trust 
Territory of the Pacific Islands.



Sec. 66.204  Application.

    (a) Application for a grant under this subpart shall be made on a 
form approved for that purpose by the Secretary. Applicants shall submit 
completed forms on or before the dates the Secretary may prescribe.
    (b) In addition to any other pertinent information that the 
Secretary may require, each application shall set forth in detail:
    (1) The subject area or areas in which the proposed research or 
training will be conducted;

[[Page 494]]

    (2) The resources and facilities available for use by recipients of 
Awards in carrying out this research or training;
    (3) The names, qualifications, and experience of the program 
director and principal staff members who will be responsible for the 
proposed program;
    (4) The criteria to be employed in selecting recipients of Awards;
    (5) The estimated number of recipients of Awards under the grant;
    (6) The proposed project period and a detailed budget and 
justification for the amount of grant funds requested; and
    (7) Proposed methods for monitoring and evaluating the performance 
of individual recipients of Awards, as well as the overall program.

(Approved by the Office of Management and Budget under control number 
0925-0022)



Sec. 66.205  Requirements.

    (a) No Award shall be made to an individual from a grant under this 
subpart unless:
    (1) For any Award made for a period in excess of twelve months, 
other than an Award made for research training at the baccalaureate 
level, the individual has submitted to the Secretary a written assurance 
(in the manner the Secretary may prescribe) that he or she will satisfy 
the requirements of Sec. 66.110 of subpart A of this part;
    (2) The individual is a citizen or non-citizen national of the 
United States or has been lawfully admitted to the United States for 
permanent residence at the time of application;
    (3) The Award includes a provision for termination in the event the 
recipient is found by the institution to have materially failed to 
comply with the terms and conditions of the Award or to carry out the 
purpose for which it was made; and
    (4) The Award is not to be used to support a residency.
    (b) No Award shall be made to an individual under such grant which 
would provide that individual with aggregate support in excess of five 
years for predoctoral training and three years for postdoctoral 
training, unless the Secretary for good cause shown as provided in 
Sec. 66.106(d) of subpart A of this part, waives the application of the 
limitation with respect to that individual.
    (c) The provisions of Secs. 66.110 and 66.111 of subpart A of this 
part constitute terms and conditions of any Award made from a grant 
under this subpart.

(Approved by the Office of Management and Budget under control number 
0925-0022)

[48 FR 24880, June 3, 1983; 48 FR 33710, July 25, 1983]



Sec. 66.206  Grant awards.

    (a) Within the limits of funds available, the Secretary shall award 
grants to those applicants:
    (1) Whose applications have been reviewed and recommended for 
approval by the appropriate national advisory council or board;
    (2) Who have satisfied the requirements of Sec. 66.105; and
    (3) Whose proposed programs would, in the judgment of the Secretary, 
best promote the purposes of section 472(a)(1)(B) of the Act, taking 
into consideration among other pertinent factors:
    (i) The scientific, technical, or educational merit of the proposed 
program;
    (ii) The adequacy of the resources and facilities available to the 
applicant;
    (iii) The qualifications and experience of the program director and 
principal staff members;
    (iv) The degree of the need for personnel in the subject area or 
areas of the proposed research or training;
    (v) The extent to which the applicant, in making Awards, gives 
special consideration to physicians who agree to undertake a minimum of 
two years of biomedical research;
    (vi) The administrative and management capability of the applicant;
    (vii) The reasonableness of the proposed budget in relation to the 
proposed program; and
    (viii) The adequacy of the methods for monitoring and evaluating the 
performance of individual recipients and the overall program.
    (b) The notice of grant award specifies how long HHS intends to 
support the project without requiring the project to recompete for 
funds. This period, called the project period, will usually be for 3-5 
years.

[[Page 495]]

    (c) Generally the grant will initially be for one year and 
subsequent continuation awards will also be for one year at a time. A 
grantee must submit a separate application to have the support continued 
for each subsequent year. Decisions regarding continuation awards and 
the funding level of such awards will be made after consideration of 
such factors as the grantee's progress and management practices, and the 
availability of funds. In all cases, continuation awards require a 
determination by HHS that continued funding is in the best interest of 
the government.
    (d) Neither the approval of any application nor the award of any 
grant commits or obligates the United States in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of any approved application.



Sec. 66.207  Other HHS regulations and policies that apply.

    Several other regulations and policies apply to grants under this 
subpart. These include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 76--Debarment and suspension from eligibility for financial 
assistance
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance
48 FR 24556--Guidelines for Research Involving Recombinant DNA Molecules 
published by the National Institutes of Health

[49 FR 38116, Sept. 27, 1984]



Sec. 66.208  Additional conditions.

    The Secretary may, with respect to any grant award, impose 
additional conditions prior to or at the time of any award when in the 
Secretary's judgment those conditions are necessary to assure or protect 
advancement of the approved program, the interests of the public health, 
or the conservation of grant funds.



PART 67--AGENCY FOR HEALTH CARE POLICY AND RESEARCH GRANTS AND CONTRACTS--Table of Contents




  Subpart A--Research Grants for Health Services Research, Evaluation, 
                Demonstration, and Dissemination Projects

Sec.
67.10  Purpose and scope.
67.11  Definitions.
67.12  Eligible applicants.
67.13  Eligible projects.
67.14  Application.
67.15  Peer review of applications.
67.16  Evaluation and disposition of applications.
67.17  Grant award.
67.18  Use of project funds.
67.19  Other applicable regulations.
67.20  Confidentiality.
67.21  Control of data and availability of publications.
67.22  Additional conditions.

   Subpart B--Peer Review of Contracts for Health Services Research, 
          Evaluation, Demonstration, and Dissemination Projects

67.101  Purpose and scope.
67.102  Definitions.
67.103  Peer review of contract proposals.
67.104  Confidentiality.
67.105  Control of data and availability of publications.

    Authority: Pub. L. 103-43, 107 Stat. 214-215, Pub. L. 102-410, 106 
Stat. 2094-2101 and sec. 6103, Pub. L. 101-239, 103 Stat. 2189-2208, 
Title IX of the Public Health Service Act (42 U.S.C. 299-299c-6); and 
sec. 1142, Social Security Act (42 U.S.C. 1320b-12).

    Source: 62 FR 12908, Mar. 18, 1997, unless otherwise noted.

[[Page 496]]



  Subpart A--Research Grants for Health Services Research, Evaluation, 
                Demonstration, and Dissemination Projects



Sec. 67.10  Purpose and scope.

    The regulations of this subpart apply to the award by AHCPR of 
grants and cooperative agreements under:
    (a) Title IX of the Public Health Service Act to support research, 
evaluation, demonstration, and dissemination projects, including 
conferences, on health care services and systems for the delivery of 
such services, as well as to establish and operate multidisciplinary 
health services research centers.
    (b) Section 1142 of the Social Security Act to support research on 
the outcomes, effectiveness, and appropriateness of health care services 
and procedures, including but not limited to, evaluations of alternative 
services and procedures; projects to improve methods and data bases for 
outcomes, effectiveness, and other research; dissemination of research 
information and clinical guidelines, conferences, and research on 
dissemination methods.



Sec. 67.11  Definitions.

    As used in this subpart--
    Administrator means the Administrator and any other officer or 
employee of the Agency for Health Care Policy and Research to whom the 
authority involved may be delegated.
    Agency for Health Care Policy and Research (AHCPR) means that unit 
of the Department of Health and Human Services established by section 
901 of the Public Health Service Act.
    Direct costs means the costs that can be identified specifically 
with a particular cost objective, such as compensation of employees for 
the time and effort devoted specifically to the approved project, and 
the costs of materials acquired, consumed, or expended specifically for 
the purpose of the approved project.
    Grant means an award of financial assistance as defined in 45 CFR 
parts 74 and 92, including cooperative agreements.
    Grantee means the organizational entity or individual to which a 
grant, including a cooperative agreement, under Title IX of the Public 
Health Service Act or section 1142 of the Social Security Act and this 
subpart is awarded and which is responsible and accountable both for the 
use of the funds provided and for the performance of the grant-supported 
project or activities. The grantee is the entire legal entity even if 
only a particular component is designated in the award document.
    Nonprofit as applied to a private entity, means that no part of the 
net earnings of such entity inures or may lawfully inure to the benefit 
of any shareholder or individual.
    Peer review group means a panel of experts, established under 
section 922(c) of the PHS Act, who by virtue of their training or 
experience are eminently qualified to carry out the duties of such peer 
review group as set out in this subpart. Officers and employees of the 
United States may not constitute more than 25 percent of the membership 
of any such group under this subpart.
    PHS Act means the Public Health Service Act, as amended.
    Principal investigator means a single individual, designated in the 
grant application and approved by the Administrator, who is responsible 
for the scientific and technical direction of the project.
    Social Security Act means the Social Security Act, as amended.



Sec. 67.12  Eligible applicants.

    Any public or nonprofit private entity or any individual is eligible 
to apply for a grant under this subpart.



Sec. 67.13  Eligible projects.

    Projects for research, evaluations, demonstrations, dissemination of 
information (including research on dissemination), and conferences, 
related to health care services and the delivery of such services, are 
eligible for grant support. These include, but are not limited to, 
projects in the following categories:
    (a) Effectiveness, efficiency, and quality of health care services;
    (b) Outcomes of health care services and procedures;

[[Page 497]]

    (c) Clinical practice, including primary care and practice-oriented 
research;
    (d) Health care technologies, facilities, and equipment, including 
assessments of health care technologies and innovative approaches to 
such assessments, and technology diffusion;
    (e) Health care costs and financing, productivity, and market 
forces;
    (f) Health promotion and disease prevention;
    (g) Health statistics and epidemiology;
    (h) Medical liability;
    (i) AID/HIV infection, particularly with respect to issues of access 
and delivery of health care services;
    (j) Rural health services;
    (k) The health of low-income, minority, elderly, and other 
underserved populations, including women and children; and
    (l) Information dissemination and research on dissemination 
methodologies, directed to health care providers, practitioners, 
consumers, educators, review organizations, and others.



Sec. 67.14  Application

    (a) To apply for a grant, an entity or individual must submit an 
application in the form and at the time that the Administrator requires. 
The application must be signed by an individual authorized to act for 
the applicant and to assume on behalf of the applicant the obligations 
imposed by the PHS Act and the Social Security Act, as pertinent, the 
regulations of this subpart, and any additional terms or conditions of 
any grant awarded.
    (b) In addition to information requested on the application form, 
the applicant must provide such other information as the Administrator 
may request.



Sec. 67.15  Peer review of applications.

    (a) General procedures for peer review. (1) All applications for 
support under this subpart will be submitted by the Administrator for 
review to a peer review group, in accordance with section 922(a) of the 
PHS Act, except that applications eligible for review under section 
922(d)(2) of the PHS Act (``small grants'') may be reviewed under 
adjusted procedures in accordance with paragraph (b) of this section.
    (2) Members of the peer review group will be selected based upon 
their training and experience in relevant scientific and technical 
fields, taking into account, among other factors:
    (i) The level of formal education (e.g., M.A., Ph.D., M.D., D.N.Sc.) 
completed by the individual and/or the individual's pertinent experience 
and expertise;
    (ii) The extent to which the individual has engaged in relevant 
research, the capacities (e.g., principal investigator, assistant) in 
which the individual has done so, and the quality of such research;
    (iii) The extent of the professional recognition received by the 
individual as reflected by awards and other honors received from 
scientific and professional organizations outside the Department of 
Health and Human Services;
    (iv) The need of the peer review group to include within its 
membership experts representing various areas of specialization within 
relevant scientific and technical fields, or specific health care 
issues; and
    (v) Appropriate representation based on gender, racial/ethnic 
origin, and geography.
    (3) Review by the peer review group under paragraph (a) of this 
section is conducted by using the criteria set out in paragraph (c) of 
this section.
    (4) The peer review group to which an application has been submitted 
under paragraph (a) of this section shall make a written report to the 
Administrator on each application, which shall contain the following 
parts:
    (i) The first part of the report shall consist of a factual summary 
of the proposed project, including a description of its purpose, 
scientific approach, location, and total budget.
    (ii) The second part of the report shall address the scientific and 
technical merit of the proposed project with a critique of the proposed 
project with regard to the factors described in paragraphs (c)(1)(i) 
through (c)(1)(x) or (c)(2)(i) through (c)(2)(vii) of this section as 
applicable. This portion of the report shall include a set of 
recommendations to the Administrator

[[Page 498]]

with respect to the disposition of the application based upon its 
scientific and technical merit. The peer review panel may recommend to 
the Administrator that an application:
    (A) Be given consideration for funding,
    (B) Be deferred for a later decision, pending receipt of additional 
information, or
    (C) Not be given further consideration.
    (iii) For each application recommended for further consideration by 
the Administrator, the report shall also provide a priority score based 
on the scientific and technical merit of the proposed project, and make 
recommendations on the appropriate project period and level of support. 
The report may also address, as applicable, the degree to which the 
proposed project relates to AHCPR-announced priorities.
    (b) Procedural adjustments for small grants. (1) The Administrator 
may make adjustments in the peer review procedures established in 
accordance with paragraph (a) of this section for grant applications 
with total direct costs that do not exceed the amount specified in 
section 922(d)(2) of the PHS Act, hereafter referred to as ``small 
grants.''
    (2) Non-Federal and Federal experts will be selected by the 
Administrator for the review of small grant applications on the basis of 
their training and experience in particular scientific and technical 
fields, their knowledge of health services research and the application 
of research findings, and their special knowledge of the issue(s) being 
addressed or methods and technology being used in the specific proposal.
    (3) Review of applications for small grants may be by a review group 
established in accordance with paragraph (a) of this section, or by 
individual field readers, or by an ad hoc group of reviewers.
    (4) The review criteria set forth in paragraph (c) of this section 
shall be used for the review of small grant applications.
    (5) Each reviewer or group of reviewers to whom an application has 
been submitted under paragraph (b) of this section shall make a written 
report to the Administrator on each application. Each report shall 
summarize the findings of the review and provide a recommendation to the 
Administrator on whether the application should be given further 
consideration. For applications recommended for further consideration, 
the report may also address, as applicable, the degree to which the 
proposed project relates to AHCPR-announced priorities.
    (c) Review criteria. The review criteria set out in this paragraph 
apply to both applications reviewed by peer review panels in accordance 
with paragraph (a) of this section, and applications for small grants 
reviewed in accordance with paragraph (b) of this section.
    (1) General review criteria. In carrying out a review under this 
section for grants (other than conference grants), the following review 
criteria will be taken into account, where appropriate:
    (i) The significance and originality from a scientific or technical 
standpoint of the goals of the project;
    (ii) The adequacy of the methodology proposed to carry out the 
project;
    (iii) The availability of data or the adequacy of the proposed plan 
to collect data required in the analyses;
    (iv) The adequacy and appropriateness of the plan for organizing and 
carrying out the project;
    (v) The qualifications and experience of the principal investigator 
and proposed staff;
    (vi) The reasonableness of the budget and the time frame for the 
project, in relation to the work proposed;
    (vii) The adequacy of the facilities and resources available to the 
grantee;
    (viii) The extent to which women and minorities are adequately 
represented in study populations;
    (ix) Where an application involves activities which could have an 
adverse effect upon humans, animals, or the environment, the adequacy of 
the proposed means for protecting against or minimizing such effects; 
and
    (x) Any additional criteria that may be announced by the 
Administrator from time to time for specific categories of grant 
applications (e.g., proposed projects for support of research centers) 
eligible for support under this subpart.

[[Page 499]]

    (xi) In addition to the scientific and technical criteria above, 
peer reviewers may be asked to consider the degree to which a proposed 
project addresses any special AHCPR priorities that have been announced 
by the Administrator, as applicable.
    (2) Review criteria for conference grants. In carrying out reviews 
of conference grants under paragraphs (a) and (b) of this section, the 
following review criteria will be taken into account, as appropriate:
    (i) The significance of the proposed conference, specifically the 
importance of the issue or problem being addressed, including 
methodological or technical issues for dealing with the development, 
conduct, or use of health services research;
    (ii) The qualifications of the staff involved in planning and 
managing the conference;
    (iii) The adequacy of the facilities and other resources available 
for the conference;
    (iv) the appropriateness of the proposed budget, including other 
sources of funding;
    (v) The extent to which the health concerns of women and minorities 
will be addressed in the conference topic(s), as appropriate;
    (vi) The plan for evaluating and disseminating the results of the 
conference; and
    (vii) Any additional criteria that may be announced by the 
Administrator.
    (viii) In addition to the scientific and technical criteria above, 
peer reviewers may be asked to consider the degree to which a proposed 
project addresses any special AHCPR priorities that have been announced 
by the Administrator, as appropriate.
    (d) Conflict of interest. (1) Members of peer review groups will be 
screened for potential conflicts of interest prior to appointment and 
will be required to follow Department policies and procedures consistent 
with the Standards of Ethical Conduct for Employees of the Executive 
Branch (5 CFR part 2635), Executive Order 12674 (as modified by 
Executive Order 12731).
    (2) In addition to any restrictions referenced under paragraph 
(d)(1) of this section:
    (i) No member of a peer review group (or individual reviewer) may 
participate in or be present during any review by such group of a grant 
application in which, to the member's knowledge, any of the following 
has a financial interest:
    (A) The member or his or her spouse, minor child, or partner;
    (B) Any organization in which the member is serving as an officer, 
director, trustee, general partner, or employee; or
    (C) Any organization with which the member is negotiating or has any 
arrangement concerning prospective employment or other similar 
association, and further;
    (ii) In the event that any member of a peer review group or his or 
her spouse, parent, child, or partner is currently or expected to be the 
principal investigator or member of the staff responsible for carrying 
out any research or development activities contemplated as part of a 
grant application, that member of the group, or the group, may be 
disqualified from the review and the review conducted by another group 
with the expertise to do so. An ad hoc group selected in accordance with 
Sec. 67.15(a), or Sec. 67.15(b) as applicable, may also be used for the 
review. Any individual reviewer to whom the conditions of this paragraph 
apply would also be disqualified as a reviewer.
    (iii) No member of a peer review group or individual may participate 
in any review under this subpart of a specific grant application for 
which the member has had or is expected to have any other responsibility 
or involvement (whether preaward or postaward) as an officer or employee 
of the United States.
    (3) Where permissible under the standards and order(s) cited in 
paragraph (d)(1) of this section, the Administrator may waive the 
requirements in paragraph (d)(2) of this section if it is determined 
that there is no other practical means for securing appropriate expert 
advice on a particular grant application.

[62 FR 12909, Mar. 18, 1997, as amended at 62 FR 37124, July 10, 1997]

[[Page 500]]



Sec. 67.16  Evaluation and disposition of application.

    (a) Evaluation. After appropriate peer review in accordance with 
Sec. 67.15, the Administrator will evaluate applications recommended for 
further consideration, taking into account, among other factors:
    (1) The degree to which the purposes of Title IX of the PHS Act and 
section 1142 of the Social Security Act, as applicable, are being 
addressed;
    (2) Recommendations made by reviewers pursuant to Sec. 67.15;
    (3) Any recommendations made by the National Advisory Council for 
Health Care Policy, Research, and Evaluation, as applicable;
    (4) The appropriateness of the budget;
    (5) The extent to which the research proposal and the fiscal plan 
provide assurance that effective use will be made of grant funds;
    (6) The demonstrated business management capability of the 
applicant;
    (7) The demonstrated competence and skill of the staff, especially 
the senior personnel, in light of the scope of the project;
    (8) The probable usefulness of the results of the project for 
dealing with national health care issues, policies, and programs; and
    (9) The degree to which AHCPR-announced priorities or purposes are 
being addressed.
    (b) Disposition. On the basis of the evaluation of the application 
as provided in paragraph (a) of this section, the Administrator shall: 
give consideration for funding, defer for a later decision, pending 
receipt of additional information, or give no further consideration for 
funding, to any application for a grant under this subpart; except that 
the Administrator may not fund an application which has not been 
recommended for further consideration as a result of peer review in 
accordance with Sec. 67.15. A recommendation against further 
consideration shall not preclude reconsideration, if the application is 
revised, responding to issues and questions raised during the review, 
and resubmitted for peer review at a later date.



Sec. 67.17  Grant award.

    (a) Within the limits of available funds, the Administrator may 
award grants to those applicants whose projects are being considered for 
funding, which in the judgment of the Administrator, will promote best 
the purposes of Title IX of the PHS Act and (if applicable) section 1142 
of the Social Security Act, AHCPR priorities, and the regulations of 
this subpart.
    (b) The Notice of Grant Award specifies how long the Administrator 
intends to support the project without requiring the project to 
recompete for funds. This period, called the project period, will 
usually be for 3-5 years, except for small grants, which usually are 1 
year awards. The project period as specified in the Notice of Grant 
Award shall begin no later than 9 months following the date of the 
award, except that the project period must begin in the same fiscal year 
as that from which funds are being awarded.
    (c) Upon request from the grantee, Department grants policy permits 
an extension of the project period for up to 12 months, without 
additional funds, when more time is needed to complete the research. The 
Administrator may approve a request for an additional extension of time 
based on unusual circumstances with written justification submitted by 
the grantee, prior to the completion of the project period. In no case 
will an additional extension of more than 12 months be approved.
    (d) Generally, a grant award will be for 1 year, and subsequent 
continuation awards will be for 1 year at a time. A grantee must submit 
a separate continuation application to have the support continued for 
each subsequent year. Decisions regarding continuation awards and the 
funding level of such awards will be made after consideration of such 
factors as the grantee's progress and management practices and the 
availability of funds. In all cases, continuation awards require a 
determination by the Administrator that continuation is in the best 
interest of the Federal Government.

[[Page 501]]

    (e) Neither the approval of any application nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application.
    (f) Small grants. For particular categories of small grants, such as 
dissertation research support, the Administrator may establish a limit 
on total direct costs to be awarded. Any categorical limits will be 
announced in advance of the deadline for receipt of applications for 
such small grants.
    (g) Supplemental awards. (1) Except for small grants, supplemental 
awards that would exceed 20 percent of the AHCPR approved direct costs 
of the project during the project period, or that request an increase in 
funds to support a change or a significant expansion of the scope of the 
project, will be reviewed as competing supplemental grants in accordance 
with Sec. 67.15(a). A supplemental award for preparation of data in 
suitable form for transmittal in accordance with Sec. 67.21 shall be 
excluded from the 20 percent aggregate.
    (2) In the case of small grants, as defined in section 922(d)(2) of 
the PHS Act, the Administrator will not approve a supplemental award 
during the project period (excluding any supplemental award for 
preparation of data in suitable form for transmittal in accordance with 
Sec. 67.21) that will, in the aggregate, exceed 10 percent of the AHCPR 
approved direct costs of the project.
    (h) Noncompeting continuation awards. Each project with a project 
period in excess of 2 years and with direct costs over the project 
period in excess of the amount specified in section 922(d)(2) may be 
reviewed during the second budget period and during each subsequent 
budget period by at least two members of the peer review group that 
reviewed the initial application, or individuals who participated in 
that review, to the extent practicable. Recommendations to the 
Administrator for continuation support will be based upon evaluation of:
    (1) The progress of the project in meeting project objectives;
    (2) The appropriateness of the management of the project and 
allocation of resources within the project;
    (3) The adequacy and appropriateness of the plan for carrying out 
the project during the budget period in light of the accomplishments 
during previous budget periods; and
    (4) The reasonableness of the proposed budget for the subsequent 
budget period.



Sec. 67.18  Use of project funds.

    Grant funds must be spent solely for carrying out the approved 
project in accordance with Title IX of PHS Act, section 1142 of the 
Social Security Act (if applicable), the regulations of this subpart, 
the terms and conditions of the award, and the provisions of 45 CFR part 
74, or part 92 for State and local government grantees.



Sec. 67.19  Other applicable regulations.

    Several other regulations apply to grants under this subpart. These 
include, but are not limited to:

37 CFR part 401--Inventions and patents
42 CFR part 50 subpart A--Responsibility of PHS awardee and applicant 
institutions for dealing with and reporting possible misconduct in 
science
42 CFR part 50 subpart D--Public Health Service grant appeals procedure
42 CFR part 50 subpart F--Responsibility of applicants for promoting 
objectivity in research for which PHS funding is sought
45 CFR part 16--Procedures of the departmental grant appeals board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 76--Governmentwide debarment and suspension (nonprocurement) 
and governmentwide requirements for drug-free workplace (grants)
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of Title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearings under Part 80 of 
this title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 86--Nondiscrimination on the basis of sex in education 
programs and activities receiving or benefiting from Federal financial 
assistance

[[Page 502]]

45 CFR part 91--Nondiscrimination on the basis of age in DHHS programs 
or activities receiving Federal financial assistance
45 CFR part 92--Uniform administrative requirements for grants and 
cooperative agreements with State and local governments
45 CFR part 93--New restrictions on lobbying



Sec. 67.20  Confidentiality.

    The confidentiality of identifying information obtained in the 
course of conducting or supporting grant and cooperative agreement 
activities under this subpart is protected by section 903(c) of the PHS 
Act. Specifically:
    (a) No information obtained in the course of conducting or 
supporting grant and cooperative agreement activities under this 
subpart, if the entity or individual supplying the information or 
described in it is identifiable, may be used for any purpose other than 
the purpose for which it was supplied, unless the identifiable entity or 
individual supplying the information or described in it has consented to 
such other use, in the recorded form and manner as the Administrator may 
require; and
    (b) No information obtained in the course of grant and cooperative 
agreement activities conducted or supported under this subpart maybe 
published or released in other form if the individual who supplied the 
information or who is described in it is identifiable, unless such 
individual has consented, in the recorded form and manner as the 
Administrator may require, to such publication or release.



Sec. 67.21  Control of data and availability of publications.

    Except as otherwise provided in the terms and conditions of the 
award and subject to the confidentiality requirements of section 903(c) 
of the PHS Act, section 1142(d) of the Social Security Act, and 
Sec. 67.20 of this subpart:
    (a) All data collected or assembled for the purpose of carrying out 
health services research, evaluation, demonstration, or dissemination 
projects supported under this subpart shall be made available to the 
Administrator, upon request:
    (b) All publications, reports, papers, statistics, or other 
materials developed from work supported, in whole or in part, by an 
award made under this subpart must be submitted to the Administrator in 
a timely manner. All such publications must include an acknowledgement 
that such materials are the results of, or describe, a grant activity 
supported by AHCPR;
    (c) The AHCPR retains a royalty-free, non-exclusive, and irrevocable 
license to reproduce, publish, use, or disseminate any copyrightable 
material developed in the course of or under a grant for any purpose 
consistent with AHCPR's statutory responsibilities, and to authorize 
others to do so for the accomplishment of AHCPR purposes; and
    (d) Except for identifying information protected by section 903(c) 
of the PHS Act, the Administrator, as appropriate, will make information 
obtained with AHCPR grant support available, and arrange for 
dissemination of such information and material on as broad a basis as 
practicable and in such form as to make them as useful as possible to a 
variety of audiences, including health care providers, practitioners, 
consumers, educators, and policymakers.



Sec. 67.22  Additional conditions.

    The Administrator may, with respect to any grant awarded under this 
subpart, impose additional conditions prior to or at the time of any 
award when in the Administrator's judgment such conditions are necessary 
to assure or protect advancement of the approved project, the interest 
of the public health, or the conservation of grant funds.



   Subpart B--Peer Review of Contracts for Health Services Research, 
          Evaluation, Demonstration, and Dissemination Projects



Sec. 67.101  Purpose and scope.

    (a) The regulations of this subpart apply to the peer review of 
contracts under:
    (1) Title IX of the Public Health Service Act to support research, 
evaluation, demonstration, and dissemination projects, including 
conferences, on health care services and systems for

[[Page 503]]

the delivery of such services; and development of clinical practice 
guidelines, quality standards, performance measures, and review 
criteria.
    (2) Section 1142 of the Social Security Act to support research on 
the outcomes, effectiveness, and appropriateness of health care services 
and procedures, including, but not limited to, evaluations of 
alternative services and procedures; projects to improve methods and 
data bases for outcomes and effectiveness research; dissemination of 
research information and clinical practice guidelines, as well as 
quality standards, performance measures, and review criteria; 
conferences; and research on dissemination methods.
    (b) The regulations of this subpart also contain provisions 
respecting confidentiality of research data, control of data, and 
availability of information.



Sec. 67.102  Definitions.

    Contract proposal means a written offer to enter into a contract 
submitted to a contracting officer by an individual or non-Federal 
organization, and including at a minimum a description of the nature, 
purpose, duration, cost of project and methods, personnel, and 
facilities to be utilized in carrying out the requirements of the 
contract.
    Peer review group means a panel of experts, as required by section 
922(c) of the PHS Act, established to conduct technical and scientific 
review of contract proposals and to make recommendations to the 
Administrator regarding the merits of such proposals.
    Request for proposals means a Government solicitation to prospective 
offerors, under procedures for negotiated contracts, to submit a 
proposal to fulfill specific agency requirements based on terms and 
conditions defined in the solicitation. The solicitation contains 
information sufficient to enable all offerors to prepare competitive 
proposals, and is as complete as possible with respect to: The nature of 
work to be performed; descriptions and specifications of items to be 
delivered; performance schedule; special requirements, clauses or other 
circumstances affecting the contract; and criteria by which the 
proposals will be evaluated.



Sec. 67.103  Peer review of contract proposals.

    (a) All contract proposals for AHCPR support will be submitted by 
the Administrator for review to a peer review group, as required in 
section 922(a) of the PHS Act. Proposals will be reviewed in accordance 
with the Federal Acquisition Regulations and the Health and Human 
Services Acquisition Regulations (48 CFR Ch. I and III) and the 
requirements of the pertinent Request for Proposal.
    (b) Establishment of peer review groups. In accordance with section 
922(c) of the PHS Act, the Administrator shall establish such peer 
review groups as may be necessary to review all contract proposals 
submitted to AHCPR.
    (c) Composition of peer review groups. The peer review groups shall 
be composed of individuals, in accordance with section 922(c) of the PHS 
Act, as amended, who by virtue of their training or experience are 
eminently qualified to carry out the duties of such a peer review group. 
Officers and employees of the United States may not constitute more than 
25 percent of the membership of any such group. Members of the peer 
review group will be selected based upon their training or experience in 
relevant scientific and technical fields, taking into account, among 
other factors:
    (1) The level of formal education (e.g., M.A., Ph.D., M.D., D.N.Sc.) 
completed by the individual and/or, as appropriate, the individual's 
pertinent experience and expertise;
    (2) The extent to which the individual has engaged in relevant 
research, the capacities (e.g., principal investigator, assistant) in 
which the individual has done so, and the quality of such research;
    (3) The extent of the professional recognition received by the 
individual as reflected by awards and other honors received from 
scientific and professional organizations outside the Department of 
Health and Human Services;
    (4) The need of the peer review group to include in its membership 
experts representing various areas of specialization in relevant 
scientific and technical fields, or specific health care issues; and

[[Page 504]]

    (5) Appropriate representation based on gender, racial/ethnic 
origin, and geography, to the extent practicable.
    (d) Term of peer review group members. Notwithstanding section 
922(c)(3) of the PHS Act, members of peer review groups appointed to 
review contract proposals will be appointed to such groups for a limited 
period of time, as determined by the Administrator; such as on an annual 
basis, or until the peer review of the contract proposals is completed, 
or until the expiration of the contract(s) awarded as a result of the 
peer review.
    (e) Conflict of interest. (1) Members of peer review groups will be 
screened for potential conflicts of interest prior to appointment and 
will be required to follow Department policies and procedures consistent 
with the Standards of Ethical Conduct for Employees of the Executive 
Branch (5 CFR part 2635) and Executive Order 12674 (as modified by 
Executive Order 12731).
    (2) In addition to any restrictions referenced under paragraph 
(e)(1) of this section:
    (i) No member of a peer review group may participate in or be 
present during any review by such group of a contract proposal in which, 
to the member's knowledge, any of the following has a financial 
interest:
    (A) The member or his or her spouse, minor child, or partner;
    (B) Any organization in which the member is serving as an officer, 
director, trustee, general partner, or employee; or
    (C) Any organization with which the member is negotiating or has any 
arrangement concerning prospective employment or other similar 
association, and further;
    (ii) In the event any member of a peer review group or his or her 
spouse, parent, child, or partner is currently or expected to be the 
project director or member of the staff responsible for carrying out any 
contract requirements as specified in the contract proposal, that member 
is disqualified and will be replaced as appropriate.



Sec. 67.104  Confidentiality.

    Identifying information obtained in the course of conducting AHCPR 
contract activities under this subpart is protected by section 903(c) of 
the PHS Act. Specifically:
    (a) No information obtained in the course of conducting AHCPR 
contract activities under this subpart, if the entity or individual 
supplying the information or described in it is identifiable, may be 
used for any purpose other than the purpose for which it was supplied, 
unless the identifiable entity or individual supplying the information 
or described in it has consented to such other use, in the recorded form 
and manner as the Administrator may require.
    (b) No information obtained in the course of conducting AHCPR 
contract activities under this subpart may be published or released in 
other form if the individual who supplied the information or who is 
described in it is identifiable, unless such individual has consented, 
in the recorded form and manner as the Administrator may require, to 
such publication or release.



Sec. 67.105  Control of data and availability of publications.

    (a) Data will be collected, maintained, and supplied as provided in 
each contract subject to the confidentiality requirements of section 
903(c) of the PHS Act, section 1142(d) of the Social Security Act, and 
Sec. 67.104 of this subpart.
    (b) All publications, reports, papers, statistics, or other 
materials developed from work supported in whole or in part by contracts 
under Title IX of the PHS Act or section 1142 of the Social Security 
Act, if applicable, must be submitted to the Administrator in accordance 
with the terms of the contract. All publications must include an 
acknowledgment that such materials are the results of, or describe, a 
contractual activity supported by AHCPR.
    (c) In accordance with 48 CFR 52.227-14, unless otherwise specified 
in the contract, AHCPR will retain a license to use, disclose, 
reproduce, prepare derivative works from, distribute copies to the 
public, and perform publicly and display publicly any copyrightable 
materials produced under a contract for any purpose consistent with 
AHCPR's statutory responsibilities, and to have or permit others to do 
so for accomplishment of AHCPR purposes.

[[Page 505]]

    (d) Except for identifying information protected by section 903(c) 
of the PHS Act, the Administrator, as appropriate, will make information 
provided in accordance with paragraphs (a) and (b) of this section 
available, and arrange for dissemination of such information and 
materials on as broad a basis as practicable and in such form as to make 
them as useful as possible to a variety of audiences, including health 
care providers, practitioners, consumers, educators, and policymakers.



PART 68a--NATIONAL INSTITUTES OF HEALTH (NIH) CLINICAL RESEARCH LOAN REPAYMENT PROGRAM FOR INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS (CR-LRP)--Table of Contents




Sec.
68a.1  What is the scope and purpose of the NIH Clinical Research Loan 
          Repayment Program for Individuals from Disadvantaged 
          Backgrounds (CR-LRP)?
68a.2  Definitions.
68a.3  Who is eligible to apply?
68a.4  Who is eligible to participate?
68a.5  Who is ineligible to participate?
68a.6  How do individuals apply to participate in the CR-LRP?
68a.7  How are applicants selected to participate in the CR-LRP?
68a.8  What does the CR-LRP provide to participants?
68a.9  What loans qualify for repayment?
68a.10  What does an individual have to do in return for loan repayments 
          received under the CR-LRP?
68a.11  How does an individual receive loan repayments beyond the 
          initial two-year contract?
68a.12  What will happen if an individual does not comply with the terms 
          and conditions of participation in the CR-LRP?
68a.13  Under what circumstances can the service or payment obligation 
          be canceled, waived, or suspended?
68a.14  When can a CR-LRP payment obligation be discharged in 
          bankruptcy?
68a.15  Additional conditions.
68a.16  What other regulations and statutes apply?

    Authority: 42 U.S.C. 288-5.

    Source: 63 FR 58312, Oct. 30, 1998, unless otherwise noted.



Sec. 68a.1  What is the scope and purpose of the NIH Clinical Research Loan Repayment Program for Individuals from Disadvantaged Backgrounds (CR-LRP)?

    This part applies to the award of educational loan payments under 
the NIH Clinical Research Loan Repayment Program for Individuals from 
Disadvantaged Backgrounds (CR-LRP) authorized by section 487E of the 
Public Health Service Act (42 U.S.C. 288-5). The purpose of this program 
is to recruit and retain appropriately qualified health professionals, 
who are from disadvantaged backgrounds and have substantial educational 
debt relative to income, to conduct clinical research as NIH employees.



Sec. 68a.2  Definitions.

    As used in this part:
    Act means the Public Health Service Act, as amended (42 U.S.C. 201 
et seq.).
    Applicant means an individual who applies to, and meets the 
eligibility criteria for the CR-LRP.
    Approved clinical research means clinical research approved by the 
Clinical Research Loan Repayment Committee.
    Clinical privileges means the delineation of privileges for patient 
care granted to qualified health professionals by the NIH Medical 
Executive Committee or other appropriate credentialing board.
    Clinical research means activities which qualify for inclusion as 
clinical research in the CR-LRP as determined by the Clinical Research 
Loan Repayment Committee.
    Clinical Research Loan Repayment Committee (CR-LRC) means the 
scientific board assembled to review, rank, and approve or disapprove 
Clinical Research Loan Repayment Program applications. The CR-LRC is 
composed of NIH scientific staff and co-chaired by the Associate 
Director for Clinical Research, NIH, and the Associate Director for 
Research on Minority Health, NIH. Members are nominated by the Deputy 
Director, Intramural Research, NIH, and the co-chairs, and appointed by 
the Director, NIH.
    Clinical Research Loan Repayment Program (CR-LRP or Program) means 
the

[[Page 506]]

NIH Clinical Research Loan Repayment Program for Individuals from 
Disadvantaged Backgrounds authorized by section 487E of the Act, as 
amended.
    Clinical Research Loan Repayment Program (CR-LRP or Program) 
contract refers to the agreement, which is signed by an applicant and 
the Secretary, wherein the applicant from a disadvantaged background 
agrees to engage in clinical research as an employee of the NIH and the 
Secretary agrees to repay qualified educational loans for a prescribed 
period as specified in this part.
    Clinical researcher means an NIH employee with clinical privileges 
who is conducting approved clinical research.
    Commercial loans means loans made by banks, credit unions, savings 
and loan associations, not-for-profit organizations, insurance 
companies, schools, and other financial or credit institutions which are 
subject to examination and supervision in their capacity as lending 
institutions by an agency of the United States or of the State in which 
the lender has its principal place of business.
    Current payment status means that a qualified educational loan is 
not past due in its payment schedule as determined by the lending 
institution.
    Debt threshold refers to the minimum amount of qualified educational 
debt an individual must have, on his/her program eligibility date, in 
order to be eligible for Program benefits and, for purposes of 
eligibility under this part, debt threshold means that the qualified 
educational debt must equal or exceed 20 percent of an individual's 
annual NIH salary on his/her program eligibility date.
    Educational expenses means the cost of the health professional's 
education, including the tuition expenses and other educational expenses 
such as fees, books, supplies, educational equipment and materials, and 
laboratory expenses.
    Government loans means loans made by Federal, State, county, or city 
agencies which are authorized by law to make such loans.
    Individual from disadvantaged background means an individual who:
    (1) Comes from an environment that inhibited the individual from 
obtaining the knowledge, skill and ability required to enroll in and 
graduate from a health professions school; or
    (2) Comes from a family with an annual income below a level based on 
low-income thresholds according to family size published by the U.S. 
Bureau of the Census, adjusted annually for changes in the Consumer 
Price Index, and adjusted by the Secretary for use in all health 
professions programs. The Secretary periodically publishes these income 
levels in the Federal Register.
    Institute, Center, or Agency (ICA) means an institute, center, or 
agency of the National Institutes of Health.
    Living expenses means the reasonable cost of room and board, 
transportation and commuting costs, and other reasonable costs incurred 
during an individual's attendance at an educational institution.
    Participant means an individual whose application to the CR-LRP has 
been approved and whose Program contract has been executed by the 
Secretary.
    Program means the NIH Clinical Research Loan Repayment Program for 
Individuals from Disadvantaged Backgrounds.
    Program eligibility date means the date on which an individual's 
Program contract is executed by the Secretary and that individual is 
engaged in approved clinical research as an employee of the NIH.
    Qualified educational loans and interest/debt include Government and 
commercial educational loans and interest for:
    (1) Undergraduate, graduate, and health professional school tuition 
expenses;
    (2) Other reasonable educational expenses required by the school(s) 
attended, including fees, books, supplies, educational equipment and 
materials, and laboratory expenses; and (3) reasonable living expenses, 
including the cost of room and board, transportation and commuting 
costs, and other reasonable living expenses incurred.
    Reasonable educational and living expenses means those educational 
and living expenses which are equal to or less than the sum of the 
school's estimated

[[Page 507]]

standard student budget for educational and living expenses for the 
degree program and for the year(s) during which the participant was 
enrolled in school. If there is no standard budget available from the 
school or if the participant requests repayment for educational and 
living expenses which exceed the standard student budget, reasonableness 
of educational and living expenses incurred must be substantiated by 
additional contemporaneous documentation, as determined by the 
Secretary.
    Repayable debt means the portion, as established by the Secretary, 
of an individual's total qualified educational debt relative to the NIH 
salary, which can be paid by the CR-LRP. Specifically, qualifying 
educational debt amounts in excess of 50 percent of the debt threshold 
will be considered for repayment.
    Salary means base pay plus quarters, subsistence, and variable 
housing allowances, if applicable.
    School means undergraduate, graduate, and health professions schools 
which are accredited by a body or bodies recognized for accreditation 
purposes by the Secretary of Education.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    Service means the Public Health Service.
    State means one of the fifty States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Northern Mariana Islands, the U.S. 
Virgin Islands, Guam, American Samoa, and the Trust Territory of the 
Pacific Islands (the Federated States of Micronesia, the Republic of the 
Marshall Islands, and the Republic of Palau).
    Withdrawal means a request by a participant, prior to the Program 
making payments on his or her behalf, for withdrawal from Program 
participation. A withdrawal is without penalty to the participant and 
without obligation to the Program.



Sec. 68a.3  Who is eligible to apply?

    To be eligible to apply to the CR-LRP, an individual must be a 
citizen, national, or permanent resident of the United States; hold a 
M.D., Ph.D., D.O., D.D.S., D.M.D., A.D.N./B.S.N., or equivalent degree; 
have, on his/her program eligibility date, qualified educational debt 
equal to or in excess of the debt threshold; and be an individual from a 
disadvantaged background.



Sec. 68a.4  Who is eligible to participate?

    To be eligible to participate in the CR-LRP, an applicant must have 
the recommendation of the employing ICA Scientific Program Director, the 
concurrence of the employing ICA Director, and the approval of the CR-
LRC. Since participation in the Program is contingent, in part, upon 
employment with NIH, a Program contract may not be awarded to an 
applicant until an employment commitment has been made by the employing 
ICA Personnel Department.



Sec. 68a.5  Who is ineligible to participate?

    The following individuals are ineligible for CR-LRP participation:
    (a) Persons who are not eligible applicants as specified under 
section 68a.3;
    (b) Persons who owe an obligation of health professional service to 
the Federal Government, a State, or other entity, unless a deferral is 
granted for the length of his/her service obligation under the CR-LRP. 
The following are examples of programs which have a service obligation: 
Physicians Shortage Area Scholarship Program, National Research Service 
Award Program, Public Health Service Scholarship, National Health 
Service Corps Scholarship Program, Armed Forces (Army, Navy, or Air 
Force) Professions Scholarship Program, Indian Health Service 
Scholarship Program, and the NIH AIDS Research Loan Repayment Program.
    (c) Persons who are not NIH employees, such as Intramural Research 
Training Award (IRTA) recipients, Visiting Fellows, National Research 
Service Award (NRSA) recipients, Guest Researchers or Special 
Volunteers, NIH-National Research Council (NRC) Biotechnology Research 
Associates Program participants, and Intergovernmental Personnel Act 
(IPA) participants; or

[[Page 508]]

    (d) Persons who do not have clinical privileges.



Sec. 68a.6  How do individuals apply to participate in the CR-LRP?

    An application for participation in the CR-LRP shall be submitted to 
the NIH office which is responsible for the Program's administration, in 
such form and manner as the Secretary may prescribe.



Sec. 68a.7  How are applicants selected to participate in the CR-LRP?

    To be selected for participation in the CR-LRP, applicants must 
satisfy the following requirements:
    (a) Applicants must meet the eligibility requirements specified in 
Sec. 68a.3 and Sec. 68a.4.
    (b) Applicants must not be ineligible for participation as specified 
in Sec. 68a.5.
    (c) Applicants must be selected for approval by the CR-LRC, based 
upon a review of their applications.



Sec. 68a.8  What does the CR-LRP provide to participants?

    (a) Loan repayments: For each year of service the individual agrees 
to serve, with a minimum of 2 years of obligated service, the Secretary 
may pay up to $20,000 per year of a participant's repayable debt.
    (b) Under Sec. 68a.8(a), the Secretary will make payments in the 
discharge of debt to the extent appropriated funds are available for 
these purposes.



Sec. 68a.9  What loans qualify for repayment?

    (a) The CR-LRP will repay participants' lenders the principal, 
interest, and related expenses of qualified Government and commercial 
educational loans obtained by participants for the following:
    (1) Undergraduate, graduate, and health professional school tuition 
expenses;
    (2) Other reasonable educational expenses required by the school(s) 
attended, including fees, books, supplies, educational equipment and 
materials, and laboratory expenses; and
    (3) Reasonable living expenses, including the cost of room and 
board, transportation and commuting costs, and other living expenses as 
determined by the Secretary.
    (b) The following educational loans are ineligible for repayment 
under the CR-LRP:
    (1) Loans obtained from other than a government entity or commercial 
lending institution;
    (2) Loans for which contemporaneous documentation is not available;
    (3) Loans or portions of loans obtained for educational or living 
expenses which exceed the standard of reasonableness as determined by 
the participant's standard school budget for the year in which the loan 
was made, and are not determined by the Secretary to be reasonable based 
on additional documentation provided by the individual;
    (4) Loans, financial debts, or service obligations incurred under 
the following programs: Physicians Shortage Area Scholarship Program 
(Federal or State), National Research Service Award Program, Public 
Health and National Health Service Corps Scholarship Training Program, 
National Health Service Corps Scholarship Program, Armed Forces (Army, 
Navy, or Air Force) Health Professions Scholarship Program, Indian 
Health Service Program, and similar programs, upon determination by the 
Secretary, which provide loans, scholarships, loan repayments, or other 
awards in exchange for a future service obligation;
    (5) Any loan in default or not in a current payment status;
    (6) Loan amounts which participants have paid or were due to have 
paid prior to the program eligibility date; and
    (7) Loans for which promissory notes have been signed after the 
program eligibility date.



Sec. 68a.10  What does an individual have to do in return for loan repayments received under the CR-LRP?

    Individuals must agree to be engaged in approved clinical research, 
as employees of the NIH, for a minimum initial period of two consecutive 
years.

[[Page 509]]



Sec. 68a.11  How does an individual receive loan repayments beyond the initial two-year contract?

    An individual may apply for and the Secretary may grant extension 
contracts for one-year periods, if there is sufficient debt remaining to 
be repaid and the individual is engaged in approved clinical research as 
an NIH employee.



Sec. 68a.12  What will happen if an individual does not comply with the terms and conditions of participation in the CR-LRP?

    (a) Absent withdrawal (see Sec. 68a.2) or termination under 
paragraph (d) of this section, any participant who fails to complete the 
minimum two-year service obligation required under the Program contract 
will be considered to have breached the contract and will be subject to 
assessment of monetary damages and penalties as follows:
    (1) Participants who leave during the first year of the initial 
contract are liable for amounts already paid by the NIH on behalf of the 
participant plus an amount equal to $1,000 multiplied by the number of 
months of the original service obligation.
    (2) Participants who leave during the second year of the contract 
are liable for amounts already paid by the NIH on behalf of the 
participant plus $1,000 for each unserved month.
    (b) Payments of any amount owed under paragraph (a) of this section 
shall be made within one year of the participant's breach (or such 
longer period as determined by the Secretary).
    (c) Participants who sign a continuation contract for any year 
beyond the initial two-year period and fail to complete the one-year 
period specified are liable for the pro rata amount of any benefits 
advanced beyond the period of completed service.
    (d) Terminations will not be considered a breach of contract in 
cases where such terminations are beyond the control of the participant 
as follows:
    (1) Terminations for cause or for convenience of the Government will 
not be considered a breach of contract and monetary damages will not be 
assessed.
    (2) Occasionally, a participant's research assignment may evolve and 
change to the extent that the individual is no longer engaged in 
approved clinical research. Similarly, the research needs and priorities 
of the ICA and/or the NIH may change to the extent that a determination 
is made that the health professional's skills may be better utilized in 
a non-clinical research assignment. Under these circumstances, the 
following will apply:
    (i) Program participation and benefits will cease as of the date an 
individual is no longer engaged in approved clinical research; and
    (ii) Normally, job changes of this nature will not be considered a 
breach of contract on the part of either the NIH or the participant. 
Based on the recommendation of the ICA Director and concurrence of the 
Secretary, the participant will be released from the remainder of his or 
her service obligation without assessment of monetary penalties. The 
participant in this case will be permitted to retain all Program 
benefits made or owed by NIH on his/her behalf up to the date the 
individual is no longer engaged in approved clinical research, except 
the pro rata amount of any benefits advanced beyond the period of 
completed service.



Sec. 68a.13  Under what circumstances can the service or payment obligation be canceled, waived, or suspended?

    (a) Any obligation of a participant for service or payment to the 
Federal Government under this part will be canceled upon the death of 
the participant.
    (b) The Secretary may waive or suspend any service or payment 
obligation incurred by the participant upon request whenever compliance 
by the participant:
    (1) Is impossible,
    (2) Would involve extreme hardship to the participant, or
    (3) If enforcement of the service or payment obligation would be 
against equity and good conscience.
    (4) The Secretary may approve a request for a suspension of the 
service or payment obligations for a period of 1 year. A renewal of this 
suspension may also be granted.
    (c) Compliance by a participant with a service or payment obligation 
will be

[[Page 510]]

considered impossible if the Secretary determines, on the basis of such 
information and documentation as may be required, that the participant 
suffers from a physical or mental disability resulting in the permanent 
inability of the participant to perform the service or other activities 
which would be necessary to comply with the obligation.
    (d) In determining whether to waive or suspend any or all of the 
service or payment obligations of a participant as imposing an undue 
hardship and being against equity and good conscience, the Secretary, on 
the basis of such information and documentation as may be required, will 
consider:
    (1) The participant's present financial resources and obligations;
    (2) The participant's estimated future financial resources and 
obligations; and
    (3) The extent to which the participant has problems of a personal 
nature, such as a physical or mental disability or terminal illness in 
the immediate family, which so intrude on the participant's present and 
future ability to perform as to raise a presumption that the individual 
will be unable to perform the obligation incurred.



Sec. 68a.14  When can a CR-LRP payment obligation be discharged in bankruptcy?

    Any payment obligation incurred under Sec. 68a.12 may be discharged 
in bankruptcy under Title 11 of the United States Code only if such 
discharge is granted after the expiration of the five-year period 
beginning on the first date that payment is required and only if the 
bankruptcy court finds that a nondischarge of the obligation would be 
unconscionable.



Sec. 68a.15  Additional conditions.

    When a shortage of funds exists, participants may be funded 
partially, as determined by the Secretary. However, once a CR-LRP 
contract has been signed by both parties, the Secretary will obligate 
such funds as necessary to ensure that sufficient funds will be 
available to pay benefits for the duration of the period of obligated 
service unless, by mutual written agreement between the Secretary and 
the applicant, specified otherwise. Benefits will be paid on a quarterly 
basis after each service period unless specified otherwise by mutual 
written agreement between the Secretary and the applicant. The Secretary 
may impose additional conditions as deemed necessary.



Sec. 68a.16  What other regulations and statutes apply?

    Several other regulations and statutes apply to this part. These 
include, but are not necessarily limited to:
    Debt Collection Act of 1982, Pub. L. 97-365 (5 U.S.C. 5514);
    Fair Credit Reporting Act (15 U.S.C. 1681 et seq.);
    Federal Debt Collection Procedures Act of 1990, Pub. L. 101-647 (28 
U.S.C. 1); and Privacy Act of 1974 (5 U.S.C. 552a).

[[Page 511]]



             SUBCHAPTER F--QUARANTINE, INSPECTION, LICENSING





PART 71--FOREIGN QUARANTINE--Table of Contents




              Subpart A--Definitions and General Provisions

Sec.
71.1  Scope and definitions.
71.2  Penalties.
71.3  Designation of yellow fever vaccination centers: Validation 
          stamps.

                  Subpart B--Measures at Foreign Ports

71.11  Bills of health.

       Subpart C--Notice of Communicable Disease Prior to Arrival

71.21  Radio report of death or illness.

     Subpart D--Health Measures at U.S. Ports: Communicable Diseases

71.31  General provisions.
71.32  Persons, carriers, and things.
71.33  Persons: Isolation and surveillance.
71.34  Carriers of U.S. military services.
71.35  Report of death or illness on carrier during stay in port.

 Subpart E--Requirements Upon Arrival at U.S. Ports: Sanitary Inspection

71.41  General provisions.
71.42  Disinsection of imports.
71.43  Exemption for mails.
71.44  Disinsection of aircraft.
71.45  Food, potable water, and waste: U.S. seaports and airports.
71.46  Issuance of Deratting Certificates and Deratting Exemption 
          Certificates.
71.47  Special provisions relating to airports: Office and isolation 
          facilities.
71.48  Carriers in intercoastal and interstate traffic.

                         Subpart F--Importations

71.51  Dogs and cats.
71.52  Turtles, tortoises, and terrapins.
71.53  Nonhuman primates.
71.54  Etiological agents, hosts, and vectors.
71.55  Dead bodies.

    Authority: Sec. 215 of Public Health Service (PHS) Act, as amended 
(42 U.S.C. 216); secs. 361-369, PHS Act, as amended (42 U.S.C. 264-272); 
E.O. 12452 of December 22, 1983, 48 FR 56927.

    Source: 50 FR 1519, Jan. 11, 1985, unless otherwise noted.



              Subpart A--Definitions and General Provisions



Sec. 71.1  Scope and definitions.

    (a) The provisions of this part contain the regulations to prevent 
the introduction, transmission, and spread of communicable disease from 
foreign countries into the States or possessions of the United States. 
Regulations pertaining to preventing the interstate spread of 
communicable diseases are contained in 21 CFR parts 1240 and 1250.
    (b) As used in this part the term:
    Carrier means a ship, aircraft, train, road vehicle, or other means 
of transport, including military.
    Communicable disease means an illness due to a specific infectious 
agent or its toxic products which arises through transmission of that 
agent or its products from an infected person or animal or a reservoir 
to a susceptible host, either directly, or indirectly through an 
intermediate animal host, vector, or the inanimate environment.
    Contamination means the presence of undesirable substances or 
material which may contain infectious agents or their toxic products.
    Controlled Free Pratique means permission for a carrier to enter a 
U.S. port, disembark, and begin operation under certain stipulated 
conditions.
    Deratting Certificate means a certificate issued under the 
instructions of the Director, in the form prescribed by the 
International Health Regulations, recording the inspection and deratting 
of the ship.
    Deratting Exemption Certificate means a certificate issued under the 
instructions of the Director, in the form prescribed by the 
International Health Regulations, recording the inspection and exemption 
from deratting of the ship which is rodent free.
    Detention means the temporary holding of a person, ship, aircraft, 
or other carrier, animal, or thing in such place and for such period of 
time as may be determined by the Director.
    Director means the Director, Centers for Disease Control, Public 
Health Service, Department of Health and

[[Page 512]]

Human Services, or his/her authorized representative.
    Disinfection means the killing of infectious agents or inactivation 
of their toxic products outside the body by direct exposure to chemical 
or physical agents.
    Disinfestation means any chemical or physical process serving to 
destroy or remove undesired small animal forms, particularly arthropods 
or rodents, present upon the person, the clothing, or the environment of 
an individual, or upon animals and carriers.
    Disinsection means the operation in which measures are taken to kill 
the insect vectors of human disease present in carriers and containers.
    Educational purpose means use in the teaching of a defined 
educational program at the university level or equivalent.
    Exhibition purpose means use as a part of a display in a facility 
comparable to a zoological park or in a trained animal act. The animal 
display must be open to the general public at routinely scheduled hours 
on 5 or more days of each week. The trained animal act must be routinely 
scheduled for multiple performances each week and open to the general 
public except for reasonable vacation and retraining periods.
    Ill person means a person who:
    (1) Has a temperature of 100  deg.F. (or 38  deg.C.) or greater, 
accompanied by a rash, glandular swelling, or jaundice, or which has 
persisted for more than 48 hours; or
    (2) Has diarrhea, defined as the occurrence in a 24-hour period of 
three or more loose stools or of a greater than normal (for the person) 
amount of loose stools.
    International Health Regulations means the International Health 
Regulations of the World Health Organization, adopted by the Twenty-
Second World Health Assembly in 1969, as amended by the Twenty-Sixth 
World Health Assembly in 1973, the Thirty-Fourth World Health Assembly 
in 1981, and as may be further amended.
    International voyage means: (1) In the case of a carrier, a voyage 
between ports or airports of more than one country, or a voyage between 
ports or airports of the same country if the ship or aircraft stopped in 
any other country on its voyage; or (2) in the case of a person, a 
voyage involving entry into a country other than the country in which 
that person begins his/her voyage.
    Isolation means: (1) When applied to a person or group of persons, 
the separation of that person or group of persons from other persons, 
except the health staff on duty, in such a manner as to prevent the 
spread of infection; or (2) when applied to animals, the separation of 
an animal or group of animals from persons, other animals, or vectors of 
disease in such a manner as to prevent the spread of infection.
    Military services means the U.S. Army, the U.S. Air Force, the U.S. 
Navy, and the U.S. Coast Guard.
    Scientific purpose means use for scientific research following a 
defined protocol and other standards for research projects as normally 
conducted at the university level. The term also includes the use for 
safety testing, potency testing, and other activities related to the 
production of medical products.
    Surveillance means the temporary supervision of a person who may 
have or has been exposed to a communicable disease.
    U.S. port means any seaport, airport, or border crossing point under 
the control of the United States.
    United States means the several States, the District of Columbia, 
Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the 
Virgin Islands, American Samoa, and the Trust Territory of the Pacific 
Islands.
    Vector means an animal (including insects) or thing which conveys or 
is capable of conveying infectious agents from a person or animal to 
another person or animal.



Sec. 71.2  Penalties.

    Any person violating any provision of these regulations shall be 
subject to a fine of not more than $1,000 or to imprisonment for not 
more than 1 year, or both, as provided in section 368 of the Public 
Health Service Act (42 U.S.C. 271).

[[Page 513]]



Sec. 71.3  Designation of yellow fever vaccination centers; Validation stamps.

    (a) Designation of yellow fever vaccination centers. (1) The 
Director is responsible for the designation of yellow fever vaccination 
centers authorized to issue certificates of vaccination. This 
responsibility is delegated by the Director to a State or territorial 
health department with respect to yellow fever vaccination activities of 
non-Federal medical, public health facilities, and licensed physicians 
functioning within the respective jurisdictions of a State or 
territorial health department. Designation may be made upon application 
and presentation of evidence satisfactory to a State or territorial 
health department that the applicant has adequate facilities and 
professionally trained personnel for the handling, storage, and 
administration of a safe, potent, and pure yellow fever vaccine. Medical 
facilities of Federal agencies are authorized to obtain yellow fever 
vaccine without being designated as a yellow fever vaccination center by 
the Director.
    (2) A designated yellow fever vaccination center shall comply with 
the instruction issued by the Director or by a delegated officer or 
employee of a State or territorial health department for the handling, 
storage, and administration of yellow fever vaccine. If a designated 
center fails to comply with such instruction, after notice to the 
center, the Director or, for non-Federal centers, a State or territorial 
health department, may revoke designation.
    (b) Validation stamps. International Certificates of Vaccination 
against cholera and yellow fever issued for vaccinations performed in 
the United States shall be validated by:
    (1) The Seal of the Public Health Service; or
    (2) The Seal of the Department of State; or
    (3) The stamp of the Department of Defense; or
    (4) The stamp issued to the National Aeronautics and Space 
Administration; or
    (5) The stamp issued by a State or territorial health department; or
    (6) An official stamp of a design and size approved by the Director 
for such purpose.



                  Subpart B--Measures at Foreign Ports



Sec. 71.11  Bills of health.

    A carrier at any foreign port clearing or departing for any U.S. 
port shall not be required to obtain or deliver a bill of health.



       Subpart C--Notice of Communicable Disease Prior to Arrival



Sec. 71.21  Radio report of death or illness.

    (a) The master of a ship destined for a U.S. port shall report 
immediately to the quarantine station at or nearest the port at which 
the ship will arrive, the occurrence, on board, of any death or any ill 
person among passengers or crew (including those who have disembarked or 
have been removed) during the 15-day period preceding the date of 
expected arrival or during the period since departure from a U.S. port 
(whichever period of time is shorter).
    (b) The commander of an aircraft destined for a U.S. airport shall 
report immediately to the quarantine station at or nearest the airport 
at which the aircraft will arrive, the occurrence, on board, of any 
death or ill person among passengers or crew.
    (c) In addition to paragraph (a) of this section, the master of a 
ship carrying 13 or more passengers must report by radio 24 hours before 
arrival the number of cases (including zero) of diarrhea in passengers 
and crew recorded in the ship's medical log during the current cruise. 
All cases of diarrhea that occur after the 24 hour report must also be 
reported not less than 4 hours before arrival.

(Approved by the Office of Management and Budget under control number 
0920-0134)



     Subpart D--Health Measures at U.S. Ports: Communicable Diseases



Sec. 71.31  General provisions.

    (a) Upon arrival at a U.S. port, a carrier will not undergo 
inspection unless the Director determines that a failure to inspect will 
present a threat of introduction of communicable diseases

[[Page 514]]

into the United States, as may exist when the carrier has on board 
individual(s) reportable in accordance with Sec. 71.21 or meets the 
circumstances described in Sec. 71.42. Carriers not subject to 
inspection under this section will be subject to sanitary inspection 
under Sec. 71.41 of this part.
    (b) The Director may require detention of a carrier until the 
completion of the measures outlined in this part that are necessary to 
prevent the introduction or spread of a communicable disease. The 
Director may issue a controlled free pratique to the carrier stipulating 
what measures are to be met, but such issuance does not prevent the 
periodic boarding of a carrier and the inspection of persons and records 
to verify that the conditions have been met for granting the pratique.



Sec. 71.32  Persons, carriers, and things.

    (a) Whenever the Director has reason to believe that any arriving 
person is infected with or has been exposed to any of the communicable 
diseases listed in paragraph (b) of this section, he/she may detain, 
isolate, or place the person under surveillance and may order 
disinfection or disinfestation as he/she considers necessary to prevent 
the introduction, transmission, or spread of the listed communicable 
diseases.
    (b) The communicable diseases authorizing the application of 
sanitary, detention, and/or isolation measures under paragraph (a) of 
this section are: cholera or suspected cholera, diphtheria, infectious 
tuberculosis, plague, suspected smallpox, yellow fever, or suspected 
viral hemorrhagic fevers (Lassa, Marburg, Ebola, Congo-Crimean, and 
others not yet isolated or named).
    (c) Whenever the Director has reason to believe that any arriving 
carrier or article or thing on board the carrier is or may be infected 
or contaminated with a communicable disease, he/she may require 
detention, disinsection, disinfection, disinfestation, fumigation, or 
other related measures respecting the carrier or article or thing as he/
she considers necessary to prevent the introduction, transmission, or 
spread of communicable diseases.



Sec. 71.33  Persons: Isolation and surveillance.

    (a) Persons held in isolation under this subpart may be held in 
facilities suitable for isolation and treatment.
    (b) The Director may require isolation where surveillance is 
authorized in this subpart whenever the Director considers the risk of 
transmission of infection to be exceptionally serious.
    (c) Every person who is placed under surveillance by authority of 
this subpart shall, during the period of surveillance:
    (1) Give information relative to his/her health and his/her intended 
destination and report, in person or by telephone, to the local health 
officer having jurisdiction over the areas to be visited, and report for 
medical examinations as may be required;
    (2) Upon arrival at any address other than that stated as the 
intended destination when placed under surveillance, or prior to 
departure from the United States, inform, in person or by telephone, the 
health officer serving the health jurisdiction from which he/she is 
departing.
    (d) From time to time the Director may, in accordance with section 
322 of the Public Health Service Act, enter into agreements with public 
or private medical or hospital facilities for providing care and 
treatment for persons detained under this part.

(Approved by the Office of Management and Budget under control number 
0920-0134)

[50 FR 1519, Jan. 11, 1985; 50 FR 3910, Jan. 29, 1985]



Sec. 71.34  Carriers of U.S. military services.

    (a) Carriers belonging to or operated by the military services of 
the United States may be exempted from inspection if the Director is 
satisfied that they have complied with regulations of the military 
services which also meet the requirements of the regulations in this 
part. (For applicable regulations of the military services, see Army 
Regulation No. 40-12, Air Force Regulation No. 161-4, Secretary of the 
Navy Instruction 6210.2, and Coast Guard Commandant Instruction 6210.2).

[[Page 515]]

    (b) Notwithstanding exemption from inspection of carriers under this 
section, animals or articles on board shall be required to comply with 
the applicable requirements of subpart F of this part.



Sec. 71.35  Report of death or illness on carrier during stay in port.

    The master of any carrier at a U.S. port shall report immediately to 
the quarantine station at or nearest the port the occurrence, on board, 
of any death or any ill person among passengers or crew.

(Approved by the Office of Management and Budget under control number 
0920-0134)



 Subpart E--Requirements Upon Arrival at U.S. Ports: Sanitary Inspection



Sec. 71.41  General provisions.

    Carriers arriving at a U.S. port from a foreign area shall be 
subject to a sanitary inspection to determine whether there exists 
rodent, insect, or other vermin infestation, contaminated food or water, 
or other insanitary conditions requiring measures for the prevention of 
the introduction, transmission, or spread of communicable disease.



Sec. 71.42  Disinfection of imports.

    When the cargo manifest of a carrier lists articles which may 
require disinfection under the provisions of this part, the Director 
shall disinfect them on board or request the appropriate customs officer 
to keep the articles separated from the other cargo pending appropriate 
disposition.



Sec. 71.43  Exemption for mails.

    Except to the extent that mail contains any article or thing subject 
to restrictions under subpart F of this part, nothing in the regulations 
in this part shall render liable to detention, disinfection, or 
destruction any mail conveyed under the authority of the postal 
administration of the United States or of any other Government.



Sec. 71.44  Disinsection of aircraft.

    (a) The Director may require disinsection of an aircraft if it has 
left a foreign area that is infected with insect-borne communicable 
disease and the aircraft is suspected of harboring insects of public 
health importance.
    (b) Disinsection shall be the responsibility of the air carrier or, 
in the case of aircraft not for hire, the pilot in command, and shall be 
subject to monitoring by the Director.
    (c) Disinsection of the aircraft shall be accomplished immediately 
after landing and blocking.
    (1) The cargo compartment shall be disinsected before the mail, 
baggage, and other cargo are discharged.
    (2) The rest of the aircraft shall be disinsected after passengers 
and crew deplane.
    (d) Disinsection shall be performed with an approved insecticide in 
accordance with the manufacturer's instructions. The current list of 
approved insecticides and sources may be obtained from the Division of 
Quarantine, Center for Prevention Services, Centers for Disease Control, 
Atlanta, GA 30333.



Sec. 71.45  Food, potable water, and waste: U.S. seaports and airports.

    (a) Every seaport and airport shall be provided with a supply of 
potable water from a watering point approved by the Commissioner of Food 
and Drugs, Food and Drug Administration, in accordance with standards 
established in title 21, Code of Federal Regulations, parts 1240 and 
1250.
    (b) All food and potable water taken on board a ship or aircraft at 
any seaport or airport intended for human consumption thereon shall be 
obtained from sources approved in accordance with regulations cited in 
paragraph (a) of this section.
    (c) Aircraft inbound or outbound on an international voyage shall 
not discharge over the United States any excrement, or waste water or 
other polluting materials. Arriving aircraft shall discharge such matter 
only at servicing areas approved under regulations cited in paragraph 
(a) of this section.



Sec. 71.46  Issuance of Deratting Certificates and Deratting Exemption Certificates.

    Valid Deratting Certificates or Deratting Exemption Certificates are

[[Page 516]]

not required for ships to enter a U.S. seaport. In accordance with 
Article 17 of the International Health Regulations, the Public Health 
Service may perform rodent infestation inspections and issue Deratting 
Certificates and Deratting Exemption Certificates.



Sec. 71.47  Special provisions relating to airports: Office and isolation facilities.

    Each U.S. airport which receives international traffic shall provide 
without cost to the Government suitable office, isolation, and other 
exclusive space for carrying out the Federal responsibilities under this 
part.



Sec. 71.48  Carriers in intercoastal and interstate traffic.

    Carriers, on an international voyage, which are in traffic between 
U.S. ports, shall be subject to inspection as described in Secs. 71.31 
and 71.41 when there occurs on board, among passengers or crew, any 
death, or any ill person, or when illness is suspected to be caused by 
insanitary conditions.



                         Subpart F--Importations



Sec. 71.51  Dogs and cats.

    (a) Definitions.
    As used in this section the term:
    Cat means all domestic cats.
    Confinement means restriction of a dog or cat to a building or other 
enclosure at a U.S. port, en route to destination and at destination, in 
isolation from other animals and from persons except for contact 
necessary for its care or, if the dog or cat is allowed out of the 
enclosure, muzzling and keeping it on a leash.
    Dog means all domestic dogs.
    Owner means owner or agent.
    Valid rabies vaccination certificate means a certificate which was 
issued for a dog not less than 3 months of age at the time of 
vaccination and which:
    (1) Identifies a dog on the basis of breed, sex, age, color, 
markings, and other identifying information.
    (2) Specifies a date of rabies vaccination at least 30 days before 
the date of arrival of the dog at a U.S. port.
    (3) Specifies a date of expiration which is after the date of 
arrival of the dog at a U.S. port. If no date of expiration is 
specified, then the date of vaccination shall be no more than 12 months 
before the date of arrival at a U.S. port.
    (4) Bears the signature of a licensed veterinarian.
    (b) General requirements for admission of dogs and cats--(1) 
Inspection by Director. The Director shall inspect all dogs and cats 
which arrive at a U.S. port, and admit only those dogs and cats which 
show no signs of communicable disease as defined in Sec. 71.1.
    (2) Examination by veterinarian and confinement of dogs and cats. 
When, upon inspection, a dog or cat does not appear to be in good health 
on arrival (e.g., it has symptoms such as emaciation, lesions of the 
skin, nervous system disturbances, jaundice, or diarrhea), the Director 
may require prompt confinement and give the owner an opportunity to 
arrange for a licensed veterinarian to examine the animal and give or 
arrange for any tests or treatment indicated. The Director will consider 
the findings of the examination and tests in determining whether or not 
the dog or cat may have a communicable disease. The owner shall bear the 
expense of the examination, tests, and treatment. When it is necessary 
to detain a dog or cat pending determination of its admissibility, the 
owner shall provide confinement facilities which in the judgment of the 
Director will afford protection against any communicable disease. The 
owner shall bear the expense of confinement. Confinement shall be 
subject to conditions specified by the Director to protect the public 
health.
    (3) Record of sickness or death of dogs and cats and requirements 
for exposed animals. (i) The carrier responsible for the care of dogs 
and cats shall maintain a record of sickness or death of animals en 
route to the United States and shall submit the record to the quarantine 
station at the U.S. port upon arrival. Dogs or cats which have become 
sick while en route or are dead on arrival shall be separated from other 
animals as soon as the sickness or death is discovered, and shall be 
held in confinement pending any necessary examination as determined by 
the Director.

[[Page 517]]

    (ii) When, upon inspection, a dog or cat appears healthy but, during 
shipment, has been exposed to a sick or dead animal suspected of having 
a communicable disease, the exposed dog or cat shall be admitted only if 
examination or tests made on arrival reveal no evidence that the animal 
may be infected with a communicable disease. The provisions of paragraph 
(b)(2) of this section shall be applicable to the examination or tests.
    (4) Sanitation. When the Director finds that the cages or other 
containers of dogs or cats arriving in the United States are in an 
insanitary or other condition that may constitute a communicable disease 
hazard, the dogs or cats shall not be admitted in such containers unless 
the owner has the containers cleaned and disinfected.
    (c) Rabies vaccination requirements for dogs. (1) A valid rabies 
vaccination certificate is required at a U.S. port for admission of a 
dog unless the owner submits evidence satisfactory to the Director that:
    (i) If a dog is less than 6 months of age, it has been only in a 
country determined by the Director to be rabies-free (a current list of 
rabies-free countries may be obtained from the Division of Quarantine, 
Center for Prevention Services, Centers for Disease Control, Atlanta, GA 
30333); or
    (ii) If a dog is 6 months of age or older, for the 6 months before 
arrival, it has been only in a country determined by the Director to be 
rabies-free; or
    (iii) The dog is to be taken to a research facility to be used for 
research purposes and vaccination would interfere with its use for such 
purposes.
    (2) Regardless of the provisions of paragraph (c)(1) of this 
section, the Director may authorize admission as follows:
    (i) If the date of vaccination shown on the vaccination certificate 
is less than 30 days before the date of arrival, the dog may be 
admitted, but must be confined until at least 30 days have elapsed since 
the date of vaccination;
    (ii) If the dog is less than 3 months of age, it may be admitted, 
but must be confined until vaccinated against rabies at 3 months of age 
and for at least 30 days after the date of vaccination;
    (iii) If the dog is 3 months of age or older, it may be admitted, 
but must be confined until it is vaccinated against rabies. The dog must 
be vaccinated within 4 days after arrival at destination but no more 
than 10 days after arrival at a U.S. port. It must be kept in 
confinement for at least 30 days after the date of vaccination.
    (3) When a dog is admitted under paragraph (c)(2) of this section, 
the Director shall notify the health department or other appropriate 
agency having jurisdiction at the point of destination and shall provide 
the address of the specified place of confinement and other pertinent 
information to facilitate surveillance and other appropriate action.
    (d) Certification requirements. The owner shall submit such 
certification regarding confinement and vaccination prescribed under 
this section as may be required by the Director.
    (e) Additional requirements for the importation of dogs and cats. 
Dogs and cats shall be subject to such additional requirements as may be 
deemed necessary by the Director or to exclusion if coming from areas 
which the Director has determined to have high rates of rabies.
    (f) Requirements for dogs and cats in transit. The provisions of 
this section shall apply to dogs and cats transported through the United 
States from one foreign country to another, except as provided below:
    (1) Dogs and cats that appear healthy, but have been exposed to a 
sick or dead animal suspected of having a communicable disease, need not 
undergo examination or tests as provided in paragraph (b)(3) of this 
section if the Director determines that the conditions under which they 
are being transported will afford adequate protection against 
introduction of communicable disease.
    (2) Rabies vaccination is not required for dogs that are transported 
by aircraft or ship and retained in custody of the carrier under 
conditions that would prevent transmission of rabies.
    (g) Disposal of excluded dogs and cats. A dog or cat excluded from 
the United States under the regulations in this part shall be exported 
or destroyed.

[[Page 518]]

Pending exportation, it shall be detained at the owner's expense in the 
custody of the U.S. Customs Service at the U.S. port.

(Approved by the Office of Management and Budget under control number 
0920-0134)



Sec. 71.52  Turtles, tortoises, and terrapins.

    (a) Definitions.
    As used in this section the term:
    Turtles includes all animals commonly known as turtles, tortoises, 
terrapins, and all other animals of the order Testudinata, class 
Reptilia, except marine species (Families Dermochelidae and 
Cheloniidae).
    (b) Importation; general prohibition. Except as otherwise provided 
in this section, live turtles with a carapace length of less than 4 
inches and viable turtle eggs may not be imported into the United 
States.
    (c) Exceptions. (1) Live turtles with a carapace length of less than 
4 inches and viable turtle eggs may be imported into the United States, 
provided that such importation is not in connection with a business, and 
the importation is limited to lots of fewer than seven live turtles or 
fewer than seven viable turtle eggs, or any combinations of such turtles 
and turtle eggs totaling fewer than seven, for any entry.
    (2) Seven or more live turtles with a carapace length of less than 4 
inches, or seven or more viable turtle eggs or any combination of 
turtles and turtle eggs totaling seven or more, may be imported into the 
United States for bona fide scientific or educational purposes or for 
exhibition when accompanied by a permit issued by the Director.
    (3) The requirements in paragraphs (c)(1) and (c)(2) of this section 
shall not apply to the eggs of marine turtles excluded from these 
regulations under Sec. 71.52(a).
    (d) Application for permits. Applications for permits to import 
turtles, as set forth in paragraph (c)(2) of this section, shall be made 
by letter to the Director, and shall contain, identify, or describe, the 
name and address of the applicant, the number of specimens, and the 
common and scientific names of each species to be imported, the holding 
facilities, the intended use of the turtles following their importation, 
the precautions to be undertaken to prevent infection of members of the 
public with Salmonella and Arizona bacteria, and any other information 
and assurances the Director may require.
    (e) Criteria for issuance of permits. A permit may be issued upon a 
determination that the holder of the permit will isolate or otherwise 
confine the turtles and will take such other precautions as may be 
determined by the Director to be necessary to prevent infection of 
members of the public with Salmonella and Arizona bacteria and on 
condition that the holder of the permit will provide such reports as the 
Director may require.
    (f) Interstate Regulations. Upon admission at a U.S. Port, turtles 
and viable turtle eggs become subject to Food and Drug Administration 
Regulations (21 CFR 1240.62) regarding general prohibition.
    (g) Other permits. Permits to import certain species of turtles may 
be required under other Federal regulations (50 CFR parts 17 and 23) 
protecting such species.

(Approved by the Office of Management and Budget under control number 
0920-0134)



Sec. 71.53  Nonhuman primates.

    (a) Definitions.
    As used in this section the term:
    Importer means any person or corporation, partnership, or other 
organization, receiving live nonhuman primates from a foreign country 
within a period of 31 days, beginning with the importation date, whether 
or not the primates were held for part of the period at another 
location. The term importer includes the original importer and any other 
person or organization receiving imported primates within the 31-day 
period.
    Nonhuman primates means all nonhuman members of the Order Primates, 
including, but not limited to, animals commonly known as monkeys, 
chimpanzees, orangutans, gorillas, gibbons, apes, baboons, marmosets, 
tamarin, lemurs, and lorises.
    (b) General prohibition. No person or organization may import live 
nonhuman primates into the United States unless registered as an 
importer

[[Page 519]]

in accordance with applicable provisions of this section.
    (c) Uses for which nonhuman primates may be imported and 
distributed. Live nonhuman primates may be imported into the United 
States and sold, resold, or otherwise distributed only for bona fide 
scientific, educational, or exhibition purposes. The importation of 
nonhuman primates for use in breeding colonies is also permitted 
provided that all offspring will be used only for scientific, 
educational, or exhibition purposes. The maintenance of nonhuman 
primates as pets, hobby, or an avocation with occasional display to the 
general public is not a permissible use.
    (d) Registration of importers. (1) Importers of nonhuman primates 
shall register with the Director in a manner prescribed by the Director.
    (2) Documentary evidence that an importer will use all nonhuman 
primates solely for the permitted purposes is required.
    (3) Registration shall inlcude certification that the nonhuman 
primates will not be shipped, sold, or otherwise transferred to other 
persons or organizations without adequate proof that the primates will 
be used only for the permitted purposes.
    (4) Registration shall be for 2 years, effective the date the 
application for registration is approved by the Director.
    (5) Registration may be renewed by filing a registration application 
form with the Director not less than 30 days nor more than 60 days 
before expiration of the current registration.
    (e) Recordkeeping and reporting requirement for registered 
importers. (1) Importers shall maintain records on each shipment of 
imported nonhuman primates received. The record on each shipment shall 
include the number of primates received, species, country of origin, 
date of importation, the number of primates in the shipment that die 
within 90 days after receipt, and cause(s) of deaths. If any primates in 
the shipment are sold or otherwise distributed within 90 days after 
receipt, the record shall include the number of primates in each 
shipment or sale, the dates of each shipment or sale, and the identity 
of the recipients. In addition, the record shall contain copies of 
documents that were presented to the importer to establish that the 
recipient would use the primates solely for the permitted purposes. The 
records shall be maintained in an organized manner in a central location 
at or in close proximity to the importer's primate holding facility. The 
records shall be maintained for a period of 3 years and shall be 
available for inspection by the Director at any time.
    (2) Importers shall report to the Director by telephone within 24 
hours the occurrence of any illness in nonhuman primates that is 
suspected of being yellow fever, monkeypox, or Marburg/Ebola disease.
    (3) Importers also shall report to the Director by telephone within 
24 hours the occurrence of illness in any member of their staff 
suspected of having an infectious disease acquired from nonhuman 
primates.
    (f) Disease control measures. Upon receipt of evidence of exposure 
of nonhuman primates to a communicable disease that may constitute a 
threat to public health, the Director may provide for or require 
examination, treatment, detention, isolation, seizure, or destruction of 
exposed animals. Any measures required shall be at the owner's expense.
    (g) Disposal of excluded nonhuman primates. Nonhuman primate(s) 
excluded from the United States by provisions of this section shall, at 
the owner's option and expense, be exported, destroyed, or given to a 
scientific, educational, or exhibition facility under arrangements 
approved by the Director. If the owner fails to dispose of the nonhuman 
primate by one of the approved options or fails to select a method of 
disposal within 7 days, the Director will select the method of disposal. 
Pending disposal, the nonhuman primate(s) shall be detained at the 
owner's expense in custody of the U.S. Customs Service at the U.S. port.
    (h) Revocation of an importer's registration. (1) An importer's 
registration may be revoked by the Director, upon notice to the importer 
holding such registration, if the Director determines that the importer 
has failed to comply with any applicable provisions of this section. The 
notice shall contain a

[[Page 520]]

statement of the grounds upon which the revocation is based.
    (2) The importer may file an answer within 20 days after receipt of 
the notice. Answers shall admit or deny specifically, and in detail, 
each allegation in the notice. Allegations in the notice not denied by 
answer shall be deemed admitted. Matters alleged as affirmative defenses 
shall be separately stated and numbered. Failure of the importer to file 
an answer within 20 days after receipt of the notice may be deemed an 
admission of all allegations of fact recited in the notice.
    (3) The importer shall be entitled to a hearing with respect to the 
revocation upon filing a written request, either in the answer or in a 
separate document, with the Director within 20 days after the effective 
date of revocation. Failure to request a hearing shall be deemed a 
waiver of hearing and as consent to the submission of the case to the 
Director for decision based on the written record. The failure both to 
file an answer and to request a hearing shall be deemed to constitute 
consent to the making of a decision on the basis of available 
information.
    (4) As soon as practicable after the completion of any hearing 
conducted pursuant to the provisions of this section, the Director shall 
render a final decision. A copy of such decision shall be served on the 
importer.
    (5) An importer's registration which has been revoked may be 
reinstated by the Director upon inspection, examination of records, 
conference with the importer, and receipt of information and assurances 
of compliance with the requirements of this section.
    (i) Other permits. In addition to the requirements under this 
section, permits to import certain species of nonhuman primates may also 
be required under other Federal regulations (50 CFR parts 17 and 23) 
protecting such species.

(Approved by the Office of Management and Budget under control number 
0920-0134)



Sec. 71.54  Etiological agents, hosts, and vectors.

    (a) A person may not import into the United States, nor distribute 
after importation, any etiological agent or any arthropod or other 
animal host or vector of human disease, or any exotic living arthropod 
or other animal capable of being a host or vector of human disease 
unless accompanied by a permit issued by the Director.
    (b) Any import coming within the provisions of this section will not 
be released from custody prior to receipt by the District Director of 
the U.S. Customs Service of a permit issued by the Director.



Sec. 71.55  Dead bodies.

    The remains of a person who died of a communicable disease listed in 
Sec. 71.32(b) may not be brought into a U.S. port unless the body is (a) 
properly embalmed and placed in a hermetically sealed casket, (b) 
cremated, or (c) accompanied by a permit issued by the Director.



PART 72--INTERSTATE SHIPMENT OF ETIOLOGIC AGENTS 1--Table of Contents



---------------------------------------------------------------------------

    1 The requirements of this part are in addition to and not in 
lieu of any other packaging or other requirements for the transportation 
of etiologic agents in interstate traffic prescribed by the Department 
of Transportation and other agencies of the Federal Government.
---------------------------------------------------------------------------

Sec.
72.1  Definitions.
72.2  Transportation of diagnostic specimens, biological products, and 
          other materials; minimum packaging requirements.
72.3  Transportation of materials containing certain etiologic agents; 
          minimum packaging requirements.
72.4  Notice of delivery; failure to receive.
72.5  Requirements; variations.
72.6  Additional requirements for facilities transferring or receiving 
          select agents.
72.7  Penalties.

Appendix A to Part 72--Select Agents

    Authority: 42 U.S.C. 264, 271; 31 U.S.C. 9701; 18 U.S.C. 3559, 3571; 
42 U.S.C. 262 note.

    Source: 45 FR 48627, July 21, 1980, unless otherwise noted.



Sec. 72.1  Definitions.

    As used in this part:
    Biological product means a biological product prepared and 
manufactured in accordance with the provisions of 9 CFR parts 102-104 
and 21 CFR parts 312 and 600-680 and which, in accordance

[[Page 521]]

with such provisions, may be shipped in interstate traffic.
    Diagnostic specimen means any human or animal material including, 
but not limited to, excreta, secreta, blood and its components, tissue, 
and tissue fluids being shipped for purposes of diagnosis.
    Etiologic agent means a viable microorganism or its toxin which 
causes, or may cause, human disease.
    Interstate traffic means the movement of any conveyance or the 
transportation of persons or property, including any portion of such 
movement or transportation which is entirely within a State or 
possession, (a) from a point of origin in any State or possession to a 
point of destination in any other State or possession, or (b) between a 
point of origin and a point of destination in the same State or 
possession but through any other State, possession, or contiguous 
foreign country.



Sec. 72.2  Transportation of diagnostic specimens, biological products, and other materials; minimum packaging requirements.

    No person may knowingly transport or cause to be transported in 
interstate traffic, directly or indirectly, any material including, but 
not limited to, diagnostic specimens and biological products which such 
person reasonably believes may contain an etiologic agent unless such 
material is packaged to withstand leakage of contents, shocks, pressure 
changes, and other conditions incident to ordinary handling in 
transportation.



Sec. 72.3  Transportation of materials containing certain etiologic agents; minimum packaging requirements.

    Notwithstanding the provisions of Sec. 72.2, no person may knowingly 
transport or cause to be transported in interstate traffic, directly or 
indirectly, any material (other than biological products) known to 
contain, or reasonably believed by such person to contain, one or more 
of the following etiologic agents unless such material is packaged, 
labeled, and shipped in accordance with the requirements specified in 
paragraphs (a) through (f) of this section:

                            Bacterial Agents

Acinetobacter calcoaceticus.
Actinobacillus-- all species.
Actinomycetaceae-- all members.
Aeromonas hydrophila.
Arachnia propionica.
Arizona hinshawii-- all serotypes.
Bacillus anthracis.
Bacteroides spp.
Bartonella-- all species.
Bordetella-- all species.
Borrelia recurrentis, B. vincenti.
Brucella-- all species.
Campylobacter (Vibrio) foetus, C. (Vibrio) jejuni.
Chlamydia psittaci, C. trachomatis.
Clostridium botulinum, Cl. chauvoei, Cl. haemolyticum, Cl. 
histolyticum,Cl. novyi, Cl. septicum, Cl. tetani.
Corynebacterium diphtheriae, C. equi, C. haemolyticum, C. 
pseudotuberculosis, C. pyogenes, C. renale.
Edwarsiella tarda.
Erysipelothrix insidiosa.
Escherichia coli, all enteropathogenic serotypes.
Francisella (Pasteurella) Tularensis.
Haemophilus ducreyi, H. influenzae.
Klebsiella-- all species and all serotypes.
Legionella-- all species and all Legionella-like organisms.
Leptospira interrogans-- all serovars.
Listeria-- all species.
Mimae polymorpha.
Moraxella-- all species.
Mycobacterium-- all species.
Mycoplasma-- all species.
Neisseria gonorrhoeae, N. meningitidis.
Nocardia asteroides.
Pasteurella-- all species.
Plesiomonas shigelloides.
Proteus-- all species.
Pseudomonas mallei.
Pseudomonas pseudomallei.
Salmonella-- all species and all serotypes.
Shigella-- all species and all serotypes.
Sphaerophorus necrophorus.
Staphylococcus aureus.
Streptobacillus moniliformis.
Streptococcus pneumoniae.
Streptococcus pyogenes.
Treponema careteum, T. pallidum, and T. pertenue.
Vibrio cholerae, V. parahemolyticus.
Yersinia (Pasteurella) pestis, Y. enterocolitica.

                              Fungal Agents

Blastomyces dermatitidis.
Coccidioides immitis.
Cryptococcus neoformans.
Histoplasma capsulatum.
Paracoccidioides brasiliensis.

                      Viral and Rickettsial Agents

Adenoviruses--human--all types.

[[Page 522]]

Arboviruses--all types.
Coxiella burnetii.
Coxsackie A and B viruses--all types.
Creutzfeldt--Jacob agent
Cytomegaloviruses.
Dengue viruses--all types.
Ebola virus.
Echoviruses--all types.
Encephalomyocarditis virus.
Hemorrhagic fever agents including, but not limited to, Crimean 
hemorrhagic fever (Congo), Junin, Machupo viruses, and Korean 
hemorrhagic fever viruses.
Hepatitis associated materials (hepatitis A, hepatitis B, hepatitis 
nonA-nonB).
Herpesvirus--all members.
Infectious bronchitis-like virus.
Influenza viruses--all types.
Kuru agent.
Lassa virus.
Lymphocytic choriomeningitis virus.
Marburg virus.
Measles virus.
Mumps virus.
Parainfluenza viruses--all types.
Polioviruses--all types.
Poxviruses--all members.
Rabies virus--all strains.
Reoviruses--all types.
Respiratory syncytial virus.
Rhinoviruses--all types.
Rickettsia-- all species.
Rochalimaea quintana.
Rotaviruses--all types.
Rubella virus.
Simian virus 40.
Tick-borne encephalitis virus complex, including Russian spring-summer 
encephalitis, Kyasanur forest disease, Omsk hemorrhagic fever, and 
Central European encephalitis viruses.
Vaccinia virus.
Varicella virus.
Variola major and Variola minor viruses.
Vesicular stomatis viruses--all types.
White pox viruses.
Yellow fever virus.2

    2 This list may be revised from time to time by Notice 
published in the Federal Register to identify additional agents which 
must be packaged in accordance with the requirements contained in this 
part.
---------------------------------------------------------------------------

    (a) Volume not exceeding 50 ml. Material shall be placed in a 
securely closed, watertight container (primary container (test tube, 
vial, etc.)) which shall be enclosed in a second, durable watertight 
container (secondary container). Several primary containers may be 
enclosed in a single secondary container, if the total volume of all the 
primary containers so enclosed does not exceed 50 ml. The space at the 
top, bottom, and sides between the primary and secondary containers 
shall contain sufficient nonparticulate absorbent material (e.g., paper 
towel) to absorb the entire contents of the primary container(s) in case 
of breakage or leakage. Each set of primary and secondary containers 
shall then be enclosed in an outer shipping container constructed of 
corrugated fiberboard, cardboard, wood, or other material of equivalent 
strength.
    (b) Volume greater than 50 ml. Packaging of material in volumes of 
50 ml. or more shall comply with requirements specified in paragraph (a) 
of this section. In addition, a shock absorbent material, in volume at 
least equal to that of the absorbent material between the primary and 
secondary containers, shall be placed at the top, bottom, and sides 
between the secondary container and the outer shipping container. Single 
primary containers shall not contain more than 1,000 ml of material. 
However, two or more primary containers whose combined volumes do not 
exceed 1,000 ml may be placed in a single, secondary container. The 
maximum amount of etiologic agent which may be enclosed within a single 
outer shipping container shall not exceed 4,000 ml.
    (c) Dry ice. If dry ice is used as a refrigerant, it must be placed 
outside the secondary container(s). If dry ice is used between the 
secondary container and the outer shipping container, the shock 
absorbent material shall be placed so that the secondary container does 
not become loose inside the outer shipping container as the dry ice 
sublimates.
    (d)(1) The outer shipping container of all materials containing 
etiologic agents transported in interstate traffic must bear a label as 
illustrated and described below:

[[Page 523]]

[GRAPHIC] [TIFF OMITTED] TC01FE91.049

    (2) The color of material on which the label is printed must be 
white, the symbol red, and the printing in red or white as illustrated.
    (3) The label must be a rectangle measuring 51 millimeters (mm) (2 
inches) high by 102.5 mm (4 inches) long.
    (4) The red symbol measuring 38 mm (1\1/2\ inches) in diameter must 
be centered in a white square measuring 51 mm (2 inches) on each side.
    (5) Type size of the letters of label shall be as follows:

Etiologic agents--10 pt. rev.
Biomedical material--14 pt.
In case of damage or leakage--10 pt. rev.
Notify Director CDC, Atlanta, Georgia--8 pt. rev.
404-633-5313--10 pt. rev.

    (e) Damaged packages. The carrier shall promptly, upon discovery of 
evidence of leakage or any other damage to packages bearing an Etiologic 
Agents/Biomedical Material label, isolate the package and notify the 
Director, Center for Disease Control, 1600 Clifton Road, NE., Atlanta, 
GA 30333, by telephone: (404) 633-5313. The carrier shall also notify 
the sender.
    (f) Registered mail or equivalent system. Transportation of the 
following etiologic agents shall be by registered mail or an equivalent 
system which requires or provides for sending notification of receipt to 
the sender immediately upon delivery:

Coccidioides immitis.
Ebola virus.
Francisella (Pasteurella) tularensis.
Hemorrhagic fever agents including, but not limited to, Crimean 
hemorrhagic fever (Congo), Junin, Machupo viruses, and Korean 
hemorrhagic fever viruses.
Herpesvirus simiae (B virus).
Histoplasma capsulatum.
Lassa virus.
Marburg virus.
Pseudomonas mallei.
Pseudomonas pseudomallei.
Tick-borne encephalitis virus complex including, but not limited to, 
Russian spring-summer encephalitis, Kyasanur forest disease, Omsk 
Hemorrhagic fever, and Central European encephalitis viruses, Variola 
minor, and Variola major.
Variola major, Variola minor, and Whitepox viruses.
Yersinia (Pasteurella) pestis.3

    3 This list may be revised from time to time by Notice 
published in the Federal Register to identify additional agents which 
must be transported in accordance with requirements contained in 
Sec. 72.3(f).
---------------------------------------------------------------------------



Sec. 72.4  Notice of delivery; failure to receive.

    When notice of delivery of materials known to contain or reasonably 
believed to contain etiologic agents listed in Sec. 72.3(f) is not 
received by the sender within 5 days following anticipated delivery of 
the package, the sender shall notify the Director, Center for Disease 
Control, 1600 Clifton Road, NE., Atlanta, GA 30333 (telephone (404) 633-
5313).

[[Page 524]]



Sec. 72.5  Requirements; variations.

    The Director, Center for Disease Control, may approve variations 
from the requirements of this section if, upon review and evaluation, it 
is found that such variations provide protection at least equivalent to 
that provided by compliance with the requirements specified in this 
section and such findings are made a matter of official record.



Sec. 72.6  Additional requirements for facilities transferring or receiving select agents.

    (a) Registration of facilities. (1) Prior to transferring or 
receiving a select agent listed in Appendix A of this part, a facility 
shall register with a registering entity authorized by the Secretary 
(paragraph (c) of this section) or be approved by the Secretary as 
equipped and capable of handling the covered agent at Biosafety Level 
(BL) 2, 3, or 4, depending on the agent.
    (2) Registration will include:
    (i) Sufficient information provided by the responsible facility 
official indicating that the applicant facility, and its laboratory or 
laboratories, are equipped and capable of handling the agents at BL 2, 
3, or 4, depending upon the agent, and the type of work being performed 
with the agents;
    (ii) Inspection of the applicant facility at the discretion of the 
Secretary or the registering entity in consultation with the Secretary;
    (iii) Issuance by the registering entity of a registration number 
unique to each facility;
    (iv) Collection of a periodic site registration fee by the 
registering entity or the Secretary.
    A schedule of fees collected by the Secretary to cover the direct 
costs (e.g., salaries, equipment, travel) and indirect costs (e.g., 
rent, telephone service and a proportionate share of management and 
administration costs) related to administration of this part will be 
published in the Federal Register and updated annually.
    (v) Follow-up inspections of the facility by the registering entity 
or the Secretary, as appropriate, to ensure the facility continues to 
meet approved standards and recordkeeping requirements.
    (3) Such registration shall remain effective until relinquished by 
the facility or withdrawn by the Secretary or the registering entity.
    (4) The registration may be denied or withdrawn by the registering 
entity or the Secretary based on:
    (i) Evidence that the facility is not or is no longer capable of 
handling covered agents at the applicable biosafety level;
    (ii) Evidence that the facility has handled covered agents in a 
manner in contravention of the applicable biosafety level requirements;
    (iii) Evidence that the facility has or intends to use covered 
agents in a manner harmful to the health of humans;
    (iv) Evidence that the facility has failed to comply with any 
provisions of this part or has acted in a manner in contravention of 
this part; or
    (v) Failure to pay any required registration fee.
    (5) The requirements for BSL-2, 3, and 4 operations pertaining to 
this section are contained in the CDC/NIH publication, ``Biosafety in 
Microbiological and Biomedical Laboratories,'' Third Edition, May 1993 
which is hereby incorporated by reference. The Director of the Federal 
Register has approved under 5 U.S.C. 552(a) and 1 C.F.R. Part 51 the 
incorporation by reference of the above publication. Copies may be 
obtained from the Superintendent of Documents, U.S. Government Printing 
Office, Washington D.C. 20402. Copies may be inspected at the Centers 
for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia, 
or at the Office of the Federal Register, 800 North Capitol Street N.W., 
Suite 700, Washington D.C.
    (6) Additional specific requirements for handling toxins subject to 
this part must be met and are found in 29 CFR Sec. 1910.1450, 
``Occupational Exposure to Hazardous Chemicals in Laboratories.''
    (b) Appeals. A decision made by the Secretary or a registering 
entity to deny or withdraw registration of a particular facility may be 
appealed to the Secretary. An application for appeal must be received by 
the Secretary no later than 14 days after the appealing party's 
application for registration was denied or no later than 14 days after 
the appealing party's registration was

[[Page 525]]

withdrawn. The application must clearly identify the issues presented by 
the appeal and fully explain the appealing party's position with respect 
to those issues. The Secretary may allow the filing of opposing briefs, 
informal conferences, or whatever steps the Secretary considers 
appropriate to fairly resolve the appeal.
    (c) Authorized registering entities. (1) The Secretary may authorize 
a state agency or private entity to register facilities under paragraph 
(a) of this section, if the Secretary determines that the registering 
entity's criteria for determining the biosafety standards for facilities 
handling select agents are consistent with the requirements contained in 
the CDC/NIH publication ``Biosafety in Microbiological and Biomedical 
Laboratories,'' Third Edition.
    (2) A registering entity shall maintain:
    (i) A database of all facilities formerly and currently registered 
as BL 2, 3, or 4 and capable of working with agents in Appendix A of 
this part. The database shall include the name and address of the 
registered facility, the date the facility was registered, the 
facility's registration number, and the name and phone number of the 
responsible facility official.
    (ii) A copy of each CDC Form EA-101 transmitted by each transferor 
registered by that registering entity. Such forms shall be made readily 
accessible to the Secretary and to appropriate federal law enforcement 
authorities and/or authorized local law enforcement authorities.
    (3) In the event the Secretary authorizes more than one registering 
entity, or if otherwise necessary, the Secretary may require the 
establishment of a consolidated database to carry out the provisions of 
Sec. 72.6(c)(2).
    (d) Requests for agents. (1) Prior to the transfer of any agent 
contained in Appendix A of this part, a CDC Form EA-101 must be 
completed for each transfer sought. As specified in CDC Form EA-101, the 
information provided must include:
    (i) The name of the requestor and requesting facility;
    (ii) The name of the transferor and transferring facility;
    (iii) The names of the responsible facility officials for both the 
transferor and requestor;
    (iv) The requesting facility's registration number;
    (v) The transferring facility's registration number;
    (vi) The name of the agent(s) being shipped;
    (vii) The proposed use of the agent(s); and
    (viii) The quantity (number of containers and amount per container) 
of the agent(s) being shipped.
    (2) The form must be signed by the transferor and requestor, and the 
responsible facility officials representing both the transferring and 
requesting facilities.
    (3) A copy of the completed CDC Form EA-101 must be retained by both 
transferring and requesting facilities for a period of five (5) years 
after the date of shipment or for five (5) years after the agents are 
consumed or properly disposed, whichever is longer.
    (4) All CDC forms EA-101 must be produced upon request to 
appropriate federal and authorized local law enforcement authorities, 
officials authorized by the Secretary, and officials of the registering 
entity.
    (e) Verification of registration. (1) Prior to transferring any 
agent covered by this part, the transferor's responsible facility 
official must verify with the requestor's responsible facility official, 
and as appropriate, with the registering entity:
    (i) That the requesting facility retains a valid, current 
registration;
    (ii) That the requestor is an employee of the requesting facility; 
and
    (iii) That the proposed use of the agent by the requestor is 
correctly indicated on CDC Form EA-101.
    (2) In the event that any party is unable to verify the information 
required in paragraph (e)(1) of this section, or there is suspicion that 
the agent may not be used for the requested purpose, then the party 
shall immediately notify CDC.
    (f) Transfer. (1) Upon completion of the CDC Form EA-101 and 
verification of registration, the transferring facility must comply with 
the packaging and shipping requirements in this part

[[Page 526]]

or other applicable regulations when transferring the agent.
    (2) The requesting facility's responsible official must acknowledge 
receipt of the agent telephonically or otherwise electronically within 
36 hours of receipt and provide a paper copy or facsimile transmission 
of receipt to the transferor within 3 business days of receipt of the 
agent.
    (3) Upon telephonic acknowledgment of receipt of the agent, the 
transferor shall provide a completed paper copy or facsimile 
transmission of CDC Form EA-101 within 24 hours to the registering 
entity (holding that facility's registration), in accordance with 
Sec. 72.6(c)(2) for filing in a centralized repository.
    (g) Inspections. (1) Registering entities or the Secretary may 
conduct random or for cause inspections of registered facilities to 
assure compliance with this part. All CDC forms EA-101 and records 
deemed relevant by inspecting officials must be produced upon request to 
authorized personnel conducting these inspections. Inspections may also 
include review of the mechanisms developed by a facility to track 
intrafacility transfers as well as the facility's agent disposal 
procedures.
    (2) In addition, the Secretary may conduct inspections of 
registering entities, and/or any consolidated database established in 
accordance with Sec. 72.6(c)(3), to assure compliance with this part.
    (h) Exemptions--(1) Exemptions for certain select agents: Select 
agents otherwise covered by this part are exempt from its provisions if:
    (i) The agent is part of a clinical specimen intended for 
diagnostic, reference, or verification purposes. Isolates of covered 
agents from clinical specimens shall be disposed of in accordance with 
Sec. 72.6(i) after diagnostic, reference, or verification procedures 
have been completed;
    (ii) The agent is a toxin having an LD50 for vertebrates 
of more than 100 nanograms per kilogram of body weight which is used for 
legitimate medical purposes or biomedical research or is one of the 
listed toxins which has been inactivated for use as a vaccine or 
otherwise detoxified for use in biomedical research procedures; or
    (iii) The agent(s) is an exempted strain specified in Appendix A of 
this part and/or CDC Form EA-101. Additional exemptions for otherwise 
covered strains will be considered when CDC reviews and updates the list 
of select agents (Appendix A of this part). Individuals seeking 
additions to the list of exemptions should submit a request to CDC that 
specifies the agent or strain to be exempted and explains why such an 
exemption should be granted. Future changes to the list of exemptions 
will be published in the Federal Register for review and comment prior 
to inclusion on Appendix A of this part.
    (2) Exemption of CLIA certified laboratories: Clinical laboratories 
certified under the Clinical Laboratory Improvement Amendments of 1988, 
(42 U.S.C. 263a) (CLIA), that utilize these select agents for 
diagnostic, reference, verification, or proficiency testing purposes are 
exempt from the provisions of Sec. 72.6.
    (3) Procedures for facilities that are not CLIA laboratories but are 
transferring or receiving select agents to or from a CLIA laboratory: 
Facilities that are not CLIA laboratories but are transferring or 
receiving select agents to or from a CLIA laboratory must comply with 
the following provisions. (No additional paperwork on behalf of CLIA 
laboratories is required by this section.)
    (i) Prior to transferring a select agent subject to this part to a 
CLIA laboratory for diagnostic, reference, verification, or proficiency 
testing purposes, the transferor must:
    (A) Provide the following information on CDC Form EA-101:
    (1) The name of the requestor and requesting facility;
    (2) The name of the transferor and transferring facility;
    (3) The name of the transferor's responsible facility official;
    (4) The requesting facility's CLIA certification number (which the 
transferor must verify as valid and current with the registering 
entity);
    (5) The transferring facility's registration number;
    (6) The name of the agent(s) being shipped;

[[Page 527]]

    (7) The proposed use of the agent(s); and
    (8) The quantity (number of containers and amount per container) of 
the agent(s) being shipped.
    (B) Verify receipt of the agent with the CLIA laboratory and note 
such receipt on CDC Form EA-101;
    (C) Transmit a copy of the form, signed by the transferror and the 
responsible facility official representing the transfering facility, to 
the registering entity holding the transferring facility's registration; 
and
    (D) Retain a copy of CDC Form EA-101 in accordance with 
Sec. 72.6(d)(3) and Sec. 72.6(d)(4).
    (ii) Prior to receiving a select agent listed in Appendix A of this 
part from a CLIA laboratory, the requestor must be registered in 
accordance with Sec. 72.6(a) and comply with the following requirements:
    (A) Provide the following information on the CDC Form EA-101:
    (1) The name of the requestor and requesting facility;
    (2) The name of the transferor and transferring facility;
    (3) The name of the requestor's responsible facility official;
    (4) The transferring facility's CLIA certification number;
    (5) The requesting facility's registration number;
    (6) The name of the agent(s) being shipped;
    (7) The proposed use of the agent(s); and
    (8) The quantity (number of containers and amount per container) of 
the agent(s) being shipped.
    (B) Upon receiving the agent, note such receipt on CDC Form EA-101;
    (C) Transmit a copy of CDC Form EA-101, signed by the requestor and 
the responsible facility official representing the requesting facility, 
to the registering entity holding the requesting facility's 
registration;
    (D) Retain a copy of the CDC Form EA-101 in accordance with 
Secs. 72.6(d)(3) and 72.6(d)(4);
    (E) Comply with the disposal requirements of Sec. 72.6(i) and all 
other sections of this part when subsequently transferring the agent.
    (i) Agent disposal. (1) Upon termination of the use of the agent, 
all cultures and stocks of it will be
    (i) Securely stored in accordance with prudent laboratory practices,
    (ii) Transferred to another registered facility in accordance with 
this part, or
    (iii) Destroyed on-site by autoclaving, incineration, or another 
recognized sterilization or neutralization process.
    (2) When an agent, previously transferred to a facility in 
accordance with this part, is consumed or destroyed, the responsible 
facility official must formally notify the registering entity. Formal 
notification must be noted on CDC Form EA-101 and a copy kept on record 
by the responsible facility official for a period of five (5) years and 
is subject to paragraph (g) of this section.
    (j) Definitions. As used in this section:
    Facility means any individual or government agency, university, 
corporation, company, partnership, society, association, firm, or other 
legal entity located at a single geographic site that may transfer or 
receive through any means a select agent subject to this part.
    Registering entity means an organization or state agency authorized 
by the Secretary to register facilities as capable of handling select 
agents at Biosafety Level 2, 3, or 4, depending on the agent, in 
accordance with the CDC/NIH publication ``Biosafety in Microbiological 
and Biomedical Laboratories.''
    Requestor means any person who receives or seeks to receive through 
any means a select agent subject to this part from any other person.
    Responsible facility official means an official authorized to 
transfer and receive select agents covered by this part on behalf of the 
transferor's and/or requestor's facility. This person should be either a 
safety officer, a senior management official of the facility, or both. 
The responsible facility official should not be an individual who 
actually transfers or receives an agent at the facility.
    Secretary means the Secretary of the Department of Health and Human 
Services or her or his designee.
    Select agent means a microorganism (virus, bacterium, fungus, 
rickettsia)

[[Page 528]]

or toxin listed in Appendix A of this part. The term also includes:
    (1) Genetically modified microorganisms or genetic elements from 
organisms on Appendix A of this part, shown to produce or encode for a 
factor associated with a disease, and
    (2) Genetically modified microorganisms or genetic elements that 
contain nucleic acid sequences coding for any of the toxins on Appendix 
A of this part, or their toxic submits.
    Single geographic site means a building or complex of buildings at a 
single mailing address.
    Transfer means:
    (1) The conveyance or movement from a point or origination to a 
point of destination either:
    (i) From one state or territory to another or;
    (ii) Entirely within one contiguous state or territory.
    (2) Intrafacility transfers within a registered facility located at 
a single geographic site are not covered by the provisions of Sec. 72.6 
(d), (e), and (f) provided that:
    (i) The intended use of the agent remains consistent with that 
specified in the most current transfer form; and
    (ii) For each intrafacility transfer, the facility maintains records 
that include the name and location of the recipient; the amount of agent 
transferred, and the date transferred. Such records must be maintained 
for a period of five (5) years after the date of transfer or for five 
(5) years after the agents are consumed or properly disposed, whichever 
is longer.
    Transferor means any person who transfers or seeks to transfer 
through any means a select agent subject to this part to any other 
person.

[61 FR 55197, Oct. 24, 1996]



Sec. 72.7  Penalties.

    Individuals in violation of this part are subject to a fine of no 
more than $250,000 or one year in jail, or both. Violations by 
organizations are subject to a fine or no more than $500,000 per event. 
A false, fictitious, or fraudulent statement or representation on the 
Government forms required in the part for registration of facilities or 
for transfers of select agents is subject to a fine or imprisonment for 
not more than five years, or both for an individual; and a fine for an 
organization.

[61 FR 55199, Oct. 24, 1996]

                  Appendix A to Part 72--Select Agents

                                 Viruses

1. Crimean-Congo haemorrhagic fever virus
2. Eastern Equine Encephalitis virus
3. Ebola viruses
4. Equine Morbillivirus
5. Lassa fever virus
6. Marburg virus
7. Rift Valley fever virus
8. South American Haemorrhagic fever viruses (Junin, Machupo, Sabia, 
Flexal, Guanarito)
9. Tick-borne encephalitis complex viruses
10. Variola major virus (Smallpox virus)
11. Venezuelan Equine Encephalitis virus
12. Viruses causing hantavirus pulmonary syndrome
13. Yellow fever virus
Exemptions: Vaccine strains of viral agents (Junin Virus strain candid 
#1, Rift Valley fever virus strain MP-12, Venezuelan Equine encephalitis 
virus strain TC-83, Yellow fever virus strain 17-D) are exempt.

                                Bacteria

1. Bacillus anthracis
2. Brucella abortus, B. melitensis, B. suis
3. Burkholderia (Pseudomonas) mallei
4. Burkholderia (Pseudomonas) pseudomallei
5. Clostridium botulinum
6. Francisella tularensis
7. Yersinia pestis
Exemptions: vaccine strains as described in Title 9 CFR, 78.1 are 
exempt.

                               Rickettsiae

1. Coxiella burnetii
2. Rickettsia prowazekii
3. Rickettsia rickettsii

                                  Fungi

1. Coccidioides immitis

                                 Toxins

1. Abrin
2. Aflatoxins
3. Botulinum toxins
4. Clostridium perfringens epsilon toxin
5. Conotoxins
6. Diacetoxyscirpenol
7. Ricin
8. Saxitoxin
9. Shigatoxin
10. Staphylococcal enterotoxins
11. Tetrodotoxin
12. T-2 toxin
Exemptions: Toxins for medical use, inactivated for use as vaccines, or 
toxin preparations for biomedical research use at an LD50

[[Page 529]]

for vertebrates of more than 100 nanograms per kilogram body weight are 
exempt. National standard toxins required for biologic potency testing 
as described in 9 CFR Part 113 are exempt.

    Recombinant Organisms/Molecules
    1. Genetically modified microorganisms or genetic elements from 
organisms on Appendix A, shown to produce or encode for a factor 
associated with a disease.
    2. Genetically modified microorganisms or genetic elements that 
contain nucleic acid sequences coding for any of the toxins listed in 
this Appendix, or their toxic subunits.

    Other Restrictions
    The deliberate transfer of a drug resistance trait to microorganisms 
listed in this Appendix that are not known to acquire the trait 
naturally is prohibited by NIH ``Guidelines for Research Involving 
Recombinant DNA Molecules,'' if such acquisition could compromise the 
use of the drug to control these disease agents in humans or veterinary 
medicine.

    Additional Exemptions
    1. Products subject to regulation under the Federal Insecticide 
Fungicide and Rodenticide Act (7 U.S.C. 136 et seq.) and the Toxic 
Substances Control Act (15 U.S.C. 2601 et seq.) are exempt.
    2. Additional exemptions for otherwise covered strains will be 
considered when CDC reviews and updates the list of select agents in 
this Appendix. Individuals seeking an exemption should submit a request 
to CDC that specifies the agent or strain to be exempted and explains 
why such an exemption should be granted. Future exemptions will be 
published in the Federal Register for review and comment prior to 
inclusion in this Appendix.

[61 FR 55199, Oct. 24, 1996]



PART 75--STANDARDS FOR THE ACCREDITATION OF EDUCATIONAL PROGRAMS FOR AND THE CREDENTIALING OF RADIOLOGIC PERSONNEL--Table of Contents




Sec.
75.1  Background and purpose.
75.2  Definitions.
75.3  Applicability.

Appendix A to Part 75--Standards for Accreditation of Education Programs 
          for Radiographers
Appendix B to Part 75--Standards for Accreditation of Dental Radiography 
          Training for Dental Hygienists
Appendix C to Part 75--Standards for Accreditation of Dental Radiography 
          Training for Dental Assistants
Appendix D to Part 75--Standards for Accreditation of Educational 
          Programs for Nuclear Medicine Technologists
Appendix E to Part 75--Standards for Accreditation of Education Programs 
          for Radiation Therapy Technologists
Appendix F to Part 75--Standards for Licensing Radiographers, Nuclear 
          Medicine Technologists, and Radiation Therapy Technologists
Appendix G to Part 75--Standards for Licensing Dental Hygienists and 
          Dental Assistants in Dental Radiography

    Authority: Sec. 979 of the Consumer-Patient Radiation Health and 
Safety Act of 1981, Pub. L. 97-35, 95 Stat. 599-600 (42 U.S.C. 10004).

    Source: 50 FR 50717, Dec. 11, 1985, unless otherwise noted.



Sec. 75.1  Background and purpose.

    (a) The purpose of these regulations is to implement the provisions 
of section 979 of the Consumer-Patient Radiation Health and Safety Act 
of 1981, 42 U.S.C. 10004, which requires the establishment by the 
Secretary of Health and Human Services of standards for the 
accreditation of programs for the education of certain persons who 
administer radiologic procedures and for the credentialing of such 
persons.
    (b) Section 979 requires the Secretary, after consultation with 
specified Federal agencies, appropriate agencies of States, and 
appropriate professional organizations, to promulgate by regulation the 
minimum standards described above. These standards distinguish between 
the occupations of (1) radiographer, (2) dental hygienist, (3) dental 
assistant, (4) nuclear medicine technologist, and (5) radiation therapy 
technologist. In the interest of public safety and to prevent the 
hazards of improper use of medical radiation identified by Congress in 
its determination of the need for standards, the Secretary is also 
authorized to prepare standards for other occupational groups utilizing 
ionizing and non-ionizing radiation as he/she finds appropriate. 
However, the standards set out below are limited to the five 
occupational groups listed above, utilizing ionizing radiation. Nothing 
in these accreditation standards is intended to discriminate against 
proprietary schools.

[[Page 530]]



Sec. 75.2  Definitions.

    All terms not defined herein shall have the meaning given them in 
the Act. As used in this part:
    Accreditation, as applied to an educational program, means 
recognition, by a State government or by a nongovernmental agency or 
association, of a specialized program of study as meeting or exceeding 
certain established qualifications and educational standards. As applied 
to a health care or educational institution, accreditation means 
recognition, by a State government or by a nongovernmental agency or 
association, of the institution as meeting or exceeding certain 
established standards or criteria for that type of institution.
    Act means the Consumer-Patient Radiation Health and Safety Act of 
1981, 42 U.S.C. 10001-10008.
    Continuing competency means the maintenance of knowledge and skills 
and/or demonstrated performance that are adequate and relevant to 
professional practice needs.
    Credentialing means any process whereby a State Government or 
nongovernmental agency or association grants recognition to an 
individual who meets certain predetermined qualifications.
    Dental hygienist means a person licensed by the State as a dental 
hygienist.
    Dental assistant means a person other than a dental hygienist who 
assists a dentist in the care of patients.
    Educational program means a set of formally structured activities 
designed to provide students with the knowledge and skills necessary to 
enter an occupation, with evaluation of student performance according to 
predetermined objectives.
    Energized laboratory means any facility which contains equipment 
that generates ionizing radiation. This does not include facilities for 
training students when the equipment is not powered to emit ionizing 
radiation, e.g., practice in setting controls and positioning of 
patients.
    Formal training means training or education, including either 
didactic or clinical practicum or both, which has a specified objective, 
planned activities for students, and suitable methods for measuring 
student attainment, and which is offered, sponsored, or approved by an 
organization or institution which is able to meet or enforce these 
criteria.
    Ionizing radiation means any electromagnetic or particulate 
radiation (X-rays, gamma rays, alpha and beta particles, high speed 
electrons, neutrons, and other nuclear particles) which interacts with 
atoms to produce ion pairs in matter.
    Licensed practitioner means a licensed doctor of medicine, 
osteopathy, dentistry, podiatry, or chiropractic.
    Licensure means the process by which an agency of State government 
grants permission to persons meeting predetermined qualifications to 
engage in an occupation.
    Nuclear medicine technologist means a person other than a licensed 
practitioner who prepares and administers radio-pharmaceuticals to human 
beings and conducts in vivo or in vitro detection and measurement of 
radioactivity for medical purposes.
    Permit means an authorization issued by a State for specific tasks 
or practices rather than the entire scope of practice in an occupation.
    Radiation therapy technologist means a person other than a licensed 
practitioner who utilizes ionizing radiation-generating equipment for 
therapeutic purposes on human subjects.
    Radiographer means an individual other than a licensed practitioner 
who (1) performs, may be called upon to perform, or who is licensed to 
perform a comprehensive scope of diagnostic radiologic procedures 
employing equipment which emits ionizing radiation, and (2) is delegated 
or exercises responsibility for the operation of radiation-generating 
equipment, the shielding of patient and staff from unnecessary 
radiation, the appropriate exposure of radiographs, or other procedures 
which contribute to any significant extent to the site or dosage of 
ionizing radiation to which a patient is exposed. Radiographers are 
distinguished from personnel whose use of diagnostic procedures is 
limited to a few specific body sites and/or standard procedures, from 
those personnel in other clinical specialties who may occasionally be

[[Page 531]]

called upon to assist in diagnostic radiology, and from those 
technicians or assistants whose activities do not, to any significant 
degree, determine the site or dosage of radiation to which a patient is 
exposed.
    Radiologist means a physician certified in radiology by the American 
Board of Radiology or the American Osteopathic Board of Radiology.



Sec. 75.3  Applicability.

    (a) Federal Government. Except as provided in section 983 of the 
Act, the credentialing standards set out in the Appendixes to this part 
apply to those individuals who administer or propose to administer 
radiologic procedures, in each department, agency and instrumentality of 
the Federal Government as follows:
    (1) Radiographer Standards apply to all individuals who are 
radiographers as defined in Sec. 75.2 and who are not practitioners 
excepted by the Act.
    (2) Nuclear Medicine Technologist Standards apply to all individuals 
who are nuclear medicine technologists as defined in Sec. 75.2, who 
perform in vivo nuclear medicine procedures, and who are not 
practitioners excepted by the Act. For purposes of this Act, any 
administration of radiopharmaceuticals to human beings is considered an 
in vivo procedure.
    (3) Radiation Therapy Technologist Standards apply to all 
individuals who perform radiation therapy and who are not practitioners 
excepted by the Act.
    (4) Dental Hygienist Standards apply to all dental hygienists who 
perform dental radiography.
    (5) Dental Assistant Standards apply to all dental assistants who 
perform dental radiography.
    (6) The following persons are deemed to have met the requirements of 
these standards:
    (i) Persons employed by the Federal government as radiologic 
personnel prior to the effective date of this regulation and who show 
evidence of current or fully satisfactory performance or certification 
of such from a licensed practitioner:
    (ii) Uniformed military personnel who receive radiologic training 
from or through the Armed Forces of the United States and who meet 
standards established by the Department of Defense or components 
thereof, provided that those standards are determined by such Department 
or component to offer equivalent protection of patient health and 
safety:
    (iii) Foreign national employed by the Federal government in 
positions outside of the United States who show evidence of training, 
experience, and competence determined by the employing agency to be 
equally protective of patients health and safety; and
    (iv) Persons first employed by the Federal government as radiologic 
personnel after the effective date of this regulation who (a) received 
training from institutions in a State or foreign jurisdiction which did 
not accredit training in that particular field at the time of 
graduation, or (b) practiced in a State or foreign jurisdiction which 
did not license that particular field or which did not allow special 
eligibility to take a licensure examination for those who did not 
graduate from an accredited educational program; provided that such 
persons show evidence of training, experience, and competence determined 
by the Office of Personnel Management or the employing agency to be 
equally protective of patient health and safety.
    (7) The following persons are exempted from these standards:
    (i) Persons who are trained to perform, or perform, covered 
radiologic procedures in emergency situations which preclude use of 
fully qualified personnel; and
    (ii) Students in approved training programs.
    (8) A department, agency, or instrumentality of the Federal 
government may, after consultation with the Secretary, use alternative 
criteria which it determines would offer equivalent protection of 
patient health and safety.
    (b) States. The States may, but are not required to, adopt standards 
for accreditation and credentialing that are consistent with the 
standards set out in the appendixes to this part.

[[Page 532]]

   Appendix A to Part 75--Standards for Accreditation of Educational 
                       Programs for Radiographers

                    A. Description of the Profession

    The radiographer shall perform effectively by:
    1. Applying knowledge of the principles of radiation protection for 
the patient, self, and others.
    2. Applying knowledge of anatomy, positioning, and radiographic 
techniques to accurately demonstrate anatomical structures on a 
radiograph.
    3. Determining exposure factors to achieve optimum radiographic 
technique with a minimum of radiation exposure to the patient.
    4. Examining radiographs for the purpose of evaluating technique, 
positioning, and other pertinent technical qualities.
    5. Exercising discretion and judgment in the performance of medical 
imaging procedures.
    6. Providing patient care essential to radiologic procedures.
    7. Recognizing emergency patient conditions and initiating 
lifesaving first aid.

                             B. Sponsorship

    1. Accreditation will be granted to the institution that assumes 
primary responsibility for curriculum planning and selection of course 
content; coordinates classroom teaching and supervised clinical 
education; appoints faculty to the program; receives and processes 
applications for admission; and grants the degree or certificate 
documenting completion of the program.
    2. Educational programs may be established in:
    (a) Community and junior colleges, senior colleges, and 
universities;
    (b) Hospitals;
    (c) Medical schools;
    (d) Postsecondary vocational/technical schools and institutions; and
    (e) Other acceptable institutions which meet comparable standards.
    3. The sponsoring institutions and affiliate(s) must be accredited 
by a recognized agency. When the sponsoring institution and 
affilitate(s) are not so recognized, they may be considered as meeting 
the requirements of accreditation if the institution meets or exceeds 
established equivalent standards.

                       C. Instructional Facilities

    1. General. Appropriate classroom and clinical space, modern 
equipment, and supplies for supervised education shall be provided.
    2. Laboratory. Energized laboratories utilized for teaching purposes 
shall be certified as required for compliance with Federal and/or State 
radiation safety regulations. The use of laboratories shall be governed 
by established educational objectives.
    3. Reference Materials. Adequate up-to-date scientific books, 
periodicals, and other reference materials related to the curriculum and 
profession shall be readily accessible to students.

                          D. Clinical Education

    1. The clinical phase of the educational program shall provide an 
environment for supervised competency-based clinical education and 
experience and offer a sufficient and well-balanced variety of 
radiographic examinations and equipment.
    2. An acceptable ratio of students to registered technologists shall 
be maintained in the clinical teaching environment.
    3. A clinical instructor(s), who shall be responsible for 
supervising students according to objectives, shall be identified for 
each primary clinical education center.
    4. The maximum student enrollment shall not exceed the capacity 
recommended on the basis of volume and variety of radiographic 
procedures, resources, and personnel available for teaching purposes.
    5. In programs where didactic and clinical experience are not 
provided in the same institution, accreditation shall be given only to 
the institution responsible for admissions, curriculum, and academic 
credit. The accredited institution shall be responsible for coordinating 
the program and assuring that the activities assigned to the students in 
the clinical setting are educational. There shall be a uniform contract 
between the accredited institution and each of its affiliate hospitals, 
clearly defining the responsibilities and obligations of each.

                              E. Curriculum

    1. The structure of the curriculum shall be based on not less than 
two calendar years of full-time study or its equivalent.
    2. Instruction shall follow a planned outline that includes:
    (a) The assignment of appropriate instructional materials;
    (b) Classroom presentations, discussions and demonstrations; and
    (c) Examinations in the didactic and clinical aspects of the 
program.
    3. All professional courses, including clinical education, must 
include specific curriculum content that shall include, but shall not be 
limited to:
    (a) Introduction to radiologic technology;
    (b) Medical ethics;
    (c) Imaging;
    (d) Radiographic processing technique;
    (e) Human structure and function;
    (f) Medical terminology;
    (g) Principals of radiographic exposure;
    (h) Radiographic procedures;
    (i) Principles of radiation protection;
    (j) Radiographic film evaluation;
    (k) Methods of patient care;

[[Page 533]]

    (l) Pathology;
    (m) Radiologic physics; and
    (n) Radiation biology.
    Related subjects added to the professional curriculum shall meet the 
requirements of the degree-granting institution.

                               F. Finances

    Financial resources for operation for the educational program shall 
be assured through regular budgets, gifts, grants, endowments, or fees.

                               G. Faculty

    1. Program Director. A program director shall be designated who is 
credentialed in radiography. The program director's responsibilities in 
teaching, administration, and coordination of the educational program in 
radiography shall not be adversely affected by educationally unrelated 
functions.
    (a) Minimum qualifications. A minimum of two years of professional 
experience and proficiency in instructing, curriculum design, program 
planning, and counseling.
    (b) Responsibilities. (1) The program director, in consultation with 
the medical director/advisor (G. 2.) shall be responsible for the 
organization, administration, periodic review, records, continued 
development, and general policy and effectiveness of the program.
    (2) Opportunities for continuing education shall be provided for all 
faculty members.
    2. Medical Director/Medical Advisor--(a) minimum qualifications. The 
medical director/ medical advisor shall be a qualified radiologist, 
certified by the American Board of Radiology, or shall possess suitable 
equivalent qualifications.
    (b) Responsibilities. The medical director/medical advisor shall 
work in consultation with the program director in developing the goals 
and objectives of the program and implementing the standards for their 
achievement.
    3. Instructors. All instructors shall be qualified through academic 
preparation and experience to teach the assigned subjects.

                               H. Students

                                Admission

    (a) Candidates for admission shall satisfy the following minimum 
requirements: Completion of four years of high school; successful 
completion of a standard equivalency test; or certification of 
equivalent education by an organization recognized by the United States 
Department of Education. Courses in physics, chemistry, biology, 
algebra, and geometry are strongly recommended.
    (b) The number of students enrolled in each class shall be 
commensurate with the most effective learning and teaching practices and 
should also be consistent with acceptable student-teacher ratios.

                               I. Records

    Records shall be maintained as dictated by good educational 
practices.

    Note: Educational programs accredited by an organization recommended 
by the United States Department of Education are considered to have met 
these standards.

Appendix B to Part 75--Standards for Accreditation of Dental Radiography 
                     Training for Dental Hygienists

                             A. Sponsorship

    Sponsorship must be by an entity that assumes primary responsibility 
for the planning and conduct of competency-based didactic and clinical 
training in dental radiography.
    1. This responsibility must include: defining the curriculum in 
terms of program goals, instructional objectives, learning experiences 
designed to achieve goals and objectives, and evaluation procedures to 
assess attainment of goals and objectives; coordinating classroom 
teaching and supervised clinical experiences; appointing faculty; 
receiving and processing applications for admission; and granting 
documents of successful completion of the program.
    2. The formal training in dental radiography may be a part of a 
total program of dental hygiene education accredited by an organization 
recognized by the United States Department of Education.
    3. The sponsoring entity and the dental radiography training must be 
approved by the State entity responsible for approving dental hygiene 
education programs or the State entity responsible for credentialing 
dental personnel in radiography.

                              B. Curriculum

    Dental radiography training for dental hygienists must provide 
sufficient content and instructional time to assure competent 
performance.
    1. The dental radiography curriculum content and learning 
experiences must include the theoretical aspects of the subject as well 
as practical application of techniques. The theoretical aspects should 
provide content necessary for dental hygienists to understand the 
critical nature of the radiological procedures they perform and of the 
judgments they make as related to patient and operator radiation safety.
    2. The dental radiography curriculum must include content in seven 
areas: radiation physics; radiation biology; radiation health,

[[Page 534]]

safety, and protection; X-ray films and radiographic film quality; 
radiographic techniques; darkroom and processing techniques; and film 
mounting.

--Radiation Physics. Curriculum content should include: historical 
background; role of radiology in modern dentistry; types of radiation; 
X-ray production principles; operation of X-ray equipment; properties of 
X-radiation; and X-radiation units, detection and monitoring devices.
--Radiation Biology. Curriculum content should include: Interaction of 
ionizing radiation with cells, tissues, and matter; factors influencing 
biological response of cells and tissues to ionizing radiation; somatic 
and genetic effects of radiation exposure; and cumulative effects of X-
radiation and latent period.
--Radiation Health, Safety, and Protection. Curriculum content should 
include: Sources and types of radiation exposure; public health 
implications and public concerns; principles of radiological health 
including collimation and filtration; radiation protection methods in 
the dental office; necessity for high diagnostic yield with a reduction 
of X-radiation exposure; and monitoring devices.
--X-ray Films and Radiographic Film Quality. Curriculum content should 
include: X-radiation production and scatter; X-ray beam quality and 
quantity; factors influencing radiographic density, contrast, 
definition, and distortion; film characteristics; dosage related to film 
speed; types of films, cassettes, and screens; and film identification 
systems.
--Radiographic Techniques. Curriculum content should include: imagery 
geometry; patient positioning; film/film holder positioning; cone 
positioning and exposure settings for the intraoral paralleling 
technique, bisecting the angle technique, and techniques for occlusal 
radiographs; extaroral panoramic techniques; and patient variations that 
affect the above techniques.
--Darkroom and Processing Techniques. Curriculum content should include: 
solution chemistry and quality maintenance; darkroom equipment and safe 
lighting; film processing techniques; automatic film processing; and 
processing errors.
--Film Mounting. Curriculum content should include: anatomical landmarks 
essential to mounting films; film mounting procedures; and diagnostic 
quality of radiographs.

    3. The curriculum must also include clinical practice assignments.

--Clinical practice assignments must be an integral part of the 
curriculum so that Dental Hygienists have the opportunity to develop 
competence in making radiographs. Faculty supervision must be provided 
during a student's radiographic technique experience. Students must 
demonstrate competence in making diagnostically acceptable radiographs 
prior to their clinical practice where there is not direct supervision 
by faculty.
--Dental hygienists must demonstrate knowledge of radiation safety 
measures before making radiographs and, where possible, should 
demonstrate competence on manikins before making radiographs on 
patients. Radiographs must be exposed for diagnostic purposes and not 
solely to demonstrate techniques or obtain experience.
--The clinical experience should provide opportunity to make a variety 
of radiographs and radiographic surveys including primary, mixed, and 
permanent dentitions, as well as edentulous and partially edentulous 
patients.

                          C. Student Evaluation

    Evaluation procedures must be developed to assess performance and 
achievement of dental radiography program objectives.

                               D. Faculty

    The dental radiography training must be conducted by faculty who are 
qualified in the curriculum subject matter.
    1. This may include a D.D.S./D.M.D. degree; graduation from an 
accredited dental assisting or dental hygiene education program with a 
certificate or an associate or baccalaureate degree; status as a 
Certified Dental Assistant certified by the Dental Assisting National 
Board; or recognition as equivalently qualified by the State entity 
which approved the training program in dental radiography.
    2. The faculty-to-student ratio must be adequate to achieve the 
stated objectives of the curriculum.

                              E. Facilities

    Adequate radiographic facilities must be available to permit 
achievement of the dental radiography training objectives. The design, 
location, and construction of radiographic facilities must provide 
optimum protection from X-radiation for patients and operators. 
Equipment shall meet State and Federal laws related to radiation. 
Monitoring devices shall be worn by dental personnel. Lead aprons must 
be placed to protect patients. Safe storage for films must be provided. 
Darkroom facilities and equipment must be available and of a quality 
that assures that films will not be damaged or lost.

                          F. Learning Resources

    A wide range of printed materials, instructional aids, and equipment 
must be available to support instruction. Current specialized reference 
texts should be provided; and models, replicas, slides, and films which 
depict

[[Page 535]]

current techniques should be available for use in instruction. As 
appropriate self-instructional materials become available, they should 
be provided for the student's use.

    Note: Educational programs accredited by an organization recognized 
by the United States Department of Education are considered to have met 
these standards. Under existing licensure provisions in all States, 
becoming a dental hygienist requires graduation from a dental hygiene 
education program accredited by an organization recognized by the United 
States Department of Education. In lieu of this requirement, Alabama 
accepts graduation from a State-approved preceptorship program.

Appendix C to Part 75--Standards for Accreditation of Dental Radiography 
                     Training for Dental Assistants

                             A. Sponsorship

    Sponsorship must be an entity that assumes primary responsibility 
for the planning and conduct of competency-based didactic and clinical 
training in dental radiography.
    1. This responsibility must include: Defining the curriculum in 
terms of program goals, instructional objectives, learning experiences 
designed to achieve goals and objectives, and evaluation procedures to 
assess attainment of goals and objectives; coordinating classroom 
teaching and supervised clinical experiences; appointing faculty; 
receiving and processing applications for admission; and granting 
documents of successful completion of the program.
    2. Dental radiography training may be freestanding (as a continuing 
education course offered by State dental/dental auxiliary societies, or 
by dental/dental auxiliary education programs); or be a part of an 
educational program in dental assisting. Such dental assisting education 
programs may be accredited by an organization recognized by the United 
States Department of Education; or located in a school accredited by an 
institutional accrediting agency recognized by the the United States 
Department of Education or approved by the State agency responsible for 
secondary and postsecondary education, or approved by a Federal agency 
conducting dental assistant education in that Agency.
    3. The sponsoring entity and the dental radiography training must be 
approved by the State entity responsible for approving dental assisting 
education programs, or the State entity responsible for credentialing 
dental personnel in radiography.

                              B. Curriculum

    Dental radiography training for dental assistants must provide 
sufficient content and instructional time to assure competent 
performance.
    1. The dental radiography curriculum content and learning 
experiences must include the theoretical aspects of the subject as well 
as practical application of techniques. The theoretical aspects should 
provide content necessary for dental assistants to understand the 
critical nature of the radiological procedures they perform and of the 
judgments they make as related to patient and operator radiation safety.
    2. The dental radiography curriculum must include content in seven 
areas: radiation physics; radiation biology; radiation health, safety, 
and protection; X-ray films and radiographic film quality; radiographic 
techniques; darkroom and processing techniques; and film mounting.

--Radiation Physics. Curriculum content should include: Historical 
background; role of radiology in modern dentistry; types of radiation; 
X-ray production principles; operation of X-ray equipment; properties of 
X-radiation; and X-radiation units, detection and monitoring devices.
--Radiation Biology. Curriculum content should include: interaction of 
ionizing radiation with cells, tissues, and matter; factors influencing 
biological response of cells and tissues to ionizing radiation; somatic 
and genetic effects of radiation exposure; and cumulative effects of X-
radiation and latent period.
--Radiation Health, Safety, and Protection. Curriculum content should 
include: sources and types of radiation exposure; public health 
implications and public concerns; principles of radiological health 
including collimation and filtration; radiation protection methods in 
the dental office; necessity for high diagnostic yield with a reduction 
of X-radiation exposure; and monitoring devices.
--X-ray Films and Radiographic Film Quality. Curriculum content should 
include: X-radiation production and scatter; X-ray beam quality and 
quantity; factors influencing radiographic density, contrast, 
definition, and distortion; film characteristics; dosage related to film 
speed; types of films, cassettes, and screens; and film identification 
systems.
--Radiographic Techniques. Curriculum content should include: imagery 
geometry; patient positioning; film/film holder positioning; cone 
positioning and exposure settings for the intraoral paralleling 
technique, bisecting the angle technique, and techniques for occlusal 
radiographs; extraoral panoramic techniques; and patient variations that 
affect the above techniques.

[[Page 536]]

--Darkroom and Processing Techniques. Curriculum content should include: 
Solution chemistry and quality maintenance; darkroom equipment and safe 
lighting; film processing techniques; automatic film processing; and 
processing errors.
--Film Mounting. Curriculum content should include: anatomical landmarks 
essential to mounting films; film mounting procedures; and diagnostic 
quality of radiographs.

    3. The curriculum must also include clinical practice assignments.

--Clinical practice assignments must be an integral part of the 
curriculum so that Dental Assistants have the opportunity to develop 
competence in making radiographs. The clinical experience may be 
conducted in the dental office in which the Dental Assistant is employed 
or is serving an externship. Faculty and/or employing dentist 
supervision must be provided during a student's radiographic technique 
experience. Students must demonstrate competence in making 
diagnostically acceptable radiographs prior to their clinical practice 
when there is not direct supervision by faculty and/or the employing 
dentist.
--Dental Assistants must demonstrate knowledge of radiation safety 
measures before making radiographs, and where possible should 
demonstrate competence on manikins before making radiographs on 
patients. Radiographs must be exposed for diagnostic purposes and not 
solely to demonstrate techniques or obtain experience.
--The clinical experience should provide opportunity to make a variety 
of radiographs and radiographic surveys, including primary, mixed, and 
permanent dentitions, as well as edentulous and partially edentulous 
patients.

                          C. Student Evaluation

    Evaluation procedures must be developed to assess performance and 
achievement of dental radiography program objectives.

                               D. Faculty

    The dental radiography training must be conducted by faculty who are 
qualified in the curriculum subject matter.
    1. This may include a D.D.S./D.M.D. degree; graduation from an 
accredited dental assisting or dental hygiene education program with a 
certificate or an associate or baccalaureate degree; status as a 
Certified Dental Assistant certified by the Dental Assisting National 
Board; or recognition as equivalently qualified by the State entity (or 
Federal agency where appropriate) which approves the educational program 
in dental radiography.
    2. The faculty-to-student ratio must be adequate to achieve the 
stated objectives of the curriculum.

                              E. Facilities

    Adequate radiographic facilities must be available to permit 
achievement of the dental radiography training objectives. The design, 
location, and construction of radiographic facilities must provide 
optimum protection from X-radiation for patients and operators. 
Equipment shall meet State and Federal laws related to radiation. 
Monitoring devices shall be worn by dental personnel. Lead aprons must 
be placed to protect patients. Safe storage for films must be provided. 
Darkroom facilities and equipment must be available and of a quality 
that assures that films will not be damaged or lost.

                          F. Learning Resources

    A wide range of printed materials, instructional aids, and equipment 
must be available to support instruction. Current specialized reference 
texts should be provided; and models, replicas, slides, and films which 
depict current techniques should be available for use in instruction. As 
appropriate self-instructional materials become available, they should 
be provided for the student's use.

    Note: Educational programs accredited by an organization recognized 
by the United States Department of Education are considered to have met 
these standards.

   Appendix D to Part 75--Standards for Accreditation of Educational 
               Programs for Nuclear Medicine Technologists

                             A. Sponsorship

    1. Accreditation will be granted to the institution that assumes 
primary responsibility for curriculum planning and selection of course 
content; coordinates classroom teaching and supervised clinical 
education; appoints faculty to the program; receives and processes 
applications for admission; and grants the degree or certificate 
documenting completion of the program.
    2. Educational programs may be established in:
    (a) Community and junior colleges, senior colleges, and 
universities;
    (b) Hospitals and clinics;
    (c) Laboratories;
    (d) Medical schools;
    (e) Postsecondary vocational/technical schools and institutions; and
    (f) Other acceptable institutions which meet comparable standards.
    3. The sponsoring institution and affiliate(s) must be accredited by 
a recognized agency. When the sponsoring institution and affiliate(s) 
are not so recognized, they may be considered as meeting the 
requirements of accreditation if the institution meets or exceeds 
established equivalent standards.

[[Page 537]]

    4. Responsibilities of the sponsor and each affiliate for program 
administration, instruction, supervision, etc., must be carefully 
described in written affiliation agreements.

                              B. Curriculum

    Instruction must follow a plan which documents:
    1. A structured curriculum including clinical education with clearly 
written syllabi which describe learning objectives and competencies to 
be achieved. The curriculum shall be based on not less than one calendar 
year of full-time study or its equivalent.
    2. The minimum professional curriculum that includes the following:
    (a) Methods of patient care;
    (b) Radiation safety and protection;
    (c) Nuclear medicine physics;
    (d) Radiation physics;
    (e) Nuclear instrumentation;
    (f) Statistics;
    (g) Radionuclide chemistry;
    (h) Radiopharmacology;
    (i) Departmental organization and function;
    (j) Radiation biology;
    (k) Nuclear medicine in vivo and in vitro procedures;
    (l) Radionuclide therapy;
    (m) Computer applications; and
    (n) Clinical practicum.
    3. Assignment of appropriate instructional materials.
    4. Classroom presentations, discussions, and demonstrations.
    5. Supervised practice, experience, and discussions. This shall 
include the following:
    (a) Patient care and patient recordkeeping;
    (b) Participation in the quality assurance program;
    (c) The preparation, calculation, identification, administration, 
and disposal of radiopharmaceuticals;
    (d) Radiation safety techniques that will minimize radiation 
exposure to the patient, public, fellow workers, and self;
    (e) The performance of an adequate number and variety of imaging and 
non-imaging procedures; and
    (f) Clinical correlation of nuclear medicine procedures.
    6. Evaluation of student's knowledge, problem-solving skills, and 
motor and clinical competencies.
    7. The competencies necessary for graduation.

                              C. Resources

    1. The program must have qualified program officials. Primary 
responsibilities shall include program development, organization, 
administration, evaluation, and revision. The following program 
officials must be identified:
    (a) Program Director--(1) Responsibilities. The program director of 
the educational program shall have overall responsibility for the 
organization, administration, periodic review, continued development, 
and general effectiveness of the program. The director shall provide 
supervision and coordination to the instructional staff in the academic 
and clinical phases of the program. Regular visits to the affiliates by 
the program director must be scheduled.
    (2) Qualifications. The program director must be a physician or 
nuclear medicine technologist. The program director must demonstrate 
proficiency in instruction, curriculum design, program planning, and 
counseling.
    (b) Medical Director-- (1) Responsibilities. The medical director of 
the program shall provide competent medical direction and shall 
participate in the clinical instruction. In multiaffiliate programs each 
clinical affiliate must have a medical director.
    (2) Qualifications. The medical director must be a physician 
qualified in the use of radionuclides and a diplomate of the American 
Board(s) of Nuclear Medicine, or Pathology, or Radiology, or possess 
suitable equivalent qualifications.
    (c) Clinical Supervisor. Each clinical affiliate must appoint a 
clinical supervisor.
    (1) Responsibilities. The clinical supervisor shall be responsible 
for the clinical education and evaluation of students assigned to that 
clinical affiliate.
    (2) Qualifications. The clinical supervisor must be a technologist 
credentialed in nuclear medicine technology.
    2. Instructional Staff--(a) Responsibilities. The instructional 
staff shall be responsible for instruction in the didactic and/or 
clinical phases of the program. They shall submit course outlines for 
each course assigned by the program director; evaluate students and 
report progress as required by the sponsoring institution; and cooperate 
with the program director in the periodic review and upgrading of course 
material.
    (b) Qualifications. The instructors must be qualified, 
knowledgeable, and effective in teaching the subjects assigned.
    (c) Instructor-to-student ratio. The instructor-to-student ratio 
shall be adequate to achieve the stated objectives of the curriculum.
    (d) Professional development. Accredited programs shall assure 
continuing education in the health profession or occupation and ongoing 
instruction for the faculty in curriculum design and teaching 
techniques.
    3. Financial resoures for continued operation of the educational 
program must be assured.
    4. Physical Resources. (a) General. Adequate classrooms, 
laboratories, and other facilities shall be provided.

[[Page 538]]

    (b) Equipment and Supplies. Modern nuclear medicine equipment, 
accurately calibrated, in working order, and meeting applicable Federal 
and State standards, if any, must be available for the full range of 
diagnostic and therapeutic procedures as outlined in the curriculum.
    (c) Reference Materials. Reference materials appropriate to the 
curriculum shall be readily accessible to students.
    (d) Records. Records shall be maintained as dictated by good 
educational practices.
    5. Instructional Resources. Instructional aids such as clinical 
materials, reference materials, demonstration and other multimedia 
materials must be provided.

                               D. Students

                         Admission Requirements

    Persons admitted into nuclear medicine technology programs shall 
have completed high school or its equivalent. They shall have completed 
postsecondary courses in the following areas:
    (1) Human anatomy and physiology;
    (2) Physics;
    (3) Mathematics;
    (4) Medical terminology;
    (5) Oral and written communications;
    (6) General chemistry; and
    (7) Medical ethics.
    Prerequisites may be completed during nuclear medicine training. 
Educational institutions such as junior colleges, universities, and 
technical vocational institutes may provide these prerequisite courses 
as part of an integrated program in nuclear medicine technology (i.e., 
two to four years).

                         E. Operational Policies

    Students may not take the responsibility nor the place of qualified 
staff. However, students may be permitted to perform procedures after 
demonstrating proficiency, with careful supervision.

                    F. Continuing Program Evaluation

    1. Periodic and systematic review of the program's effectiveness 
must be documented.
    2. One element of program evaluation shall be the initial employment 
of graduates of the program.

    Note: Educational programs accredited by an organization recognized 
by the United States Department of Education are considered to have met 
these standards.

   Appendix E to Part 75--Standards for Accreditation of Educational 
              Programs for Radiation Therapy Technologists

                             A. Sponsorship

    1. Educational programs may be established in:
    (a) Community and junior colleges, senior colleges, and 
universities;
    (b) Hospitals, clinics, or autonomous radiation oncology centers 
meeting the criteria for major cancer management centers or meeting 
demonstrably equivalent standards;
    (c) Medical schools; and
    (d) Postsecondary vocational/technical schools and institutions.
    2. The sponsoring institution and affiliates, if any, must be 
accredited by recognized agencies or meet equivalent standards. When 
more than one clinical education center is used, each must meet the 
standards of a major cancer management center.
    3. When didactic preparation and supervised clinical education are 
not provided in the same institution, accreditation must be obtained by 
the sponsoring institution for the total program. This institution will 
be the one responsible for admission, curriculum, and academic credit. 
The accredited institution shall be responsible for coordinating the 
program and assuring that the activities assigned to the student in the 
clinical setting are educational. There shall be a uniform, written, 
affiliation agreement between the accredited institution and each 
clinical education center, clearly defining the responsibilities and 
obligations of each.

                              B. Curriculum

    Educational programs of 24 months and 12 months or their equivalents 
may be developed. A 24-month program shall admit those candidates with a 
high school diploma (or equivalent) as outlined in D.1. The 12-month 
program shall be designed for those students admitted with backgrounds 
as outlined in D.2.
    Instruction must follow a plan which documents:
    1. A structured curriculum with clearly written course syllabi which 
describe competencies and learning objectives to be achieved. The 
curriculum shall include but not necessarily be limited to the 
following:
    (a) Orientation to radiation therapy technology;
    (b) Medical ethics and law;
    (c) Methods of patient care;
    (d) Medical terminology;
    (e) Human structure and function;

[[Page 539]]

    (f) Oncologic pathology;
    (g) Radiation oncology;
    (h) Radiobiology;
    (i) Mathematics;
    (j) Radiation physics;
    (k) Radiation protection;
    (l) Radiation oncology technique;
    (m) Radiographic imaging; and
    (n) Clinical dosimetry.

The curriculum must include a plan for well-structured competency-based 
clinical education.

    2. Assignment of appropriate instructional materials.
    3. Classroom presentations, discussions, and demonstrations.
    4. Supervised clinical education and laboratory practicum.
    5. Evaluation of students to assess knowledge, problem-solving 
skills, and motor and clinical competencies.
    6. Program graduates must demonstrate competencies including, but 
not limited to, the following:
    (a) Practice oral and written communications;
    (b) Maintain records of treatment administered;
    (c) Perform basic mathematical functions;
    (d) Demonstrate knowledge of human structure, function, and 
pathology;
    (e) Demonstrate knowledge of radiation physics in radiation 
interactions and radiation protection techniques;
    (f) Provide basic patient care and cardiopulmonary resuscitation;
    (g) Deliver a planned course of radiation therapy;
    (h) Verify physician's prescribed course of radiation therapy and 
recognize errors in computation;
    (i) Demonstrate awareness of patterns of physical and emotional 
stress exhibited by patients;
    (j) Produces and utilize immobilization and beam directional 
devices;
    (k) Prepare commonly used brachytherapy sources;
    (l) Demonstrate knowledge of methods of calibration of equipment, 
and quality assurance;
    (m) Prepare isodose summations;
    (n) Detect malfunctioning equipment;
    (o) Apply rules and regulations for radiation safety, and detect 
defects which might pose a radiation hazard;
    (p) Understand the function of equipment and accessories;
    (q) Demonstrate knowledge of methods of continuing patient 
evaluation (follow up);
    (r) Apply wedge and compensating filters;
    (s) Recognize patients' clinical progress, complications, and 
demonstrate knowledge of when to withhold treatment until consultation 
with the physician; and
    (t) Interact with patients and families concerning the physical and 
psychological needs of patients.

                              C. Resources

    1. Program Officials. The program must have a qualified program 
official or officials. Primary responsibilities shall include program 
development, organization, administration, evaluation, and revision. A 
program director is necessary; other program officials may be required.
    (a) Program Director--(1) Responsibilities.
--The director of the educational program shall be responsible for the 
organization, administration, periodic review, continued development, 
and general effectiveness of the program. The program director's 
responsibilities in teaching, administration, and coordination of the 
educational program in radiation therapy technology shall not be 
adversely affected by educationally unrelated functions.
--In a college-sponsored program, or a hospital-sponsored multiple 
affiliate program, the program director shall be a employee of the 
sponsoring institution. A schedule of regular affiliate visits must be 
maintained.

    (2) Qualifications.

--Must be a technologist qualified in radiation therapy technology and 
educational methodologies.
--Must be credentialed in radiation therapy technology or possess 
suitable equivalent qualifications.
--Must have at least two years' experience as an instructor in an 
accredited educational program.
    (b) Clinical Supervisor. Each clinical education center shall 
appoint a clinical supervisor.
    (1) Responsibilities. The clinical supervisor shall be responsible 
for the clinical education and evaluation of students assigned to that 
clinical education center.
    (2) Qualifications. Must be a technologist, with suitable 
experience, qualified in radiation therapy technology and educational 
methodologies and must be credentialed in radiation therapy technology.
    (c) Medical Director/Medical Advisor--
    (1) Responsibilities. The medical director/medical advisor shall 
work in consultation with the program director in developing the goals 
and objectives of the program and implementing the standards for 
achievement.
    (2) Qualifications. The medical director/medical advisor shall be a 
qualified radiation oncologist certified by the American Board of 
Radiology, or shall possess suitable equivalent qualifications.
    2. Instructional Staff-- (a) Responsibilities. The instructional 
staff shall be responsible for submitting course outlines for each 
course assigned by the program director; evaluating students and 
reporting progress

[[Page 540]]

as required by the sponsoring institution; and cooperating with the 
program director in the periodic review and upgrading of course 
material.
    (b) Qualifications. The instructors must be individually qualified, 
must be effective in teaching the subjects assigned, and must meet the 
standards required by the sponsoring institution.
    (c) Instructor-to-Student Ratio. The instructor-to-student ratio 
shall be adequate to achieve the stated objectives of the curriculum.
    (d) Professional Development. Programs shall have a policy that 
encourages continuing education in radiation therapy technology and 
assures ongoing instruction for the faculty in curriculm design and 
teaching strategies.
    3. Financial Resources. Financial resources for continued operation 
of the educational program must be assured.
    4. Physical Resources--(a) General. Adequate classrooms, 
laboratories, and other facilities shall be provided. All affiliated 
institutions shall provide space required for these facilities.
    (b) Equipment and Supplies. Appropriate modern equipment and 
supplies in sufficient quantities shall be provided.
    (c) Laboratory. Energized laboratories must meet Federal and/or 
State radiation and safety regulations.
    (d) Reference Materials. An adequate supply of up-to-date books, 
periodicals, and other reference materials related to the curriculum and 
the profession shall be readily available to students.
    (e) Records. Records shall be maintained as dictated by good 
educational practices.
    5. Instructional Resources. Instructional aids such as clinical 
materials, reference materials, and demonstration and other multimedia 
materials must be provided.

                               D. Students

                                Admission

    1. Applicants must be high school graduates (or equivalent) with an 
educational background in basic science and mathematics.
    2. For admission to a 12-month program, the candidate must satisfy 
one of the following requirements:
    (a) Graduation from an accredited or equivalent program in 
radiography.
    (b) Successful completion or challenge of courses in the following 
prerequisite content areas:

--Radiation physics;
--Human structure and function;
--Radiation protection;
--Medical ethics and law;
--Methods of patient care;
--Medical terminology; and
--Mathematics.

    (c) Successful demonstration of the following competencies:

--Practice oral and written communications;
--Perform basic mathematical functions;
--Demonstrate knowledge of human structure and function;
--Demonstrate knowledge of radiation physics in radiation interactions 
and radiation protection techniques;
--Provide basic patient care and cardiopulmonary resuscitation;
--Demonstrate awareness of patterns of physical and emotional stress 
exhibited by patients;
--Apply rules and regulations for radiation safety, detect defects which 
might pose a radiation hazard, and maintain control, if a radiation 
accident occurs; and
--Interact with patients and families concerning patients physical and 
psychological needs.

                    E. Continuing Program Evaluation

    1. A process for periodic and systematic review of the program's 
effectiveness must be documented and reflected in policies.
    2. Program evaluation shall include the employment performance of 
recent graduates.

    Note: Educational programs accredited by an organization recognized 
by the United States Department of Education are considered to have met 
these standards.

 Appendix F to Part 75--Standards for Licensing Radiographers, Nuclear 
       Medicine Technologists, and Radiation Therapy Technologists

    The following section describes basic elements to be incorporated in 
credentialing programs of States that choose to regulate personnel who 
perform radiologic procedures.

                              A. Licensure

    1. Only eligible applicants who have passed the licensure 
examination shall be licensed as Radiographers, Nuclear Medicine 
Technologists, or Radiation Therapy Technologists.
    2. Licenses shall be renewed at periodic intervals.

                             B. Eligibility

    1. For regular eligibility to take the licensure examination, 
applicants shall have successfully completed an accredited program of 
formal education in radiography, nuclear medicine technology, or 
radiation therapy technology.
    2. Special eligibility to take the licensure examination shall be 
provided for applicants whose training and/or experience are equal

[[Page 541]]

to, or in excess of, those of a graduate of an accredited educational 
program.

                             C. Examination

    A criterion-referenced examination in radiography, nuclear medicine 
technology, or radiation therapy technology shall be utilized to test 
the knowledge and competencies of applicants.

                        D. Continuing Competency

    The licensed Radiographer, Nuclear Medicine Technologist, or 
Radiation Therapy Technologist shall maintain continuing competency in 
the area in which he/she is practicing.

                       E. Policies and Procedures

    An organization that seeks to be recognized for the certifying of 
personnel shall adopt definite policies to ensure validity, objectivity, 
and fairness in the certifying process. The National Commission for 
Health Certifying Agencies (NCHCA) has published suitable criteria for a 
certifying organization to adopt with respect to policies for: (1) 
Determination of appropriate examination content (but not the actual 
content for any specific occupation); (2) construction of examinations; 
(3) administration of examinations; and (4) fulfilling responsibilities 
to applicants. An organization (whether an NCHCA member or not) that 
adopts these or equivalent criteria will meet all of the requirements of 
this section of these standards.

  Appendix G to Part 75--Standards for Licensing Dental Hygienists and 
                 Dental Assistants in Dental Radiography

    The following section describes basic elements to be incorporated in 
credentialing programs of States that choose to regulate personnel who 
perform radiologic procedures.
    Currently, Dental Hygienists are credentialed through individual 
State licensure processes, all of which include assessment of competence 
in dental radiography. In all States, Dental Hygienists are required to 
be licensed prior to practicing. The existing State dental hygiene 
licensure processes meet the intent and purpose of the Consumer-Patient 
Radiation Health and Safety Act of 1981 and the standards for licensing 
Dental Hygienists in dental radiography set forth below.

                           A. Licensure/Permit

    1. To those who have passed a licensure or designated dental 
radiography examination, a license or permit shall be issued by the 
State entity responsible for credentialing dental personnel.
    2. Licenses or permits shall be renewed at periodic intervals.

                             B. Eligibility

    1. An individual shall provide proof of graduating student status or 
graduation from an accredited or approved dental hygiene or dental 
assisting education program.
    2. For dental assistants, special eligibility to take the 
examination shall be provided to applicants with appropriate 
combinations of training and/or experience.

                             C. Examination

    A criterion-referenced examination in dental radiography shall be 
utilized to test the knowledge and competencies of applicants.

                        D. Continuing Competency

    The Dental Hygienist or Dental Assistant shall be required to 
maintain continuing competency in the area in which he/she is 
practicing.

                       E. Policies and Procedures

    An organization that seeks to be recognized for the certifying of 
personnel shall adopt definite policies to ensure validity, objectivity, 
and fairness in the certifying process. The National Commission for 
Health Certifying Agencies (NCHCA) has published suitable criteria for a 
certifying organization to adopt with respect to policies for: (1) 
Determination of appropriate examination content (but not the actual 
content for any specific occupation); (2) construction of examinations; 
(3) administration of examinations; and (4) fulfilling responsibilities 
to applicants. An organization (whether an NCHCA member or not) that 
adopts these or equivalent criteria will meet all of the requirements of 
this section of these standards.

[[Page 542]]



   SUBCHAPTER G--OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED 
                               ACTIVITIES





PART 80--ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES--Table of Contents




Subparts A-C  [Reserved]

               Subpart D--Tuition Fees for Direct Training

Sec.
80.41  Applicability.
80.42  Definitions.
80.43  Tuition fees.
80.44  Schedule of fees.
80.45  Procedure for payment.
80.46  Refunds.

Subparts A-C  [Reserved]



               Subpart D--Tuition Fees for Direct Training

    Authority: Sec. 501, 65 Stat. 290; 31 U.S.C. 483a.

    Source: 38 FR 16645, June 25, 1973, unless otherwise noted.



Sec. 80.41  Applicability.

    The provisions of this subpart set forth the policies of the 
National Institute for Occupational Safety and Health with respect to 
its charging fees for direct training in occupational safety or health.



Sec. 80.42  Definitions.

    Any term not defined herein shall have the same meaning as given it 
in the act. As used in this subpart:
    (a) Act means the Occupational Safety and Health Act of 1970 (29 
U.S.C. 651 et seq.).
    (b) Direct training means all technical training courses conducted 
directly by NIOSH for personnel of State and local governmental 
agencies, other Federal agencies, private industries, universities, and 
other non-NIOSH agencies and organizations.
    (c) NIOSH or Institute means the National Institute for Occupational 
Safety and Health.
    (d) Registration Office means the Direct Training Registration 
Office, NIOSH, 1014 Broadway, Cincinnati, OH 45202.



Sec. 80.43  Tuition fees.

    In accordance with the provisions of the subpart, the National 
Institute for Occupational Safety and Health will charge fees for all 
students attending NIOSH direct training courses which commence on or 
after July 1, 1973.



Sec. 80.44  Schedule of fees.

    (a) Tuition fees will be computed on the basis of the cost to the 
Government for the Institute's participation in the course, as 
determined by the Director of the Institute.
    (b) Total tuition charges for each course will be set forth in the 
course announcement.



Sec. 80.45  Procedure for payment.

    (a) Applications for direct training courses shall be completed and 
submitted to the registration office in accordance with the instructions 
issued by that office.
    (b) Federal agency personnel shall, upon notification of their 
acceptance, submit a letter identifying the agency and office to be 
billed, the agency order number, and any code numbers or other 
information necessary for billing purposes.
    (c) All other applicants shall, upon notification of their 
acceptance by NIOSH, submit a check payable to the National Institute 
for Occupational Safety and Health in the amount indicated by the course 
announcement prior to the commencement of the training course.



Sec. 80.46  Refunds.

    An applicant may withdraw his application and receive full 
reimbursement of the fee provided that written notification to the 
registration office is mailed no later than 10 days before the 
commencement of the course for which registration has been submitted.

[[Page 543]]



PART 84--APPROVAL OF RESPIRATORY PROTECTIVE DEVICES--Table of Contents




                      Subpart A--General Provisions

Sec.
84.1  Purpose.
84.2  Definitions.
84.3  Respirators for mine rescue or other emergency use in mines.

                   Subpart B--Application for Approval

84.10  Application procedures.
84.11  Contents of application.
84.12  Delivery of respirators and components by applicant; 
          requirements.

                             Subpart C--Fees

84.20  Examination, inspection, and testing of complete respirator 
          assemblies; fees.
84.21  Examination, inspection, and testing of respirator components or 
          subassemblies; fees.
84.22  Unlisted fees; additional fees; payment by applicant prior to 
          approval.

                   Subpart D--Approval and Disapproval

84.30  Certificates of approval; scope of approval.
84.31  Certificates of approval; contents.
84.32  Notice of disapproval.
84.33  Approval labels and markings; approval of contents; use.
84.34  Revocation of certificates of approval.
84.35  Changes or modifications of approved respirators; issuance of 
          modification of certificate of approval.
84.36  Delivery of changed or modified approved respirator.

                       Subpart E--Quality Control

84.40  Quality control plans; filing requirements.
84.41  Quality control plans; contents.
84.42  Proposed quality control plans; approval by the Institute.
84.43  Quality control records; review by the Institute; revocation of 
          approval.

 Subpart F--Classification of Approved Respirators; Scope of Approval; 
                    Atmospheric Hazards; Service Time

84.50  Types of respirators to be approved; scope of approval.
84.51  Entry and escape, or escape only; classification.
84.52  Respiratory hazards; classification.
84.53  Service time; classification.

      Subpart G--General Construction and Performance Requirements

84.60  Construction and performance requirements; general.
84.61  General construction requirements.
84.62  Component parts; minimum requirements.
84.63  Test requirements; general.
84.64  Pretesting by applicant; approval of test methods.
84.65  Conduct of examinations, inspections, and tests by the Institute; 
          assistance by applicant; observers; recorded data; public 
          demonstrations.
84.66  Withdrawal of applications; refund of fees.

              Subpart H--Self-Contained Breathing Apparatus

84.70  Self-contained breathing apparatus; description.
84.71  Self-contained breathing apparatus; required components.
84.72  Breathing tubes; minimum requirements.
84.73  Harnesses; installation and construction; minimum requirements.
84.74  Apparatus containers; minimum requirements.
84.75  Half-mask facepieces, full facepieces, mouthpieces; fit; minimum 
          requirements.
84.76  Facepieces; eyepieces; minimum requirements.
84.77  Inhalation and exhalation valves; minimum requirements.
84.78  Head harnesses; minimum requirements.
84.79  Breathing gas; minimum requirements.
84.80  Interchangeability of oxygen and air prohibited.
84.81  Compressed breathing gas and liquefied breathing gas containers; 
          minimum requirements.
84.82  Gas pressure gages; minimum requirements.
84.83  Timers; elapsed time indicators; remaining service life 
          indicators; minimum requirements.
84.84  Hand-operated valves; minimum requirements.
84.85  Breathing bags; minimum requirements.
84.86  Component parts exposed to oxygen pressures; minimum 
          requirements.
84.87  Compressed gas filters; minimum requirements.
84.88  Breathing bag test.
84.89  Weight requirement.
84.90  Breathing resistance test; inhalation.
84.91  Breathing resistance test; exhalation.
84.92  Exhalation valve leakage test.
84.93  Gas flow test; open-circuit apparatus.

[[Page 544]]

84.94  Gas flow test; closed-circuit apparatus.
84.95  Service-time test; open-circuit apparatus.
84.96  Service-time test; closed-circuit apparatus.
84.97  Test for carbon dioxide in inspired gas; open- and closed-circuit 
          apparatus; maximum allowable limits.
84.98  Tests during low temperature operation.
84.99  Man tests; testing conditions; general requirements.
84.100  Man tests 1, 2, 3, and 4; requirements.
84.101  Man test 5; requirements.
84.102  Man test 6; requirements.
84.103  Man tests; performance requirements.
84.104  Gas tightness test; minimum requirements.

                     Tables to Subpart H of Part 84

                          Subpart I--Gas Masks

84.110  Gas masks; description.
84.111  Gas masks; required components.
84.112  Canisters and cartridges in parallel; resistance requirements.
84.113  Canisters and cartridges; color and markings; requirements.
84.114  Filters used with canisters and cartridges; location; 
          replacement.
84.115  Breathing tubes; minimum requirements.
84.116  Harnesses; installation and construction; minimum requirements.
84.117  Gas mask containers; minimum requirements.
84.118  Half-mask facepieces, full facepieces, and mouthpieces; fit; 
          minimum requirements.
84.119  Facepieces; eyepieces; minimum requirements.
84.120  Inhalation and exhalation valves; minimum requirements.
84.121  Head harnesses; minimum requirements.
84.122  Breathing resistance test; minimum requirements.
84.123  Exhalation valve leakage test.
84.124  Facepiece tests; minimum requirements.
84.125  Particulate tests; canisters containing particulate filters; 
          minimum requirements.
84.126  Canister bench tests; minimum requirements.

                     Tables to Subpart I of Part 84

                   Subpart J--Supplied-Air Respirators

84.130  Supplied-air respirators; description.
84.131  Supplied-air respirators; required components.
84.132  Breathing tubes; minimum requirements.
84.133  Harnesses; installation and construction; minimum requirements.
84.134  Respirator containers; minimum requirements.
84.135  Half-mask facepieces, full facepieces, hoods, and helmets; fit; 
          minimum requirements.
84.136  Facepieces, hoods, and helmets; eyepieces; minimum requirements.
84.137  Inhalation and exhalation valves; check valves; minimum 
          requirements.
84.138  Head harnesses; minimum requirements.
84.139  Head and neck protection; supplied-air respirators; minimum 
          requirements.
84.140  Air velocity and noise levels; hoods and helmets; minimum 
          requirements.
84.141  Breathing gas; minimum requirements.
84.142  Air supply source; hand-operated or motor driven air blowers; 
          Type A supplied-air respirators; minimum requirements.
84.143  Terminal fittings or chambers; Type B supplied-air respirators; 
          minimum requirements.
84.144  Hand-operated blower test; minimum requirements.
84.145  Motor-operated blower test; minimum requirements.
84.146  Method of measuring the power and torque required to operate 
          blowers.
84.147  Type B supplied-air respirator; minimum requirements.
84.148  Type C supplied-air respirator, continuous-flow class; minimum 
          requirements.
84.149  Type C supplied-air respirator, demand and pressure demand 
          class; minimum requirements.
84.150  Air-supply line tests; minimum requirements.
84.151  Harness test; minimum requirements.
84.152  Breathing tube test; minimum requirements.
84.153  Airflow resistance test, Type A and Type AE supplied-air 
          respirators; minimum requirements.
84.154  Airflow resistance test; Type B and Type BE supplied-air 
          respirators; minimum requirements.
84.155  Airflow resistance test; Type C supplied-air respirator, 
          continuous flow class and Type CE supplied-air respirator; 
          minimum requirements.
84.156  Airflow resistance test; Type C supplied-air respirator, demand 
          class; minimum requirements.
84.157  Airflow resistance test; Type C supplied-air respirator, 
          pressure-demand class; minimum requirements.
84.158  Exhalation valve leakage test.
84.159  Man tests for gases and vapors; supplied-air respirators; 
          general performance requirements.

[[Page 545]]

84.160  Man tests for gases and vapors; Type A and Type AE respirators; 
          test requirements.
84.161  Man tests for gases and vapors; Type B and Type BE respirators; 
          test requirements.
84.162  Man test for gases and vapors; Type C respirators, continuous-
          flow class and Type CE supplied-air respirators; test 
          requirements.
84.163  Man test for gases and vapors; Type C supplied-air respirators, 
          demand and pressure-demand classes; test requirements.

                     Tables to Subpart J of Part 84

      Subpart K--Non-Powered Air-Purifying Particulate Respirators

84.170  Non-powered air-purifying particulate respirators; description.
84.171  Non-powered air-purifying particulate respirators; required 
          components.
84.172  Breathing tubes; minimum requirements.
84.173  Harnesses; installation and construction; minimum requirements.
84.174  Respirator containers; minimum requirements.
84.175  Half-mask facepieces, full facepieces, hoods, helmets, and 
          mouthpieces; fit; minimum requirements.
84.176  Facepieces, hoods, and helmets; eyepieces; minimum requirements.
84.177  Inhalation and exhalation valves; minimum requirements.
84.178  Head harnesses; minimum requirements.
84.179  Non-powered air-purifying particulate respirators; filter 
          identification.
84.180  Airflow resistance tests.
84.181  Non-powered air-purifying particulate filter efficiency level 
          determination.
84.182  Exhalation valve leakage test; minimum requirements.

                Subpart L--Chemical Cartridge Respirators

84.190  Chemical cartridge respirators: description.
84.191  Chemical cartridge respirators; required components.
84.192  Cartridges in parallel; resistance requirements.
84.193  Cartridges; color and markings; requirements.
84.194  Filters used with chemical cartridges; location; replacement.
84.195  Breathing tubes; minimum requirements.
84.196  Harnesses; installation and construction; minimum requirements.
84.197  Respirator containers; minimum requirements.
84.198  Half-mask facepieces, full facepieces, mouthpieces, hoods, and 
          helmets; fit; minimum requirements.
84.199  Facepieces, hoods, and helmets; eyepieces; minimum requirements.
84.200  Inhalation and exhalation valves; minimum requirements.
84.201  Head harnesses; minimum requirements.
84.202  Air velocity and noise levels; hoods and helmets; minimum 
          requirements.
84.203  Breathing resistance test; minimum requirements.
84.204  Exhalation valve leakage test; minimum requirements.
84.205  Facepiece test; minimum requirements.
84.206  Particulate tests; respirators with filters; minimum 
          requirements; general.
84.207  Bench tests; gas and vapor tests; minimum requirements; general.

                     Tables to Subpart L of Part 84

Subpart M  [Reserved]

                   Subpart N--Special Use Respirators

84.250  Vinyl chloride respirators; description.
84.251  Required components.
84.252  Gas masks; requirements and tests.
84.253  Chemical-cartridge respirators; requirements and tests.
84.254  Powered air-purifying respirators; requirements and tests.
84.255  Requirements for end-of-service-life indicator.
84.256  Quality control requirements.
84.257  Labeling requirements.
84.258  Fees.

Subparts O-JJ  [Reserved]

 Subpart KK--Dust, Fume, and Mist; Pesticide; Paint Spray; Powered Air-
     Purifying High Efficiency Respirators and Combination Gas Masks

84.1100  Scope and effective dates.
84.1101  Definitions.
84.1102  Examination, inspection and testing of complete respirator 
          assemblies; fees.
84.1103  Approval labels and markings; approval of contents; use.
84.1130  Respirators; description.
84.1131  Respirators; required components.
84.1132  Breathing tubes; minimum requirements.
84.1133  Harnesses; installation and construction; minimum requirements.
84.1134  Respirator containers; minimum requirements.
84.1135  Half-mask facepieces, full facepieces, hoods, helmets, and 
          mouthpieces; fit; minimum requirements.
84.1136  Facepieces, hoods, and helmets; eyepieces; minimum 
          requirements.
84.1137  Inhalation and exhalation valves; minimum requirements.

[[Page 546]]

84.1138  Head harnesses; minimum requirements.
84.1139  Air velocity and noise levels; hoods and helmets; minimum 
          requirements.
84.1140  Dust, fume, and mist respirators; performance requirements; 
          general.
84.1141  Isoamyl acetate tightness test; dust, fume, and mist 
          respirators designed for respiratory protection against fumes 
          of various metals having an air contamination level not less 
          than 0.05 milligram per cubic meter; minimum requirements.
84.1142  Isoamyl acetate tightness test; respirators designed for 
          respiratory protection against dusts, fumes, and mists having 
          an air contamination level less than 0.05 milligram per cubic 
          meter, or against radionuclides; minimum requirements.
84.1143  Dust, fume, and mist air-purifying filter tests; performance 
          requirements; general.
84.1144  Silica dust test for dust, fume, and mist respirators; single-
          use or reusable filters; minimum requirements.
84.1145  Silica dust test; non-powered single-use dust respirators; 
          minimum requirements.
84.1146  Lead fume test for dust, fume, and mist respirators; minimum 
          requirements.
84.1147  Silica mist test for dust, fume, and mist respirators; minimum 
          requirements.
84.1148  Tests for respirators designed for respiratory protection 
          against more than one type of dispersoid; minimum 
          requirements.
84.1149  Airflow resistance tests; all dust, fume, and mist respirators; 
          minimum requirements.
84.1150  Exhalation valve leakage test; minimum requirements.
84.1151  DOP filter test; respirators designed as respiratory protection 
          against dusts, fumes, and mists having an air contamination 
          level less than 0.05 milligram per cubic meter and against 
          radionuclides; minimum requirements.
84.1152  Silica dust loading test; respirators designed as protection 
          against dusts, fumes, and mists having an air contamination 
          level less than 0.05 milligram per cubic meter and against 
          radionuclides; minimum requirements.
84.1153  Dust, fume, mist, and smoke tests; canister bench tests; gas 
          mask canisters containing filters; minimum requirements.
84.1154  Canister and cartridge requirements.
84.1155  Filters used with canisters and cartridges; location; 
          replacement.
84.1156  Pesticide respirators; performance requirements; general.
84.1157  Chemical cartridge respirators with particulate filters; 
          performance requirements; general.
84.1158  Dust, fume, and mist tests; respirators with filters; minimum 
          requirements; general.

                     Tables to Subpart KK of Part 84

    Authority: 29 U.S.C. 577a, 651 et seq., and 657(g); 30 U.S.C. 3, 5, 
7, 811, 842(h), 844.

    Source: 60 FR 30355, June 8, 1995, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 84.1  Purpose.

    The purpose of the regulations contained in this part 84 is:
    (a) To establish procedures and prescribe requirements which must be 
met in filing applications for approval by the National Institute for 
Occupational Safety and Health of respirators or changes or 
modifications of approved respirators;
    (b) To establish a schedule of fees to be charged each applicant for 
the inspections, examinations, and testing conducted by the Institute 
under the provisions of this part;
    (c) To provide for the issuance of certificates of approval or 
modifications of certificates of approval for respirators which have met 
the applicable construction, performance, and respiratory protection 
requirements set forth in this part; and
    (d) To specify minimum requirements and to prescribe methods to be 
employed by the Institute and by the applicant in conducting 
inspections, examinations, and tests to determine the effectiveness of 
respirators used during entry into or escape from hazardous atmospheres.



Sec. 84.2  Definitions.

    As used in this part--
    (a) Applicant means an individual, partnership, company, 
corporation, association, or other organization that designs, 
manufactures, assembles, or controls the assembly of a respirator and 
who seeks to obtain a certificate of approval for such respirator.
    (b) Approval means a certificate or formal document issued by the 
Institute stating that an individual respirator or combination of 
respirators has met the minimum requirements of this part, and that the 
applicant is authorized to use and attach an approval

[[Page 547]]

label to any respirator, respirator container, or instruction card for 
any respirator manufactured or assembled in conformance with the plans 
and specifications upon which the approval was based, as evidence of 
such approval.
    (c) Approved means conforming to the minimum requirements of this 
part.
    (d) Auxiliary equipment means a self-contained breathing apparatus, 
the use of which is limited in underground mine rescue and recovery 
operations to situations where the wearer has ready access to fresh air 
and at least one crew equipped with approved self-contained breathing 
apparatus of 2 hours or longer rating, is in reserve at a fresh-air 
base.
    (e) Certification and Quality Assurance Branch means the 
Certification and Quality Assurance Branch, Division of Safety Research, 
Appalachian Laboratory for Occupational Safety and Health, National 
Institute for Occupational Safety and Health, 1095 Willowdale Road, 
Morgantown, West Virginia 26505-2888.
    (f) Compressed-breathing gas means oxygen or air stored in a 
compressed state and supplied to the wearer in gaseous form.
    (g) dBA means sound pressure levels in decibels, as measured with 
the A-weighted network of a standard sound level meter using slow 
response.
    (h) Dust means a solid mechanically produced particle with a size 
ranging from submicroscopic to macroscopic.
    (i) Respirators for entry into and escape from means respiratory 
devices providing protection during entry into and escape from hazardous 
atmospheres.
    (j) Respirators for escape only means respiratory devices providing 
protection only during escape from hazardous atmospheres.
    (k) A facepiece or mouthpiece is a respirator component designed to 
provide a gas-tight or dust-tight fit with the face and may include 
headbands, valves, and connections for canisters, cartridges, filters, 
or respirable gas source.
    (l) Final inspection means that activity carried out on a product 
after all manufacturing and assembly operations are completed to insure 
completeness and adherence to performance or other specifications, 
including satisfactory appearance.
    (m) Fume means a solid condensation particle, generally less than 1 
micrometer in diameter.
    (n) Gas means an aeriform fluid which is in a gaseous state at 
ordinary temperature and pressure.
    (o) Hazardous atmosphere means:
    (1) Any atmosphere containing a toxic or disease producing gas, 
vapor, dust, fume, mist, or pesticide, either immediately or not 
immediately dangerous to life or health; or
    (2) Any oxygen-deficient atmosphere.
    (p) A hood or helmet is a respirator component which covers the 
wearer's head and neck, or head, neck, and shoulders, and is supplied 
with incoming respirable air for the wearer to breathe. It may include a 
headharness and connection for a breathing tube.
    (q) Immediately dangerous to life or health means conditions that 
pose an immediate threat to life or health or conditions that pose an 
immediate threat of severe exposure to contaminants, such as radioactive 
materials, which are likely to have adverse cumulative or delayed 
effects on health.
    (r) Incoming inspection means the activity of receiving, examining, 
and accepting only those materials and parts whose quality conforms to 
specification requirements.
    (s) In-process inspection means the control of products at the 
source of production and at each step of the manufacturing process, so 
that departures from specifications can be corrected before defective 
components or materials are assembled into the finished product.
    (t) Institute means the National Institute for Occupational Safety 
and Health, Department of Health and Human Services.
    (u) Liquefied-breathing gas means oxygen or air stored in liquid 
form and supplied to the wearer in a gaseous form.
    (v) Mist means a liquid condensation particle with a size ranging 
from submicroscopic to macroscopic.
    (w) MSHA means the Mine Safety and Health Administration, U.S. 
Department of Labor.

[[Page 548]]

    (x) Not immediately dangerous to life or health means any hazardous 
atmosphere which may produce physical discomfort immediately, chronic 
poisoning after repeated exposure, or acute adverse physiological 
symptoms after prolonged exposure.
    (y) Oxygen-deficient atmosphere means an atmosphere which contains 
an oxygen partial pressure of less than 148 millimeters of mercury (19.5 
percent by volume at sea level).
    (z) Powered air-purifying respirator means a device equipped with a 
facepiece, hood, or helmet, breathing tube, canister, cartridge, filter, 
canister with filter, or cartridge with filter, and a blower.
    (aa) Respirator means any device designed to provide the wearer with 
respiratory protection against inhalation of a hazardous atmosphere.
    (bb) Single-use respirator means a respirator that is entirely 
discarded after excessive resistance, sorbent exhaustion, or physical 
damage renders it unsuitable for further use.
    (cc) Vapor means the gaseous state of a substance that is solid or 
liquid at ordinary temperature and pressure.



Sec. 84.3  Respirators for mine rescue or other emergency use in mines.

    (a)(1) NIOSH and the Mine Safety and Health Administration (MSHA), 
U.S. Department of Labor, shall jointly review and issue certifications 
for respirators used for mine emergencies and mine rescue, including any 
associated service-life plans, users' manuals and other supporting 
documentation.
    (2) Each certification for a respirator designed for mine rescue or 
other emergency use in mines shall include, as a condition of approval, 
any use limitations related to mine safety and health.
    (b) NIOSH and MSHA shall jointly determine appropriate recall and 
retrofit remedies for field complaints or identified deficiencies 
involving any respirators used in the mining environment.



                   Subpart B--Application for Approval



Sec. 84.10  Application procedures.

    (a) Inspection, examination, and testing leading to the approval of 
the types of respirators classified in subpart F of this part shall be 
undertaken by the Institute only pursuant to written applications which 
meet the minimum requirements set forth in this subpart B.
    (b) Applications shall be submitted to the Certification and Quality 
Assurance Branch, and shall be accompanied by a check, bank draft, or 
money order in the amount specified in subpart C of this part, payable 
to the order of the National Institute for Occupational Safety and 
Health.
    (c) Except as provided in Sec. 84.64, the examination, inspection, 
and testing of all respirators shall be conducted by the Certification 
and Quality Assurance Branch.
    (d) Applicants, manufacturers, or their representatives may visit or 
communicate with the Certification and Quality Assurance Branch in order 
to discuss the requirements for approval of any respirator or the 
proposed designs thereof. No charge shall be made for such consultation 
and no written report shall be issued to applicants, manufacturers, or 
their representatives by the Institute as a result of such consultation.
    (e) Respirators having electrical or electronic components that are 
required to be permissible under chapter I of title 30 shall be tested 
in accordance with 30 CFR part 18. Applications for approval of such 
respirators by MSHA shall be submitted in writing to: MSHA, Approval and 
Certification Center, Box 251, Industrial Park Road, Triadelphia, West 
Virginia 26059.



Sec. 84.11  Contents of application.

    (a) Each application for approval shall contain a complete written 
description of the respirator for which approval is requested together 
with drawings and specifications (and lists

[[Page 549]]

thereof) showing full details of construction of the respirator and of 
the materials used.
    (b) Drawings shall be titled, numbered, and dated; any revision 
dates shall be shown on the drawings, and the purpose of each revision 
being sought shall be shown on the drawing or described on an attachment 
to the drawing to which it applies.
    (c) Each application for approval shall contain a proposed plan for 
quality control which meets the minimum requirements set forth in 
subpart E of this part.
    (d) Each application shall contain a statement that the respirator 
has been pretested by the applicant as prescribed in Sec. 84.64, and 
shall include the results of such tests.
    (e) Each application for approval shall contain a statement that the 
respirator and component parts submitted for approval are either 
prototypes, or made on regular production tooling, with no operation 
included which will not be incorporated in regular production 
processing.

(The information collections contained in this section are approved 
under OMB control number 0920-0109)



Sec. 84.12  Delivery of respirators and components by applicant; requirements.

    (a) Each applicant shall, when an application is filed pursuant to 
Sec. 84.10, be advised by the Institute of the total number of 
respirators and component parts required for testing.
    (b) The applicant shall deliver, at his own expense, the number of 
completely assembled respirators and component parts required for 
testing, to the Certification and Quality Assurance Branch.
    (c) Respirators and component parts submitted for approval must be 
made from materials specified in the application.
    (d) One completely assembled respirator approved under the 
provisions of this part may be retained by the Institute as a laboratory 
exhibit, the remaining respirators may be returned to the applicant at 
his own expense, upon written request within 30 days after notice of 
approval. If no such request is made, the respirators will be disposed 
of by the Institute in such manner as it deems appropriate.
    (e) Where a respirator fails to meet the requirements for approval 
set forth in this part, all respirators and components delivered in 
accordance with this section may be returned to the applicant at his own 
expense, upon written request within 30 days after notice of 
disapproval. If no such request is made, the respirators will be 
disposed of by the Institute in such manner as it deems appropriate.



                             Subpart C--Fees



Sec. 84.20  Examination, inspection, and testing of complete respirator assemblies; fees.

    Except as provided in Sec. 84.22, the following fees shall be 
charged by the Institute for the examination, inspection and testing of 
complete respirator assemblies:

Self-contained breathing apparatus:
  Entry and escape, 1 hour or more.............................   $3,500
  Entry and escape, less than 1 hour...........................    2,750
  Escape only..................................................    2,000
Gas masks:
  Single hazard................................................    1,100
  Type N.......................................................    4,100
Supplied-air respirators.......................................      750
Particulate respirators........................................    1,250
Chemical cartridge respirators.................................    1,150
 



Sec. 84.21  Examination, inspection, and testing of respirator components or subassemblies; fees.

    Except as provided in Sec. 84.22, the following fees shall be 
charged by the Institute for the examination, inspection and testing of 
the individual respirator components or subassemblies:

Facepieces.......................................................   $450
Canisters........................................................    900
Cartridges.......................................................    600
Filters..........................................................    650
Hoses............................................................    250
Blowers..........................................................    250
Harnesses........................................................    100
 



Sec. 84.22  Unlisted fees; additional fees; payment by applicant prior to approval.

    (a) Applications for the examination, inspection and testing of 
complete respirator assemblies which are not listed in Sec. 84.20, or 
for the examination, inspection, and testing of respirator components or 
subassemblies which are not

[[Page 550]]

listed in Sec. 84.21, shall be accompanied by the following deposits:

Complete respirator assembly...................................   $1,500
Each individual component or subassembly.......................      500
 

    (b) The Institute reserves the right to conduct any examination, 
inspection, or test it deems necessary to determine the quality and 
effectiveness of any listed or unlisted respirator assembly or 
respirator component or subassembly, and to assess the cost of such 
examinations, inspections, or tests against the applicant prior to the 
issuance of any approval for such assembly, component, or subassembly.
    (c) The fees charged for the examination, inspection, and testing of 
unlisted respirator assemblies, unlisted individual respirator 
components or subassemblies, and for the additional examination, 
inspection, and testing of listed respirator assemblies and components 
or subassemblies shall be at the rate of $100 per day for each man-day 
required to be expended by the Institute.
    (d) Upon completion of all examinations, inspections, and tests of 
unlisted respirator assemblies or components, or following the 
completion of any additional examination, inspections, or tests of 
listed assemblies, or components or subassemblies, including retesting 
subsequent to disapproval, the Institute shall advise the applicant in 
writing of the total cost assessed and the additional amount, if any, 
which must be paid to the Institute as a condition of approval.
    (e) In the event the amount assessed by the Institute for unlisted 
assemblies, or components or subassemblies is less than the amount of 
the deposit submitted in accordance with paragraph (a) of this section, 
the Institute shall refund the overpayment upon the issuance of any 
approval or notice of disapproval.



                   Subpart D--Approval and Disapproval



Sec. 84.30  Certificates of approval; scope of approval.

    (a) The Institute shall issue certificates of approval pursuant to 
the provisions of this subpart only for individual, completely assembled 
respirators which have been examined, inspected, and tested, and which 
meet the minimum requirements set forth in subparts H through L of this 
part, as applicable.
    (b) The Institute will not issue certificates of approval for any 
respirator component or for any respirator subassembly.
    (c) The Institute shall not issue an informal notification of 
approval. However, if the application for approval, submitted in 
accordance with Sec. 84.11, states that the submitted respirator and 
component parts are only prototypes, the Institute will examine, 
inspect, and test such respirator and component parts in accordance with 
the provisions of this part. If, upon completion of such examinations, 
inspections and tests, it is found that the prototype meets the minimum 
requirements set forth in this part, the Institute may inform the 
applicant, in writing, of the results of the examinations, inspections, 
and tests, and may require him to resubmit respirators and component 
parts made on regular production tooling, with no operations included 
which will not be incorporated in regular production processing, for 
further examination, inspection, and testing, prior to issuance of the 
certificate of approval.
    (d) Applicants required to resubmit respirators and component parts 
made on regular production tooling, with no operation included which 
will not be incorporated in regular production processing, shall be 
charged fees in accordance with subpart C of this part.



Sec. 84.31  Certificates of approval; contents.

    (a) The certificate of approval shall contain a classification and a 
description of the respirator or combination of respirators for which it 
is issued, as provided in this part.
    (b) The certificate of approval shall specifically set forth any 
restrictions or limitations on the respirator's use in hazardous 
atmospheres.
    (c) Each certificate of approval shall be accompanied by the 
drawings and specifications (and lists thereof) submitted by the 
applicant in accordance

[[Page 551]]

with Sec. 84.11. These drawings and specifications shall be referenced 
in the certificate of approval, and shall be maintained by the 
applicant. The drawings and specifications listed in each certificate of 
approval shall set forth in detail the design and construction 
requirements which shall be met by the applicant during commercial 
production of the respirator.
    (d) Each certificate of approval shall be accompanied by a 
reproduction of the approval label design to be employed by the 
applicant with each approved respirator, as provided in Sec. 84.33.
    (e) No test data or specific laboratory findings will accompany any 
certificate of approval, however, the Institute will release pertinent 
test data and specific findings upon written request by the applicant, 
or as required by statute or regulation.
    (f) Each certificate of approval shall also contain the approved 
quality control plan as specified in Sec. 84.42.



Sec. 84.32  Notice of disapproval.

    (a) If, upon the completion of the examinations, inspections, and 
tests required to be conducted in accordance with the provisions of this 
part, it is found that the respirator does not meet the minimum 
requirements set forth in this part, the Institute shall issue a written 
notice of disapproval to the applicant.
    (b) Each notice of disapproval shall be accompanied by all pertinent 
data or findings with respect to the defects of the respirator for which 
approval was sought with a view to the possible correction of any such 
defects.
    (c) The Institute shall not disclose, except to the applicant or as 
required by statute or regulation, any data, findings, or other 
information with respect to any respirator for which a notice of 
disapproval is issued.



Sec. 84.33  Approval labels and markings; approval of contents; use.

    (a) Full-scale reproductions of approval labels and markings, and a 
sketch or description of the method of application and position on the 
harness, container, canister, cartridge, filter, or other component, 
together with instructions for the use and maintenance of the respirator 
shall be submitted to the Institute for approval.
    (b) Approval labels shall bear the emblem of the National Institute 
for Occupational Safety and Health and the seal of the Department of 
Health and Human Services, the applicant's name and address, an approval 
number assigned by the Institute and, where appropriate, restrictions or 
limitations placed upon the use of the respirator by the Institute. The 
approval number assigned by the Institute shall be designated by the 
prefix TC and a serial number.
    (c) The Institute shall, where necessary, notify the applicant when 
additional labels, markings, or instructions will be required.
    (d) Approval labels and markings shall only be used by the applicant 
to whom they were issued.
    (e) Legible reproductions or abbreviated forms of the label approved 
by the Institute for use on each respirator shall be attached to or 
printed at the following locations:

------------------------------------------------------------------------
        Respirator type             Label type            Location
------------------------------------------------------------------------
Self-contained breathing        Entire...........  Harness assembly and
 apparatus.                                         canister (where
                                                    applicable).
Gas mask......................  Entire...........  Mask container and
                                                    canister.
Supplied air respirator.......  ......do.........  Respirator container
                                                    or instruction card.
Particulate respirator........  ......do.........  Respirator container
                                                    and filter
                                                    container.
                                Abbreviated......  Filters.
Chemical-cartridge respirator.  Entire...........  Respirator container,
                                                    cartridge container,
                                                    and filter
                                                    containers (where
                                                    applicable).
                                Abbreviated......  Cartridges and
                                                    filters and filter
                                                    containers.
------------------------------------------------------------------------

    (f) The use of any Institute approval label obligates the applicant 
to whom it is issued to maintain or cause to be maintained the approved 
quality control sampling schedule and the acceptable quality level for 
each characteristic tested, and to assure that it

[[Page 552]]

is manufactured according to the drawings and specifications upon which 
the certificate of approval is based.
    (g) Each respirator, respirator component, and respirator container 
shall, as required by the Institute to assure quality control and proper 
use of the respirator, be labeled distinctly to show the name of the 
applicant, and the name and letters or numbers by which the respirator 
or respirator component is designated for trade purposes, and the lot 
number, serial number, or approximate date of manufacture.



Sec. 84.34  Revocation of certificates of approval.

    The Institute reserves the right to revoke, for cause, any 
certificate of approval issued pursuant to the provisions of this part. 
Such causes include, but are not limited to, misuse of approval labels 
and markings, misleading advertising, and failure to maintain or cause 
to be maintained the quality control requirements of the certificate of 
approval.



Sec. 84.35  Changes or modifications of approved respirators; issuance of modification of certificate of approval.

    (a) Each applicant may, if he desires to change any feature of an 
approved respirator, request a modification of the original certificate 
of approval issued by the Institute for such respirator by filing an 
application for such modification in accordance with the provisions of 
this section.
    (b) Applications shall be submitted as for an original certificate 
of approval, with a request for a modification of the existing 
certificate to cover any proposed change.
    (c) The application shall be accompanied by appropriate drawings and 
specifications, and by a proposed quality control plan which meets the 
requirements of subpart E of this part.
    (d) The application for modification, together with the accompanying 
material, shall be examined by the Institute to determine whether 
testing will be required.
    (e) The Institute shall inform the applicant of the fee required for 
any additional testing and the applicant will be charged for the actual 
cost of any examination, inspection, or test required, and such fees 
shall be submitted in accordance with the provisions of subpart C of 
this part.
    (f) If the proposed change or modification meets the requirements of 
this part, a formal certificate of modification will be issued, 
accompanied, where necessary, by a list of new and revised drawings and 
specifications covering the change(s) and reproductions of revised 
approval labels.

(The information collections contained in this section are approved 
under OMB control number 0920-0109)



Sec. 84.36  Delivery of changed or modified approved respirator.

    An approved respirator for which a formal certificate of 
modification has been issued shall be delivered, with proper markings 
and containers, by the applicant to the Certification and Quality 
Assurance Branch, as soon as it is commercially produced.



                       Subpart E--Quality Control



Sec. 84.40  Quality control plans; filing requirements.

    As a part of each application for approval or modification of 
approval submitted pursuant to this part, each applicant shall file with 
the Institute a proposed quality control plan which shall be designed to 
assure the quality of respiratory protection provided by the respirator 
for which approval is sought.



Sec. 84.41  Quality control plans; contents.

    (a) Each quality control plan shall contain provisions for the 
management of quality, including:
    (1) Requirements for the production of quality data and the use of 
quality control records;
    (2) Control of engineering drawings, documentations, and changes;
    (3) Control and calibration of measuring and test equipment;
    (4) Control of purchased material to include incoming inspection;
    (5) Lot identification, control of processes, manufacturing, 
fabrication, and assembly work conducted in the applicant's plant;

[[Page 553]]

    (6) Audit of final inspection of the completed product; and
    (7) The organizational structure necessary to carry out these 
provisions.
    (b) Each provision for incoming and final inspection in the quality 
control plan shall include a procedure for the selection of a sample of 
respirators and the components thereof for testing, in accordance with 
procedures set forth in Military Standard MIL-STD-414, 11 June 1957, 
including Change Notice No. 1, ``Sampling Procedures and Tables for 
Inspection by Variables for Percent Defective,'' or an approved 
equivalent sampling procedure, or an approved combination of sampling 
procedures. The procedure of Military Standard MIL-STD-105D, 29 April 
1963, ``Sampling Procedures and Tables for Inspection by Attributes,'' 
is an example of an equivalent sampling procedure. MIL-STD-414 is 
incorporated by reference and has been approved by the Director of the 
Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. 
Copies may be obtained from DODSSP, Standardization Document Order Desk, 
700 Robbins Avenue, Bldg. 4D, Philadelphia, PA 19111-5094. Copies may be 
inspected at the NIOSH, Certification and Quality Assurance Branch, 1095 
Willowdale Road, Morgantown, WV 26505-2888, or at the Office of the 
Federal Register, 800 North Capitol Street NW., suite 700, Washington, 
DC. Copies of MIL-STD-105D may be inspected or obtained from the NIOSH, 
Certification and Quality Assurance Branch, 1095 Willowdale Road, 
Morgantown, WV 26505-2888. Incoming bulk raw material inspection or 
verification of specification, and in-process inspection shall be 
sufficient to ensure control of product quality through the 
manufacturing cycle.
    (c) The sampling procedure shall include a list of the 
characteristics to be tested by the applicant or his agent.
    (d) The characteristics listed in accordance with paragraph (c) of 
this section shall be classified according to the potential effect of 
such defect and grouped into the following classes:
    (1) Critical. A defect that judgment and experience indicate is 
likely to result in a condition immediately hazardous to life or health 
for individuals using or depending upon the respirator;
    (2) Major A. A defect, other than critical, that is likely to result 
in failure to the degree that the respirator does not provide any 
respiratory protection, or a defect that reduces protection and is not 
detectable by the user;
    (3) Major B. A defect, other than Major A or critical, that is 
likely to result in reduced respiratory protection, and is detectable by 
the user; and
    (4) Minor. A defect that is not likely to materially reduce the 
usability of the respirator for its intended purpose, or a defect that 
is a departure from established standards and has little bearing on the 
effective use or operation of the respirator.
    (e) The quality control inspection test method to be used by the 
applicant or his agent for each characteristic required to be tested 
shall be described in detail.
    (f) Each item manufactured shall be 100 percent inspected for 
defects in all critical characteristics and all defective items shall be 
rejected.
    (g) The Acceptable Quality Level (AQL) for each major or minor 
defect so classified by the applicant shall be:
    (1) Major A. 1.0 percent;
    (2) Major B. 2.5 percent; and
    (3) Minor. 4.0 percent.
    (h) Except as provided in paragraph (i) of this section, inspection 
level IV as described in MIL-STD-414, 11 June 1957, including Change 
Notice No.1, ``Sampling Procedures and Tables for Inspection by 
Variables for Percent Defective,'' or an equivalent procedure, shall be 
used for major and minor characteristics and 100 percent inspection for 
critical characteristics. Inspection level II as described in MIL-STD-
105D, 29 April 1963, ``Sampling Procedures and Tables for Inspection by 
Attributes,'' is an example of an equivalent procedure.
    (i) Subject to the approval of the Institute, where the quality 
control plan provisions for raw material, processes, manufacturing, and 
fabrication, inspections are adequate to ensure control of finished 
article quality, destructive testing of finished articles may be

[[Page 554]]

conducted at a lower level of inspection than that specified in 
paragraph (h) of this section.

(The information collections contained in this section are approved 
under OMB control number 0920-0109)



Sec. 84.42  Proposed quality control plans; approval by the Institute.

    (a) Each proposed quality control plan submitted in accordance with 
this subpart shall be reviewed by the Institute to determine its 
effectiveness in ensuring the quality of respiratory protection provided 
by the respirator for which an approval is sought.
    (b) If the Institute determines that the proposed quality control 
plan submitted by the applicant will not ensure adequate quality 
control, the Institute shall require the applicant to modify the 
procedures and testing requirements of the plan prior to approval of the 
plan and issuance of any certificate of approval.
    (c) Approved quality control plans shall constitute a part of and be 
incorporated into any certificate of approval issued by the Institute, 
and compliance with such plans by the applicant shall be a condition of 
approval.



Sec. 84.43  Quality control records; review by the Institute; revocation of approval.

    (a) The applicant shall keep quality control inspection records 
sufficient to carry out the procedures required in MIL-STD-414, 11 June 
1957, including Change Notice No. 1, ``Sampling Procedures and Tables 
for Inspection by Variables for Percent Defective,'' or an approved 
equivalent sampling procedure. MIL-STD-105D, 29 April 1963, ``Sampling 
Procedures and Tables for Inspection by Attributes,'' is an example of 
an approved equivalent sampling procedure. MIL-STD-414 is incorporated 
by reference and has been approved by the Director of the Federal 
Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies 
may be obtained from DODSSP, Standardization Document Order Desk, 700 
Robbins Avenue, Bldg. 4D, Philadelphia, Pa. 19111-5094. Copies may be 
inspected at the NIOSH, Certification and Quality Assurance Branch, 1095 
Willowdale Road, Morgantown, WV 26505-2888, or at the Office of the 
Federal Register, 800 North Capitol Street, NW., suite 700, Washington, 
DC. Copies of MIL-STD-105D may be inspected or obtained from the NIOSH, 
Certification and Quality Assurance Branch, 1095 Willowdale Road, 
Morgantown, WV 26505-2888.
    (b) The Institute reserves the right to have its representatives 
inspect the applicant's quality control test methods, equipment, and 
records, and to interview any employee or agent of the applicant in 
regard to quality control test methods, equipment, and records.
    (c) The Institute reserves the right to revoke, for cause, any 
certificate of approval where it is found that the applicant's quality 
control test methods, equipment, or records do not ensure effective 
quality control over the respirator for which the approval was issued.

(The information collections contained in this section are approved 
under OMB control number 0920-0109)



 Subpart F--Classification of Approved Respirators; Scope of Approval; 
                    Atmospheric Hazards; Service Time



Sec. 84.50  Types of respirators to be approved; scope of approval.

    Approvals shall be issued for the types of respirators which have 
been classified pursuant to this subpart F, have been inspected, 
examined and tested by the Institute, in accordance with the provisions 
of subparts G through L of this part, and have been found to provide 
respiratory protection for fixed periods of time against the hazards 
specified in such approval.



Sec. 84.51  Entry and escape, or escape only; classification.

    Respirators described in subparts H through L of this part shall be 
classified for use as follows:
    (a) Entry and escape. Respirators designed and approved for use 
during entry into a hazardous atmosphere, and for escape from a 
hazardous atmosphere; or
    (b) Escape only. Respirators designed and approved for use only 
during escape from a hazardous atmosphere.

[[Page 555]]



Sec. 84.52  Respiratory hazards; classification.

    Respirators described in subparts H through L of this part shall be 
classified as approved for use against any or all of the following 
respiratory hazards:
    (a) Oxygen deficiency;
    (b) Gases and vapors; and
    (c) Particles, including dusts, fumes and mists.



Sec. 84.53  Service time; classification.

    (a) Respirators described in subparts H through L of this part shall 
be classified, where applicable, as approved for use during the 
following prescribed service times:
    (1) Four hours;
    (2) Three hours;
    (3) Two hours;
    (4) One hour;
    (5) Forty-five minutes;
    (6) Thirty minutes;
    (7) Fifteen minutes;
    (8) Ten minutes;
    (9) Five minutes; or
    (10) Three minutes.
    (b) Other service times may be prescribed by the Institute.



      Subpart G--General Construction and Performance Requirements



Sec. 84.60  Construction and performance requirements; general.

    (a) The Institute shall issue approvals for the types of respirators 
described in subparts H through L of this part which have met the 
minimum requirements set forth for such respirators in this part.
    (b) In addition to the types of respirators specified in subparts H 
through L of this part, the Institute shall issue approvals for other 
respiratory protective devices not specifically described in this part 
subject to such additional requirements as may be imposed in accordance 
with Sec. 84.63(c).



Sec. 84.61  General construction requirements.

    (a) Respirators will not be accepted by the Institute for 
examination, inspection and testing unless they are designed on sound 
engineering and scientific principles, constructed of suitable materials 
and evidence good workmanship.
    (b) Respirator components which come into contact with the wearer's 
skin shall be made of nonirritating materials.
    (c) Components replaced during or after use shall be constructed of 
materials which will not be damaged by normal handling.
    (d) Mouthpieces, hoods, helmets, and facepieces, except those 
employed in single-use respirators, shall be constructed of materials 
which will withstand repeated disinfection as recommended by the 
applicant in his instructions for use of the device.



Sec. 84.62  Component parts; minimum requirements.

    (a) The component parts of each respirator shall be:
    (1) Designed, constructed, and fitted to insure against creation of 
any hazard to the wearer;
    (2) Assembled to permit easy access for inspection and repair of 
functional parts; and
    (3) Assembled to permit easy access to parts which require periodic 
cleaning and disinfecting.
    (b) Replacement parts shall be designed and constructed to permit 
easy installation and to maintain the effectiveness of the respirator.



Sec. 84.63  Test requirements; general.

    (a) Each respirator and respirator component shall when tested by 
the applicant and by the Institute, and meet the applicable requirements 
set forth in subparts H through L of this part.
    (b) Where a combination respirator is assembled from two or more 
types of respirators, as described in this part, each of the individual 
respirator types which have been combined shall, as applicable, meet the 
minimum requirements for such respirators set forth in subparts H 
through L of this part, and such combination respirators, except as 
specified in Sec. 84.70(b)(2), will be classified by the type of 
respirator in the combination which provides the least protection to the 
user.
    (c) In addition to the minimum requirements set forth in subparts H 
through L of this part, the Institute reserves the right to require, as 
a further

[[Page 556]]

condition of approval, any additional requirements deemed necessary to 
establish the quality, effectiveness, and safety of any respirator used 
as protection against hazardous atmospheres.
    (d) Where it is determined after receipt of an application that 
additional requirements will be required for approval, the Institute 
will notify the applicant in writing of these additional requirements, 
and necessary examinations, inspections, or tests, stating generally the 
reasons for such requirements, examinations, inspections, or tests.



Sec. 84.64  Pretesting by applicant; approval of test methods.

    (a) Prior to making or filing any application for approval or 
modification of approval, the applicant shall conduct, or cause to be 
conducted, examinations, inspections, and tests of respirator 
performance which are equal to or exceed the severity of those 
prescribed in this part.
    (b) With the application, the applicant shall provide a statement to 
the Institute showing the types and results of the examinations, 
inspections, and tests required under paragraph (a) of this section and 
state that the respirator meets the minimum requirements of subparts H 
through L of this part, as applicable. Complete examination, inspection, 
and test data shall be retained on file by the applicant and be 
submitted, upon request, to the Institute.
    (c) The Institute may, upon written request by the applicant, 
provide drawings and descriptions of its test equipment and otherwise 
assist the applicant in establishing a test laboratory or securing the 
services of a testing agency.
    (d) No approval will be issued until the Institute has validated the 
applicant's test results.



Sec. 84.65  Conduct of examinations, inspections, and tests by the Institute; assistance by applicant; observers; recorded data; public demonstrations.

    (a) All examinations, inspections, and tests conducted pursuant to 
subparts H through L of this part will be under the sole direction and 
control of the Institute.
    (b) The Institute may, as a condition of approval, require the 
assistance of the applicant or agents of the applicant during the 
assembly, disassembly, or preparation of any respirator or respirator 
component prior to testing or in the operation of such equipment during 
testing.
    (c) Only Institute personnel, persons assisting the Institute 
pursuant to paragraph (b) of this section, and such other persons as are 
requested by the Institute or the applicant to be observers, shall be 
present during any examination, inspection, or test conducted prior to 
the issuance of an approval by the Institute for the equipment under 
consideration.
    (d) The Institute shall hold as confidential any analyses, drawings, 
specifications, or materials submitted by the applicant and shall not 
disclose any principles or patentable features of such equipment, except 
as required by statute or regulation.
    (e) As a condition of each approval issued for any respirator, the 
Institute reserves the right, following the issuance of such approval, 
to conduct such public tests and demonstrations of the approved 
respiratory equipment as is deemed appropriate.



Sec. 84.66  Withdrawal of applications; refund of fees.

    (a) Any applicant may, upon a written request submitted to the 
Institute, withdraw any application for approval of any respirator.
    (b) Upon receipt of a written request for the withdrawal of an 
application, the Institute shall determine the total man-days expended 
and the amount due for services already performed during the course of 
any examinations, inspections, or tests conducted pursuant to such 
application. The total amount due shall be determined in accordance with 
the provisions of Sec. 84.22 and assessed against the fees submitted by 
the applicant. If the total amount assessed is less than the fees 
submitted, the Institute shall refund the balance together with a 
statement of the charges made for services rendered.

[[Page 557]]



              Subpart H--Self-Contained Breathing Apparatus



Sec. 84.70  Self-contained breathing apparatus; description.

    (a) Self-contained breathing apparatus, including all completely 
assembled, portable, self-contained devices designed for use as 
respiratory protection during entry into and escape from or escape only 
from hazardous atmospheres, are described as follows:
    (1) Closed-circuit apparatus. An apparatus of the type in which the 
exhalation is rebreathed by the wearer after the carbon dioxide has been 
effectively removed and a suitable oxygen concentration restored from 
sources composed of:
    (i) Compressed oxygen; or
    (ii) Chemical oxygen; or
    (iii) Liquid-oxygen.
    (2) Open-circuit apparatus. An apparatus of the following types from 
which exhalation is vented to the atmosphere and not rebreathed:
    (i) Demand-type apparatus. An apparatus in which the pressure inside 
the facepiece in relation to the immediate environment is positive 
during exhalation and negative during inhalation; or
    (ii) Pressure-demand-type apparatus. An apparatus in which the 
pressure inside the facepiece in relation to the immediate environment 
is positive during both inhalation and exhalation.
    (b) The following respirators may be classified as designed and 
approved for use during emergency entry into a hazardous atmosphere:
    (1) A combination respirator which includes a self-contained 
breathing apparatus; and
    (2) A Type ``C'' or Type ``CE'' supplied air respirator, where--
    (i) The self-contained breathing apparatus is classified for 3-, 5-, 
or 10-minute service time and the air line supply is used during entry; 
or
    (ii) The self-contained breathing apparatus is classified for 15 
minutes or longer service time and not more than 20 percent of the rated 
capacity of the air supply is used during entry.
    (c) Self-contained breathing apparatus classified for less than 1 
hour service time will not be approved for use during underground mine 
rescue and recovery operations except as auxiliary equipment.
    (d) Self-contained breathing apparatus classified for less than 30 
minutes' service time will not be approved for use as auxiliary 
equipment during underground mine rescue and recovery operations.



Sec. 84.71  Self-contained breathing apparatus; required components.

    (a) Each self-contained breathing apparatus described in Sec. 84.70 
shall, where its design requires, contain the following component parts:
    (1) Facepiece or mouthpiece, and noseclip;
    (2) Respirable breathing gas container;
    (3) Supply of respirable breathing gas;
    (4) Gas pressure or liquid level gages;
    (5) Timer;
    (6) Remaining service life indicator or warning device;
    (7) Hand-operated valves;
    (8) Breathing bag;
    (9) Safety relief valve or safety relief system; and
    (10) Harness.
    (b) The components of each self-contained breathing apparatus shall 
meet the minimum construction requirements set forth in subpart G of 
this part.



Sec. 84.72  Breathing tubes; minimum requirements.

    Flexible breathing tubes used in conjunction with breathing 
apparatus shall be designed and constructed to prevent:
    (a) Restriction of free head movement;
    (b) Disturbance of the fit of facepieces and mouthpieces;
    (c) Interference with the wearer's activities; and
    (d) Shutoff of airflow due to kinking, or from chin or arm pressure.



Sec. 84.73  Harnesses; installation and construction; minimum requirements.

    (a) Each apparatus shall, where necessary, be equipped with a 
suitable harness designed and constructed to hold the components of the 
apparatus in position against the wearer's body.

[[Page 558]]

    (b) Harnesses shall be designed and constructed to permit easy 
removal and replacement of apparatus parts and, where applicable, 
provide for holding a full facepiece in the ready position when not in 
use.



Sec. 84.74  Apparatus containers; minimum requirements.

    (a) Apparatus may be equipped with a substantial, durable container 
bearing markings which show the applicant's name, the type and 
commercial designation of the respirator it contains, and all 
appropriate approval labels.
    (b) Containers supplied by the applicant for carrying or storing 
self-contained breathing apparatus will be inspected, examined, and 
tested as components of the respirator for which approval is sought.
    (c) Containers for self-contained breathing apparatus shall be 
designed and constructed to permit easy removal of the apparatus.



Sec. 84.75  Half-mask facepieces, full facepieces, mouthpieces; fit; minimum requirements.

    (a) Half-mask facepieces and full facepieces shall be designed and 
constructed to fit persons with various facial shapes and sizes, either:
    (1) By providing more than one facepiece size; or
    (2) By providing one facepiece size which will fit varying facial 
shapes and sizes.
    (b) Full facepieces shall provide for the optional use of corrective 
spectacles or lenses which shall not reduce the respiratory protective 
qualities of the apparatus.
    (c) Apparatus with mouthpieces shall be equipped with noseclips 
which are securely attached to the mouthpiece or apparatus and provide 
an airtight seal.
    (d) Facepieces shall be designed to prevent eyepiece, spectacle, and 
lens fogging.



Sec. 84.76  Facepieces; eyepieces; minimum requirements.

    (a) Facepieces shall be designed and constructed to provide adequate 
vision which is not distorted by the eyepiece.
    (b) All eyepieces shall be designed and constructed to be impact and 
penetration resistant. Federal Specification, Mask, Air Line: and 
Respirator, Air Filtering, Industrial, GGG-M-125d, October 11, 1965 with 
interim amendment-1, July 30, 1969, is an example of an appropriate 
standard for determining impact and penetration resistance. Copies of 
GGG-M-125d may be obtained from the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888.



Sec. 84.77  Inhalation and exhalation valves; minimum requirements.

    (a) Inhalation and exhalation valves shall be provided where 
necessary and protected against damage and distortion.
    (b) Exhalation valves shall be--
    (1) Protected against external influence; and
    (2) Designed and constructed to prevent inward leakage of 
contaminated air.



Sec. 84.78  Head harnesses; minimum requirements.

    (a) Facepieces shall be equipped with adjustable and replaceable 
head harnesses designed and constructed to provide adequate tension 
during suspension and an even distribution of pressure over the entire 
area in contact with the face.
    (b) Mouthpieces shall be equipped, where applicable, with adjustable 
and replaceable harnesses designed and constructed to hold the 
mouthpiece in place.



Sec. 84.79  Breathing gas; minimum requirements.

    (a) Breathing gas used to supply apparatus shall be respirable and 
contain no less than 19.5 (dry atmosphere) volume percent of oxygen.
    (b) Oxygen, including liquid oxygen, shall contain not less than 
99.0 percent, by volume, of pure O2, not more than 0.03%, by 
volume, carbon dioxide, and not more than 0.001%, by volume, carbon 
monoxide. Methods for making these determinations can be found in the 
U.S. Pharmacopeia National Formulary. Containers used for oxygen must 
not be treated with any toxic, sleep-inducing, narcosis-producing, or 
respiratory tract irritating compounds.

[[Page 559]]

    (c) Compressed, gaseous breathing air shall meet the applicable 
minimum grade requirements for Type I gaseous air set forth in the 
Compressed Gas Association Commodity Specification for Air, G-7.1, 1966 
(Grade D or higher quality). G-7.1 is incorporated by reference and has 
been approved by the Director of the Federal Register in accordance with 
5 U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from American 
National Standards Institute, Inc., 1430 Broadway, New York, NY 10018. 
Copies may be inspected at the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888, or at 
the Office of the Federal Register, 800 North Capitol Street, NW., suite 
700, Washington, DC.
    (d) Compressed, liquefied breathing air shall meet the applicable 
minimum grade requirements for Type II liquid air set forth in the 
Compressed Gas Association Commodity Specification for Air, G-7.1, 1966 
(Grade B or higher quality). G-7.1 is incorporated by reference and has 
been approved by the Director of the Federal Register in accordance with 
5 U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from American 
National Standards Institute, Inc., 1430 Broadway, New York, NY 10018. 
Copies may be inspected at the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888, or at 
the Office of the Federal Register, 800 North Capitol Street, NW., suite 
700, Washington, DC.



Sec. 84.80  Interchangeability of oxygen and air prohibited.

    Approvals shall not be issued by the Institute for any apparatus, 
combination of respirator assemblies, or any apparatus or respirator 
component which is designed or constructed to permit the interchangeable 
use of oxygen and air.



Sec. 84.81  Compressed breathing gas and liquefied breathing gas containers; minimum requirements.

    (a) Compressed breathing gas and liquefied breathing gas containers 
shall meet the minimum requirements of the Department of Transportation 
for interstate shipment of such containers when fully charged.
    (b) Such containers shall be permanently and legibly marked to 
identify their contents, e.g., compressed breathing air, compressed 
breathing oxygen, liquefied breathing air, or liquefied breathing 
oxygen.
    (c) Containers normally removed from apparatus for refilling shall 
be equipped with a dial indicating gage which shows the pressure in the 
container.
    (d) Compressed breathing gas contained valves or a separate charging 
system or adapter provided with each apparatus shall be equipped with 
outlet threads specified for the service by the American Standards 
Association, Compressed Gas Cylinder Valve Outlet and Inlet Connections, 
B57.1-1965. B57.1-1965 is incorporated by reference and has been 
approved by the Director of the Federal Register in accordance with 5 
U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from American 
National Standards Institute, Inc., 1430 Broadway, New York, NY Copies 
may be inspected at the NIOSH, Certification and Quality Assurance 
Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888, or at the 
Office of the Federal Register, 800 North Capitol Street, NW., suite 
700, Washington, DC.



Sec. 84.82  Gas pressure gages; minimum requirements.

    (a) Gas pressure gages employed on compressed breathing gas 
containers shall be calibrated in pounds per square inch.
    (b) Liquid-level gages shall be calibrated in fractions of total 
container capacity, or in units of liquid volume.
    (c) Gas pressure gages other than those specified in paragraphs (a) 
and (b) of this section shall be calibrated in:
    (1) Pounds per square inch; or
    (2) In fractions of total container capacity; or
    (3) Both in pounds per square inch and fractions of total container 
capacity.
    (d)(1) Dial-indicating gages shall be reliable to within 
5 percent of full scale when tested both up and down the 
scale at each of 5 equal intervals.
    (2) The full-scale graduation of dial-indicating gages shall not 
exceed 150 percent of the maximum rated cylinder

[[Page 560]]

pressures specified for the container in applicable Department of 
Transportation specifications or permits.
    (e)(1) Stem-type gages shall be readable by sight and by touch and 
shall have a stem travel distance of not less than one-fourth inch 
between each graduation.
    (2) A minimum of five graduations shall be engraved on the stem of 
each gage and these graduations shall include readings for empty, one-
quarter, one-half, three-quarters, and full.
    (3) Stem gage readings shall not vary from true readings by more 
than one-sixteenth inch per inch of stem travel.
    (f) The loss of gas through a broken gage or severed gage connection 
shall not exceed 70 liters per minute when the cylinder pressure is 
6,900 kN/m.2 (1,000 pounds per square inch gage) or when the 
liquid level is at one-half.
    (g) Where gages are connected to the apparatus through a gage line, 
the gage and line shall be capable of being isolated from the apparatus 
except where the failure of the gage or line would not impair the 
performance or service life of the apparatus.
    (h) Oxygen pressure gages shall have the words ``Oxygen'' and ``Use 
No Oil'' marked prominently on the gage.
    (i)(1) Apparatus using compressed breathing gas, except apparatus 
classified for escape only, shall be equipped with gages visible to the 
wearer which indicate the remaining gas content in the container.
    (2) Apparatus using liquefied breathing gas, except apparatus 
classified for escape only, shall be equipped with gages visible to the 
wearer which indicate the remaining liquid content in the container; 
however, where the liquid content cannot be rapidly vented, and the 
service time of the device begins immediately after filling, a timer 
shall be provided in place of a visible gage.



Sec. 84.83  Timers; elapsed time indicators; remaining service life indicators; minimum requirements.

    (a) Elapsed time indicators shall be provided for apparatus with a 
chemical oxygen source, except:
    (1) Apparatus used for escape only; or
    (2) Liquefied breathing gas apparatus equipped with gages visible to 
the wearer which indicate the remaining liquid content in the container.
    (b) The timer or other indicator shall be accurately calibrated in 
minutes of remaining service life.
    (c) Timers shall be readable by sight and by touch during use by the 
wearer.
    (d) Timers shall be equipped with automatically preset alarms which 
will warn the wearer for a period of 7 seconds or more after the preset 
time has elapsed.
    (e) Remaining service-life indicators or warning devices shall be 
provided in addition to a pressure gage on compressed gas self-contained 
breathing apparatus, except apparatus used for escape only, and shall 
operate automatically without preadjustment by the wearer.
    (f) Each remaining service-life indicator or warning device shall 
give an alarm when the remaining service life of the apparatus is 
reduced within a range of 20 to 25 percent of its rated service time.



Sec. 84.84  Hand-operated valves; minimum requirements.

    (a) Hand-operated valves shall be designed and constructed to 
prevent removal of the stem from the valve body during normal usage to 
insure against a sudden release of the full pressure of the container 
when the valve is opened.
    (b) Valves shall be designed or positioned to prevent accidental 
opening and closing, and damage from external forces.
    (c) Valves operated during use of the apparatus shall be installed 
in locations where they can be readily adjusted by the wearer.
    (d) Main-line valves, designed and constructed to conserve gas in 
the event of a regulator or demand valve failure, shall be provided in 
addition to gas container valves, except when such failure will not 
affect performance.
    (e) Hand-operated bypass systems designed and constructed to permit 
the wearer to breathe and to conserve his gas supply in the event of a 
regulator or demand valve failure, shall be provided where necessary.
    (f) Valves installed on apparatus shall be clearly distinguishable 
from one another by sight and touch.

[[Page 561]]

    (g) The bypass system valve control shall be colored red.
    (h) A main-line or bypass valve or system will not be required on 
apparatus for escape only.
    (i) Safety relief valves or systems, designed and constructed to 
release excess pressure in the breathing circuit, shall be provided on 
closed-circuit apparatus, and shall meet the following requirements:
    (1) The relief valve or system shall operate automatically when the 
pressure in the breathing circuit on the inhalation side of the 
breathing bag reaches 13 mm. (one-half inch) water-column height of 
pressure above the minimum pressure required to fill the breathing bag, 
within the breathing resistance requirements for the apparatus.
    (2) The relief valve or system shall be designed to prevent external 
atmospheres from entering the breathing circuit.
    (3) The relief valve or system shall be designed to permit manual 
overriding for test purposes and in the event of a failure in the valve 
or system.



Sec. 84.85  Breathing bags; minimum requirements.

    (a) Breathing bags shall have sufficient volume to prevent gas waste 
during exhalation and to provide an adequate reserve for inhalation.
    (b) Breathing bags shall be constructed of materials which are 
flexible and resistant to gasoline vapors.
    (c) Breathing bags shall be installed in a location which will 
protect them from damage or collapse by external forces, except on 
apparatus classified for escape only.



Sec. 84.86  Component parts exposed to oxygen pressures; minimum requirements.

    Each applicant shall certify that the materials employed in the 
construction of component parts exposed to oxygen pressures above 
atmospheric pressure are safe and compatible for their intended use.



Sec. 84.87  Compressed gas filters; minimum requirements.

    All self-contained breathing apparatus using compressed gas shall 
have a filter downstream of the gas source to effectively remove 
particles from the gas stream.



Sec. 84.88  Breathing bag test.

    (a) Breathing bags will be tested in an air atmosphere saturated 
with gasoline vapor at room temperature (24-30  deg.C./75-85  deg.F.) 
for a continuous period of twice the rated time of the apparatus (except 
for apparatus for escape only where the test period shall be the rated 
time of the apparatus).
    (b) The bag will be operated during this test by a breathing machine 
with 24 respirations per minute and a minute-volume of 40 liters.
    (c) A breathing machine cam with a work rate of 622 kp.-m./min. will 
be used. The dimensions of a suitable breathing machine cam are 
available from the Institute upon request.
    (d) The air within the bag(s) shall not contain more than 100 parts 
per million of gasoline vapor at the end of the test.



Sec. 84.89  Weight requirement.

    (a) The completely assembled and fully charged apparatus shall not 
weigh more than 16 kg. (35 pounds); however, where the weight decreases 
by more than 25 percent of its initial charge weight during its rated 
service life, the maximum allowable weight of a completely assembled and 
fully charged apparatus shall be 18 kg. (40 pounds).
    (b) Where an apparatus employs equipment which contributes 
materially to the wearer's comfort, e.g., a cooling system, the 
completely assembled and fully charged apparatus shall not weigh more 
than 18 kg. (40 pounds) regardless of the decrease in weight during use.



Sec. 84.90  Breathing resistance test; inhalation.

    (a) Resistance to inhalation airflow will be measured in the 
facepiece or mouthpiece while the apparatus is operated by a breathing 
machine as described in Sec. 84.88.
    (b) The inhalation resistance of open-circuit apparatus shall not 
exceed 32 mm. (1.25 inch) water-column height (at a flow rate of 120 
liters per minute).
    (c) The inhalation resistance of closed-circuit apparatus shall not 
exceed the difference between exhalation

[[Page 562]]

resistance (Sec. 84.91(e)) and 10 cm. (4 inches) water-column height.



Sec. 84.91  Breathing resistance test; exhalation.

    (a) Resistance to exhalation airflow will be measured in the 
facepiece or mouthpiece of open-circuit apparatus with air flowing at a 
continuous rate of 85 liters per minute.
    (b) The exhalation resistance of demand apparatus shall not exceed 
25 mm. (1 inch) water-column height.
    (c) The exhalation resistance of pressure-demand apparatus shall not 
exceed the static pressure in the facepiece by more than 51 mm. (2 
inches) water-column height.
    (d) The static pressure (at zero flow) in the facepiece shall not 
exceed 38 mm. (1.5 inches) water-column height.
    (e) Resistance to exhalation airflow will be measured in the 
facepiece or mouthpiece of closed-circuit apparatus with a breathing 
machine as described in Sec. 84.88, and the exhalation resistance shall 
not exceed 51 mm. (2 inches) water-column height.



Sec. 84.92  Exhalation valve leakage test.

    (a) Dry exhalation valves and valve seats will be subjected to a 
suction of 25 mm. (1 inch) water-column height while in a normal 
operating position.
    (b) Leakage between the valve and the valve seat shall not exceed 30 
milliliters per minute.



Sec. 84.93  Gas flow test; open-circuit apparatus.

    (a) A static-flow test will be performed on all open-circuit 
apparatus.
    (b) The flow from the apparatus shall be greater than 200 liters per 
minute when the pressure in the facepiece of demand-apparatus is lowered 
by 51 mm. (2 inches) water-column height when full container pressure is 
applied.
    (c) Where pressure demand apparatus are tested, the flow will be 
measured at zero gage pressure in the facepiece.
    (d) Where apparatus with compressed-breathing-gas containers are 
tested, the flow test shall also be made with 3,450 kN/m.\2\ (500 
p.s.i.g.) container pressure applied.



Sec. 84.94  Gas flow test; closed-circuit apparatus.

    (a) Where oxygen is supplied by a constant-flow device only, the 
rate of flow shall be at least 3 liters per minute for the entire rated 
service time of the apparatus.
    (b) Where constant flow is used in conjunction with demand flow, the 
constant flow shall be greater than 1.5 liters per minute for the entire 
rated service time.
    (c) All demand-flow devices shall provide at least 30 liters of 
oxygen per minute when in the fully open position.



Sec. 84.95  Service time test; open-circuit apparatus.

    (a) Service time will be measured with a breathing machine as 
described in Sec. 84.88.
    (b) The open-circuit apparatus will be classified according to the 
length of time it supplies air or oxygen to the breathing machine.
    (c) The service time obtained on this test will be used to classify 
the open-circuit apparatus in accordance with Sec. 84.53.



Sec. 84.96  Service time test; closed-circuit apparatus.

    (a) The closed-circuit apparatus will be classified according to the 
length of time it supplies adequate breathing gas to the wearer during 
man test No. 4 described in Table 4 of this subpart.
    (b) The service time obtained on man test No. 4 will be used to 
classify the closed-circuit apparatus in accordance with Sec. 84.53.



Sec. 84.97  Test for carbon dioxide in inspired gas; open- and closed-circuit apparatus; maximum allowable limits.

    (a) Open-circuit apparatus. (1) The concentration of carbon dioxide 
in inspired gas in open-circuit apparatus will be measured at the mouth 
while the apparatus mounted on a dummy head is operated by a breathing 
machine. An acceptable method for measuring the concentration of carbon 
dioxide is described in Bureau of Mines Report of Investigations 6865, A 
Machine-

[[Page 563]]

Test Method for Measuring Carbon Dioxide in the Inspired Air of Self-
Contained Breathing Apparatus, 1966. Copies of Report of Investigations 
6865 may be inspected or obtained from the NIOSH, Certification and 
Quality Assurance Branch, 1095 Willowdale Road, Morgantown, WV. 26505-
2888.
    (2) The breathing rate will be 14.5 respirations per minute with a 
minute-volume of 10.5 liters.
    (3) A sedentary breathing machine cam will be used.
    (4) The apparatus will be tested at a temperature of 27  
2 deg. C. (80  5 deg. F.).
    (5) A concentration of 5 percent carbon dioxide in air will be 
exhaled into the facepiece.
    (b) Closed-circuit apparatus. The concentration of carbon dioxide in 
inspired gas in closed-circuit apparatus will be measured at the mouth 
while the parts of the apparatus contributing to dead-air space are 
mounted on a dummy head and operated by the breathing machine as in 
paragraphs (a) (1) through (5) of this section.
    (c) During the testing required by paragraphs (a) and (b) of this 
section, the concentration of carbon dioxide in inspired gas at the 
mouth will be continuously recorded, and the maximum average 
concentration during the inhalation portion of the breathing cycle shall 
not exceed the following limits:

------------------------------------------------------------------------
                                                    Maximum allowable
                                                  average concentration
           Where the service time is               of carbon dioxide in
                                                 inspired air percent by
                                                          volume
------------------------------------------------------------------------
Not more than 30 minutes.......................                      2.5
1 hour.........................................                      2.0
2 hours........................................                      1.5
3 hours........................................                      1.0
4 hours........................................                      1.0
------------------------------------------------------------------------

    (d) In addition to the test requirements for closed-circuit 
apparatus set forth in paragraph (b) of this section, gas samples will 
be taken during the course of the man tests described in Tables 1, 2, 3, 
and 4 of this subpart. These gas samples will be taken from the closed-
circuit apparatus at a point downstream of the carbon dioxide sorbent, 
and they shall not contain more than 0.5 percent carbon dioxide at any 
time, except on apparatus for escape only, using a mouthpiece only, the 
sample shall not contain more than 1.5 percent carbon dioxide at any 
time.



Sec. 84.98  Tests during low temperature operation.

    (a) The applicant shall specify the minimum temperature for safe 
operation and two persons will perform the tests described in paragraphs 
(c) and (d) of this section, wearing the apparatus according to 
applicant's directions. At the specified temperature, the apparatus 
shall meet all the requirements described in paragraph (e) of this 
section.
    (b) The apparatus will be precooled at the specified minimum 
temperature for 4 hours.
    (c) The apparatus will be worn in the low temperature chamber for 30 
minutes, or for the service time of the apparatus, whichever is less.
    (d) During the test period, alternate 1-minute periods of exercise 
and rest will be required with the exercise periods consisting of 
stepping onto and off a box 21.5 cm. (8\1/2\ inches) high at a rate of 
30 cycles per minute.
    (e)(1) The apparatus shall function satisfactorily at the specified 
minimum temperature on duplicate tests.
    (2) The wearer shall have sufficient unobscured vision to perform 
the work.
    (3) The wearer shall not experience undue discomfort because of 
airflow restriction or other physical or chemical changes in the 
operation of the apparatus.
    (f) Auxiliary low-temperature parts which are commercially available 
to the user may be used on the apparatus to meet the requirements 
described in paragraph (e) of this section.



Sec. 84.99  Man tests; testing conditions; general requirements.

    (a) The man tests described in Tables 1, 2, 3, and 4 of this subpart 
represent the workload performed in the mining, mineral, or allied 
industries by a person wearing the apparatus tested.
    (b) The apparatus tested will be worn by Institute personnel trained 
in the use of self-contained breathing apparatus, and the wearer will, 
before participating in these tests, pass a physical examination 
conducted by a qualified physician.

[[Page 564]]

    (c) All man tests will be conducted by the Institute.
    (d) The apparatus will be examined before each man test to ensure 
that it is in proper working order.
    (e) Breathing resistance will be measured within the facepiece or 
mouthpiece and the wearer's pulse and respiration rate will be recorded 
during each 2 minute sample period prescribed in tests 1, 2, 3, and 4.
    (f) Man tests 1, 2, 3, 4, 5, and 6 will be conducted in duplicate.
    (g) If man tests are not completed through no fault of the 
apparatus, the test will be repeated.



Sec. 84.100  Man tests 1, 2, 3, and 4; requirements.

    Man tests 1, 2, 3, and 4, set forth in Tables 1, 2, 3, and 4 of this 
subpart, respectively, prescribe the duration and sequence of specific 
activities. These tests will be conducted to--
    (a) Familiarize the wearer with the apparatus during use;
    (b) Provide for a gradual increase in activity;
    (c) Evaluate the apparatus under different types of work and 
physical orientation; and
    (d) Provide information on the operating and breathing 
characteristics of the apparatus during actual use.



Sec. 84.101  Man test 5; requirements.

    (a) Test 5 will be conducted to determine the maximum length of time 
the apparatus will supply the respiratory needs of the wearer while he 
is sitting at rest.
    (b) The wearer will manipulate the devices controlling the supply of 
breathing gas to the advantage of the apparatus.
    (c) Samples of inspiration from within the apparatus facepiece or 
mouthpiece shall be taken once every 15 minutes, and shall meet the 
minimum requirement for oxygen specified in Sec. 84.79(a), and the 
maximum allowable average concentration of carbon dioxide specified in 
Sec. 84.97(c).
    (d) One sample of inspiration will be taken in the case of 3-, 5-, 
and 10-minute apparatus.



Sec. 84.102  Man test 6; requirements.

    (a) Man test 6 will be conducted with respect to liquefied breathing 
gas apparatus only.
    (b) This test will be conducted to evaluate operation of the 
apparatus in other than vertical positions.
    (c) The wearer will lie face downward for one-fourth the service 
life of the apparatus with a full charge of liquefied breathing gas, and 
then a one-quarter full charge of liquefied breathing gas.
    (d) The test will be repeated with the wearer lying on each side and 
on his back.
    (e) The oxygen content of the gas supplied to the wearer by the 
apparatus will be continuously measured.



Sec. 84.103  Man tests; performance requirements.

    (a) The apparatus shall satisfy the respiratory requirements of the 
wearer for the classified service time.
    (b) Fogging of the eyepiece shall not obscure the wearer's vision, 
and the wearer shall not experience undue discomfort because of fit or 
other characteristics of the apparatus.
    (c) When the ambient temperature during testing is 246 
deg.C. (7510  deg.F.), the maximum temperature of inspired 
air recorded during man tests shall not exceed the following, after 
correction for deviation from 24  deg.C. (75  deg.F.):

------------------------------------------------------------------------
                                 Where percent     Maximum permissible
                                   relative      temperature of inspired
     Where service life of        humidity of    air shall not exceed--
        apparatus is--           inspired air  -------------------------
                                     is--          deg.F.       deg.C.
------------------------------------------------------------------------
\1/4\ hour or less............           0-100          135           57
\1/4\ hour to \3/4\ hour......            0-50          125           52
                                        50-100      \1\ 110       \1\ 43
1 to 2 hours..................            0-50          115           46
                                        50-100       \1\105        \1\41
3 hours.......................            0-50          110           43
                                        50-100       \1\100       \1\ 38

[[Page 565]]

 
4 hours.......................            0-50          105           41
                                        50-100       \1\ 95       \1\ 35
------------------------------------------------------------------------
\1\ Where percent relative humidity is 50-100 and apparatus is designed
  for escape only, these maximum permissible temperatures will be
  increased by 5 deg.C (10 deg.F).



Sec. 84.104  Gas tightness test; minimum requirements.

    (a) Each apparatus will be tested for tightness by persons wearing 
it in an atmosphere of 1,000 p.p.m. isoamyl acetate.
    (b) Six persons will each wear the apparatus in the test 
concentrations specified in paragraph (a) of this section for 2 minutes 
and none shall detect the odor or taste of the test vapor.

[[Page 566]]



                                         Tables to Subpart H of Part 84
 
 


                                      Table 1.--Duration and Sequence of Specific Activities for Test 1, in Minutes
                                                               [42 CFR part 84, subpart H]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                        Service time--
              Activity               -------------------------------------------------------------------------------------------------------------------
                                       3 minutes    5 minutes    10 minutes   15 minutes   30 minutes   45 minutes     1 hour       2, 3, and 4 hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sampling and readings...............  ...........  ...........  ...........            2            2            2            2  Perform 1 hour test 2,
                                                                                                                                  3, or 4 times
                                                                                                                                  respectively.
Walks at 4.8 km. (3 miles) per hour.            3            5            3            4            8           12           18
Sampling and readings...............  ...........  ...........            2            2            2            2            2
Walks at 4.8 km. (3 miles) per hour.  ...........  ...........            3            5            8           12           18
Sampling and readings...............  ...........  ...........            2            2            2            2            2  .......................
Walks at 4.8 km. (3 miles) per hour.  ...........  ...........  ...........  ...........            6           13           16
Sampling and readings...............  ...........  ...........  ...........  ...........            2            2            2  .......................
--------------------------------------------------------------------------------------------------------------------------------------------------------


                                      Table 2.--Duration and Sequence of Specific Activities For Test 2, in Minutes
                                                               [42 CFR part 84, subpart H]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                     Service time--
                              --------------------------------------------------------------------------------------------------------------------------
           Activity                                                                                                                     2, 3 and 4 hours
                                3 minutes    5 minutes     10 minutes      15 minutes      30 minutes      45 minutes        1 hour            \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sampling and readings........  ...........  ...........  ..............  2.............  2.............  2.............  2............  2
Walks at 4.8 km. (3 miles)     ...........  ...........  1.............  1.............  3.............  4.............  6............  10.
 per hour.
Carries 23 kg. (50 pound)      ...........  ...........  1 time in 2     1 time in 2     2 times in 4    3 times in 6    4 times in 8   5 times in 10
 weight over overcast.                                    minutes.        minutes.        minutes.        minutes.        minutes.       minutes.
Walks at 4.8 km. (3 miles)     ...........  ...........  ..............  1.............  3.............  3.............  3............  5.
 per hour.
Climbs vertical treadmill \2\            1            1  1.............  1.............  1.............  1.............  1............  1.
 (or equivalent).
Walks at 4.8 km. (3 miles)     ...........            1  1.............  ..............  ..............  2.............  3............  5
 per hour.
Climbs vertical treadmill (or  ...........            1  ..............  ..............  ..............  1.............  1............  1.
 equivalent).
Sampling and readings........  ...........  ...........  ..............  ..............  2.............  2.............  2............  2.
Walks at 4.8 km. (3 miles)     ...........  ...........  ..............  2.............  2.............  3.............  5............  11.
 per hour.
Climbs vertical treadmill (or  ...........  ...........  ..............  1.............  1.............  1.............  1............  1.
 equivalent).
Carries 23 kg. (50 pound)      ...........  ...........  ..............  1 time in 2     3 times in 6    4 times in 8    5 times in 10  5 times in 10
 weight over overcast.                                                    minutes.        minutes.        minutes.        minutes.       minutes.
Sampling and readings........  ...........  ...........  2.............  ..............  ..............  2.............  2............  2.
Walks at 4.8 km. (3 miles)     ...........  ...........  ..............  1.............  3.............  3.............  3............  ................
 per hour.
Climbs vertical treadmill (or  ...........  ...........  1.............  1.............  1.............  1.............  1............  Then repeat
 equivalent).                                                                                                                            above
                                                                                                                                         activities
                                                                                                                                         once.
Walks at 4.8 km. (3 miles)     ...........  ...........  2.............  ..............  ..............  2.............  3............
 per hour.
Climbs vertical treadmill (or  ...........  ...........  ..............  ..............  ..............  1.............  1............  ................
 equivalent).

[[Page 567]]

 
Carries 20 kg. (45 pound)                1  ...........  ..............  ..............  ..............  ..............  2............  ................
 weight and walks at 4.8 km.
 (3 miles) per hour.
Walks at 4.8 km. (3 miles)               1            2  ..............  ..............  ..............  1.............  4............  ................
 per hour.
Sampling and readings........  ...........  ...........  ..............  2.............  2.............  2.............  2............  ................
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Total test time for Test 2 for 2-hour, 3-hour, and 4-hour apparatus is 2 hours.
\2\ Treadmill shall be inclined 15 deg. from vertical and operated at a speed of 1 foot per second.


                                      Table 3.--Duration and Sequence of Specific Activities For Test 3, in Minutes
                                                               [42 CFR part 84, subpart H]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                     Service time--
                               -------------------------------------------------------------------------------------------------------------------------
           Activity                                                                                                                           2, 3 and 4
                                 3 minutes      5 minutes      10 minutes      15 minutes      30 minutes      45 minutes        1 hour       hours \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sampling and readings.........  ...........  ..............  ..............  2.............  2.............  2.............  2.............        (\2\)
Walks at 4.8 km. (3 miles) per  ...........  ..............  1.............  1.............  2.............  2.............  3.............  ...........
 hour.
Runs at 9.7 km. (6 miles) per             1  1.............  1.............  1.............  1.............  1.............  1.............  ...........
 hour.
Pulls 20 kg. (45 pound) weight  ...........  15 times in 1   ..............  30 times in 2   30 times in 2   30 times in 2   60 times in 6   ...........
 to 5 feet.                                   minute.                         minutes.        minutes.        minutes.        minutes.
Lies on side..................          1/2  1.............  1.............  2.............  3.............  4.............  5.............  ...........
Lies on back..................          1/2  1.............  1.............  2.............  2.............  3.............  3.............  ...........
Crawls on hands and knees.....            1  1.............  1.............  2.............  2.............  2.............  2.............  ...........
Sampling and readings.........  ...........  ..............  2.............  ..............  2.............  2.............  2.............  ...........
Runs at 9.7 km. (6 miles) per   ...........  ..............  ..............  1.............  1.............  1.............  1.............  ...........
 hour.
Walks at 4.8 km. (3 miles) per  ...........  ..............  ..............  ..............  2.............  8.............  10............  ...........
 hour.
Pulls 20 kg. (45 pound) weight  ...........  ..............  30 times in 2   ..............  60 times in 6   60 times in 6   60 times in 6   ...........
 to 5 feet.                                                   minutes.                        minutes.        minutes.        minutes.
Sampling and readings.........  ...........  ..............  ..............  2.............  ..............  2.............  2.............  ...........
Walks at 4.8 km. (3 miles) per  ...........  ..............  1.............  ..............  3.............  4.............  10............  ...........
 hour.
Lies on side..................  ...........  ..............  ..............  ..............  ..............  2.............  4.............  ...........
Lies on back..................  ...........  ..............  ..............  ..............  ..............  2.............  1.............  ...........
Sampling and readings.........  ...........  ..............  ..............  ..............  2.............  2.............  2.............  ...........
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Total test time for Test 3 for 2-hour, 3-hour, and 4-hour apparatus is 2 hours.
\2\ Perform test No. 3 for 1 hr. apparatus; then perform test No. 1 for 1 hour apparatus.


                                                          Table 4.--Duration and Sequence of Specific Activities for Test 4, in Minutes
                                                                                   [42 CFR part 84, subpart H]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                          Service time--
            Activity             ---------------------------------------------------------------------------------------------------------------------------------------------------------------
                                      3 minutes          5 minutes        10 minutes        15 minutes        30 minutes        45 minutes          1 hour        2 hours    3 hours    4 hours
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Sampling and readings...........  .................  ................  ................  2...............  2...............  2...............  2...............      (\2\)      (\3\)      (\4\)
Walks at 4.8 km. (3 miles) per    .................  ................  ................  1...............  2...............  2...............  2...............  .........  .........  .........
 hour.
Climbs vertical treadmill \1\     1................  1...............  1...............  1...............  1...............  1...............  1...............  .........  .........  .........
 (or equivalent).

[[Page 568]]

 
Walks at 4.8 km. (3 miles) per    .................  1...............  1...............  1...............  2...............  2...............  2                 .........  .........  .........
 hour.
Pulls 20 kg. (45 pound) weight    .................  30 times in 2     30 times in 2     30 times in 2     60 times in 5     60 times in 5     60 times in 5     .........  .........  .........
 to 5 feet.                                           minutes.          minutes.          minutes.          minutes.          minutes.          minutes.
Walks at 4.8 km. (3 miles) per    .................  ................  1...............  1...............  1...............  2...............  3...............  .........  .........  .........
 hour.
Carries 23 kg. (50 pound) weight  .................  ................  ................  1 time in 1       1 time in 1       2 times in 3      4 times in 8      .........  .........  .........
 over overcast.                                                                           minute.           minute.           minutes.          minutes.
Sampling and readings...........  .................  ................  2...............  ................  2...............  2...............  2...............  .........  .........  .........
Walks at 4.8 km. (3 miles) per    .................  ................  ................  1...............  3...............  3...............  4...............  .........  .........  .........
 hour.
Runs at 9.7 km. (6 miles) per     .................  1...............  1...............  1...............  1...............  1...............  1...............  .........  .........  .........
 hour.
Carries 23 kg. (50 pound) weight  .................  ................  1 time in 1       1 time in 1       2 times in 3      4 times in 6      6 times in 9      .........  .........  .........
 over overcast.                                                         minute.           minute.           minutes.          minutes.          minutes.
Pulls 20 kg (45 pound) weight to  15 times in 1      ................  ................  15 times in 1     60 times in 5     30 times in 2     36 times in 3     .........  .........  .........
 5 feet.                           minute.                                                minute.           minutes.          minutes.          minutes.
Sampling and readings...........  .................  ................  ................  2...............  2...............  2...............  2...............  .........  .........  .........
Walks at 4.8 km. (3 miles) per    1................  ................  1...............  ................  ................  2...............  6...............  .........  .........
 hour.
Pulls 20 kg. (45 pound) weight    .................  ................  ................  ................  ................  60 times in 5     60 times in 5     .........  .........  .........
 to 5 feet.                                                                                                                   minutes.          minutes.
Carries 20 kg. (45 pound) weight  .................  ................  ................  ................  ................  3...............  3...............  .........  .........  .........
 and walks at 4.8 km. (3 miles)
 per hour.
Sampling and readings...........  .................  ................  ................  ................  ................  2...............  2...............  .........  .........  .........
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Treadmill shall be inclined 15 deg. from vertical and operated at a speed of 30 cm. (1 foot) per second.
\2\ Perform test No. 1 for 30-minute apparatus; then perform test No. 4 for 1-hour apparatus; then perform test No. 1 for 30-minute apparatus.
\3\ Perform test No. 1 for 1-hour apparatus; then perform test No. 4 for 1-hour apparatus; then perform test No. 1 for 1-hour apparatus.
\4\ Perform test No. 1 for 1-hour apparatus; then perform test No. 4 for 1-hour apparatus; then perform test No. 1 for 1-hour apparatus twice (i.e., two one-hour tests).


[[Page 569]]



                          Subpart I--Gas Masks



Sec. 84.110  Gas masks; description.

    (a) Gas masks including all completely assembled air purifying masks 
designed for use as respiratory protection during entry into atmospheres 
not immediately dangerous to life or health or escape only from 
hazardous atmospheres containing adequate oxygen to support life are 
described as follows:
    (1) Front-mounted or back-mounted gas mask. A gas mask which 
consists of a full facepiece, a breathing tube, a canister at the front 
or back, a canister harness, and associated connections.
    (2) Chin-style gas mask. A gas mask which consists of a full 
facepiece, a canister which is usually attached to the facepiece, and 
associated connections.
    (3) Escape gas mask. A gas mask designed for use during escape only 
from hazardous atmospheres which consists of a facepiece or mouthpiece, 
a canister, and associated connections.
    (b) Gas masks shall be further described according to the types of 
gases or vapors against which they are designed to provide respiratory 
protection, as follows:

------------------------------------------------------------------------
 
Type of front-mounted or back-mounted gas mask:
  Acid gas 1 2 3
  Ammonia
  Carbon monoxide
  Organic Vapor 1 2 3
  Other gas(es) and vapor(s) 1 2 3
  Combination of two or more of the above gases and vapors.1 2 3
  Combination of acid gas, ammonia, carbon monoxide, and organic
   vapors.1 2 3
Type of chin-style gas mask:
  Acid gas 1 2 3
  Ammonia
  Carbon monoxide
  Organic vapor 1 2 3
  Other gas(es) and vapor 1 2 3
  Combination of two or more of the above gases and vapors.1 2 3
Type of escape gas mask:
  Acid gas 1 2 3 4
  Ammonia \4\
  Carbon monoxide
  Organic vapor 1 2 3 4
  Other gas(s) and vapor(s) 1 2 3 4
  Combination of two or more of the above gases and vapors. 1 2 3 4
------------------------------------------------------------------------
\1\ Approval may be for acid gases or organic vapors as a class or for
  specific acid gases or organic vapors.
\2\ Not for use against gases or vapors with poor warning properties
  (except where MSHA or Occupational Safety and Health Administration
  standards permit such use for a specific gas or vapor), or those which
  generate high heats or reaction with sorbent materials in the
  canister.
\3\ Use of the gas mask may be limited by factors such as lower
  explosive limit, toxicological effects, and facepiece fit. Limitations
  on gas mask service life and sorbent capacity limitations shall be
  specified by the applicant in instructions for selection, use and
  maintenance of the gas mask.
\4\ Eye protection may be required in certain concentrations of gases
  and vapors.

    (c) Gas masks for respiratory protection against gases and vapors 
other than those specified in paragraph (b) of this section, may be 
approved upon submittal of an application in writing for approval to the 
Certification and Quality Assurance Branch listing the gas or vapor and 
suggested maximum use concentration for the specific type of gas mask. 
The Institute will consider the application and accept or reject it on 
the basis of effect on the wearer's health and safety and any field 
experience in use of gas masks for such exposures. If the application is 
accepted, the Institute will test such masks in accordance with the 
requirements of this subpart.



Sec. 84.111  Gas masks; required components.

    (a) Each gas mask described in Sec. 84.110 shall, where its design 
requires, contain the following component parts:
    (1) Facepiece or mouthpiece and noseclip;
    (2) Canister or cartridge;
    (3) Canister harness;
    (4) External check valve; and
    (5) Breathing tube.
    (b) The components of each gas mask shall meet the minimum 
construction requirements set forth in subpart G of this part.

[[Page 570]]



Sec. 84.112  Canisters and cartridges in parallel; resistance requirements.

    Where two or more canisters or cartridges are used in parallel, 
their resistance to airflow shall be essentially equal.



Sec. 84.113  Canisters and cartridges; color and markings; requirements.

    The color and markings of all canisters and cartridges or labels 
shall conform with the requirements of the American National Standards 
Institute, American National Standard for Identification of Air-
Purifying Respirator Canisters and Cartridges, ANSI K13.1-1973. ANSI 
K13.1 is incorporated by reference and has been approved by the Director 
of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR 
part 51. Copies may be obtained from American National Standards 
Institute, Inc., 1430 Broadway, New York, NY 10018. Copies may be 
inspected at the NIOSH, Certification and Quality Assurance Branch, 1095 
Willowdale Road, Morgantown, WV 26505-2888, or at the Office of the 
Federal Register, 800 North Capitol Street, NW., suite 700, Washington, 
DC.



Sec. 84.114  Filters used with canisters and cartridges; location; replacement.

    (a) Particulate matter filters used in conjunction with a canister 
or cartridge shall be located on the inlet side of the canister or 
cartridge.
    (b) Filters shall be incorporated in or firmly attached to the 
canister or cartridge and each filter assembly shall, where applicable, 
be designed to permit its easy removal from and replacement in the 
canister or cartridge.



Sec. 84.115  Breathing tubes; minimum requirements.

    Flexible breathing tubes used in conjunction with gas masks shall be 
designed and constructed to prevent:
    (a) Restriction of free head movement;
    (b) Disturbance of the fit of facepieces or mouthpieces;
    (c) Interference with the wearer's activities; and
    (d) Shutoff of airflow due to kinking, or from chin or arm pressure.



Sec. 84.116  Harnesses; installation and construction; minimum requirements.

    (a) Each gas mask shall, where necessary, be equipped with a 
suitable harness designed and constructed to hold the components of the 
gas mask in position against the wearer's body.
    (b) Harnesses shall be designed and constructed to permit easy 
removal and replacement of gas mask parts, and where applicable, provide 
for holding a full facepiece in the ready position when not in use.



Sec. 84.117  Gas mask containers; minimum requirements.

    (a) Gas masks shall be equipped with a substantial, durable 
container bearing markings which show the applicant's name, the type and 
commercial designation of mask it contains and all appropriate approval 
labels.
    (b) Containers for gas masks shall be designed and constructed to 
permit easy removal of the mask.



Sec. 84.118  Half-mask facepieces, full facepieces, and mouthpieces; fit; minimum requirements.

    (a) Half-mask facepieces and full facepieces shall be designed and 
constructed to fit persons with various facial shapes and sizes either:
    (1) By providing more than one facepiece size; or
    (2) By providing one facepiece size which will fit varying facial 
shapes and sizes.
    (b) Full facepieces shall provide for optional use of corrective 
spectacles or lenses, which shall not reduce the respiratory protective 
qualities of the gas mask.
    (c) Half-mask facepieces shall not interfere with the fit of common 
industrial safety spectacles, as determined by the Institute's facepiece 
tests in Sec. 84.124.
    (d) Gas masks with mouthpieces shall be equipped with noseclips 
which are securely attached to the mouthpiece or gas mask and provide an 
airtight seal.
    (e) Facepieces shall be designed to prevent eyepiece fogging.

[[Page 571]]



Sec. 84.119  Facepieces; eyepieces; minimum requirements.

    (a) Full facepieces shall be designed and constructed to provide 
adequate vision which is not distorted by the eye.
    (b) All eyepieces shall be designed and constructed to be impact and 
penetration resistant. Federal Specification, Mask, Air Line: and 
Respirator, Air Filtering, Industrial, GGG-M-125d, October 11, 1965 with 
interim amendment-1, July 30, 1969, is an example of an appropriate 
standard for determining impact and penetration resistance. Copies of 
GGG-M-125d may be obtained from the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888.



Sec. 84.120  Inhalation and exhalation valves; minimum requirements.

    (a) Inhalation and exhalation valves shall be provided where 
necessary and protected against damage and distortion.
    (b) Inhalation valves shall be designed and constructed to prevent 
excessive exhaled air from adversely affecting cartridges, canisters, 
and filters.
    (c) Exhalation valves shall be protected against external influence, 
and designed and constructed to prevent inward leakage of contaminated 
air.



Sec. 84.121  Head harnesses; minimum requirements.

    (a) Facepieces shall be equipped with adjustable and replaceable 
head harnesses, designed and constructed to provide adequate tension 
during use and an even distribution of pressure over the entire area in 
contact with the face.
    (b) Mouthpieces shall be equipped, where applicable, with adjustable 
and replaceable harnesses designed and constructed to hold the 
mouthpiece in place.



Sec. 84.122  Breathing resistance test; minimum requirements.

    (a) Resistance to airflow will be measured in the facepiece or 
mouthpiece of a gas mask mounted on a breathing machine both before and 
after each test conducted in accordance with Secs. 84.124, 84.125, and 
84.126, with air flowing at a continuous rate of 85 liters per minute.
    (b) The maximum allowable resistance requirements for gas masks are 
as follows:

                           Maximum Resistance
                        [mm. water-column height]
------------------------------------------------------------------------
                                          Inhalation
         Type of gas mask         --------------------------  Exhalation
                                     Initial     Final \1\
------------------------------------------------------------------------
Front-mounted or back-mounted               60           75           20
 (without particulate filter)....
Front-mounted or back-mounted               70           85           20
 (with approved particulate
 filter).........................
Chin-style (without particulate             40           55           20
 filter).........................
Chin-style (with approved                   65           80           20
 particulate filter).............
Escape (without particulate                 60           75           20
 filter).........................
Escape (with approved particulate           70           85           20
 filter).........................
------------------------------------------------------------------------
\1\ Measured at end of the service life specified in Tables 5, 6, and 7
  of this subpart.



Sec. 84.123  Exhalation valve leakage test.

    (a) Dry exhalation valves and valve seats will be subjected to a 
suction of 25 mm. water-column height while in a normal operating 
position.
    (b) Leakage between the valve and valve seat shall not exceed 30 
milliliters per minute.



Sec. 84.124  Facepiece tests; minimum requirements.

    (a) The complete gas mask will be fitted to the faces of persons 
having varying facial shapes and sizes.
    (b) Where the applicant specifies a facepiece size or sizes for the 
gas mask, together with the approximate measurements of faces they are 
designed to fit, the Institute will insure that test

[[Page 572]]

subjects suit such facial measurements.
    (c) Any gas mask parts which must be removed to perform the 
facepiece or mouthpiece fit test shall be replaceable without special 
tools and without disturbing the facepiece or mouthpiece fit.
    (d) The facepiece or mouthpiece fit test, using positive or negative 
pressure recommended by the applicant and described in his instructions 
will be used before each test specified in paragraph (e) of this 
section, and in Sec. 84.125.
    (e)(1) Each wearer will enter a chamber containing 100 p.p.m. 
isoamyl acetate vapor for a half-mask facepiece and 1,000 p.p.m. isoamyl 
acetate vapor for a full facepiece or mouthpiece.
    (2) The facepiece or mouthpiece may be adjusted, if necessary, in 
the test chamber before starting the tests.
    (3) Each wearer will remain in the chamber for 8 minutes while 
performing the following activities:
    (i) Two minutes, nodding and turning head;
    (ii) Two minutes, calisthenic arm movements;
    (iii) Two minutes, running in place; and
    (iv) Two minutes, pumping with a tire pump into a 28 liter (1 cubic 
foot) container.
    (4) Each wearer shall not detect the odor of isoamyl acetate during 
the test.



Sec. 84.125  Particulate tests; canisters containing particulate filters; minimum requirements.

    Gas mask canisters containing filters for protection against 
particulates (e.g. dusts, fumes, mists, and smokes) in combination with 
gases, vapors, or gases and vapors, shall also comply with the 
requirements as prescribed in Secs. 84.170 through 84.183, except for 
the airflow resistance test of Sec. 84.181.



Sec. 84.126  Canister bench tests; minimum requirements.

    (a)(1) Bench tests, except for carbon monoxide tests, will be made 
on an apparatus that allows the test atmosphere at 505 
percent relative humidity and room temperature (252.5 
deg.C.) to enter the canister continuously at concentrations and rates 
of flow specified in Tables 5, 6, and 7 of this subpart.
    (2) Three canisters will be removed from containers and tested as 
received from the applicant.
    (3) Two canisters, other than those described in paragraph (a)(2) of 
this section, will be equilibrated at room temperature by passing 25 
percent relative humidity air through them at 64 liters per minute for 6 
hours.
    (4) Two canisters, other than those described in paragraphs (a) (2) 
and (3) of this section, will be equilibrated at room temperature by 
passing 85 percent relative humidity air through them at 64 liters per 
minute for 6 hours.
    (5) The equilibrated canisters will be resealed, kept in an upright 
position at room temperature, and tested within 18 hours.
    (b) Front-mounted and back-mounted gas mask canisters will be tested 
and shall meet the minimum requirements set forth in Table 5 of this 
subpart.
    (c)(1) Front-mounted, and back-mounted, and chin-style canisters 
designated as providing respiratory protection against gases, ammonia, 
organic vapors, carbon monoxide and particulate contaminants shall have 
a window or other indicator to warn the gas mask wearer when the 
canister will no longer satisfactorily remove carbon monoxide from the 
inhaled air.
    (2) Other types of front- and back-mounted canisters may also be 
equipped with a window or other indicator to warn of imminent leakage of 
other gases or vapors.
    (3) The window indicator canisters will be tested as regular 
canisters, but shall show a satisfactory indicator change or other 
warning before the allowable canister penetration has occurred.
    (d) Chin-style gas mask canisters shall meet the minimum 
requirements set forth in Table 6 of this subpart.
    (e) Escape gas mask canisters shall meet the minimum requirements 
set forth in Table 7 of this subpart.

[[Page 573]]



                                         Tables to Subpart I of Part 84
 
 


                          Table 5.--Canister Bench Tests and Requirements for Front-Mounted and Back-Mounted Gas Mask Canisters
                                                               [42 CFR part 84, subpart I]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                    Test atmosphere
                                                                   ------------------------------------------------              Maximum
                                                                                                         Flow rate  Number of   allowable     Minimum
            Canister type                    Test condition                               Concentration   (liters     tests    penetratin   service life
                                                                        Gas or vapor        (parts per      per                (parts per  (minutes) \1\
                                                                                             million)     minute)               million)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Acid gas............................  As received                   SO2                         20,000          64          3           5           12
                                      Equilibrated                  Cl2                         20,000          64          3           5           12
                                      ............................  SO2                         20,000          32          4           5           12
                                      ............................  Cl2                         20,000          32          4           5           12
Organic vapor.......................  As received                   CCl4                        20,000          64          3           5           12
                                      Equilibrated                  CCl4                        20,000          32          4           5           12
Ammonia.............................  As received                   NH3                         30,000          64          3          50           12
                                      Equilibrated                  NH3                         30,000          32          4          50           12
Carbon monoxide.....................  As received                   CO                          20,000      \4\ 64          2       (\3\)           60
                                      Equilibrated                  CO                           5,000      \2\ 32          3       (\3\)           60
                                      ............................  CO                           3,000      \2\ 32          3       (\3\)           60
Combination of 2 or 3 of above types
 \5\
Combination of all above types \6\
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Minimum life will be determined at the indicated penetration.
\2\ Relative humidity of test atmosphere will be 953pct; temperature of test atmosphere will be 252.5 deg. C.
\3\ Maximum allowable CO penetration will be 385 cm \3\ during the minimum life. The penetration shall not exceed 500 p/m during this time.
\4\ Relative humidity of test atmosphere will be 953pct; temperature of test atmosphere entering the test fixture will be 02.5
  deg.C-0 deg.C.
\5\ Test conditions and requirements will be applicable as shown in this table.
\6\ Test conditions and requirements will be applicable as shown in this table, except the minimum service lives for acid gas, organic vapor, and
  ammonia will be 6 min instead of 12 min.


                                    Table 6--Canister Bench Tests and Requirements for Chin-Style Gas Mask Canisters
                                                               [42 CFR part 84, subpart I]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                   Test atmosphere
                                                                   -----------------------------------------------              Maximum
                                                                                                        Flow rate  Number of   allowable      Minimum
            Canister type                    Test condition                              Concentration   (liters     tests    penetration   service life
                                                                        Gas or vapor       (parts per      per                 (parts per  (minutes) \1\
                                                                                            million)     minute)                million)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Acid gas............................  As received Equilibrated      SO2                        50,000          64          3           5            12
                                      ............................  Cl2                         5,000          64          3           5            12
                                      ............................  SO2                         5,000          32          4           5            12
                                      ............................  Cl2                         5,000          32          4           5            12
Organic vapor.......................  As received Equilibrated      CCl4                        5,000          64          3           5            12
                                      ............................  CCl4                        5,000          32          4           5            12
Ammonia.............................  As received Equilibrated      NH3                         5,000          64          3          50            12

[[Page 574]]

 
                                      As received Equilibrated      NH3                         5,000          32          4          50            12
Carbon monoxide.....................  As received                   CO                         20,000      \2\ 64          2       (\3\)            60
                                      ............................  CO                          5,000      \4\ 32          3       (\3\)            60
                                      ............................  CO                          3,000      \2\ 32          3       (\3\)            60
Combination of 2 or 3 of above types
 \5\
Combination of all above types \6\
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Minimum life will be determined at the indicated penetration.
\2\ Relative humidity of test atmosphere will be 95  3pct; temperature of test atmosphere will be 25  2.5 deg. C.
\3\ Maximum allowable CO penetration will be 385 cm \3\ during the minimum life. The penetration shall not exceed 500 p/m during this time.
\4\ Relative humidity of test atmosphere will be 95  3pct; temperature of test atmosphere entering the test fixture will be 0 
  2.5 deg. C-0 deg. C.
\5\ Test conditions and requirements will be applicable as shown in this table.
\6\ Test conditions and requirements will be applicable as shown in this table, except the minimum service lives for acid gas, organic vapor, and
  ammonia will be 6 min instead of 12 min.


                                      Table 7.--Canister Bench Tests and Requirements for Escape Gas Mask Canisters
                                                               [42 CFR part 84, subpart I]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                   Test atmosphere
                                                                   -----------------------------------------------              Maximum
                                                                                                        Flow rate  Number of   allowable      Minimum
            Canister type                    Test condition                              Concentration   (liters     tests    penetration   service life
                                                                        Gas or vapor       (parts per      per                 (parts per  (minutes) \1\
                                                                                            million)     minute)                million)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Acid gas............................  As received.................  SO2                         5,000          64          3           5            12
                                      Equilibrated................  Cl2                         5,000          64          3           5            12
                                                                    SO2                         5,000          32          4           5            12
                                                                    Cl2                         5,000          32          4           5            12
Organic vapor.......................  As received.................  CCl4                        5,000          64          3           5            12
                                      Equilibrated................  CCl4                        5,000          32          4           5            12
Ammonia.............................  As received.................  NH3                         5,000          64          3          50            12
                                      Equilibrated................  NH3                         5,000          32          4          50            12
Carbon monoxide.....................  As received.................  CO                         10,000      \2\ 32          2       (\3\)        \4\ 60
                                                                    CO                          5,000      \5\ 32          3       (\3\)            60
                                                                    CO                          3,000      \2\ 32          3       (\3\)            60
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Minimum life will be determined at the indicated penetration.
\2\ Relative humidity of test atmosphere will be 953pct; temperature of test atmosphere will be 252.5 deg. C.
\3\ Maximum allowable CO penetration will be 385 cm \3\ during the minimum life. The penetration shall not exceed 500 p/m during this time.
\4\ If effluent temperature exceeds 100 deg. C during this test, the escape gas mask shall be equipped with an effective heat exchanger.
\5\ Relative humidity of test atmosphere will be 953 pct; temperature of test atmosphere entering the test fixture will be 02.5
  deg. C--0 deg. C.


[[Page 575]]



                   Subpart J--Supplied-Air Respirators



Sec. 84.130  Supplied-air respirators; description.

    Supplied-air respirators, including all completely assembled 
respirators designed for use as respiratory protection during entry into 
and escape from atmospheres not immediately dangerous to life or health 
are described as follows:
    (a) Type ``A'' supplied-air respirators. A hose mask respirator, for 
entry into and escape from atmospheres not immediately dangerous to life 
or health, which consists of a motor-driven or hand-operated blower that 
permits the free entrance of air when the blower is not operating, a 
strong large-diameter hose having a low resistance to airflow, a harness 
to which the hose and the life-line are attached and a tight-fitting 
facepiece.
    (b) Type ``AE'' supplied-air respirators. A Type ``A'' supplied-air 
respirator equipped with additional devices designed to protect the 
wearer's head and neck against impact and abrasion from rebounding 
abrasive material, and with shielding material such as plastic, glass, 
woven wire, sheet metal, or other suitable material to protect the 
window(s) of facepieces, hoods, and helmets which do not unduly 
interfere with the wearer's vision and permit easy access to the 
external surface of such window(s) for cleaning.
    (c) Type ``B'' supplied-air respirators. A hose mask respirator, for 
entry into and escape from atmospheres not immediately dangerous to life 
or health, which consists of a strong large-diameter hose with low 
resistance to airflow through which the user draws inspired air by means 
of his lungs alone, a harness to which the hose is attached, and a 
tight-fitting facepiece.
    (d) Type ``BE'' supplied-air respirators. A type ``B'' supplied-air 
respirator equipped with additional devices designed to protect the 
wearer's head and neck against impact and abrasion from rebounding 
abrasive material, and with shielding material such as plastic, glass, 
woven wire, sheet metal, or other suitable material to protect the 
window(s) of facepieces, hoods, and helmets which do not unduly 
interfere with the wearer's vision and permit easy access to the 
external surface of such window(s) for cleaning.
    (e) Type ``C'' supplied-air respirators. An airline respirator, for 
entry into and escape from atmospheres not immediately dangerous to life 
or health, which consists of a source of respirable breathing air, a 
hose, a detachable coupling, a control valve, orifice, a demand valve or 
pressure demand valve, an arrangement for attaching the hose to the 
wearer, and a facepiece, hood, or helmet.
    (f) Type ``CE'' supplied-air respirators. A type ``C'' supplied-air 
respirator equipped with additional devices designed to protect the 
wearer's head and neck against impact and abrasion from rebounding 
abrasive material, and with shielding material such as plastic, glass, 
woven wire, sheet metal, or other suitable material to protect the 
window(s) of facepieces, hoods, and helmets which do not unduly 
interfere with the wearer's vision and permit easy access to the 
external surface of such window(s) for cleaning.



Sec. 84.131  Supplied-air respirators; required components.

    (a) Each supplied-air respirator described in Sec. 84.130 shall, 
where its design requires, contain the following component parts:
    (1) Facepiece, hood, or helmet;
    (2) Air supply valve, orifice, or demand or pressure-demand 
regulator;
    (3) Hand operated or motor driven air blower;
    (4) Air supply hose;
    (5) Detachable couplings;
    (6) Flexible breathing tube; and
    (7) Respirator harness.
    (b) The component parts of each supplied-air respirator shall meet 
the minimum construction requirements set forth in subpart G of this 
part.



Sec. 84.132  Breathing tubes; minimum requirements.

    Flexible breathing tubes used in conjunction with supplied-air 
respirators shall be designed and constructed to prevent:
    (a) Restriction of free head movement;

[[Page 576]]

    (b) Disturbance of the fit of facepieces, mouthpieces, hoods, or 
helmets;
    (c) Interference with the wearer's activities; and
    (d) Shutoff of airflow due to kinking, or from chin or arm pressure.



Sec. 84.133  Harnesses; installation and construction; minimum requirements.

    (a) Each supplied-air respirator shall, where necessary, be equipped 
with a suitable harness designed and constructed to hold the components 
of the respirator in position against the wearer's body.
    (b) Harnesses shall be designed and constructed to permit easy 
removal and replacement of respirator parts, and where applicable, 
provide for holding a full facepiece in the ready position when not in 
use.



Sec. 84.134  Respirator containers; minimum requirements.

    Supplied-air respirators shall be equipped with a substantial, 
durable container bearing markings which show the applicant's name, the 
type and commercial designation of the respirator it contains, and all 
appropriate approval labels.



Sec. 84.135  Half-mask facepieces, full facepieces, hoods, and helmets; fit; minimum requirements.

    (a) Half-mask facepieces and full facepieces shall be designed and 
constructed to fit persons with various facial shapes and sizes either:
    (1) By providing more than one facepiece size; or
    (2) By providing one facepiece size which will fit varying facial 
shapes and sizes.
    (b) Full facepieces shall provide for optional use of corrective 
spectacles or lenses, which shall not reduce the respiratory protective 
qualities of the respirator.
    (c) Hoods and helmets shall be designed and constructed to fit 
persons with various head sizes, provide for the optional use of 
corrective spectacles or lenses, and insure against any restriction of 
movement by the wearer.
    (d) Facepieces, hoods, and helmets shall be designed to prevent 
eyepiece fogging.



Sec. 84.136  Facepieces, hoods, and helmets; eyepieces; minimum requirements.

    (a) Facepieces, hoods, and helmets shall be designed and constructed 
to provide adequate vision which is not distorted by the eyepiece.
    (b) All eyepieces except those on Types B, BE, C, and CE supplied-
air respirators shall be designed and constructed to be impact and 
penetration resistant. Federal Specification, Mask, Air Line: and 
Respirator, Air Filtering, Industrial, GGG-M-125d, October 11, 1965 with 
interim amendment-1, July 30, 1969, is an example of an appropriate 
standard for determining impact and penetration resistance. Copies of 
GGG-M-125d may be obtained from the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888.
    (c)(1) The eyepieces of AE, BE, and CE type supplied-air respirators 
shall be shielded by plastic, glass, woven wire, sheet metal, or other 
suitable material which does not interfere with the vision of the 
wearer.
    (2) Shields shall be mounted and attached to the facepiece to 
provide easy access to the external surface of the eyepiece for 
cleaning.



Sec. 84.137  Inhalation and exhalation valves; check valves; minimum requirements.

    (a) Inhalation and exhalation valves shall be provided where 
necessary and protected against distortion.
    (b) Exhalation valves shall be:
    (1) Protected against damage and external influence; and
    (2) Designed and constructed to prevent inward leakage of 
contaminated air.
    (c) Check valves designed and constructed to allow airflow toward 
the facepiece only shall be provided in the connections to the facepiece 
or in the hose fitting near the facepiece of all Type A, AE, B, and BE 
supplied-air respirators.



Sec. 84.138  Head harnesses; minimum requirements.

    Facepieces shall be equipped with adjustable and replaceable head 
harnesses which are designed and constructed to provide adequate tension

[[Page 577]]

during use, and an even distribution of pressure over the entire area in 
contact with the face.



Sec. 84.139  Head and neck protection; supplied-air respirators; minimum requirements.

    Type AE, BE, and CE supplied-air respirators shall be designed and 
constructed to provide protection against impact and abrasion from 
rebounding abrasive materials to the wearer's head and neck.



Sec. 84.140  Air velocity and noise levels; hoods and helmets; minimum requirements.

    Noise levels generated by the respirator will be measured inside the 
hood or helmet at maximum airflow obtainable within pressure and hose 
length requirements and shall not exceed 80 dBA.



Sec. 84.141  Breathing gas; minimum requirements.

    (a) Breathing gas used to supply supplied-air respirators shall be 
respirable breathing air and contain no less than 19.5 volume-percent of 
oxygen.
    (b) Compressed, gaseous breathing air shall meet the applicable 
minimum grade requirements for Type I gaseous air set forth in the 
Compressed Gas Association Commodity Specification for Air, G-7.1, 1966 
(Grade D or higher quality). G-7.1 is incorporated by reference and has 
been approved by the Director of the Federal Register in accordance with 
5 U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from American 
National Standards Institute, Inc., 1430 Broadway, New York, NY 10018. 
Copies may be inspected at the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888, or at 
the Office of the Federal Register, 800 North Capitol Street, NW., suite 
700, Washington, DC.
    (c) Compressed, liquefied breathing air shall meet the applicable 
minimum grade requirements for Type II liquid air set forth in the 
Compressed Gas Association Commodity Specification for Air, G-7.1, 1966 
(Grade B or higher quality). G-7.1 is incorporated by reference and has 
been approved by the Director of the Federal Register in accordance with 
5 U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from American 
National Standards Institute, Inc., 1430 Broadway, New York, NY 10018. 
Copies may be inspected at the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888, or at 
the Office of the Federal Register, 800 North Capitol Street, NW., suite 
700, Washington, DC.



Sec. 84.142  Air supply source; hand-operated or motor driven air blowers; Type A supplied-air respirators; minimum requirements.

    (a) Blowers shall be designed and constructed to deliver an adequate 
amount of air to the wearer with either direction of rotation, unless 
constructed to permit rotation in one direction only, and to permit the 
free entrance of air to the hose when the blower is not operated.
    (b) No multiple systems, whereby more than one user is supplied by 
one blower, will be approved, unless each hose line is connected 
directly to a manifold at the blower.



Sec. 84.143  Terminal fittings or chambers; Type B supplied-air respirators; minimum requirements.

    (a) Blowers or connections to air supplies providing positive 
pressures shall not be approved for use on Type B supplied-air 
respirators.
    (b) Terminal fittings or chambers employed in Type B supplied-air 
respirators, shall be:
    (1) Installed in the inlet of the hose.
    (2) Designed and constructed to provide for the drawing of air 
through corrosion resistant material arranged so as to be capable of 
removing material larger than 0.149 mm. in diameter (149 micrometers, 
100-mesh, U.S. Standard sieve).
    (3) Installed to provide a means for fastening or anchoring the 
fitting or chamber in a fixed position in a zone of respirable air.



Sec. 84.144  Hand-operated blower test; minimum requirements.

    (a) Hand-operated blowers shall be tested by attaching them to a 
mechanical drive and operating them 6 to 8 hours daily for a period of 
100 hours at a speed necessary to deliver 50 liters of

[[Page 578]]

air per minute through each completely assembled respirator. Each 
respirator shall be equipped with the maximum length of hose with which 
the device is to be approved and the hose shall be connected to each 
blower or manifold outlet designed for hose connections.
    (b) The crank speed of the hand-operated blower shall not exceed 50 
revolutions per minute in order to deliver the required 50 liters of air 
per minute to each facepiece.
    (c) The power required to deliver 50 liters of air per minute to 
each wearer through the maximum length of hose shall not exceed one-
fiftieth horsepower, and the torque shall not exceed a force of 2.3 kg. 
(5 pounds) on a 20 cm. (8-inch) crank, as defined in Sec. 84.146.
    (d) The blower shall operate throughout the period without failure 
or indication of excessive wear of bearings or other working parts.



Sec. 84.145  Motor-operated blower test; minimum requirements.

    (a) Motor-operated blowers shall be tested by operating them at 
their specified running speed 6 to 8 hours daily for a period of 100 
hours when assembled with the kind and maximum length of hose for which 
the device is to be approved and when connected to each blower or 
manifold outlet designed for hose connections.
    (b) The connection between the motor and the blower shall be so 
constructed that the motor may be disengaged from the blower when the 
blower is operated by hand.
    (c) The blower shall operate throughout the period without failure 
or indication of excessive wear of bearings or other working parts.
    (d) Where a blower, which is ordinarily motor driven, is operated by 
hand, the power required to deliver 50 liters of air per minute to each 
wearer through the maximum length of hose shall not exceed one-fiftieth 
horsepower, and the torque shall not exceed a force of 2.3 kg. (5 
pounds) on a 20 cm. (8-inch) crank, as defined in Sec. 84.146.
    (e) Where the respirator is assembled with the facepiece and 15 m. 
(50 feet) of the hose for which it is to be approved, and when connected 
to one outlet with all other outlets closed and operated at a speed not 
exceeding 50 revolutions of the crank per minute, the amount of air 
delivered into the respiratory-inlet covering shall not exceed 150 
liters per minute.



Sec. 84.146  Method of measuring the power and torque required to operate blowers.

    As shown in Figure 1 of this section, the blower crank is replaced 
by a wooden drum, a (13 cm. (5 inches) in diameter is convenient). This 
drum is wound with about 12 m. (40 feet) of No. 2 picture cord, b. A 
weight, c, of sufficient mass to rotate the blower at the desired speed 
is suspended from this wire cord. A mark is made on the cord about 3 to 
4.5 m. (10 to 15 feet) from the weight, c. Another mark is placed at a 
measured distance (6-9 m./20-30 feet is convenient) from the first. 
These are used to facilitate timing. To determine the torque or 
horsepower required to operate the blower, the drum is started in 
rotation manually at or slightly above the speed at which the power 
measurement is to be made. The blower is then permitted to assume 
constant speed, and then as the first mark on the wire leaves the drum, 
a stopwatch is started. The watch is stopped when the second mark leaves 
the drum. From these data the foot-pounds per minute and the torque may 
be calculated.

[[Page 579]]

Figure 1--Apparatus for measuring power required to operate blower. (42 
                  CFR part 84, subpart J, Sec. 84.146)
[GRAPHIC] [TIFF OMITTED] TC01FE91.050



Sec. 84.147  Type B supplied-air respirator; minimum requirements.

    No Type B supplied-air respirator shall be approved for use with a 
blower or with connection to an air supply device at positive pressures.



Sec. 84.148  Type C supplied-air respirator, continuous flow class; minimum requirements.

    (a) Respirators tested under this section shall be approved only 
when they supply respirable air at the pressures and quantities 
required.
    (b) The pressure at the inlet of the hose connection shall not 
exceed 863 kN/m.\2\ (125 pounds per square inch gage).
    (c) Where the pressure at any point in the supply system exceeds 863 
kN/m.\2\ (125 pounds per square inch gage), the respirator shall be 
equipped with a pressure-release mechanism that will prevent the 
pressure at the hose connection from exceeding 863 kN/m.\2\ (125 pounds 
per square inch gage) under any conditions.



Sec. 84.149  Type C supplied-air respirator, demand and pressure demand class; minimum requirements.

    (a) Respirators tested under this section shall be approved only 
when used to supply respirable air at the pressures and quantities 
required.
    (b) The manufacturer shall specify the range of air pressure at the 
point of attachment of the air-supply hose to the air-supply system, and 
the range of hose length for the respirator. For example, he might 
specify that the respirator be used with compressed air at pressures 
ranging from 280-550 kN/m.\2\ (40 to 80 pounds per square inch) with 
from 6 to 76 m. (15 to 250 feet) of air-supply hose.

[[Page 580]]

    (c) The specified air pressure at the point of attachment of the 
hose to the air-supply system shall not exceed 863 kN/m.\2\ (125 pounds 
per square inch gage).
    (d)(1) Where the pressure in the air-supply system exceeds 863 kN/
m.\2\ (125 pounds per square inch gage), the respirator shall be 
equipped with a pressure-release mechanism that will prevent the 
pressure at the point of attachment of the hose to the air-supply system 
from exceeding 863 kN/m.\2\ (125 pounds per square inch gage).
    (2) The pressure-release mechanism shall be set to operate at a 
pressure not more than 20 percent above the manufacturer's highest 
specified pressure. For example, if the highest specified pressure is 
863 kN/m.\2\ (125 pounds per square inch), the pressure-release 
mechanism would be set to operate at a maximum of 1,035 kN/m.\2\ (150 
pounds per square inch).



Sec. 84.150  Air-supply line tests; minimum requirements.

    Air supply lines employed on Type A, Type B, and Type C supplied-air 
respirators shall meet the minimum test requirements set forth in Table 
8 of this subpart.



Sec. 84.151  Harness test; minimum requirements.

    (a)(1) Shoulder straps employed on Type A supplied-air respirators 
shall be tested for strength of material, joints, and seams and must 
separately withstand a pull of 113 kg. (250 pounds) for 30 minutes 
without failure.
    (2) Belts, rings, and attachments for life lines must withstand a 
pull of 136 kg. (300 pounds) for 30 minutes without failure.
    (3) The hose shall be firmly attached to the harness so as to 
withstand a pull of 113 kg. (250 pounds) for 30 minutes without 
separating, and the hose attachments shall be arranged so that the pull 
or drag of the hose behind an advancing wearer does not disarrange the 
harness or exert pull upon the facepiece.
    (4) The arrangement and suitability of all harness accessories and 
fittings will be considered.
    (b)(1) The harness employed on Type B supplied-air respirators shall 
not be uncomfortable, disturbing, or interfere with the movements of the 
wearer.
    (2) The harness shall be easily adjustable to various sizes.
    (3) The hose shall be attached to the harness in a manner that will 
withstand a pull of 45 kg. (100 pounds) for 30 minutes without 
separating or showing signs of failure.
    (4) The design of the harness and attachment of the line shall 
permit dragging the maximum length of hose considered for approval over 
a concrete floor without disarranging the harness or exerting a pull on 
the facepiece.
    (5) The arrangement and suitability of all harness accessories and 
fittings will be considered.
    (c) The harness employed on Type C respirators shall be similar to 
that required on the Type B respirator, or, it may consist of a simple 
arrangement for attaching the hose to a part of the wearer's clothing in 
a practical manner that prevents a pull equivalent to dragging the 
maximum length of the hose over a concrete floor from exerting pull upon 
the respiratory-inlet covering.
    (d) Where supplied-air respirators have a rigid or partly rigid head 
covering, a suitable harness shall be required to assist in holding this 
covering in place.



Sec. 84.152  Breathing tube test; minimum requirements.

    (a)(1) Type A and Type B supplied-air respirators shall employ one 
or two flexible breathing tubes of the nonkinking type which extend from 
the facepiece to a connecting hose coupling attached to the belt or 
harness.
    (2) The breathing tubes employed shall permit free head movement, 
insure against closing off by kinking or by chin or arm pressure, and 
they shall not create a pull that will loosen the facepiece or disturb 
the wearer.
    (b) Breathing tubes employed on Type C supplied-air respirators of 
the continuous flow class shall meet the minimum requirements set forth 
in paragraph (a) of this section, however, an extension of the 
connecting hose may be employed in lieu of the breathing tubes required.
    (c)(1) A flexible, nonkinking type breathing tube shall:

[[Page 581]]

    (i) Be employed on Type C supplied-air respirators of the demand and 
pressure-demand class; and
    (ii) Extend from the facepiece to the demand or pressure-demand 
valve, except where the valve is attached directly to the facepiece.
    (2) The breathing tube shall permit free head movement, insure 
against closing off by kinking or by chin or arm pressure, and shall not 
create a pull that will loosen the facepiece or disturb the wearer.



Sec. 84.153  Airflow resistance test, Type A and Type AE supplied-air respirators; minimum requirements.

    (a) Airflow resistance will be determined when the respirator is 
completely assembled with the respiratory-inlet covering, the air-supply 
device, and the maximum length of air-supply hose coiled for one-half 
its length in loops 1.5 to 2.1 m. (5 to 7 feet) in diameter.
    (b) The inhalation resistance, drawn at the rate of 85 liters (3 
cubic feet) per minute when the blower is not operating or under any 
practical condition of blower operation shall not exceed the following 
amounts:

------------------------------------------------------------------------
 Maximum length of hose for which     Maximum resistance, water column
      respirator is approved                       height
------------------------------------------------------------------------
      Feet             Meters            Inches           Millimeters
------------------------------------------------------------------------
           75                23               1.5                 38
          150                46               2.5                 64
          250                76               3.5                 89
          300                91               4.0                102
------------------------------------------------------------------------

    (c) The exhalation resistance shall not exceed 25 mm. (1 inch) of 
water-column height at a flow rate of 85 liters (3 cubic feet) per 
minute when the blower is not operating or under any practical condition 
of blower operation.



Sec. 84.154  Airflow resistance test; Type B and Type BE supplied-air respirators; minimum requirements.

    (a) Airflow resistance shall be determined when the respirator is 
completely assembled with the respiratory-inlet covering and the hose in 
the maximum length to be considered for approval, coiled in loops 1.5 to 
2.1 m. (5 to 7 feet) in diameter.
    (b) Airflow resistance shall not exceed 38 mm. (1.5 inches) of 
water-column height to air drawn at the flow rate of 85 liters (3 cubic 
feet) per minute.
    (c) The exhalation resistance shall not exceed 25 mm. (1 inch) of 
water-column height at this flow rate.



Sec. 84.155  Airflow resistance test; Type C supplied-air respirator, continuous flow class and Type CE supplied-air respirator; minimum requirements.

    The resistance to air flowing from the respirator shall not exceed 
25 mm. (1 inch) of water-column height when the air flow into the 
respiratory-inlet covering is 115 liters (4 cubic feet) per minute.



Sec. 84.156  Airflow resistance test; Type C supplied-air respirator, demand class; minimum requirements.

    (a) Inhalation resistance shall not exceed 50 millimeters (2 inches) 
of water at an air flow of 115 liters (4 cubic feet) per minute.
    (b) The exhalation resistance to a flow of air at a rate of 85 
liters (3 cubic feet) per minute shall not exceed 25 millimeters (1 
inch) of water.



Sec. 84.157  Airflow resistance test; Type C supplied-air respirator, pressure-demand class; minimum requirements.

    (a) The static pressure in the facepiece shall not exceed 38 mm. 
(1.5 inches) of water-column height.
    (b) The pressure in the facepiece shall not fall below atmospheric 
at inhalation airflows less than 115 liters (4 cubic feet) per minute.
    (c) The exhalation resistance to a flow of air at a rate of 85 
liters (3 cubic feet) per minute shall not exceed the static pressure in 
the facepiece by more than 51 mm. (2 inches) of water-column height.



Sec. 84.158  Exhalation valve leakage test.

    (a) Dry exhalation valves and valve seats will be subjected to a 
suction of 25 mm. water-column height while in a normal operating 
position.
    (b) Leakage between the valve and valve seat shall not exceed 30 
milliliters per minute.

[[Page 582]]



Sec. 84.159  Man tests for gases and vapors; supplied-air respirators; general performance requirements.

    (a) Wearers will enter a chamber containing a gas or vapor as 
prescribed in Secs. 84.160, 84.161, 84.162, and 84.163.
    (b) Each wearer will spend 10 minutes in work to provide 
observations on freedom of the device from leakage. The freedom and 
comfort allowed the wearer will also be considered.
    (c) Time during the test period will be divided as follows:
    (1) Five minutes. Walking, turning head, dipping chin; and
    (2) Five minutes. Pumping air with a tire pump into a 28-liter (1 
cubic foot) container, or equivalent work.
    (d) No odor of the test gas or vapor shall be detected by the wearer 
in the air breathed during any such test, and the wearer shall not be 
subjected to any undue discomfort or encumbrance because of the fit, air 
delivery, or other features of the respirator during the testing period.



Sec. 84.160  Man test for gases and vapors; Type A and Type AE respirators; test requirements.

    (a) The completely assembled respirator will be worn in a chamber 
containing 0.10.025 percent isoamyl acetate vapor, and the 
blower, the intake of the hose, and not more than 25 percent of the hose 
length will be located in isoamyl acetate-free air.
    (b) The man in the isoamyl acetate atmosphere will draw his inspired 
air through the hose, connections, and all parts of the air device by 
means of his lungs alone (blower not operating).
    (c) The 10-minute work test will be repeated with the blower in 
operation at any practical speed up to 50 revolutions of the crank per 
minute.



Sec. 84.161  Man test for gases and vapors; Type B and Type BE respirators; test requirements.

    (a) The completely assembled respirator will be worn in a chamber 
containing 0.10.025 percent isoamyl acetate vapor, and the 
intake of the hose, and not more than 25 percent of the hose length will 
be located in isoamyl acetate-free air.
    (b) The man in the isoamyl acetate atmosphere will draw his inspired 
air through the hose and connections by means of his lungs alone.



Sec. 84.162  Man test for gases and vapors; Type C respirators, continuous-flow class and Type CE supplied-air respirators; test requirements.

    (a) The completely assembled respirator will be worn in a chamber 
containing 0.10.025 percent isoamyl acetate vapor, the 
intake of the hose will be connected to a suitable source of respirable 
air, and not more than 25 percent of the hose length will be located in 
isoamyl acetate-free air.
    (b) The minimum flow of air required to maintain a positive pressure 
in the respiratory-inlet covering throughout the entire breathing cycle 
will be supplied to the wearer, provided however, that airflow shall not 
be less than 115 liters per minute for tight-fitting and not less than 
170 liters per minute for loose-fitting respiratory inlet-coverings.
    (c) The test will be repeated with the maximum rate of flow 
attainable within specified operating pressures.



Sec. 84.163  Man test for gases and vapors; Type C supplied-air respirators, demand and pressure-demand classes; test requirements.

    (a) The completely assembled respirator will be worn in a chamber 
containing 0.10.025 percent isoamyl acetate vapor, the 
intake of the hose will be connected to a suitable source of respirable 
air, and not more than 25 percent of the hose length will be located in 
isoamyl acetate-free air.
    (b) The test will be conducted at the minimum pressure with the 
maximum hose length and will be repeated at the maximum pressure with 
the minimum hose length.

[[Page 583]]

                     Tables to Subpart J of Part 84

                                 Table 8--Air-Supply-Line Requirements and Tests
                                           [42 CFR part 84, subpart J]
----------------------------------------------------------------------------------------------------------------
                                     Requirements for the air-supply lines of the indicated type of supplied-air
                                                                     respirators
       Specific requirements        ----------------------------------------------------------------------------
                                             Type A                  Type B                     Type C
----------------------------------------------------------------------------------------------------------------
Length of hose.....................  Maximum of 91 m. (300   Maximum of 23 m. (75    Maximum of 91 m. (300 feet)
                                      feet), in multiples     feet) in multiples of   in multiples of 7.6 m. (25
                                      of 7.6 m. (25 feet).    7.6 m. (25 feet).       feet). It will be
                                                                                      permissible for the
                                                                                      applicant to supply hose
                                                                                      of the approved type of
                                                                                      shorter length than 7.6 m.
                                                                                      (25 feet) provided it
                                                                                      meets the requirements of
                                                                                      the part.
Air flow...........................  None..................  None..................  The air-supply hose with
                                                                                      air regulating valve or
                                                                                      orifice shall permit a
                                                                                      flow of not less than 115
                                                                                      liters (4 cubic feet) per
                                                                                      minute to tight-fitting
                                                                                      and 170 liters (6 cubic
                                                                                      feet) per minute to loose-
                                                                                      fitting respiratory-inlet
                                                                                      coverings through the
                                                                                      maximum length of hose for
                                                                                      which approval is granted
                                                                                      and at the minimum
                                                                                      specified air-supply
                                                                                      pressure. The maximum flow
                                                                                      shall not exceed 425
                                                                                      liters (15 cubic feet) per
                                                                                      minute at the maximum
                                                                                      specified air-supply
                                                                                      pressure with the minimum
                                                                                      length of hose for which
                                                                                      approval is granted.
Air flow...........................  ......do..............  ......do..............  The air-supply hose,
                                                                                      detachable coupling, and
                                                                                      demand valve of the demand
                                                                                      class or pressure-demand
                                                                                      valve of the pressure-
                                                                                      demand class for Type C
                                                                                      supplied-air respirators,
                                                                                      demand and pressure-demand
                                                                                      classes, shall be capable
                                                                                      of delivering respirable
                                                                                      air at a rate of not less
                                                                                      than 115 liters (4 cubic
                                                                                      feet) per minute to the
                                                                                      respiratory-inlet covering
                                                                                      at an inhalation
                                                                                      resistance not exceeding
                                                                                      50 millimeters (2 inches)
                                                                                      of water-column height
                                                                                      measured in the
                                                                                      respiratory-inlet covering
                                                                                      with any combination of
                                                                                      air-supply pressure and
                                                                                      length of hose within the
                                                                                      applicant's specified
                                                                                      range of pressure and hose
                                                                                      length. The air-flow rate
                                                                                      and resistance to
                                                                                      inhalation shall be
                                                                                      measured while the demand
                                                                                      or pressure-demand valve
                                                                                      is actuated 20 times per
                                                                                      minute by a source of
                                                                                      intermittent suction. The
                                                                                      maximum rate of flow to
                                                                                      the respiratory-inlet
                                                                                      covering shall not exceed
                                                                                      425 liters (15 cubic feet)
                                                                                      per minute under the
                                                                                      specified operating
                                                                                      conditions.

[[Page 584]]

 
Air-regulating valve...............  ......do..............  ......do..............  If an air-regulating valve
                                                                                      is provided, it shall be
                                                                                      so designed that it will
                                                                                      remain at a specific
                                                                                      adjustment, which will not
                                                                                      be affected by the
                                                                                      ordinary movement of the
                                                                                      wearer. The valve must be
                                                                                      so constructed that the
                                                                                      air supply with the
                                                                                      maximum length of hose and
                                                                                      at the minimum specified
                                                                                      air-supply pressure will
                                                                                      not be less than 115
                                                                                      liters (4 cubic feet) of
                                                                                      air per minute to tight-
                                                                                      fitting and 170 liters (6
                                                                                      cubic feet) of air per
                                                                                      minute of loose-fitting
                                                                                      respiratory inlet
                                                                                      coverings for any
                                                                                      adjustment of the valve.
                                                                                      If a demand or pressure-
                                                                                      demand valve replaces the
                                                                                      air-regulating valve, it
                                                                                      shall be connected to the
                                                                                      air-supply at the maximum
                                                                                      air pressure for which
                                                                                      approval is sought by
                                                                                      means of the minimum
                                                                                      length of air-supply hose
                                                                                      for which approval is
                                                                                      sought. The outlet of the
                                                                                      demand or pressure-demand
                                                                                      valve shall be connected
                                                                                      to a source of
                                                                                      intermittent suction so
                                                                                      that the demand or
                                                                                      pressure-demand valve is
                                                                                      actuated approximately 20
                                                                                      times per minute for a
                                                                                      total of 100,000
                                                                                      inhalations. To expedite
                                                                                      this test, the rate of
                                                                                      actuation may be increased
                                                                                      if mutually agreeable to
                                                                                      the applicant and NIOSH.
                                                                                      During this test the valve
                                                                                      shall function without
                                                                                      failure and without
                                                                                      excessive wear of the
                                                                                      moving parts. The demand
                                                                                      or pressure-demand valve
                                                                                      shall not be damaged in
                                                                                      any way when subjected at
                                                                                      the outlet to a pressure
                                                                                      or suction of 25 cm. (10
                                                                                      inches) of water gage for
                                                                                      2 minutes.
Noncollapsibility..................  The hose shall not      Same as Type A........  None.
                                      collapse or exhibit
                                      permanent deformation
                                      when a force of 90
                                      kg. (200 pounds) is
                                      applied for 5 minutes
                                      between 2 planes 7.6
                                      cm. (3 inches) wide
                                      on opposite sides of
                                      the hose.
Nonkinkability.....................  None..................  None..................  A 7.6 m. (25 foot) section
                                                                                      of the hose will be placed
                                                                                      on a horizontal-plane
                                                                                      surface and shaped into a
                                                                                      one-loop coil with one end
                                                                                      of the hose connected to
                                                                                      an airflow meter and the
                                                                                      other end of the hose
                                                                                      supplied with air at the
                                                                                      minimum specified supply
                                                                                      pressure. The connection
                                                                                      shall be in the plane of
                                                                                      the loop. The other end of
                                                                                      the hose will be pulled
                                                                                      tangentially to the loop
                                                                                      and in the plane of the
                                                                                      loop until the hose
                                                                                      straightens. To meet the
                                                                                      requirements of this test
                                                                                      the loop shall maintain a
                                                                                      uniform near-circular
                                                                                      shape and ultimately
                                                                                      unfold as a spiral,
                                                                                      without any localized
                                                                                      deformation that decreases
                                                                                      the flow of air to less
                                                                                      than 90 percent of the
                                                                                      flow when the hose is
                                                                                      tested while remaining in
                                                                                      a straight line.
Strength of hose and couplings.....  Hose and couplings      Same as Type A........  Hose and couplings shall
                                      shall not separate or                           not exhibit any separation
                                      fail when tested with                           or failure when tested
                                      a pull of 113 kg.                               with a pull of 45 kg. (100
                                      (250 pounds) for 5                              pounds) for 5 minutes and
                                      minutes.                                        when tested by subjecting
                                                                                      them to an internal air
                                                                                      pressure of 2 times the
                                                                                      maximum respirator-supply
                                                                                      pressure that is specified
                                                                                      by the applicant or at 173
                                                                                      kN/m. 2 (25 pounds per
                                                                                      square inch) gage,
                                                                                      whichever is higher.

[[Page 585]]

 
Tightness..........................  No air leakage shall    None..................  Leakage of air exceeding 50
                                      occur when the hose                             cc. per minute at each
                                      and couplings are                               coupling shall not be
                                      joined and the                                  permitted when the hose
                                      joint(s) are immersed                           and couplings are joined
                                      in water and                                    and are immersed in water,
                                      subjected to an                                 with air flowing through
                                      internal air pressure                           the respirator under a
                                      of 35 kN/m. 2 (5                                pressure of 173 kN/m. 2
                                      pounds per square                               (25 pounds per square
                                      inch) gage.                                     inch) gage applied to the
                                                                                      inlet end of the air-
                                                                                      supply hose, or at twice
                                                                                      the maximum respirator-
                                                                                      supply pressure that is
                                                                                      specified by the
                                                                                      applicant, whichever is
                                                                                      higher.
Permeation of hose by gasoline.....  The permeation of the   Same as for Type A....  Same as for Type A, except
                                      hose by gasoline will                           the test period shall be 1
                                      be tested by                                    hour.
                                      immersing 7.6 m. (25
                                      feet) of hose and one
                                      coupling in gasoline,
                                      with air flowing
                                      through the hose at
                                      the rate of 8 liters
                                      per minute for 6
                                      hours. The air from
                                      the hose shall not
                                      contain more than
                                      0.01 percent by
                                      volume of gasoline
                                      vapor at the end of
                                      the test.
Detachable coupling................  None..................  None..................  A hand-operated detachable
                                                                                      coupling by which the
                                                                                      wearer can readily attach
                                                                                      or detach the connecting
                                                                                      hose shall be provided at
                                                                                      a convenient location.
                                                                                      This coupling shall be
                                                                                      durable, remain connected
                                                                                      under all conditions of
                                                                                      normal respirator use, and
                                                                                      meet the prescribed tests
                                                                                      for strength and tightness
                                                                                      of hose and couplings.
----------------------------------------------------------------------------------------------------------------



      Subpart K--Non-Powered Air-Purifying Particulate Respirators



Sec. 84.170  Non-powered air-purifying particulate respirators; description.

    (a) Non-powered air-purifying particulate respirators utilize the 
wearer's negative inhalation pressure to draw the ambient air through 
the air-purifying filter elements (filters) to remove particulates from 
the ambient air. They are designed for use as respiratory protection 
against atmospheres with particulate contaminants (e.g., dusts, fumes, 
mists) that are not immediately dangerous to life or health and that 
contain adequate oxygen to support life.
    (b) Non-powered air-purifying particulate respirators are classified 
into three series, N-, R-, and P-series. The N-series filters are 
restricted to use in those workplaces free of oil aerosols. The R- and 
P-series filters are intended for removal of any particulate that 
includes oil-based liquid particulates.
    (c) Non-powered air-purifying particulate respirators are classified 
according to the efficiency level of the filter(s) as tested according 
to the requirements of this part.
    (1) N100, R100, and P100 filters shall demonstrate a minimum 
efficiency level of 99.97 percent.
    (2) N99, R99, and P99 filters shall demonstrate a minimum efficiency 
level of 99 percent.
    (3) N95, R95, and P95 filters shall demonstrate a minimum efficiency 
level of 95 percent.



Sec. 84.171  Non-powered air-purifying particulate respirators; required components.

    (a) Each non-powered air-purifying particulate respirator described 
in Sec. 84.170 shall, where its design requires, contain the following 
component parts:

[[Page 586]]

    (1) Facepiece, mouthpiece with noseclip, hood, or helmet;
    (2) Filter unit;
    (3) Harness;
    (4) Attached blower; and
    (5) Breathing tube.
    (b) The components of each non-powered air-purifying particulate 
respirator shall meet the minimum construction requirements set forth in 
subpart G of this part.



Sec. 84.172  Breathing tubes; minimum requirements.

    Flexible breathing tubes used in conjunction with respirators shall 
be designed and constructed to prevent:
    (a) Restriction of free head movement;
    (b) Disturbance of the fit of facepieces, mouthpieces, hoods, or 
helmets;
    (c) Interference with the wearer's activities; and
    (d) Shutoff of airflow due to kinking, or from chin or arm pressure.



Sec. 84.173  Harnesses; installation and construction; minimum requirements.

    (a) Each respirator shall, where necessary, be equipped with a 
suitable harness designed and constructed to hold the components of the 
respirator in position against the wearer's body.
    (b) Harnesses shall be designed and constructed to permit easy 
removal and replacement of respirator parts, and, where applicable, 
provide for holding a full facepiece in the ready position when not in 
use.



Sec. 84.174  Respirator containers; minimum requirements.

    (a) Except as provided in paragraph (b) of this section each 
respirator shall be equipped with a substantial, durable container 
bearing markings which show the applicant's name, the type of respirator 
it contains, and all appropriate approval labels.
    (b) Containers for single-use respirators may provide for storage of 
more than one respirator, however, such containers shall be designed and 
constructed to prevent contamination of respirators which are not 
removed, and to prevent damage to respirators during transit.



Sec. 84.175  Half-mask facepieces, full facepieces, hoods, helmets, and mouthpieces; fit; minimum requirements.

    (a) Half-mask facepieces and full facepieces shall be designed and 
constructed to fit persons with various facial shapes and sizes either:
    (1) By providing more than one facepiece size; or
    (2) By providing one facepiece size which will fit varying facial 
shapes and sizes.
    (b) Full facepieces shall provide for optional use of corrective 
spectacles or lenses, which shall not reduce the respiratory protective 
qualities of the respirator.
    (c) Hoods and helmets shall be designed and constructed to fit 
persons with various head sizes, provide for the optional use of 
corrective spectacles or lenses, and insure against any restriction of 
movement by the wearer.
    (d) Mouthpieces shall be equipped with noseclips which are securely 
attached to the mouthpiece or respirator and provide an airtight seal.
    (e) Facepieces, hoods, and helmets shall be designed to prevent 
eyepiece fogging.
    (f) Half-mask facepieces shall not interfere with the fit of common 
industrial safety corrective spectacles.



Sec. 84.176  Facepieces, hoods, and helmets; eyepieces; minimum requirements.

    Facepieces, hoods, and helmets shall be designed and constructed to 
provide adequate vision which is not distorted by the eyepieces.



Sec. 84.177  Inhalation and exhalation valves; minimum requirements.

    (a) Inhalation and exhalation valves shall be protected against 
distortion.
    (b) Inhalation valves shall be designed and constructed and provided 
where necessary to prevent excessive exhaled air from adversely 
affecting filters, except where filters are specifically designed to 
resist moisture.
    (c) Exhalation valves shall be:
    (1) Provided where necessary;
    (2) Protected against damage and external influence; and

[[Page 587]]

    (3) Designed and constructed to prevent inward leakage of 
contaminated air.



Sec. 84.178  Head harnesses; minimum requirements.

    (a) All facepieces shall be equipped with head harnesses designed 
and constructed to provide adequate tension during use and an even 
distribution of pressure over the entire area in contact with the face.
    (b) Facepiece head harnesses, except those employed on single-use 
respirators, shall be adjustable and replaceable.
    (c) Mouthpieces shall be equipped, where applicable, with adjustable 
and replaceable harnesses, designed and constructed to hold the 
mouthpiece in place.



Sec. 84.179  Non-powered air-purifying particulate respirators; filter identification.

    (a) The respirator manufacturer, as part of the application for 
certification, shall specify the filter series and the filter efficiency 
level (i.e., ``N95'', ``R95, ``P95'', ``N99, ``R99'', ``P99'', ``N100'', 
``R100'', or ``P100'') for which certification is being sought.
    (b) Filters shall be prominently labeled as follows:
    (1) N100 filters shall be labeled ``N100 Particulate Filter (99.97% 
filter efficiency level)'' and shall be a color other than magenta.
    (2) R100 filters shall be labeled ``R100 Particulate Filter (99.97% 
filter efficiency level)'' and shall be a color other than magenta.
    (3) P100 filters shall be labeled ``P100 Particulate Filter (99.97% 
filter efficiency level)'' and shall be color coded magenta.
    (4) N99 filters shall be labeled ``N99 Particulate Filter (99% 
filter efficiency level)'' and shall be a color other than magenta.
    (5) R99 filters shall be labeled ``R99 Particulate Filter (99% 
filter efficiency level)'' and shall be a color other than magenta.
    (6) P99 filters shall be labeled ``P99 Particulate Filter (99% 
filter efficiency level)'' and shall be a color other than magenta.
    (7) N95 filters shall be labeled as ``N95 Particulate Filter (95% 
filter efficiency level)'' and shall be a color other than magenta.
    (8) R95 filters shall be labeled as ``R95 Particulate Filter (95% 
filter efficiency level)'' and shall be a color other than magenta.
    (9) P95 filters shall be labeled as ``P95 Particulate Filter (95% 
filter efficiency level)'' and shall be a color other than magenta.



Sec. 84.180  Airflow resistance tests.

    (a) Resistance to airflow will be measured in the facepiece, 
mouthpiece, hood, or helmet of a particulate respirator (complete 
respirator) mounted on a test fixture with air flowing at continuous 
rate of 852 liters per minute, before each test conducted in 
accordance with Sec. 84.182.
    (b) The resistances for particulate respirators upon initial 
inhalation shall not exceed 35 mm water column height pressure and upon 
initial exhalation shall not exceed 25 mm water column height pressure.



Sec. 84.181  Non-powered air-purifying particulate filter efficiency level determination.

    (a) Twenty filters of each non-powered air-purifying particulate 
respirator model shall be tested for filter efficiency against:
    (1) A solid sodium chloride particulate aerosol as per this section, 
if N-series certification is requested by the applicant.
    (2) A dioctyl phthalate or equivalent liquid particulate aerosol as 
per this section, if R-series or P-series certification is requested by 
the applicant.
    (b) Filters including holders and gaskets; when separable, shall be 
tested for filter efficiency level, as mounted on a test fixture in the 
manner as used on the respirator.
    (c) Prior to filter efficiency testing of 20 N-series filters, the 
20 to be tested shall be taken out of their packaging and placed in an 
environment of 855 percent relative humidity at 
382.5  deg.C for 251 hours. Following the pre-
conditioning, filters shall be sealed in a gas-tight container and 
tested within 10 hours.

[[Page 588]]

    (d) When the filters do not have separable holders and gaskets, the 
exhalation valves shall be blocked so as to ensure that leakage, if 
present, is not included in the filter efficiency level evaluation.
    (e) For non-powered air-purifying particulate respirators with a 
single filter, filters shall be tested at a continuous airflow rate of 
854 liters per minute. Where filters are to be used in 
pairs, the test-aerosol airflow rate shall be 42.52 liters 
per minute through each filter.
    (f) Filter efficiency test aerosols. (1) When testing N-series 
filters, a sodium chloride or equivalent solid aerosol at 
255  deg.C and relative humidity of 3010 percent 
that has been neutralized to the Boltzmann equilibrium state shall be 
used. Each filter shall be challenged with a concentration not exceeding 
200 mg/m\3\.
    (2) When testing R-series and P-series filters, a neat cold-
nebulized dioctyl phthalate (DOP) or equivalent aerosol at 
255  deg.C that has been neutralized to the Boltzmann 
equilibrium state shall be used. Each filter shall be challenged with a 
concentration not exceeding 200 mg/m\3\.
    (3) The test shall continue until minimum efficiency is achieved or 
until an aerosol mass of at least 2005 mg has contacted the 
filter. For P-series filters, if the filter efficiency is decreasing 
when the 2005 mg challenge point is reached, the test shall 
be continued until there is no further decrease in efficiency.
    (g) The sodium chloride test aerosol shall have a particle size 
distribution with count median diameter of 0.0750.020 
micrometer and a standard geometric deviation not exceeding 1.86 at the 
specified test conditions as determined with a scanning mobility 
particle sizer or equivalent. The DOP aerosol shall have a particle size 
distribution with count median diameter of 0.1850.020 
micrometer and a standard geometric deviation not exceeding 1.60 at the 
specified test conditions as determined with a scanning mobility 
particle sizer or equivalent.
    (h) The efficiency of the filter shall be monitored and recorded 
throughout the test period by a suitable forward-light-scattering 
photometer or equivalent instrumentation.
    (i) The minimum efficiency for each of the 20 filters shall be 
determined and recorded and be equal to or greater than the filter 
efficiency criterion listed for each level as follows:

P100, R100 and N100: Efficiency 99.97%
P99, R99 and N99: Efficiency 99%
P95, R95 and N95: Efficiency 95%



Sec. 84.182  Exhalation valve leakage test; minimum requirements.

    (a) Dry exhalation valves and valve seats will be subjected to a 
suction of 25 mm. water-column height while in a normal operating 
position.
    (b) Leakage between the valve and valve seat shall not exceed 30 
milliliters per minute.



                Subpart L--Chemical Cartridge Respirators



Sec. 84.190  Chemical cartridge respirators: description.

    (a) Chemical cartridge respirators including all completely 
assembled respirators which are designed for use as respiratory 
protection during entry into or escape from atmospheres not immediately 
dangerous to life and health, are described according to the specific 
gases or vapors against which they are designed to provide respiratory 
protection, as follows:

------------------------------------------------------------------------
                                                            Maximum use
                                                          concentration,
        Type of chemical cartridge respirator \1\            parts per
                                                              million
------------------------------------------------------------------------
Ammonia.................................................            300
Chlorine................................................             10
Hydrogen chloride.......................................             50
Methyl amine............................................            100
Organic vapor...........................................      \2\ 1,000
Sulfur dioxide..........................................             50
Vinyl chloride..........................................             10
------------------------------------------------------------------------
\1\ Not for use against gases or vapors with poor warning properties
  (except where MSHA or Occupational Safety and Health Administration
  standards may permit such use for a specific gas or vapor) or those
  which generate high heats of reaction with sorbent material in the
  cartridge.
\2\ Maximum use concentrations are lower for organic vapors which
  produce atmospheres immediately hazardous to life or health at
  concentrations equal to or lower than this concentration.

    (b) Chemical cartridge respirators for respiratory protection 
against gases or vapors, which are not specifically listed with their 
maximum use concentration, may be approved if the applicant

[[Page 589]]

submits a request for such approval, in writing, to the Institute. The 
Institute shall consider each such application and accept or reject the 
application after a review of the effects on the wearer's health and 
safety and in the light of any field experience in use of chemical 
cartridge respirators as protection against such hazards.



Sec. 84.191  Chemical cartridge respirators; required components.

    (a) Each chemical cartridge respirator described in Sec. 84.190 
shall, where its design requires, contain the following component parts:
    (1) Facepiece, mouthpiece, and noseclip, hood, or helmet;
    (2) Cartridge;
    (3) Cartridge with filter;
    (4) Harness;
    (5) Breathing tube; and
    (6) Attached blower.
    (b) The components of each chemical cartridge respirator shall meet 
the minimum construction requirements set forth in subpart G of this 
part.



Sec. 84.192  Cartridges in parallel; resistance requirements.

    Where two or more cartridges are used in parallel, their resistance 
to airflow shall be essentially equal.



Sec. 84.193  Cartridges; color and markings; requirements.

    The color and markings of all cartridges or labels shall conform 
with the requirements of the American National Standards Institute, 
American National Standard for Identification of Air-Purifying 
Respirator Canisters and Cartridges, ANSI K13.1-1973. ANSI K13.1 is 
incorporated by reference and has been approved by the Director of the 
Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. 
Copies may be obtained from American National Standards Institute, Inc., 
1430 Broadway, New York, NY 10018. Copies may be inspected at the NIOSH, 
Certification and Quality Assurance Branch, 1095 Willowdale Road, 
Morgantown, WV 26505-2888, or at the Office of the Federal Register, 800 
North Capitol Street, NW., suite 700, Washington, DC.



Sec. 84.194  Filters used with chemical cartridges; location; replacement.

    (a) Particulate matter filters used in conjunction with a chemical 
cartridge shall be located on the inlet side of the cartridge.
    (b) Filters shall be incorporated in or firmly attached to the 
cartridge and each filter assembly shall, where applicable, be designed 
to permit its easy removal from and replacement on the cartridge.



Sec. 84.195  Breathing tubes; minimum requirements.

    Flexible breathing tubes used in conjunction with respirators shall 
be designed and constructed to prevent:
    (a) Restriction of free head movement;
    (b) Disturbance of the fit of facepieces, mouthpieces, hoods, or 
helmets;
    (c) Interference with the wearer's activities; and
    (d) Shutoff of airflow due to kinking, or from chin or arm pressure.



Sec. 84.196  Harnesses; installation and construction; minimum requirements.

    (a) Each respirator shall, where necessary, be equipped with a 
suitable harness designed and constructed to hold the components of the 
respirator in position against the wearer's body.
    (b) Harnesses shall be designed and constructed to permit easy 
removal and replacement of respirator parts and, where applicable, 
provide for holding a full facepiece in the ready position when not in 
use.



Sec. 84.197  Respirator containers; minimum requirements.

    Respirators shall be equipped with a substantial, durable container 
bearing markings which show the applicant's name, the type and 
commercial designation of the respirator it contains and all appropriate 
approval labels.

[[Page 590]]



Sec. 84.198  Half-mask facepieces, full facepieces, mouthpieces, hoods, and helmets; fit; minimum requirements.

    (a) Half-mask facepieces and full facepieces shall be designed and 
constructed to fit persons with various facial shapes and sizes either:
    (1) By providing more than one facepiece size; or
    (2) By providing one facepiece size which will fit varying facial 
shapes and sizes.
    (b) Hoods and helmets shall be designed and constructed to fit 
persons with various head sizes, provide for the optional use of 
corrective spectacles or lenses, and insure against any restriction of 
movement by the wearer.
    (c) Mouthpieces shall be equipped with noseclips which are securely 
attached to the mouthpiece or respirator and provide an airtight fit.
    (d) Full facepieces shall provide for optional use of corrective 
spectacles or lenses which shall not reduce the respiratory protective 
qualities of the respirator.
    (e) Facepieces, hoods, and helmets shall be designed to prevent 
eyepiece fogging.



Sec. 84.199  Facepieces, hoods, and helmets; eyepieces; minimum requirements.

    Facepieces, hoods, and helmets shall be designed and constructed to 
provide adequate vision which is not distorted by the eyepieces.



Sec. 84.200  Inhalation and exhalation valves; minimum requirements.

    (a) Inhalation and exhalation valves shall be provided where 
necessary and protected against distortion.
    (b) Inhalation valves shall be designed and constructed to prevent 
excessive exhaled air from entering cartridges or adversely affecting 
canisters.
    (c) Exhalation valves shall be--
    (1) Protected against damage and external influence; and
    (2) Designed and constructed to prevent inward leakage of 
contaminated air.



Sec. 84.201  Head harnesses; minimum requirements.

    (a)(1) Facepieces for chemical cartridge respirators other than 
single-use vinyl chloride shall be equipped with adjustable and 
replaceable head harnesses designed and constructed to provide adequate 
tension during use and an even distribution of pressure over the entire 
area in contact with the face.
    (2) Facepieces for single-use vinyl chloride respirators shall be 
equipped with adjustable head harnesses designed and constructed to 
provide adequate tension during use and an even distribution of pressure 
over the entire area in contact with the face.
    (b) Mouthpieces shall be equipped where applicable, with an 
adjustable and replaceable harness designed and constructed to hold the 
mouthpiece in place.



Sec. 84.202  Air velocity and noise levels; hoods and helmets; minimum requirements.

    Noise levels generated by the respirator will be measured inside the 
hood or helmet at maximum airflow obtainable and shall not exceed 80 
dBA.



Sec. 84.203  Breathing resistance test; minimum requirements.

    (a) Resistance to airflow will be measured in the facepiece, 
mouthpiece, hood, or helmet of a chemical cartridge respirator mounted 
on a test fixture with air flowing at a continuous rate of 85 liters per 
minute, both before and after each test conducted in accordance with 
Secs. 84.206 through 84.207.
    (b) The maximum allowable resistance requirements for chemical 
cartridge respirators are as follows:

                           Maximum Resistance
                    [Millimeter water column height]
------------------------------------------------------------------------
                                          Inhalation
    Type of chemical-cartridge    --------------------------  Exhalation
            respirator               Initial      Final\1\
------------------------------------------------------------------------
Other than single-use vinyl
 chloride respirators:
    For gases, vapors, or gases             40           45           20
     and vapors..................

[[Page 591]]

 
    For gases, vapors, or gases             50           70           20
     and vapors, and particulates
Single-use respirator with
 valves:
    For vinyl chloride...........           20           25           20
    For vinyl chloride and                  30           45            2
     particulates................
Single-use respirator without
 valves:
    For vinyl chloride...........           15           20          (2)
    For vinyl chloride and                  25           40          (2)
     particulates................
------------------------------------------------------------------------
\1\ Measured at end of service life specified in Table 11 of this
  subpart.
\2\ Same as inhalation.



Sec. 84.204  Exhalation valve leakage test; minimum requirements.

    (a) Dry exhalation valves and valve seats will be subjected to a 
suction of 25 mm. water-column height while in a normal operating 
position.
    (b) Leakage between the valve and valve seat shall not exceed 30 
milliliters per minute.



Sec. 84.205  Facepiece test; minimum requirements.

    (a) The complete chemical cartridge respirator will be fitted to the 
faces of persons having varying facial shapes and sizes.
    (b) Where the applicant specifies a facepiece size or sizes for the 
respirator together with the approximate measurement of faces they are 
designed to fit, the Institute will provide test subjects to suit such 
facial measurements.
    (c) Any chemical cartridge respirator part which must be removed to 
perform the facepiece or mouthpiece fit test shall be replaceable 
without special tools and without disturbing facepiece or mouthpiece 
fit.
    (d) The facepiece or mouthpiece fit test using the positive or 
negative pressure recommended by the applicant and described in his 
instructions will be used before each test.
    (e)(1) Each wearer will enter a chamber containing 100 p.p.m. 
isoamyl acetate vapor for half-mask facepieces, and 1,000 p.p.m. for 
full facepieces, mouthpieces, hoods, and helmets.
    (2) The facepiece or mouthpiece may be adjusted, if necessary, in 
the test chamber before starting the test.
    (3) Each wearer will remain in the chamber for 8 minutes while 
performing the following activities:
    (i) Two minutes, nodding and turning head;
    (ii) Two minutes, calisthenic arm movements;
    (iii) Two minutes, running in place; and
    (iv) Two minutes, pumping with a tire pump into a 28-liter (1 cubic-
foot) container.
    (4) Each wearer shall not detect the odor of isoamyl-acetate vapor 
during the test.



Sec. 84.206  Particulate tests; respirators with filters; minimum requirements; general.

    (a) Three respirators with cartridges containing, or having attached 
to them, filters for protection against particulates will be tested in 
accordance with the provisions of Sec. 84.207.
    (b) In addition to the test requirements set forth in paragraph (a) 
of this section, three such respirators will be tested, as appropriate, 
in accordance with the provisions of Secs. 84.179 through 84.183; 
however, the maximum allowable resistance of complete particulate, and 
gas, vapor, or gas and vapor chemical cartridge respirators shall not 
exceed the maximum allowable limits set forth in Sec. 84.203.



Sec. 84.207  Bench tests; gas and vapor tests; minimum requirements; general.

    (a) Bench tests will be made on an apparatus that allows the test 
atmosphere at 505 percent relative humidity and room 
temperature, approximately 25  deg.C, to enter the cartridges 
continuously at predetermined concentrations and rates of flow, and that 
has means

[[Page 592]]

for determining the test life of the cartridges.
    (b) Where two cartridges are used in parallel on a chemical 
cartridge respirator, the bench test will be performed with the 
cartridges arranged in parallel, and the test requirements will apply to 
the combination rather than to the individual cartridges.
    (c) Three cartridges or pairs of cartridges will be removed from 
containers and tested as received from the applicant.
    (d) Two air purifying cartridges or pairs of cartridges will be 
equilibrated at room temperature by passing 25 percent relative humidity 
air through them at the flow rate of 25 liters per minute (l.p.m.) for 6 
hours.
    (e) Two air purifying cartridges or pairs of cartridges will be 
equilibrated by passing 85 percent relative humidity air through them at 
the flow rate of 25 l.p.m.
    (f) All cartridges will be resealed, kept in an upright position, at 
room temperatures, and tested within 18 hours.
    (g) Cartridges will be tested and shall meet the minimum 
requirements set forth in Table 11 of this subpart.

                     Tables to Subpart L of Part 84

                                                               Tables 9 and 10 [Reserved]
                                                     Table 11-Cartridge Bench Tests and Requirements
                                                               [42 CFR part 84, subpart L]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                       Test atmosphere
                                                            -------------------------------------   Flowrate    Number of   Penetration \1\    Minimum
             Cartridge                   Test condition                            Concentration    (l.p.m.)      tests         (p.p.m.)       life \2\
                                                                 Gas or vapor         (p.p.m.)                                                  (min.)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Ammonia............................  As received...........  NH3                           1000            64            3             50             50
Ammonia............................  Equilibrated..........  NH3                           1000            32            4             50             50
Chlorine...........................  As received...........  Cl2                            500            64            3              5             35
Chlorine...........................  Equilibrated..........  Cl2                            500            32            4              5             35
Hydrogen chloride..................  As received...........  HCl                            500            64            3              5             50
Hydrogen chloride..................  Equilibrated..........  HCl                            500            32            4              5             50
Methylamine........................  As received...........  CH3 NH2                       1000            64            3             10             25
Methylamine........................  Equilibrated..........  CH3 NH2                       1000            32            4             10             25
Organic vapors.....................  As received...........  CCl4                          1000            64            3              5             50
Organic vapors.....................  Equilibrated..........  CCl4                          1000            32            4              5             50
Sulfur dioxide.....................  As received...........  SO2                            500            64            3              5             30
Sulfur dioxide.....................  Equilibrated..........  SO2                            500            32            4              5             30
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Minimum life will be determined at the indicated penetration.
\2\ Where a respirator is designed for respiratory protection against more than one type of gas or vapor, as for use in ammonia and in chlorine, the
  minimum life shall be one-half that shown for each type of gas or vapor. Where a respirator is designed for respiratory protection against more than
  one gas of a type, as for use in chlorine and sulfur dioxide, the stated minimal life shall apply.

Subpart M  [Reserved]



                   Subpart N--Special Use Respirators



Sec. 84.250  Vinyl chloride respirators; description.

    Vinyl chloride respirators, including all completely assembled 
respirators which are designed for use as respiratory protection during 
entry into and escape from vinyl chloride atmospheres containing 
adequate oxygen to support life, are described according to their 
construction as follows:
    (a) Front-mounted or back-mounted gas masks;
    (b) Chin-style gas masks;
    (c) Chemical-cartridge respirators;
    (d) Powered air-purifying respirators; and
    (e) Other devices, including combination respirators.

[[Page 593]]



Sec. 84.251  Required components.

    (a) Each vinyl chloride respirator described in Sec. 84.250 shall, 
where its design requires, contain the following component parts:
    (1) Facepiece;
    (2) Canister with end-of-service-life indicator;
    (3) Cartridge with end-of-service-life indicator;
    (4) Harness;
    (5) Attached blower; and
    (6) Breathing tube.
    (b) The components of each vinyl chloride respirator shall meet the 
minimum construction requirements set forth in Subpart G of this part.



Sec. 84.252  Gas masks; requirements and tests.

    (a) Except for the tests prescribed in Sec. 84.126, the minimum 
requirements and performance tests for gas masks, prescribed in Subpart 
I of this part, are applicable to vinyl chloride gas masks.
    (b) The following bench tests are applicable to canisters designed 
for use with gas masks for entry into and escape from vinyl chloride 
atmospheres containing adequate oxygen to support life:
    (1) Four canisters will be equilibrated at 255  deg.C by 
passing 855 percent relative humidity air through them at 64 
liters per minute for six hours.
    (2) The equilibrated canisters will be resealed, kept in an upright 
position at room temperature, and tested according to paragraph (b)(3) 
of this section within 18 hours.
    (3) The canisters equilibrated and stored as described in paragraphs 
(b) (1) and (2) of this section will be tested on an apparatus that 
allows the test atmosphere at 855 percent relative humidity 
and 255  deg.C to enter the canister continuously at a 
concentration of 25 ppm vinyl chloride monomer at a total flow rate of 
64 liters per minute.
    (4) The maximum allowable penetration after six hours of testing 
according to paragraph (b)(3) of this section shall not exceed 1 ppm 
vinyl chloride.
    (c) Where canisters are submitted for testing and approval with a 
service life of more than four hours, the period of time for testing for 
vinyl chloride penetration will be performed at 150% of the service life 
specified in the manufacturer's application. (Example: If a manufacturer 
requests approval of a respirator for six hours use against exposure to 
vinyl chloride, the maximum allowable penetration after nine hours of 
testing shall not exceed 1 ppm vinyl chloride.)



Sec. 84.253  Chemical-cartridge respirators; requirements and tests.

    (a) Except for the tests prescribed in Secs. 84.206 and 84.207, the 
minimum requirements and performance tests for chemical-cartridge 
respirators prescribed in Subpart L of this part are applicable to 
replaceable-cartridge and single-use vinyl chloride chemical-cartridge 
respirators.
    (b) The following bench tests are applicable to cartridges designed 
for use with chemical-cartridge respirators for entry into and escape 
from vinyl chloride atmospheres containing adequate oxygen to support 
life:
    (1) Where two cartridges are used in parallel on a chemical-
cartridge respirator, the bench test requirements will apply to the 
combination rather than the individual cartridges.
    (2) Four cartridges or pairs of cartridges will be equilibrated at 
255  deg.C by passing 855 percent relative 
humidity air through them at 25 liters per minute for six hours.
    (3) The equilibrated cartridges will be resealed, kept in an upright 
position, at room temperature, and tested according to paragraphs (b)(4) 
and (b)(5) of this section for other than single-use respirators or 
according to paragraphs (b)(6) and (b)(7) of this section for single-use 
respirators within 18 hours.
    (4) The cartridges or pairs of cartridges for other than single-use 
respirators, equilibrated and stored as described in paragraphs (b)(1), 
(b)(2), and (b)(3) of this section, will be tested on an apparatus that 
allows the test atmosphere at 855 percent relative humidity 
and 255  deg.C, to enter the cartridges or pairs of 
cartridges continuously at a concentration of 10 ppm vinyl chloride 
monomer at a total flowrate of 64 liters per minute.
    (5) The maximum allowable penetration after 90 minutes testing of 
cartridges or pairs of cartridges for other than single-use respirators, 
according

[[Page 594]]

to paragraph (b)(4) of this section shall not exceed 1 ppm vinyl 
chloride.
    (6) The single-use respirators, equilibrated and stored as described 
in paragraphs (b)(2) and (b)(3) of this section, will be tested on an 
apparatus that allows a test atmosphere at 855 percent 
relative humidity and 255  deg.C to be cycled through the 
respirator by a breathing machine at a concentration of 10 ppm vinyl 
chloride monomer at the rate of 24 respirations per minute at a minute 
volume of 400.6 liters. Air exhaled through the respirator 
will be 352  deg.C with 943 percent relative 
humidity.
    (7) The maximum allowable penetration after 144 minutes testing of 
respirators, according to paragraph (b)(6) of this section, shall not 
exceed 1 ppm vinyl chloride.



Sec. 84.254  Powered air-purifying respirators; requirements and tests.

    (a) Except for the tests prescribed in Sec. 84.207, the minimum 
requirements and performance tests for powered air-purifying respirators 
prescribed in subpart L of this part are applicable to vinyl chloride 
powered air-purifying respirators.
    (b) The following bench tests are applicable to cartridges designed 
for use with powered air-purifying respirators for entry into and escape 
from vinyl chloride atmospheres containing adequate oxygen to support 
life:
    (1) Four cartridges will be equilibrated at 25  deg.C by 
passing 855 percent relative humidity air through them at 
115 liters per minute for tight-fitting facepieces and 170 liters per 
minute for loose-fitting hoods and helmets, for six hours.
    (2) The equilibrated cartridges will be resealed, kept in an upright 
position at room temperature and tested according to paragraph (b)(3) of 
this section within 18 hours.
    (3) The cartridges equilibrated and stored as described in 
paragraphs (b) (1) and (2) of this section will be tested on an 
apparatus that allows the test atmosphere at 855 percent 
relative humidity and 255  deg.C to enter the cartridge 
continuously at a concentration of 25 ppm vinyl chloride monomer at a 
total flow rate of 115 liters per minute for tight-fitting facepieces 
and 170 liters per minute for loose-fitting hoods and helmets.
    (4) The maximum allowable penetration after six hours of testing 
according to paragraph (b)(3) of this section shall not exceed 1 ppm 
vinyl chloride.



Sec. 84.255  Requirements for end-of-service-life indicator.

    (a) Each canister or cartridge submitted for testing and approval in 
accordance with Secs. 84.252, 84.253, and 84.254 shall be equipped with 
a canister or cartridge end-of-service-life indicator which shows a 
satisfactory indicator change or other obvious warning before 1 ppm 
vinyl chloride penetration occurs. The indicator shall show such change 
or afford such warning at 8010 percent of the total service 
life to 1 ppm leakage, as determined by continuing each test described 
in Secs. 84.252(b), 84.253(b), and 84.254(b) until a 1 ppm leakage of 
vinyl chloride occurs.
    (b) The applicant shall provide sufficient pretest data to verify 
the performance of the end-of-service-life indicator required in 
paragraph (a) of this section.



Sec. 84.256  Quality control requirements.

    (a) In addition to the construction and performance requirements 
specified in Secs. 84.251, 84.252, 84.253, 84.254, and 84.255, the 
quality control requirements in paragraphs (b), (c), and (d) of this 
section apply to approval of gas masks, chemical cartridge respirators, 
and powered air-purifying respirators for entry into and escape from 
vinyl chloride atmospheres containing adequate oxygen to support life.
    (b) The respirators submitted for approval as described in paragraph 
(a) of this section shall be accompanied by a complete quality control 
plan meeting the requirements of subpart E of this part.
    (c)(1) The applicant shall specify in the plan that a sufficient 
number of samples will be drawn from each bulk container of sorbent 
material and that where activated carbon is used, the following specific 
tests will be performed:
    (i) Apparent density;
    (ii) Iodine number;
    (iii) Moisture content;

[[Page 595]]

    (iv) Carbon tetrachloride number; and
    (v) Mesh size.
    (2) The tests in paragraph (c)(1) of this section shall be performed 
in a quantity necessary to assure continued satisfactory conformance of 
the canisters and cartridges to the requirements of this subpart.
    (d) Final performance quality control tests on the complete 
canisters and cartridges shall be accomplished using the bench tests and 
procedures prescribed in Secs. 84.252, 84.253, 84.254, and 84.255.



Sec. 84.257  Labeling requirements.

    (a) A warning shall be placed on the label of each gas mask, 
chemical-cartridge respirator, and powered air-purifying respirator, and 
on the label of each canister and cartridge, alerting the wearer to the 
need for a fitting test in accordance with the manufacturer's facepiece 
fitting instructions, providing service life information, providing 
specific instructions for disposal, and advising that the wearer may 
communicate to NIOSH any difficulties that may be experienced in the 
design and performance of any gas mask, chemical-cartridge respirator, 
or powered air-purifying respirator approved under the requirements of 
this subpart. The service lives of respirators meeting the test 
requirements of this subpart shall be specified as follows:

Chemical-cartridge respirator....................................1 hour.
Gas mask........................................................4 hours.
Powered air-purifying respirator................................4 hours.

    (b) Where the service life of a respirator is approved for more than 
four hours, the service life for which the respirator has been approved 
will be specified.



Sec. 84.258  Fees.

    The following fees shall be charged for the examination, inspection, 
and testing of complete assemblies and components of respirators 
described in Secs. 84.250 and 84.251:

Complete gas mask.................................................$1,100
Complete chemical-cartridge   respirator.......................... 1,150
Complete powered air-purifying respirator......................... 1,500
Canister or cartridge only........................................  750.

Subparts O-JJ  [Reserved]



 Subpart KK--Dust, Fume, and Mist; Pesticide; Paint Spray; Powered Air-
     Purifying High Efficiency Respirators and Combination Gas Masks



Sec. 84.1100  Scope and effective dates.

    The purpose of this subpart KK is to establish procedures and 
requirements for issuing extensions of approval of particulate 
respirators certified prior to July 10, 1995 under the provisions of 30 
CFR part 11 (See 30 CFR part 11 edition, as revised July 1, 1994.), new 
approvals and extensions of approval of particulate respirators for 
applications that are in NIOSH receipt on July 10, 1995, and approval of 
powered air-purifying respirators.
    (a) Air-purifying respirators with particulate filters approved 
under the provisions of this subpart after July 10, 1995 will have a 30 
CFR part 11 approval label.
    (b) Only changes or modifications of non-powered air-purifying 
respirators with particulate filters approved under the provisions of 
subparts I, K, L, or M of 30 CFR part 11 or paragraph (a) of this 
section and deemed necessary by NIOSH to ensure the health and safety of 
the wearer will be approved until July 10, 1998 and will have a 30 CFR 
part 11 approval label.
    (c) Only changes or modifications of powered air-purifying 
respirators with particulate filters approved under the provisions of 
subparts I, K, L, or M of 30 CFR part 11 or paragraph (a) of this 
section and deemed necessary by NIOSH to ensure the health and safety of 
the wearer will be approved under this subpart until July 10, 1998 and 
will have a 30 CFR part 11 label.
    (d) Approval of powered air-purifying respirators will be issued 
under this subpart. Particulate filters for powered air-purifying 
respirators approved under the provisions of this subpart shall be only 
high-efficiency (HEPA) as described in Sec. 84.1130(a)(4) and will carry 
a 42 CFR part 84 approval label. In addition, changes or modifications 
of powered HEPA air-purifying respirators approved under the provisions 
of this subpart KK will be approved

[[Page 596]]

under this subpart and will have a 42 CFR part 84 approval label.



Sec. 84.1101  Definitions.

    As used in this subpart
    (a) Air Contamination Level means the standards of contaminant 
levels prescribed by the Secretary of Labor in accordance with the 
provisions of the Occupational Safety and Health Act of 1970 (Pub. L. 
91-596; 84 Stat. 1590).
    (b) DOP means a homogenous liquid aerosol, having a particle 
diameter of 0.3 micrometer, which is generated by vaporization and 
condensation of dioctyl phthalate.
    (c) Pesticide means:
    (1) Any substance or mixture of substances (including solvents and 
impurities) intended to prevent, destroy, repel, or mitigate any insect, 
rodent, nematode, fungus, weed, or other form of plant or animal life or 
virus; and
    (2) Any substance or mixture of substances (including solvents and 
impurities) intended for use as a plant regulator, defoliant, or 
desiccant, as defined in the Federal Insecticide, Fungicide, and 
Rodenticide Act of 1947, as amended (7 U.S.C. 135-135k), excluding 
fumigants which are applied as gases or vapors or in a solid or liquid 
form as pellets or poured liquids for subsequent release as gases or 
vapors.
    (d) Radionuclide means an atom identified by the constitution of its 
nucleus (specified by the number of protons Z, number of neutrons N, and 
energy, or, alternatively, by the atomic number Z, mass number A=(N+Z), 
and atomic mass) which exists for a measurable time; decays or 
disintegrates spontaneously, emits radiation, and results in the 
formation of new nuclides.
    (e) Smoke means the products of incomplete combustion of organic 
substances in the form of solid and liquid particles and gaseous 
products in air, usually of sufficient concentration to perceptibility 
obscure vision.



Sec. 84.1102  Examination, inspection and testing of complete respirator assemblies; fees.

    The following fees shall be charged by the Institute for the 
examination, inspection and testing of complete respirator assemblies 
approved under this subpart:
    (a) Gas masks with particulate filter, including pesticide gas 
masks--
    (1) Single hazard--$1,100.
    (2) Type N--$4,100.
    (b) Dust, fume and mist respirators--
    (1) Single particulate hazard having an Air Contamination Level more 
than 0.05 mg./m.\3\ or 2 million particles per cubic foot--$500.
    (2) Combination particulate hazards having an Air Contamination 
Level more than 0.05 mg./m.\3\ or 2 million particles per cubic foot--
$750.
    (3) Particulate hazards having an Air Contamination Level less than 
0.05 mg./m.\3\ or 2 million particles per cubic foot, radon daughters --
$1,250.
    (4) All dusts, fumes and mists--$2,000.
    (c) Paint spray respirators--$1,600.
    (d) Pesticide respirators--$1,600.
    (e) Chemical cartridge respirators with particulate filter--$1,150.



Sec. 84.1103  Approval labels and markings; approval of contents; use.

    (a) Full-scale reproductions of approval labels and markings, and a 
sketch or description of the method of application and position on the 
harness, container, canister, cartridge, filter, or other component, 
together with instructions for the use and maintenance of the respirator 
shall be submitted to MSHA and the Institute for approval.
    (b) Approval labels for non-powered and powered air-purifying dust, 
fume, mist respirators approved prior to July 10, 1995 under the 
provisions of subpart K of 30 CFR part 11 (See 30 CFR Part 11 edition, 
revised as of July 1, 1994.) shall bear the emblem of the Mine Safety 
and Health Administration and the seal of the Department of Health and 
Human Services, the applicant's name and address, an approval number 
assigned by the Institute, a statement that the respirator was tested 
and approved under subpart K of 30 CFR part 11 and, where appropriate, 
restrictions or limitations placed upon the use of the respirator by the 
Institute. The approval number assigned by the Institute shall be 
designated by the prefix TC and a serial number.
    (c) Approval labels for powered air-purifying respirators approved 
under the provisions of this subpart shall

[[Page 597]]

bear the emblem of the National Institute for Occupational Safety and 
Health and the seal of the Department of Health and Human Services, the 
applicant's name and address, an approval number assigned by the 
Institute, a statement stating the respirator was tested under the 
provisions of this subpart, and, where appropriate, restrictions or 
limitations placed upon the use of the respirator by the Institute. The 
approval number assigned by the Institute shall be designated by the 
prefix TC and a serial number.
    (c) The Institute shall, where necessary, notify the applicant when 
additional labels, markings, or instructions will be required.
    (d) Approval labels and markings shall only be used by the applicant 
to whom they were issued.
    (e) Legible reproductions or abbreviated forms of the label approved 
by the Institute for use on each respirator shall be attached to or 
printed at the following locations:

------------------------------------------------------------------------
        Respirator type             Label type            Location
------------------------------------------------------------------------
Gas mask with a particulate     Entire...........  Mask and container.
 filter, including pesticide
 gas mask.
Dust, fume, and mist            Entire...........  Respirator container
 respirators.                                       and filter
                                                    container.
                                Abbreviated......  Filters.
Chemical-cartridge respirator   Entire...........  Respirator container,
 with a particulate filter,                         cartridge container,
 including paint spray                              and filter
 respirator.                                        containers (where
                                                    applicable).
                                Abbreviated......  Cartridges and
                                                    filters and filter
                                                    containers.
Pesticide respirator..........  Entire...........  Respirator container,
                                                    and cartridge and
                                                    filter containers.
                                Abbreviated......  Cartridges and
                                                    filters.
------------------------------------------------------------------------

    (f) The use of any MSHA and Institute approval label obligates the 
applicant to whom it is issued to maintain or cause to be maintained the 
approved quality control sampling schedule and the acceptable quality 
level for each characteristic tested, and to assure that it is 
manufactured according to the drawings and specifications upon which the 
certificate of approval is based.
    (g) Each respirator, respirator component, and respirator container 
shall, as required by the Institute to assure quality control and proper 
use of the respirator, be labeled distinctly to show the name of the 
applicant, and the name and letters or numbers by which the respirator 
or respirator component is designated for trade purposes, and the lot 
number, serial number, or approximate date of manufacture.

    Editorial Note: At 60 FR 30388, June 8, 1995, Sec. 84.1103 was added 
with two paragraph (c) designations.



Sec. 84.1130  Respirators; description.

    (a) Dust, fume, and mist respirators, including all completely 
assembled respirators designed for use as respiratory protection during 
entry into and escape from atmospheres which contain adequate oxygen to 
support life and hazardous particulates, are described as follows:
    (1) Air-purifying respirators, either with replaceable or reusable 
filters, designed as respiratory protection against dusts:
    (i) Having an air contamination level not less than 0.05 milligram 
per cubic meter of air, including but not limited to coal, arsenic, 
cadmium, chromium, lead, and manganese; or
    (ii) Having an air contamination level not less than 2 million 
particles per cubic foot of air, including but not limited to aluminum, 
flour, iron ore, and free silica, resulting principally from the 
disintegration of a solid, e.g., dust clouds produced in mining, 
quarrying, and tunneling, and in dusts produced during industrial 
operations, such as grinding, crushing, and the general processing of 
minerals and other materials.
    (2) Air-purifying respirators, with replaceable filters, designed as 
respiratory protection against fumes of various metals having an air 
contamination level not less than 0.05 milligram per cubic meter, 
including but not limited to aluminum, antimony, arsenic, cadmium, 
chromium, copper,

[[Page 598]]

iron, lead, magnesium, manganese, mercury (except mercury vapor), and 
zinc, which result from the sublimation or condensation of their 
respective vapors, or from the chemical reaction between their 
respective vapors and gases.
    (3) Air-purifying respirators, with replaceable filters, designed as 
respiratory protection against mists of materials having an air 
contamination level not less than 0.05 milligram per cubic meter or 2 
million particles per cubic foot, e.g., mists produced by spray coating 
with vitreous enamels, chromic acid mist produced during chromium 
plating, and other mists of materials whose liquid vehicle does not 
produce harmful gases or vapors.
    (4) Air-purifying respirators, with replaceable filters, designed as 
respiratory protection against dusts, fumes, and mists having an air 
contamination level less than 0.05 milligram per cubic meter, including 
but not limited to lithium hydride and beryllium, and against 
radionuclides.
    (5) Air-purifying respirators, with replaceable filters, designed as 
respiratory protection against radon daughters, and radon daughters 
attached to dusts, fumes, and mists.
    (6) Air-purifying respirators, with replaceable filters, designed as 
respiratory protection against asbestos-containing dusts and mists.
    (7) Air-purifying respirators, with replaceable filters, designed as 
protection against various combinations of particulate matter.
    (8) Air-purifying dust respirators designed as respiratory 
protection against pneumoconiosis- and fibrosis-producing dusts, or 
dusts and mists, including but not limited to aluminum, asbestos, coal, 
flour, iron ore, and free silica.
    (b) Gas masks containing filters for protection against dusts, 
fumes, mists, and smokes in combination with gases, vapors, or gases and 
vapors. These respirators are not for use against gases or vapors with 
poor warning properties (except where MSHA or Occupational Safety and 
Health Administration standards may permit such use for a specific gas 
or vapor) or those which generate high heats of reaction with sorbent 
material in the canister.
    (c) Pesticide respirators, including all completely assembled 
respirators which are designed for use as respiratory protection during 
entry into and escape from atmospheres which contain pesticide hazards, 
are described according to their construction as follows:
    (1) Front-mounted or back-mounted gas masks;
    (2) Chin-style gas mask;
    (3) Chemical cartridge;
    (4) Air-purifying respirator with attached blower; and,
    (5) Other devices, including combination respirators.
    (d) Respirators with cartridges containing or having attached to 
them, filters for protection against mists of paints, lacquers, and 
enamels. These respirators are not for use against gases or vapors with 
poor warning properties (except where MSHA or Occupational Safety and 
Health Administration standards may permit such use for a specific gas 
or vapor) or those which generate high heats of reaction with sorbent 
material in the cartridge.
    (e) Respirators with cartridges containing or having attached to 
them filters for protection against dusts, fumes, and mists, except the 
mists of paints, lacquers, and enamels. These respirators are not for 
use against gases or vapors with poor warning properties (except where 
MSHA or Occupational Safety and Health Administration standards may 
permit such use for a specific gas or vapor) or those which generate 
high heats of reaction with sorbent material in the cartridge.



Sec. 84.1131  Respirators; required components.

    (a) Each respirator described in Sec. 84.1130 shall, where its 
design requires, contain the following component parts:
    (1) Facepiece, mouthpiece with noseclip, hood, or helmet;
    (2) Filter unit, canister with filter, or cartridge with filter;
    (3) Harness;
    (4) Attached blower; and
    (5) Breathing tube.
    (b) The components of each respirator shall meet the minimum 
construction requirements set forth in Subpart G of this part.

[[Page 599]]



Sec. 84.1132  Breathing tubes; minimum requirements.

    (a) Flexible breathing tubes used in conjunction with respirators 
shall be designed and constructed to prevent:
    (1) Restriction of free head movement;
    (2) Disturbance of the fit of facepieces, mouthpieces, hoods, or 
helmets;
    (3) Interference with the wearer's activities; and
    (4) Shutoff of airflow due to kinking, or from chin or arm pressure.



Sec. 84.1133  Harnesses; installation and construction; minimum requirements.

    (a) Each respirator shall, where necessary, be equipped with a 
suitable harness designed and constructed to hold the components of the 
respirator in position against the wearer's body.
    (b) Harnesses shall be designed and constructed to permit easy 
removal and replacement of respirator parts, and, where applicable, 
provide for holding a full facepiece in the ready position when not in 
use.



Sec. 84.1134  Respirator containers; minimum requirements.

    (a) Except as provided in paragraph (b) of this section each 
respirator shall be equipped with a substantial, durable container 
bearing markings which show the applicant's name, the type of respirator 
it contains, and all appropriate approval labels. Except for dust, fume, 
and mist respirators, the commercial designation of the respirator it 
contains shall be shown.
    (b) Containers for single-use respirators may provide for storage of 
more than one respirator, however, such containers shall be designed and 
constructed to prevent contamination of respirators which are not 
removed, and to prevent damage to respirators during transit.
    (c) Containers for gas masks combinations shall be designed and 
constructed to permit easy removal of the mask.



Sec. 84.1135  Half-mask facepieces, full facepieces, hoods, helmets, and mouthpieces; fit; minimum requirements.

    (a) Half-mask facepieces and full facepieces shall be designed and 
constructed to fit persons with various facial shapes and sizes either:
    (1) By providing more than one facepiece size; or
    (2) By providing one facepiece size which will fit varying facial 
shapes and sizes.
    (b) Full facepieces shall provide for optional use of corrective 
spectacles or lenses, which shall not reduce the respiratory protective 
qualities of the respirator.
    (c) Hoods and helmets shall be designed and constructed to fit 
persons with various head sizes, provide for the optional use of 
corrective spectacles or lenses, and insure against any restriction of 
movement by the wearer.
    (d) Mouthpieces shall be equipped with noseclips which are securely 
attached to the mouthpiece or respirator and provide an airtight seal.
    (e) Facepieces, hoods, and helmets shall be designed to prevent 
eyepiece fogging.
    (f) Half-mask facepieces shall not interfere with the fit of common 
industrial safety corrective spectacles, as determined by the 
Institute's facepiece tests in Secs. 84.1141, 84.1142, and 84.1156(b).



Sec. 84.1136  Facepieces, hoods, and helmets; eyepieces; minimum requirements.

    (a) Facepieces, hoods, and helmets shall be designed and constructed 
to provide adequate vision which is not distorted by the eyepieces.
    (b) All eyepieces of gas masks combinations shall be designed and 
constructed to be impact and penetration resistant. Federal 
Specification, Mask, Air Line: and Respirator, Air Filtering, 
Industrial, GGG-M-125d, October 11, 1965, with interim amendment-1, July 
30, 1969, is an example of an appropriate standard for determining 
impact and penetration resistance. Copies of GGG-M-125d may be obtained 
from the

[[Page 600]]

NIOSH, Certification and Quality Assurance Branch, 1095 Willowdale Road, 
Morgantown, WV 26505-2888.



Sec. 84.1137  Inhalation and exhalation valves; minimum requirements.

    (a) Inhalation and exhalation valves shall be protected against 
distortion.
    (b) Inhalation valves shall be designed and constructed and provided 
where necessary to prevent excessive exhaled air from adversely 
affecting filters, cartridges, and canisters, except where filters of 
dust, fume, and mist respirators are specifically designed to resist 
moisture as prescribed in Sec. 84.1145.
    (c) Exhalation valves shall be:
    (1) Provided where necessary;
    (2) Protected against damage and external influence; and
    (3) Designed and constructed to prevent inward leakage of 
contaminated air.



Sec. 84.1138  Head harnesses; minimum requirements.

    (a) All facepieces shall be equipped with head harnesses designed 
and constructed to provide adequate tension during use and an even 
distribution of pressure over the entire area in contact with the face.
    (b) Facepiece head harnesses, except those employed on single-use 
dust, fume, and mist respirators, shall be adjustable and replaceable.
    (c) Mouthpieces shall be equipped, where applicable, with adjustable 
and replaceable harnesses, designed and constructed to hold the 
mouthpiece in place.



Sec. 84.1139  Air velocity and noise levels; hoods and helmets; minimum requirements.

    Noise levels generated by the respirator will be measured inside the 
hood or helmet at maximum airflow obtainable and shall not exceed 80 
dBA.



Sec. 84.1140  Dust, fume, and mist respirators; performance requirements; general.

    Dust, fume, and mist respirators and the individual components of 
each such device shall, as appropriate, meet the requirements for 
performance and protection specified in the tests described in 
Secs. 84.1141 through 84.1152 and prescribed in Tables 12 and 13.



Sec. 84.1141  Isoamyl acetate tightness test; dust, fume, and mist respirators designed for respiratory protection against fumes of various metals having an air


          contamination level not less than 0.05 milligram per cubic 
          meter; minimum requirements.

    (a) The respirator will be modified in such a manner that all of the 
air that normally would be inhaled through the inhalation port(s) is 
drawn through an efficient activated charcoal-filled canister, or 
cartridge(s), without interference with the face-contacting portion of 
the facepiece.
    (b) The modified respirator will be worn by persons for at least 2 
minutes each in a test chamber containing 100 parts (by volume) of 
isoamyl-acetate vapor per million parts of air.
    (c) The odor of isoamyl-acetate shall not be detected by the wearers 
of the modified respirator while in the test atmosphere.



Sec. 84.1142  Isoamyl acetate tightness test; respirators designed for respiratory protection against dusts, fumes, and mists having an air contamination level 

          less than 0.05 milligram per cubic meter, or against 
          radionuclides; minimum requirements.

    (a) The applicant shall provide a charcoal-filled canister or 
cartridge of a size and resistance similar to the filter unit with 
connectors which can be attached to the facepiece in the same manner as 
the filter unit.
    (b)(1) The canister or cartridge will be used in place of the filter 
unit, and persons will each wear a modified half-mask facepiece for 5 
minutes in a test chamber containing 100 parts (by volume) of isoamyl-
acetate vapor per million parts of air.
    (2) The following work schedule will be performed by each wearer in 
the test chamber:
    (i) Two minutes walking, nodding, and shaking head in normal 
movements; and
    (ii) Three minutes exercising and running in place.
    (3) The facepiece shall be capable of adjustment, according to the 
applicant's instructions, to each wearer's

[[Page 601]]

face, and the odor of isoamyl-acetate shall not be detectable by any 
wearer during the test.
    (c) Where the respirator is equipped with a full facepiece, hood, 
helmet, or mouthpiece, the canister or cartridge will be used in place 
of the filter unit, and persons will each wear the modified respiratory-
inlet covering for 5 minutes in a test chamber containing 1,000 parts 
(by volume) of isoamyl-acetate vapor per million parts of air, 
performing the work schedule specified in paragraph (b)(2) of this 
section.



Sec. 84.1143  Dust, fume, and mist air-purifying filter tests; performance requirements; general.

    Dust, fume, and mist respirators will be tested in accordance with 
the schedule set forth in Table 13 of this subpart to determine their 
effectiveness as protection against the particulate hazards specified in 
Table 13.



Sec. 84.1144  Silica dust test for dust, fume, and mist respirators; single-use or reusable filters; minimum requirements.

    (a) Three non-powered respirators with single-use filters will be 
tested for periods of 90 minutes each at a continuous airflow rate of 32 
liters per minute.
    (b) The relative humidity in the test chamber will be 20-80 percent, 
and the room temperature approximately 25 deg. C.
    (c) The test suspension in the chamber will not be less than 50 nor 
more than 60 milligrams of flint (99+ percent free silica) per cubic 
meter of air.
    (d) The flint in suspension will be ground to pass 99+ percent 
through a 270-mesh sieve.
    (e) The particle-size distribution of the test suspension will have 
a geometric mean of 0.4 to 0.6 micrometer, and the standard geometric 
deviation will not exceed 2.
    (f) The total amount of unretained test suspension in samples taken 
during testing shall not exceed 1.5 milligrams for a non-powered air-
purifying respirator.
    (g) Three non-powered respirators with reusable filters will be 
tested and shall meet the requirements specified in paragraphs (a) 
through (f) of this section; each filter shall be tested three times: 
Once as received; once after cleaning; and once after recleaning. The 
applicant's instructions shall be followed for each cleaning.



Sec. 84.1145  Silica dust test; non-powered single-use dust respirators; minimum requirements.

    (a) Three respirators will be tested.
    (b) As described in Sec. 84.1144, airflow will be cycled through the 
respirator by a breathing machine at the rate of 24 respirations per 
minute with a minute volume of 40 liters; a breathing machine cam with a 
work rate of 622 kg.-m.2/minute shall be used.
    (c) Air exhaled through the respirator will be 35 deg. 
2 deg. C. with 94 3 percent relative humidity. 
    (d) Air inhaled through the respirator will be sampled and analyzed 
for respirator leakage.
    (e) The total amount of unretained test suspension, after drying, in 
samples taken during testing, shall not exceed 1.8 milligrams for any 
single test.



Sec. 84.1146  Lead fume test for dust, fume, and mist respirators; minimum requirements.

    (a) Three non-powered respirators will be tested for a period of 312 
minutes each at a continuous airflow rate of 32 liters per minute.
    (b) The relative humidity in the test chamber will be 20-80 percent, 
and the room temperature approximately 25 deg. C.
    (c) The test suspension in the test chamber will not be less than 15 
nor more than 20 milligrams of freshly generated lead-oxide fume, 
calculated as lead (Pb), per cubic meter of air.
    (d) The fume will be generated by impinging an oxygen-gas flame on 
molten lead.
    (e) Samples of the test suspension will be taken during each test 
period for analysis.
    (f) The total amount of unretained test suspension in the samples 
taken during testing, which is analyzed and calculated as lead (Pb), 
shall not exceed 1.5 milligrams of lead for a non-powered air-purifying 
respirator.

[[Page 602]]



Sec. 84.1147  Silica mist test for dust, fume, and mist respirators; minimum requirements.

    (a) Three non-powered respirators will be tested for a period of 312 
minutes each at a continuous airflow rate of 32 liters per minute.
    (b) The room temperature in the test chamber will be approximately 
25 deg.C.
    (c) The test suspension in the test chamber will not be less than 20 
nor more than 25 milligrams of silica mist, weighed as silica dust, per 
cubic meter of air.
    (d) Mist will be produced by spraying an aqueous suspension of flint 
(99+ percent free silica), and the flint shall be ground to pass 99+ 
percent through a 270-mesh sieve.
    (e) Samples of the test suspension will be taken during each test 
period for analysis.
    (f) The total amount of silica mist unretained in the samples taken 
during testing, weighed as silica dust, shall not exceed 2.5 milligrams 
for a non-powered air-purifying respirator.



Sec. 84.1148  Tests for respirators designed for respiratory protection against more than one type of dispersoid; minimum requirements.

    Respirators designed as respiratory protection against more than one 
particulate hazard (dust, fume, or mist) shall comply with all the 
requirements of this part, with respect to each of the specific hazards 
involved.



Sec. 84.1149  Airflow resistance tests; all dust, fume, and mist respirators; minimum requirements.

    (a) Resistance to airflow will be measured in the facepiece, 
mouthpiece, hood, or helmet of a dust, fume, or mist respirator mounted 
on a test fixture with air flowing at a continuous rate of 85 liters per 
minute, both before and after each test conducted in accordance with 
Secs. 84.1144 through 84.1147.
    (b) The maximum allowable resistance requirements for dust, fume, 
and mist respirators are as follows:

                           Maximum Resistance
                        [mm. water-column height]
------------------------------------------------------------------------
                                     Initial       Final
        Type of respirator          inhalation   inhalation   Exhalation
------------------------------------------------------------------------
Pneumoconiosis- and fibrosis-               12           15           15
 producing dusts, or dusts and
 mists...........................
Dust, fume, and mist, with single-          30           50           20
 use filter......................
Dust, fume, and mist, with                  20           40           20
 reusable filter.................
Radon daughter...................           18       \1\ 25           15
Asbestos dust and mist...........           18           25           15
------------------------------------------------------------------------
\1\ Measured after silica dust test described in Sec.  84.1144.



Sec. 84.1150  Exhalation valve leakage test; minimum requirements.

    (a) Dry exhalation valves and valve seats will be subjected to a 
suction of 25 mm. water-column height while in a normal operating 
position.
    (b) Leakage between the valve and valve seat shall not exceed 30 
milliliters per minute.



Sec. 84.1151  DOP filter test; respirators designed as respiratory protection against dusts, fumes, and mists having an air contamination level less than 0.05 
          milligram per cubic meter and against radionuclides; minimum 
          requirements.

    (a) All single air-purifying respirator filter units will be tested 
in an atmosphere concentration of 100 micrograms of DOP per liter of air 
at continuous flow rates of 32 and 85 liters per minute for a period of 
5 to 10 seconds.
    (b) Where filters are to be used in pairs, the flow rates will be 16 
and 42.5 liters per minute, respectively, through each filter.
    (c) The filter will be mounted on a connector in the same manner as 
used on the respirator, and the total leakage for the connector and 
filter shall not exceed 0.03 percent of the ambient DOP concentration at 
either flow rate.

[[Page 603]]



Sec. 84.1152  Silica dust loading test; respirators designed as protection against dusts, fumes, and mists having an air contamination level less than 0.05 
          milligram per cubic meter and against radionuclides; minimum 
          requirements.

    (a) Three non-powered respirators will be tested in accordance with 
the provisions of Sec. 84.1144, or equivalent, and shall meet the 
minimum requirements of Secs. 84.1144 and 84.1149.
    (b) Three powered air-purifying respirators will be tested in 
accordance with the provisions of Sec. 84.1144 except they will be 
tested for a period of 4 hours each at a flowrate not less than 115 
liters per minute to tight-fitting facepieces, and not less than 170 
liters per minute to loose-fitting hoods and helmets. The total amount 
of unretained test suspension in samples taken during testing shall not 
exceed 14.4 milligrams for a powered air-purifying respirator with 
tight-fitting facepiece, and 21.3 milligrams for a powered air-purifying 
respirator with loose-fitting hood or helmet. They shall meet the 
minimum requirements of Sec. 84.1149.



Sec. 84.1153  Dust, fume, mist, and smoke tests; canister bench tests; gas masks canisters containing filters; minimum requirements.

    (a) Gas mask canisters containing filters for protection against 
dusts, fumes, mists, and smokes in combination with gases, vapors, or 
gases and vapors, will be tested as prescribed in Sec. 84.1140 except 
for the breathing resistance which will be in accordance with 
Sec. 84.122.
    (b) Gas mask canisters designed for protection against smokes will 
be tested in an atmospheric concentration of 100 micrograms of dioctyl 
phthalate per liter of air at continuous flow rates of 32 liters per 
minute and 85 liters per minute for a period of 5 to 10 seconds, and the 
DOP leakage through the canister shall not exceed 0.03 percent of the 
test concentration.
    (c) Gas mask canisters containing filters for protection against 
dusts, fumes, mists, and smokes in combination with gases, vapors, or 
gases and vapors, will be tested as prescribed in Sec. 84.126.



Sec. 84.1154  Canister and cartridge requirements.

    (a) Where two or more canisters or cartridges are used in parallel, 
their resistance to airflow shall be essentially equal.
    (b) The color and markings of all canisters and cartridges or labels 
shall conform with the requirements of the American National Standards 
Institute, American National Standard for Identification of Air-
Purifying Respirator Canisters and Cartridges, ANSI K13.1-1973. ANSI 
K13.1 is incorporated by reference and has been approved by the Director 
of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR 
part 51. Copies may be obtained from American National Standards 
Institute, Inc., 1430 Broadway, New York, NY 10018. Copies may be 
inspected at the NIOSH, Certification and Quality Assurance Branch, 1095 
Willowdale Road, Morgantown, WV 26505-2888, or at the Office of the 
Federal Register, 800 North Capitol Street, NW., suite 700, Washington, 
DC.



Sec. 84.1155  Filters used with canisters and cartridges; location; replacement.

    (a) Particulate matter filters used in conjunction with a canister 
or cartridge shall be located on the inlet side of the canister or 
cartridge.
    (b) Filters shall be incorporated into or firmly attached to the 
canister or cartridge and each filter assembly shall, where applicable, 
be designed to permit its easy removal from and replacement on the 
canister or cartridge.



Sec. 84.1156  Pesticide respirators; performance requirements; general.

    Pesticide respirators and the individual components of each such 
device shall, as appropriate, meet the following minimum requirements 
for performance and protection:
    (a) Breathing resistance test. (1) Airflow resistance will be 
measured in the facepiece, mouthpiece, hood, or helmet of a pesticide 
respirator mounted on a test fixture with air flowing at a continuous 
rate of 85 liters per minute, both before and after each test conducted 
in accordance with paragraphs (c) and (f) of this section.

[[Page 604]]

    (2) The maximum allowable resistance requirements for pesticide 
respirators are as follows:

                           Maximum Resistance
                        [mm. water-column height]
------------------------------------------------------------------------
                                          Inhalation
   Type of pesticide respirator   --------------------------  Exhalation
                                     Initial     Final \1\
------------------------------------------------------------------------
Front- or back-mounted gas mask..           70           85           20
Chin-style gas mask..............           65           80           20
Powered air-purifying \2\........       \2\ 50       \2\ 70           20
Chemical Cartridge...............           50           70           20
------------------------------------------------------------------------
\1\ Measured at end of the service life specified in Table 14 of this
  subpart.
\2\ Resistance of filter(s), cartridge(s), and breathing tube(s) only
  with blower not operating.

    (b) Facepiece test. (1) The complete pesticide respirator will be 
fitted to the faces of persons having varying facial shapes and sizes.
    (2) Where the applicant specifies a facepiece size or sizes for his 
respirator together with the approximate measurements of faces they are 
designed to fit, the Institute will provide test subjects to suit such 
facial measurements.
    (3) Any pesticide respirator part which must be removed to perform 
the facepiece fit test shall be replaceable without special tools and 
without disturbing facepiece fit.
    (4) The facepiece or mouthpiece fit test using positive or negative 
pressure recommended by the applicant and described in his instructions 
will be used during each test.
    (5)(i) Each wearer will enter a chamber containing 1,000 p.p.m. 
isoamyl-acetate vapor for a respirator equipped with a full facepiece, 
mouthpiece, hood, or helmet and 100 p.p.m. isoamyl-acetate vapor for a 
respirator equipped with a half-mask facepiece.
    (ii) The facepiece, mouthpiece, hood, or helmet may be adjusted, if 
necessary, in the test chamber before starting the test.
    (iii) Each wearer will remain in the chamber while performing the 
following activities:
    (A) Two minutes, nodding and turning head;
    (B) Two minutes, calisthenic arm movements;
    (C) Two minutes, running in place; and
    (D) Two minutes, pumping with a tire pump into a 28-liter (1 cubic 
foot) container.
    (iv) Each wearer shall not detect the odor of isoamyl-acetate during 
the test.
    (c) Silica dust test. Three completely assembled pesticide 
respirators will be tested with a mechanical-testing apparatus as 
follows:
    (1) Temperature in the test chamber will be approximately 25 deg. C.
    (2) Continuous airflow through the respirator will be 32 liters per 
minute for front-mounted, back-mounted, and chin-style gas mask 
pesticide respirators and chemical cartridge pesticide respirators, and 
not less than 115 (4 cubic feet) liters per minute to tight-fitting 
facepieces and 170 liters (6 cubic feet) per minute to loose-fitting 
hoods and helmets of powered air-purifying respirators.
    (3) The test aerosol will contain 50-60 milligrams of 99+ percent 
free silica per cubic meter of air.
    (4) The particle size distribution of the test suspension will have 
a geometric mean diameter of 0.4 to 0.6 micrometer, with a standard 
geometric deviation less than 2.
    (5) Front-mounted, back-mounted, and chin-style gas mask pesticide 
respirators and chemical cartridge pesticide respirators will be tested 
for 90 minutes and powered air-purifying respirators will be tested for 
4 hours.
    (d) Lead fume test. Three completely assembled pesticide respirators 
will be tested with a mechanical-testing apparatus as follows:
    (1) Continuous airflow through the respirator will be 32 liters per 
minute for front-mounted, back-mounted, and

[[Page 605]]

chin-style gas mask pesticide respirators and chemical cartridge 
pesticide respirators and not less than 115 liters (4 cubic feet) per 
minute, for powered air-purifying respirators with tight-fitting 
facepieces, and not less than 170 liters (6 cubic feet) per minute for 
powered air-purifying respirators with loose-fitting hoods and helmets.
    (2) The test aerosol will contain 15-20 milligrams of freshly 
generated lead-oxide fume, calculated as lead, per cubic meter of air.
    (3) The fume will be generated by impinging an oxygen-gas flame on 
molten lead.
    (4) Front-mounted, back-mounted, and chin-style gas mask pesticide 
respirators and chemical cartridge pesticide respirators will be tested 
for 90 minutes and powered air-purifying pesticide respirators will be 
tested for 4 hours.
    (5) The total amount of unretained test suspension, which is 
analyzed and calculated as lead, shall not exceed:
    (i) 0.43 milligram for any 90-minute test;
    (ii) 4.8 milligrams for any 4-hour test made at 115 liters (4 cubic 
feet) per minute; or
    (iii) 6.2 milligrams for any 4-hour test made at 170 liters (6 cubic 
feet) per minute.
    (e) Dioctyl-phthalate test. (1) All canisters submitted for use with 
front-mounted and back-mounted gas mask pesticide respirators will be 
tested in an atmospheric concentration of 100 micrograms of dioctyl-
phthalate per liter of air at continuous flow rates of 32 and 85 liters 
per minute for a test period of 5 to 10 seconds.
    (2) The DOP leakage through the canister shall not exceed 0.03 
percent of the ambient DOP concentration.
    (f) Bench tests for pesticide respirators. (1)(i) Bench tests will 
be made on an apparatus that allows the test atmosphere at 
505 percent relative humidity and at room temperature 
(25 deg.2.5 deg. C.) to enter the canister or cartridge at 
predetermined concentrations and rates of flow, and that has a means for 
determining the test life of the canister or cartridge against carbon 
tetrachloride.
    (ii) Canisters and cartridges will be tested as they are used on 
each pesticide respirator, either singly or in pairs.
    (iii) Three canisters or cartridges or pairs of cartridges will be 
removed from containers and tested as received from the applicant.
    (iv) Two canisters, cartridges, or pairs of cartridges will be 
equilibrated at room temperature by passing 25 percent relative humidity 
air through them at the following flow rates (expressed as liters per 
minute (l.p.m.)) for 6 hours:

------------------------------------------------------------------------
                                                                Airflow
                Type of canister or cartridge                    rate,
                                                                 l.p.m.
------------------------------------------------------------------------
Air-purifying canister.......................................         64
Air-purifying cartridge......................................         25
Powered air-purifying with tight-fitting facepiece...........        115
Powered air-purifying with loose-fitting hood or helmet......        170
------------------------------------------------------------------------

    (v) Two canisters, cartridges, or pairs of cartridges will be 
equilibrated at room temperature by passing 85 percent relative humidity 
air through them at the flow rates stated in paragraph (f)(1)(iv) of 
this section for 6 hours.
    (vi) The equilibrated canisters or cartridges will be resealed, kept 
in an upright position at room temperature, and tested within 18 hours.
    (2) Canisters and cartridges tested in accordance with the 
provisions of this section shall meet the requirements specified in 
Table 14 of this subpart.



Sec. 84.1157  Chemical cartridge respirators with particulate filters; performance requirements; general.

    Chemical cartridge respirators with particulate filters and the 
individual components of each such device shall, as appropriate, meet 
the following minimum requirements for performance and protection:
    (a) Breathing resistance test. (1) Resistance to airflow will be 
measured in the facepiece, mouthpiece, hood, or helmet of a chemical 
cartridge respirator mounted on a test fixture with air flowing at a 
continuous rate of 85 liters per minute, both before and after each test 
conducted in accordance with paragraphs (d) through (f) of this section.
    (2) The maximum allowable resistance requirements for chemical 
cartridge respirators are as follows:

[[Page 606]]



                           Maximum Resistance
                        [mm. water-column height]
------------------------------------------------------------------------
                                          Inhalation
    Type of chemical cartridge    --------------------------  Exhalation
            respirator               Initial     Final \1\
------------------------------------------------------------------------
For gases, vapors, or gases and             50           70           20
 vapors, and dusts, fumes, and
 mists...........................
For gases, vapors, or gases and             50           70           20
 vapors, and mists of paints,
 lacquers, and enamels...........
------------------------------------------------------------------------
\1\ Measured at end of service life specified in Table 11 in subpart L
  of this part.

    (b) Facepiece test. The facepiece test will be conducted as 
specified in Sec. 84.205.
    (c) Lacquer and enamel mist tests; general. (1) Three respirators 
with cartridges containing or having attached to them, filters for 
protection against mists of paints, lacquers, and enamels shall be 
tested in accordance with the provisions of paragraph (f) of this 
section.
    (2) In addition to the test requirements set forth in paragraph 
(c)(1) of this section, three such respirators will be tested against 
each aerosol in accordance with the provisions of paragraphs (d) and (e) 
of this section.
    (d) Lacquer mist test. (1) Temperature in the test chamber will be 
approximately 25 deg. C.
    (2) Continuous airflow through the respirator will be 32 liters per 
minute for air-purifying respirators, and not less than 115 liters per 
minute to tight fitting facepieces and 170 liters per minute to loose-
fitting hoods and helmets of powered air-purifying respirators.
    (3) Airflow through the chamber will be 20-25 air changes per 
minute.
    (4) The atomizer employed will be a No. 64-5 nozzle with setup 3, or 
equivalent, operating at 69 kN/m.\2\ (10 pounds per square inch gage).
    (5) The test aerosol will be prepared by atomizing a mixture of one 
volume of clear cellulose nitrate lacquer and one volume of lacquer 
thinner. The lacquer described in Federal Specification TT-L-31, October 
7, 1953, is an example of an acceptable lacquer. Copies of TT-L-31 may 
be inspected or obtained from the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888.
    (6) The concentration of cellulose nitrate in the test aerosol will 
be 95-125 milligrams per cubic meter.
    (7) The test aerosol will be drawn to each respirator for a total of 
156 minutes for air-purifying respirators and 240 minutes for powered 
air-purifying respirators.
    (8) The total amount of unretained mist in the samples taken during 
testing, weighed as cellulose nitrate, shall not exceed 5 milligrams for 
an air-purifying respirator, 28 milligrams for a powered air-purifying 
respirator with tight-fitting facepiece, and 41 milligrams for a powered 
air-purifying respirator with loose-fitting hood or helmet.
    (e) Enamel mist test. (1) Temperature in the test chamber will be 
approximately 25 deg. C.
    (2) Continuous airflow through the respirator will be 32 liters per 
minute for air-purifying respirators, and not less than 115 liters per 
minute to tight-fitting facepieces and 170 liters per minute to loose-
fitting hoods and helmets of powered air-purifying respirators.
    (3) Airflow through the chamber will be 20-25 air changes per 
minute.
    (4) The atomizer employed will be a No. 64 nozzle with setup 1A, or 
equivalent, operating at 69 kN/m.2 (10 pounds per square inch 
gage).
    (5) The test aerosol will be prepared by atomizing a mixture of 1 
volume of white enamel and 1 volume of turpentine. The enamel described 
in Federal Specification TT-E-489b, May 12, 1953, with amendment-1 of 9 
November 1955 is an example of an acceptable enamel. Copies of TT-E-489b 
may be inspected or obtained from the NIOSH, Certification and Quality 
Assurance Branch, 1095 Willowdale Road, Morgantown, WV 26505-2888.
    (6) The concentration of pigment in the test aerosol, weighed as 
ash, will be 95-125 milligrams per cubic meter.

[[Page 607]]

    (7) The test aerosol will be drawn to each respirator for a total of 
156 minutes for air-purifying respirators and 240 minutes for power air-
purifying respirators.
    (8) The total amount of unretained mist in the samples taken during 
testing, weighed as ash, shall not exceed 1.5 milligrams for any air-
purifying respirator, 8.3 milligrams for a powered air-purifying 
respirator with tight-fitting facepiece, and 12.3 milligrams for a 
powered air-purifying respirator with loose-fitting hood or helmet.
    (f) Bench tests; gas and vapor tests. (1) Bench tests will be made 
in accordance with Sec. 84.207 and tested cartridges shall meet the 
minimum requirements set forth in Table 11 of subpart L of this part. 
Cartridges will be equilibrated in accordance with paragraph (f)(2) of 
this section.
    (2)(i) Two powered air-purifying cartridges or pairs of cartridges 
will be equilibrated at room temperature by passing 25 percent relative 
humidity air through them at the following flow rates (expressed in 
liters per minute (l.p.m.)) for 6 hours:

------------------------------------------------------------------------
                                                                Airflow
                      Type of cartridge                          rate,
                                                                 l.p.m.
------------------------------------------------------------------------
Powered air purifying with tight-fitting facepiece...........        115
Powered air purifying with loose-fitting hood or helmet......        170
------------------------------------------------------------------------

    (ii) Two powered air-purifying cartridges or pairs of cartridges 
will be equilibrated by passing 85 percent relative humidity air through 
them at the flow rates stated in paragraph (f)(2)(i) of this section.
    (iii) All cartridges will be resealed, kept in an upright position, 
at room temperatures, and tested within 18 hours.



Sec. 84.1158  Dust, fume, and mist tests; respirators with filters; minimum requirements; general.

    (a) Three respirators with cartridges containing, or having attached 
to them, filters for protection against dusts, fumes, and mists, except 
the mists of paints, lacquers, and enamels, will be tested in accordance 
with the provisions of Sec. 84.1157(f).
    (b) In addition to the test requirements set forth in paragraph (a) 
of this section, three such respirators will be tested, as appropriate, 
in accordance with the provisions of Secs. 84.1141 through 84.1152; 
however, the maximum allowable resistance of complete dust, fume, and 
mist, and gas, vapor, or gas and vapor chemical cartridge respirators 
shall not exceed the maximum allowable limits set forth in 
Sec. 84.1157(a)(2).



Tables to Subpart KK of Part 84--Table of Contents




                 Table 12.--Facepiece Test Requirements
                      [42 CFR Part 84, Subpart KK]
------------------------------------------------------------------------
                                  Pressure       Isoamyl acetate test
       Respirator types           tightness  ---------------------------
                                  test \1\       84.1141       84.1142
------------------------------------------------------------------------
Dusts: Air Contamination Level            X
 not less than 0.05 mg/M3 or 2
 mppcf........................
Fumes: Air Contamination Level            X             X
 not less than 0.05 mg/M3.....
Mists: Air Contamination Level            X
 not less than 0.05 mg/M3 or 2
 mppcf........................
Dusts, Fumes, and Mists: Air              X                           X
 Contamination Level less than
 0.05 mg/M3 or 2 mppcf, and
 radionuclides................
Radon daughters...............            X             X
Asbestos-containing dusts and             X
 mists........................
------------------------------------------------------------------------
\1\ Test is required only where applicable.


        Table 13.--Air-Purifying and Powered Air-Purifying Respirator Filter Tests Required for Approval
                                          [42 CFR Part 84, Subpart KK]
----------------------------------------------------------------------------------------------------------------
                                          Silica dust tests
      Respirator types       ------------------------------------------   Lead fume    Silica mist    DOP test
                                 84.1144       84.1145       84.1152    test 84.1146  test 84.1147     84.1151
----------------------------------------------------------------------------------------------------------------
Dusts: Air Contamination                X
 Level not less than 0.05 mg/
 M3 or 2 mppcf..............
Fumes: Air Contamination                                                          X
 Level not less than 0.05 mg/
 M3.........................

[[Page 608]]

 
Mists: Air Contamination                                                                        X
 Level not less than 0.05 mg/
 M3 or 2 mppcf..............
Dusts, Fumes, and Mists: Air                                        X                                         X
 Contamination Level less
 than 0.05 mg/M3 or 2 mppcf,
 and radionuclides..........
Radon daughters.............          1 X                                                     2 X
Asbestos-containing dusts             2 X                                                     3 X
 and mists..................
Single use dust and mist                            3 X                                       3 X
 respirators................
----------------------------------------------------------------------------------------------------------------
\1\ For resistance only.
\2\ For penetration only.
\3\ Test required only where applicable.


            Table 14.--Carbon Tetrachloride Bench Tests and Requirements for Canisters and Cartridges
                                          [42 CFR part 84, Subpart KK]
----------------------------------------------------------------------------------------------------------------
                                                                 Test                                  Minimum
               Type of pesticide respirator                 concentration   Flow rate    Number of       life
                                                             p.p.m. CCl4      l.p.m.       tests       minutes1
----------------------------------------------------------------------------------------------------------------
Chest-mounted or back-mounted gas mask (as received)......        20,000            64            3           12
Chest-mounted or back-mounted gas mask (equilibrated).....        20,000            32            4           12
Chin-style gas mask (as received).........................         5,000            64            3           12
Chin-style gas mask (equilibrated)........................         5,000            32            4           12
Chemical Cartridge respirator (as received)...............         1,000            64            3           50
Chemical cartridge respirator (equilibrated)..............         1,000            32            4           50
Powered air-purifying respirator (tight-fitting facepiece,         1,000         2 115            3           50
 as received).............................................
Powered air-purifying respirator (tight-fitting facepiece,         1,000         2 115            4           25
 equilibrated)............................................
Powered air-purifying respirator (loose-fitting hood or            1,000         3 170            3           50
 helmet, as received).....................................
Powered air-purifying respirator (loose-fitting hood or            1,000         3 170            4           25
 helmet, equilibrated)....................................
----------------------------------------------------------------------------------------------------------------
\1\ Minimum life will be determined at 5 p.p.m. leakage.
\2\ The flow rate shall be the effective flow rate of the device, but shall be not less than 115 l.p.m.
\3\ The flow rate shall be the effective flow rate of the device, but shall be not less than 170 l.p.m.



PART 85--REQUESTS FOR HEALTH HAZARD EVALUATIONS--Table of Contents




Sec.
85.1  Applicability.
85.2  Definitions.
85.3  Procedures for requesting health hazard evaluations.
85.3-1  Contents of a request for health hazard evaluations.
85.4  Acting on requests.
85.5  Authority for investigations.
85.6  Advance notice of visits.
85.7  Conduct of investigations.
85.8  Provision of suitable space for employee interviews and 
          examinations; identification of employees.
85.9  Representatives of employers and employees; employee requests.
85.10  Imminent dangers.
85.11  Notification of determination to employers, affected employees, 
          and Department of Labor.
85.12  Subsequent requests for health hazard evaluations.

    Authority: Sec. 8(g), 84 Stat. 1600; 29 U.S.C. 657(g) and sec. 508, 
83 Stat. 803; 30 U.S.C. 957.

    Source: 37 FR 23640, Nov. 7, 1972, unless otherwise noted.



Sec. 85.1  Applicability.

    This part 85 applies to health hazard evaluations requested by any 
employer or authorized representative of employees under section 
20(a)(6) of the Occupational Safety and Health Act of 1970 or section 
501(a)(11) of the Federal Mine Safety and Health Act of 1977. This part 
is not intended to preclude the use of other channels of communication 
with the National Institute for Occupational Safety and Health to

[[Page 609]]

obtain information and technical assistance concerning toxic substances 
or physical agents.

[45 FR 2652, Jan. 14, 1980]



Sec. 85.2  Definitions.

    Any term defined in the Occupational Safety and Health Act of 1970 
or the Federal Mine Safety and Health Act of 1977 and not defined below 
shall have the meaning given it in the respective Acts. As used in this 
part:
    OSH Act means the Occupational Safety and Health Act of 1970 (29 
U.S.C. 651, et seq.).
    FMSH Act means the Federal Mine Safety and Health Act of 1977 (30 
U.S.C. 801, et seq.).
    Authorized representative of employees means any person or 
organization meeting the conditions specified in Sec. 85.3-1(e) (1), 
(2), or (3).
    Employee has the same meaning as stated in the OSH Act and for the 
purposes of this part includes miner as defined in the FMSH Act.
    Employer has the same meaning as stated in the OSH Act and for the 
purposes of this part includes Operator as defined in the FMSH Act.
    Health hazard evaluation means the investigation and the 
determination of potentially toxic or hazardous effects of: (a) Any 
substance normally used or found in any place of employment to which the 
OSH Act is applicable, or (b) any substance or physical agent normally 
used or found in any place of employment to which the FMSH Act is 
applicable.
    Investigation means a physical inspection of the place of employment 
under section 8 of the OSH Act or section 103 of the FMSH Act and 
includes inspection, sampling, observations, review of pertinent 
records, and other measurements reasonably necessary to determine 
whether any substance or physical agent found in the place of employment 
has potentially toxic or hazardous effects in the concentrations or 
levels used or found.
    NIOSH means the National Institute for Occupational Safety and 
Health, Center for Disease Control, Public Health Service, Department of 
Health and Human Services.
    NIOSH officer means a NIOSH employee who has been authorized by the 
Director, NIOSH, to conduct investigations according to this part.
    Physical agent means any condition produced by the environment and/
or work processes that can result in hazardous effects as defined in 
this section. Examples of physical agents are noise, temperature, 
illumination, vibration, radiation, and pressure.
    Place of employment means any coal or other mine, factory, plant, 
establishment, construction site, or other area, workplace, or 
environment where work is performed by any employee of an employer.
    Substance means any chemical or biological agent or dust which has 
the potential to produce toxic effects.
    Toxic effects or hazardous effects are those effects which result in 
short- or long-term disease, bodily injury, affect health adversely, or 
endanger human life.

[45 FR 2652, Jan. 14, 1980]



Sec. 85.3  Procedures for requesting health hazard evaluations.

    (a) Requests for health hazard evaluations should be addressed to 
the National Institute for Occupational Safety and Health as follows:
    (1) Requests from general industry. Hazard Evaluations and Technical 
Assistance Branch, Division of Surveillance, Hazard Evaluations, and 
Field Studies, NIOSH, 4676 Columbia Parkway, Cincinnati, OH 45226.
    (2) Requests from mining industry. Environmental Investigations 
Branch, Division of Respiratory Disease Studies, NIOSH, 944 Chestnut 
Ridge Road, Morgantown, WV 26505.
    (b) Requests for health hazard evaluations shall be submitted in 
writing and signed by either: (1) The employer in whose place of 
employment the substance or physical agent is normally found, or (2) an 
authorized representative of employees (see Sec. 85.3-1(e)) in the place 
of employment where the substance or physical agent is normally found.

[45 FR 2653, Jan. 14, 1980]



Sec. 85.3-1  Contents of a request for health hazard evaluation.

    Each request for health hazard evaluation shall contain:

[[Page 610]]

    (a) The requester's name, address, and telephone number, if any.
    (b) The name and address of the place of employment where the 
substance or physical agent is normally found.
    (c) The specific process or type of work which is the source of the 
substance or physical agent, or in which the substance or physical agent 
is used.
    (d) Details of the conditions or circumstances which prompted the 
request.
    (e) A statement, if the requester is not the employer, that the 
requester is:
    (1) An authorized representative or an officer of the organization 
representing the employees for purposes of collective bargaining; or
    (2) An employee of the employer and is authorized by two or more 
employees employed in the same place of employment to represent them for 
purposes of these Acts (each such authorization shall be in writing and 
a copy submitted with the request for health hazard evaluation); or
    (3) One of three or less employees employed in the place of 
employment where the substance or physical agent is normally found.
    (f) A statement indicating whether or not the name(s) of the 
requester or those persons who have authorized the requester to 
represent them may be revealed to the employer by NIOSH.
    (g) The following supplementary information if known to the 
requester:
    (1) Identity of each substance or physical agent involved;
    (2) The trade name, chemical name, and manufacturer of each 
substance involved;
    (3) Whether the substance or its container or the source of the 
physical agent has a warning label; and
    (4) The physical form of the substance or physical agent, number of 
people exposed, length of exposure (hours per day), and occupations of 
exposed employees.

    Note: NIOSH has developed two forms entitled ``Request for Health 
Hazard Evaluation'' and ``Request for Mining Health Hazard Evaluation'' 
to assist persons in requesting evaluations. The forms are available 
upon request from the offices listed in Sec. 85.3(a) (1) and (2) or from 
the Regional Consultant for Occupational Safety and Health in any 
Regional Office of the Department of Health and Human Services.

[45 FR 2653, Jan. 14, 1980]



Sec. 85.4  Acting on requests.

    (a) Upon receipt of a request for health hazard evaluation submitted 
under this part, NIOSH will determine whether or not there is reasonable 
cause to justify conducting an investigation.
    (b) If NIOSH determines that an investigation is justified, a NIOSH 
officer will inspect the place of employment, collect samples where 
appropriate, and perform tests necessary to the conduct of a health 
hazard evaluation, including medical examinations of employees.
    (c) If NIOSH determines that an investigation is not justified, the 
requester will be notified in writing of the decision.

[45 FR 2653, Jan. 14, 1980]



Sec. 85.5  Authority for investigations.

    (a) NIOSH officers who have been issued official NIOSH credentials 
(Form No. CDC/NIOSH 2.93) are authorized by the Director, NIOSH, under 
sections 20(a) (6) and 8 of the OSH Act and sections 501(a)(11) and 103 
of the FMSH Act: To enter without delay any place of employment for the 
purpose of conducting investigations of all pertinent processes, 
conditions, structures, machines, apparatus, devices, equipment, 
records, and materials within the place of employment; and to conduct 
medical examinations, anthropometric measurements, and functional tests 
of employees within the place of employment as may be directly related 
to the specific health hazard evaluation being conducted. Investigations 
will be conducted in a reasonable manner, during regular working hours 
or at other reasonable times and within reasonable limits. In connection 
with any investigation, the NIOSH officers may question privately any 
employer, owner, operator, agent, or employee from the place of 
employment; and review, abstract, and duplicate records required by the 
Acts and regulations and any other related records.
    (b) Areas under investigation which contain information classified 
by any

[[Page 611]]

agency of the United States Government in the interest of national 
security will be investigated only by NIOSH officers who have obtained 
the proper security clearance and authorization.

[45 FR 2653, Jan. 14, 1980]



Sec. 85.6  Advance notice of visits.

    (a) Advance notice of visits to the place of employment may be given 
to expedite a thorough and effective investigation. Advance notice will 
not be given when, in the judgment of the NIOSH officer, giving such 
notice would adversely affect the validity and effectiveness of the 
investigation.
    (b) Where a request in accordance with this part has been made by an 
authorized representative of employees, advance notice in accordance 
with paragraph (a) of this section will be given by NIOSH to the 
requester, the representative of the employees for purposes of 
collective bargaining if such representative is other than the 
requester, and to the employer.
    (c) Where a request in accordance with this part has been made by 
any employer, advance notice will be given by NIOSH to the employer. 
Upon the request of the employer, NIOSH will inform the authorized 
representative of employees of the visit: Provided, The employer 
furnishes NIOSH in writing with the identity of such representative and 
with such information as is necessary to enable NIOSH promptly to inform 
such representative of the visit.



Sec. 85.7  Conduct of investigations.

    (a) Prior to beginning an investigation, NIOSH officers shall 
present their credentials to the owner, operator, or agent in charge at 
the place of employment, explain the nature, purpose, and scope of the 
investigation and the records specified in Sec. 85.5 which they wish to 
review. Where the investigation is the result of a request submitted by 
an authorized representative of employees, a copy of the request shall 
be provided to the employer, except where the requester or any person 
authorizing the requester pursuant to Sec. 85.3-1(e)(2) has indicated 
that NIOSH not reveal his name to the employer, in which case a summary 
of the basis for the request shall be provided to the employer.
    (b) At the commencement of an investigation, the employer should 
precisely identify information which can be obtained in the workplace or 
workplaces to be inspected as trade secrets. If the NIOSH officer has no 
clear reason to question such identification, such information shall not 
be disclosed except in accordance with the provisions of section 
20(a)(6) and section 15 of the OSH Act or section 501(a)(11) of the FMSH 
Act. However, if NIOSH at any time questions such identification by an 
employer, not less than 15 days' notice to an employer shall be given of 
the intention to remove the trade secret designation from such 
information. The employer may within that period submit a request to the 
Director, NIOSH, to reconsider this intention and may provide additional 
information in support of the trade secret designation. The Director, 
NIOSH, shall notify the employer in writing of the decision which will 
become effective no sooner than 15 days after the date of such notice.
    (c) NIOSH officers are authorized to collect environmental samples 
and samples of substances or measurements of physical agents (including 
measurement of employee exposure by the attachment of personal sampling 
devices to employees with their consent), to take or obtain photographs 
related to the purpose of the investigation, employ other reasonable 
investigative techniques, including medical examinations of employees 
with the consent of such employees, and to question privately any 
employer, owner, operator, agent, or employee. The employer shall have 
the opportunity to review photographs taken or obtained for the purpose 
of identifying those which contain or might reveal a trade secret.
    (d) NIOSH officers shall comply with all safety and health rules and 
practices at the place of employment being investigated, and they shall 
provide and use appropriate protective clothing and equipment. In 
situations requiring specialized or unique types of protective 
equipment, such equipment shall be furnished by the employer.

[[Page 612]]

    (e) The conduct of investigations shall be such as to preclude 
unreasonable disruption of the operations of the employer's 
establishment.

[37 FR 23640, Nov. 7, 1972, as amended at 45 FR 2653, Jan. 14, 1980; 49 
FR 4739, Feb. 8, 1984]



Sec. 85.8  Provision of suitable space for employee interviews and examinations; identification of employees.

    An employer shall, in request of the NIOSH officer, provide suitable 
space, if such space is reasonably available, to NIOSH to conduct 
private interviews with, and examinations of, employees. NIOSH officers 
shall consult with the employer as to the time and place of the medical 
examination and shall schedule such examinations so as to avoid undue 
disruption of the operations of the employer's establishment. NIOSH 
shall conduct, and assume the medical costs of, examinations conducted 
under this part.



Sec. 85.9  Representatives of employers and employees; employee requests.

    (a) NIOSH officers shall be in charge of investigations. Where the 
request for a health hazard evaluation has been made by an authorized 
representative of employees, a representative of the employer and a 
representative authorized by his employees who is an employee of the 
employer shall be given an opportunity to accompany the NIOSH officer 
during the initial physical inspection of any workplace for the purpose 
of aiding the investigation by identifying the suspected hazard. The 
NIOSH officer may permit additional employer representatives and such 
additional representatives authorized by employees to accompany him 
where he determines that such additional representatives will further 
aid the investigation. However, if in the judgment of the NIOSH officer, 
good cause has been shown why accompaniment by a third party who is not 
an employee of the employer is reasonably necessary to the conduct of an 
effective and thorough investigation of the workplace, such third party 
may accompany the NIOSH officer during the inspection: Provided, 
however, That access by such persons to areas described in paragraph (d) 
of this section shall be in accordance with the requirements of such 
provision, and access to areas described in paragraph (e) of this 
section shall be with the consent of the employer. A different employer 
and employee representative may accompany the officer during each 
different phase of an inspection if this will not interfere with the 
conduct of the investigation.
    (b) NIOSH officers are authorized to resolve all disputes as to who 
is the representative authorized by the employer and employees for the 
purpose of this section. If there is no authorized representative of 
employees, or if the NIOSH officer is unable to determine with 
reasonable certainty who is such representative, he shall consult with a 
reasonable number of employees concerning matters directly related to 
the health hazard evaluation.
    (c) NIOSH officers are authorized to deny the right of accompaniment 
under this section to any person whose conduct interferes with a fair 
and orderly physical inspection.
    (d) With regard to information classified by an agency of the U.S. 
Government in the interest of national security, only persons authorized 
to have access to such information may accompany an officer in areas 
containing such information.
    (e) Upon request of an employer, any representative authorized under 
this Sec. 85.9 by employees in any area containing trade secrets shall 
be an employee in that area or an employee authorized by the employer to 
enter that area.



Sec. 85.10  Imminent dangers.

    Whenever, during the course of, or as a result of, an investigation 
under this part, the NIOSH officer believes that there is a reasonable 
basis for an allegation of an imminent danger, NIOSH will immediately 
advise the employer and those employees who appear to be in immediate 
danger of such allegation and will inform appropriate representatives of 
the Department of Labor or the State agency designated under section 
18(b) of the OSH Act.

[37 FR 23640, Nov. 7, 1972, as amended at 45 FR 2653, Jan. 14, 1980]

[[Page 613]]



Sec. 85.11  Notification of determination to employers, affected employees and Department of Labor.

    (a) Upon conclusion of an investigation, NIOSH will make a 
determination concerning the potentially toxic or hazardous effects of 
each substance or physical agent investigated as a result of the request 
for health hazard evaluation. At a minimum, the determination will: (1) 
Identify each substance or physical agent involved and describe, where 
appropriate, the concentrations or levels of the substance or physical 
agent found in the place of employment and the conditions of use, and 
(2) state whether each substance or physical agent has potentially toxic 
or hazardous effects in the concentrations or levels found, as well as 
the basis for the judgments.
    (b) Copies of the determination will be mailed to the employer and 
to the authorized representatives of employees.
    (c) Except as hereinafter provided, the employer shall post a copy 
of the determination for a period of 30 calendar days at or near the 
workplace(s) of affected employees. The employer shall take steps to 
insure that the posted determinations are not altered, defaced, or 
covered by other material during such period. The employer will not be 
required to post the determination if the employer requests that copies 
of the determination be mailed to affected employees and furnishes NIOSH 
with a list of the names and mailing addresses of the employees employed 
in the workplace(s) designated by the NIOSH Officer. In the latter 
event, NIOSH will mail such copies to affected employees at the mailing 
addresses provided by the employer.
    (d) For purposes of this section, the term ``affected employees'' 
means those employees determined by NIOSH to be exposed to the 
substance(s) or physical agent(s) which is the subject of the health 
hazard evaluation.
    (e) Copies of determinations made under the OSH Act will be 
forwarded to the Department of Labor and the appropriate State agency 
designated under section 18(b) of the OSH Act. Copies of determinations 
made under the FMSH Act will be forwarded to the Mine Safety and Health 
Administration of the Department of Labor; the Bureau of Mines, 
Department of the Interior; and the State agency which, in the judgment 
of NIOSH, would benefit the most from the information. If NIOSH 
determines that any substance or physical agent has potentially toxic or 
hazardous effects at the concentrations or levels at which it is used or 
found in a place of employment, and the substance or physical agent is 
not covered by a safety or health standard established under section 6 
of the OSH Act or section 101 of the FMSH Act, NIOSH will immediately 
submit the determination to the Secretary of Labor, together with all 
pertinent criteria.

[37 FR 23640, Nov. 7, 1972, as amended at 45 FR 2653, Jan. 14, 1980]



Sec. 85.12  Subsequent requests for health hazard evaluations.

    If a request is received for a health hazard evaluation in a place 
of employment in which an evaluation under this part was made 
previously, NIOSH may make another investigation if, as a result of the 
passage of time or additional information, another investigation would 
be consistent with the purposes of the Acts.

[45 FR 2654, Jan. 14, 1980]



PART 85a--OCCUPATIONAL SAFETY AND HEALTH INVESTIGATIONS OF PLACES OF EMPLOYMENT--Table of Contents




Sec.
85a.1  Applicability.
85a.2  Definitions.
85a.3  Authority for investigations of places of employment.
85a.4  Procedures for initiating investigations of places of employment.
85a.5  Conduct of investigations of places of employment.
85a.6  Provision of suitable space for employee interviews and 
          examinations.
85a.7  Imminent dangers.
85a.8  Reporting of results of investigations of places of employment.

    Authority: Sec. 8(g), 84 Stat. 1600; 29 U.S.C. 657(g) and sec. 508, 
83 Stat. 803; 30 U.S.C. 957.

[[Page 614]]



Sec. 85a.1  Applicability.

    (a) Except as otherwise provided in paragraph (b) of this section, 
the provisions of this part apply to investigations of places of 
employment which are conducted by NIOSH under sections 20 and 8 of the 
Occupational Safety and Health Act of 1970 and sections 501 and 103 of 
the Federal Mine Safety and Health Act of 1977.
    (b) The provisions of this part do not apply to those activities 
covered by part 85 of this chapter.

[41 FR 45002, Oct. 14, 1976, as amended at 45 FR 2654, Jan. 14, 1980]



Sec. 85a.2  Definitions.

    Any term defined in the Occupational Safety and Health Act of 1970 
or the Federal Mine Safety and Health Act of 1977 and not defined below 
shall have the meaning given it in the Acts. As used in this part:
    (a) OSH Act means the Occupational Safety and Health Act of 1970 (29 
U.S.C. 651 et seq.) and FMSH Act means the Federal Mine Safety and 
Health Act of 1977 (30 U.S.C. 801 et seq.).
    (b) Assistant Regional Director means any one of the ten 
Occupational Safety and Health Administration Assistant Regional 
Directors for Occupational Safety and Health.
    (c) Informed consent means the knowing consent of an individual or 
his legally authorized representative, so situated as to be able to 
exercise free power of choice without undue inducement or any element of 
force, fraud, deceit, duress, or other form of constraint or coercion. 
The basic elements of information necessary to such consent include:
    (1) A fair explanation of the procedures to be followed, and their 
purposes, including identification of any procedures which are 
experimental;
    (2) A description of any attendant discomforts and risks reasonably 
to be expected;
    (3) A description of any benefits reasonably to be expected;
    (4) A disclosure of any appropriate alternative procedures that 
might be advantageous for the subject;
    (5) An offer to answer any inquiries concerning the procedures; and
    (6) An instruction that the person is free to withdraw his consent 
and to discontinue participation in the investigation any time without 
prejudice to the subject.
    (d) Investigation means research projects, experiments, 
demonstrations, studies, and similar activities of NIOSH which are 
conducted under section 20 of the OSH Act and section 501 of the FMSH 
Act.
    (e) Legally authorized representative means an individual or 
judicial or other body authorized under applicable law to consent on 
behalf of a prospective subject to such subject's participation in the 
particular activity or procedure.
    (f) NIOSH means the National Institute for Occupational Safety and 
Health of the Center for Disease Control, Public Health Service, 
Department of Health and Human Services.
    (g) NIOSH authorized representative means a person authorized by 
NIOSH to conduct investigations of places of employment, including any 
person that is fulfilling a contract agreement with NIOSH or is serving 
as an expert or consultant to NIOSH pursuant to the Act.
    (h) NIOSH Regional Office means any one of the ten Department of 
Health and Human Services Regional Offices, the addresses of which are 
specified in Sec. 5.31 of title 45, Code of Federal Regulations.
    (i) Place of employment means any coal or other mine, factory, 
plant, establishment, construction site, or other area, workplace or 
environment where work is performed by any employee of an employer.
    (j) MSHA District Office means any one of the Mine Safety and Health 
Administration's District Offices.
    (k) BOM means the Bureau of Mines, Department of the Interior.
    (l) Employee has the same meaning as stated in the OSH Act and for 
the purposes of this part includes miner as defined in the FMSH Act.
    (m) Employer has the same meaning as stated in the OSH Act and for 
the purposes of this part includes operator as defined in the FMSH ACT.

[41 FR 45002, Oct. 14, 1976, as amended at 45 FR 2654, Jan. 14, 1980]

[[Page 615]]



Sec. 85a.3  Authority for investigations of places of employment.

    (a) NIOSH authorized representatives who have been issued official 
NIOSH credentials are authorized by the Director, NIOSH, under sections 
20 and 8 of the OSH Act, sections 501 and 103 of the FMSH Act, and this 
part. To enter without delay any place of employment for the purpose of 
conducting investigations of all pertinent processes, conditions, 
structures, machines, apparatus, devices, equipment, and materials 
within the place of employment; and to conduct medical examinations, 
anthropometric measurements and functional tests of employees within the 
place of employment as may be directly related to the specific 
investigation being conducted. Such investigations will be conducted in 
a reasonable manner, during regular working hours or at other reasonable 
times and within reasonable limits. In connection with any 
investigations, such NIOSH authorized representatives may question 
privately any employer, owner, operator, agent, or employee from the 
place of employment; and review, abstract, or duplicate employment 
records, medical records, records required by the Act and regulations, 
and other related records. In those instances where systems of records 
subject to review, abstraction or duplication are of a confidential 
nature, such as medical records, and are abstracted or duplicated, NIOSH 
will maintain such systems in accordance with the Privacy Act of 1974 (5 
U.S.C. 552a) and the implementing regulation of the Department of Health 
and Human Services (45 CFR part 5b).
    (b) Areas under investigation which contain information classified 
by any agency of the United States Government in the interest of 
national security will be investigated only by NIOSH authorized 
representatives who have obtained the appropriate security clearance and 
authorization.

[41 FR 45002, Oct. 14, 1976, as amended at 45 FR 2654, Jan. 14, 1980]



Sec. 85a.4  Procedures for initiating investigations of places of employment.

    (a) Except as otherwise provided in paragraph (b) of this section, 
NIOSH authorized representatives will contact an official representative 
of the place of employment prior to any site visits and will provide the 
details of why an investigation of the place of employment is being 
conducted. Prior to the initiation of a site visit of a place of 
employment, representatives of the following organizations will be 
advised of the site visit and the reason for its conduct:
    (1) The appropriate State agency designated under section 18(b) of 
the OSH Act, or if no State agency has been designated under the OSH Act 
and in the case of the FMSH Act, the State agency which, in the judgment 
of NIOSH, would benefit the most from the investigation's findings;
    (2) If there is a local union at the place of employment, the local 
president, business manager or other appropriate individual;
    (3) The appropriate Assistant Regional Director, when investigations 
are conducted under the OSH Act;
    (4) The appropriate MSHA District Office; the Director, BOM, and the 
Assistant Director for Mining, BOM, when investigations are conducted 
under the FMSH Act.
    (b) Advance notice of site visits will not be given to the place of 
employment or local union at the place of employment when, in the 
judgment of the NIOSH authorized representatives, giving such notice 
would adversely affect the validity and effectiveness of an 
investigation. Those individuals and organizations specified in 
Sec. 85a.4(a)(1), (a)(3) and (a)(4) will be notified prior to the 
initiation of such a site visit. After the site visit has been 
initiated, and, as soon as possible thereafter, the NIOSH authorized 
representatives will contact those individuals specified in 
Sec. 85a.4(a)(2) concerning the nature and details of the site visit.
    (c) In those instances where site visits are not necessary to the 
conduct of an investigation, the NIOSH authorized representatives will 
contact an official representative of the place of employment either 
verbally or through a written communication and provide the details of 
why an investigation of the place of employment is being conducted. If 
appropriate, the NIOSH authorized representatives will contact

[[Page 616]]

those individuals stipulated in paragraphs (a)(1), (a)(2), (a)(3), and 
(a)(4) of this section about the nature and details of the 
investigation.

[41 FR 45002, Oct. 14, 1976, as amended at 45 FR 2654, Jan. 14, 1980]



Sec. 85a.5  Conduct of investigations of places of employment.

    (a)(1) Prior to beginning a site visit, NIOSH authorized 
representatives will present their credentials to the employer, owner, 
operator or agent in charge at the place of employment, explain the 
nature, purpose and scope of the investigation and the records specified 
in Sec. 85a.3 which they wish to review, abstract or duplicate.
    (2) In those instances where site visits are not necessary to the 
conduct of an investigation and the initial contact is made verbally, 
NIOSH authorized representatives will, at the request of the employer, 
owner, operator or agent in charge at the place of employment, provide a 
written explanation of the nature, purpose and scope of the 
investigation and the records specified in Sec. 85a.3 which they wish to 
review, abstract or duplicate.
    (b)(1) At the commencement of an investigation, the employer, owner, 
operator or agent in charge at the place of employment shall precisely 
identify that information which is trade secret and might be seen or 
obtained by the NIOSH authorized representatives during the 
investigation. If the NIOSH authorized representatives have no clear 
reason to question such identification, such information will not be 
disclosed by NIOSH in accordance with the provisions of section 15 of 
the OSH Act. Generally, NIOSH will not question trade secret 
designations; however, if NIOSH at any time does question such 
identification, not less than 15 days' notice to the employer, owner, 
operator or agent will be given of the intention to remove the trade 
secret designation from such information. The employer, owner, operator 
or agent may within that period submit a request to the Director, NIOSH, 
to reconsider this intention and may provide additional information in 
support of the trade secret designation. The Director, NIOSH, will 
notify the employer, owner, operator or agent in writing of the decision 
which will become effective no sooner than 15 days after the date of 
such notice.
    (2) In those instances where the NIOSH authorized representative is 
a person fulfilling a contact agreement with NIOSH or is serving as an 
expert or consultant to NIOSH pursuant to the Act, the employer, owner, 
operator or agent in charge at the place of employment may, after 
advising the NIOSH contractor or consultant in writing, elect to 
withhold information deemed to be a trade secret from such a NIOSH 
authorized representative or prohibit entry into the area of the place 
of employment where such entry will reveal trade secrets. In those 
instances, where the subject information is needed or access to the area 
of the place of employment is necessary, in the judgment of NIOSH, to 
fulfill the goals of the investigation, NIOSH regular employees will 
then obtain the information or enter the subject area of the place of 
employment.
    (c)(1) NIOSH authorized representatives will be in charge of site 
visits conducted pursuant to this part.
    (2) Where there is a request by the representative of the State 
agency and/or employees, who were notified pursuant to Sec. 85a.4(a)(1) 
or Sec. 85a.4(a)(2) to accompany the NIOSH authorized representatives 
during the site visit of the place of employment, the NIOSH authorized 
representatives will allow this request if they determine that this will 
aid the investigation; or where, in the judgment of the NIOSH authorized 
representatives, good cause has been shown why accompaniment by a third 
party who is not an employee of the employer is reasonably necessary to 
the conduct of an effective and thorough site visit, they may permit 
such third party to accompany them during the site visit: Provided 
however, That access by such person(s) to areas described in 
Sec. 85a.5(c)(4) shall be in accordance with the requirements of such 
provision and access to areas containing trade secrets shall be with the 
consent of the employer, owner, operator or agent in charge at the place 
of employment.
    (3) NIOSH authorized representatives are authorized to deny the 
right of accompaniment under this paragraph to

[[Page 617]]

any person whose conduct in their judgment interferes with a fair and 
orderly site visit. In all instances, a representative of the employer 
shall be permitted to accompany the NIOSH authorized representatives 
during the site visit of the place of employment.
    (4) With regard to information classified by an agency of the United 
States Government in the interest of national security, only persons 
authorized to have access to such information may accompany NIOSH 
authorized representatives in areas containing such information.
    (d)(1) NIOSH authorized representatives are authorized: To collect 
environmental samples and samples of substances; to measure 
environmental conditions and employee exposures (including measurement 
of employee exposure by the attachment of personal sampling devices to 
employees with their consent); to take or obtain photographs, motion 
pictures or videotapes related to the purpose of the investigation; to 
employ other reasonable investigative techniques, including medical 
examinations, anthropometric measurements and standardized and 
experimental functional tests of employees with the informed consent of 
such employees; to review, abstract, and duplicate such personnel 
records as are pertinent to mortality, morbidity, injury, safety, and 
other similar studies; and to question and interview privately any 
employer, owner, operator, agency, or employee from the place of 
employment. The employer, owner, operator, or agency shall have the 
opportunity to review photographs, motion pictures, and videotapes taken 
or obtained for the purpose of identifying those which contain or might 
reveal a trade secret.
    (2) Prior to the conduct of medical examinations, anthropometric 
measurements or functional tests of any employees, the NIOSH authorized 
representatives will obtain approval of the procedures to be utilized 
from the NIOSH Human Subjects Review Board and no employee examination, 
measurement or test will be undertaken without the informed consent of 
such employee.
    (e) NIOSH authorized representatives will comply with all safety and 
health rules and practices at the place of employment and all NIOSH, 
Occupational Safety and Health Administration, and Mine Safety and 
Health Administration regulations and policies during a site visit and 
will provide and use appropriate protective clothing and equipment. In 
situations requiring specialized or unique types of protective 
equipment, such equipment shall be furnished by the employer, owner, 
operator or agent in charge at the place of employment.
    (f) The conduct of site visits will be such as to preclude 
unreasonable disruption of the operations of the place of employment.

[41 FR 45002, Oct. 14, 1976, as amended at 45 FR 2654, Jan. 14, 1980; 49 
FR 4739, Feb. 8, 1984]



Sec. 85a.6  Provision of suitable space for employee interviews and examinations.

    An employer, owner, operator or agent in charge at the place of 
employment shall, on request of the NIOSH authorized representatives, 
provide suitable space at the place of employment, if such space is 
reasonably available, to NIOSH to conduct private interviews with, and 
medical examinations, anthropometric measurements and functional tests 
of employees. NIOSH authorized representatives will consult with the 
employer, owner, operator or agent as to the time and place of the 
private interviews, medical examination, anthropometric measurements and 
functional tests and will schedule same so as to avoid undue disruption 
of work at the place of employment. NIOSH will conduct the medical 
interviews, measurements, examinations and tests specified under this 
part at its own expense.

[41 FR 45002, Oct. 14, 1976]



Sec. 85a.7  Imminent dangers.

    Whenever, during the course of, or as a result of, an investigation 
under this part, the NIOSH authorized representatives believe there is a 
reasonable basis for an allegation of an imminent danger, NIOSH will 
immediately advise the employer, owner, operator or agent in charge at 
the place of employment and those employees who appear to be in 
immediate danger of such allegation

[[Page 618]]

and will inform the agencies identified in Sec. 85a.4(a)(1), (a)(3), and 
(a)(4).

[41 FR 45002, Oct. 16, 1976, as amended at 45 FR 2654, Jan. 14, 1980]



Sec. 85a.8  Reporting of results of investigations of places of employment.

    (a)(1) Specific reports of investigations of each place of 
employment under this part, with identification of the place of 
employment, will be made available by NIOSH to the employer, owner, 
operator or agent in charge at the place of employment, with copies to 
the appropriate officials and Agencies notified pursuant to 
Sec. 85a.4(a). Prior to release of such reports, a preliminary report 
will be sent by NIOSH to the employer, owner, operator or agent for 
review for trade secret information and technical inaccuracies that may 
inadvertently be presented in the report. If requested in writing, the 
data used to compile the reports will be made available by NIOSH to the 
employer, owner, operator or agent in charge at the place of employment, 
except that data will not be released in a form that is individually 
identifiable.
    (2) All specific reports of investigations of each place of 
employment under this part will be available to the public from the 
NIOSH Regional Consultant for Occupational Safety and Health in the 
appropriate NIOSH Regional Office.
    (3) In certain instances, specific reports of investigations of each 
place of employment will not be prepared. In such instances, a closing 
conference at the place of employment will be conducted by the NIOSH 
authorized representatives and those individuals participating in the 
site visit to discuss the findings of the site visit and appropriate 
recommendations.
    (b)(1) Any specific findings of individual employee medical 
examinations, anthropometric measurements and functional tests will be 
released by NIOSH authorized representatives to the company physician, 
private physician, or other person only pursuant to the written 
authorization of the employee; otherwise, the specific findings and 
other personal records concerning individuals will be maintained in 
accordance with 45 CFR part 5b and section 3 of the Privacy Act of 1974 
(5 U.S.C. 552a). Notice of all NIOSH systems of records as defined in 45 
CFR 5b.1(n) as a result of the investigations of places of employment 
pursuant to this part will be published in the Federal Register under 
Notices of Systems of Records for the Department of Health and Human 
Services.
    (2) In cases where an employee shows positive significant medical 
findings, the employee and the physician(s) designated by the employee 
under Sec. 85a.8(b)(1) will be immediately notified by NIOSH.
    (3) A summary of the findings of the examinations for each employee 
will be sent by NIOSH to the individual.
    (c) The findings of a total investigation generally will be 
disseminated as part of NIOSH criteria documents, NIOSH technical 
reports, NIOSH information packets, scientific journals, presentations 
at technical meetings, or in other similar manners. These findings of a 
total investigation will be presented in a manner which does not 
identify any specific place of employment; however, it should be noted 
that the specific reports of investigations of each place of employment 
under this part are subject to mandatory disclosure, upon request, under 
the provisions of the Freedom of Information Act (5 U.S.C. 552).

[41 FR 45002, Oct. 14, 1976]



PART 86--GRANTS FOR EDUCATION PROGRAMS IN OCCUPATIONAL SAFETY AND HEALTH--Table of Contents




                           Subpart A--General

Sec.
86.1  Applicability.
86.2  Definitions.
86.3  Inventions and discoveries.
86.4  Publications and copyrights.
86.5  Grant appeals procedure.

        Subpart B--Occupational Safety and Health Training Grants

86.10  Nature and purpose of training grants.
86.11  Eligibility.
86.12  Application for a grant.
86.13  Project requirements.
86.14  Evaluation and grant award.
86.15  Payments.
86.16  Use of project funds.
86.17  Nondiscrimination.
86.18  Grantee accountability.

[[Page 619]]

86.19  Human subjects; animal welfare.
86.20  Additional conditions.
86.21  Applicability of 45 CFR part 74.

      Subpart C--Occupational Safety and Health Direct Traineeships

86.30  Nature and purpose of direct traineeships.
86.31  Eligibility; minimum requirements.
86.32  Application for direct traineeship.
86.33  Human subjects; animal welfare.
86.34  Evaluation and award of direct traineeships.
86.35  Payments.
86.36  Duration and continuation.
86.37  Terms and conditions.
86.38  Accountability.
86.39  Termination of direct traineeship.

    Authority: Sec. 8(g), 84 Stat. 1600, 29 U.S.C. 657(g); sec. 21(a), 
84 Stat. 1612, 29 U.S.C. 670(a).

    Source: 40 FR 29076, July 10, 1975, unless otherwise noted.



                           Subpart A--General



Sec. 86.1  Applicability.

    The regulations of this part are applicable to the award of training 
grants and direct traineeships pursuant to section 21(a)(1) of the 
Occupational Safety and Health Act of 1970 (29 U.S.C. 670(a)(1)) to 
assist in providing an adequate supply of qualified personnel to carry 
out the purposes of the Act.



Sec. 86.2  Definitions.

    Any term not defined herein shall have the same meaning as given it 
in the Act. As used in this part:
    (a) Act means the Occupational Safety and Health Act of 1970 (29 
U.S.C. 651 et seq.).
    (b) [Reserved]
    (c) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (d) State means a State of the United States, the District of 
Columbia, Puerto Rico, the Virgin Islands, American Samoa, Guam, and the 
Trust Territory of the Pacific Islands.
    (e) Training means job-specific skill development, the purpose of 
which is to provide qualified personnel to carry out the purposes of the 
Act.

[40 FR 29076, July 10, 1975, as amended at 47 FR 53012, Nov. 24, 1982]



Sec. 86.3  Inventions and discoveries.

    Any grant award pursuant to Sec. 86.14 or Sec. 86.33 is subject to 
the regulations of the Department of Health and Human Services as set 
forth in 45 CFR parts 6 and 8, as amended. Such regulations shall apply 
to any activity for which grant funds are in fact used whether within 
the scope of the project as approved or otherwise. Appropriate measures 
shall be taken by the grantee and by the Secretary to assure that no 
contracts, assignments or other arrangements inconsistent with the grant 
obligation are continued or entered into and that all personnel involved 
in the supported activity are aware of and comply with such obligations. 
Laboratory notes, related technical data, and information pertaining to 
inventions and discoveries shall be maintained for such periods, and 
filed with or otherwise made available to the Secretary, or those he may 
designate at such times and in such manner, as he may determine 
necessary to carry out such Department regulations.



Sec. 86.4  Publications and copyrights.

    Except as may otherwise be provided under the terms and conditions 
of the award, the grantee may copyright without prior approval any 
publications, films or similar materials developed or resulting from a 
project supported by a grant under this part, subject, however, to a 
royalty-free, nonexclusive, and irrevocable license or right in the 
Government to reproduce, translate, publish, use, disseminate, and 
dispose, of such materials and to authorize others to do so.



Sec. 86.5  Grant appeals procedure.

    The informal Public Health Service procedure for resolution of post-
award grant disputes set forth in subpart D of part 50 of this title and 
the Department post-award grant appeals procedure in 45 CFR part 16 are 
applicable to any award made pursuant to this part.

[[Page 620]]



        Subpart B--Occupational Safety and Health Training Grants



Sec. 86.10  Nature and purpose of training grants.

    (a) Long-term training project grant. A long-term training project 
grant is an award of funds to an eligible institution or agency, 
hereinafter called the ``grantee,'' to pay part or all of the costs of 
organized identifiable activities, hereinafter termed the ``project,'' 
that are undertaken to establish, strengthen, or expand graduate, 
undergraduate, or special training, of persons in the field of 
occupational safety and health. Such grants may be used to support 
training in, for example, occupational medicine, industrial hygiene, 
industrial nursing and occupational safety engineering and the training 
of technicians and paraprofessionals in such areas.
    (b) Short-term training project grant. A short-term training project 
grant is an award of funds to an eligible institution or agency, 
hereinafter called the ``grantee,'' to pay part or all of the costs of 
organized identifiable activities, hereinafter termed the ``project'' 
that are undertaken to provide intensive training programs of less than 
1 year for any one or a combination of the following purposes:
    (1) To provide specialized instruction for occupational safety and 
health professional or career personnel which will increase their 
competence in an area in their respective fields.
    (2) To prepare or expand the capabilities of occupational safety and 
health professional or career personnel for leadership roles as 
administrators or supervisors, and
    (3) To prepare or expand the teaching capabilities of occupational 
safety and health professionals and career personnel.
    (c) Educational Resource Center Grant. An educational resource 
center grant is an award of funds to an eligible institution or agency, 
hereinafter called the ``grantee,'' to pay part or all of the costs of 
organized identifiable activities, hereinafter termed the ``project,'' 
that are undertaken to provide for the combination of long-term and 
short-term training activities as described in Sec. 86.13 (c).

[40 FR 29076, July 10, 1975, as amended at 42 FR 52401, Sept. 30, 1977]



Sec. 86.11  Eligibility.

    (a) Eligible applicants. Any public or private educational or 
training agency or institution located in a state is eligible to apply 
for a grant under this subpart.
    (b) Projects eligible for long-term or short-term training grants or 
educational resource center grants. Any project found by the Secretary 
to be a long-term training project within the meaning of Sec. 86.10(a) 
or a short-term training project within the meaning of Sec. 86.10(b) or 
an educational resource center grant project within the meaning of 
Sec. 86.10(c) shall be eligible for a grant award. However, no applicant 
is eligible for assistance for a separate training project grant in any 
project period in which it receives an educational resource center 
grant. Nothing in the section shall prevent an existing training grant 
from being incorporated into an educational resource center grant award.

[40 FR 29076, July 10, 1975, as amended at 42 FR 52401, Sept. 30, 1977; 
47 FR 53012, Nov. 24, 1982]



Sec. 86.12  Application for a grant.

    (a) An application for a grant under this subpart shall be submitted 
to the Secretary at such time and in such form and manner as the 
Secretary may prescribe.1 The application shall contain a 
full and adequate description of the project and of the manner in which 
the applicant intends to conduct the project in accordance with the 
requirements of this subpart, and a budget and justification of the 
amount of grant funds requested, and such other pertinent information as 
the Secretary may require.
---------------------------------------------------------------------------

    1 Applications and instructions may be obtained from the 
Procurement and Grants Office, Centers for Disease Control, Atlanta, GA 
30333.
---------------------------------------------------------------------------

    (b) The application shall be executed by an individual authorized to 
act for the applicant and to assume for the applicant the obligations 
imposed by the

[[Page 621]]

---------------------------------------------------------------------------
regulations of this subpart and any additional conditions of the grant.

[40 FR 29076, July 10, 1975, as amended at 49 FR 38117, Sept. 27, 1984]



Sec. 86.13  Project requirements.

    (a) An approvable application for a long-term training grant must 
contain each of the following, unless the Secretary determines that the 
applicant has established good cause for its omission.
    (1) Provision of a method for development of the training curriculum 
and any attendant training materials and resources;
    (2) Provision of a method for implementation of the needed training;
    (3) Provision of an evaluation methodology, including the manner in 
which such methodology will be employed, to measure the achievement of 
the objectives of the training program; and
    (4) Provision of a method by which trainees will be selected.
    (b) In addition to the requirements set forth in paragraph (a) of 
this section, an approvable application for a short-term training grant 
must contain each of the following, unless the Secretary determines that 
the applicant has established good cause for its omission.
    (1) Provision of a methodology to assess the particular skills, or 
knowledge that prospective trainees need to develop;
    (2) Provision of at least 18 hours of formal instruction for a 
period of not less than 2\1/2\ days and not more than 1 academic year; 
and
    (3) Assurances that no portion of the Federal funds will be used for 
(i) inservice training courses designed only for employees of a single 
agency, institution, or organization; (ii) correspondence courses; (iii) 
regular courses usually given for academic credit; or (iv) training the 
grantee's financial officers, program director, or the official who 
executed the application.
    (c) In addition to the requirements set forth in paragraphs (a), 
(b)(1), and (b)(3) (ii), (iii) and (iv) of this section, an approvable 
application for an educational resource center grant must contain each 
of the following, unless the Secretary determines that the applicant has 
established good cause for its omission:
    (1) A description, supported by appropriate documents, of 
cooperative arrangements to conduct an educational resource center among 
a medical school (with an established program in preventive or 
occupational medicine), a school of nursing, a school of public health 
or its equivalent, and a school of engineering or its equivalent. Other 
schools or departments with relevant disciplines and resources--e.g., 
toxicology, biostatistics, environmental health, law, business 
administration, education--may be represented and contribute as 
appropriate to the conduct of the total program.
    (2) The identification of an educational resource center Director 
who possesses a demonstrated capacity for sustained productivity and 
leadership in occupational safety and health training who shall oversee 
the general operation of the educational resource center program and 
shall, to the extent possible, directly participate in training 
activities.
    (3) A description of the full-time professional staff representing 
various disciplines and qualifications relevant to occupational safety 
and health and capable of planning, establishing, and carrying out or 
administering training projects undertaken by the educational resource 
center.
    (4) A description of the training and research expertise, 
appropriate facilities and ongoing training and research activities in 
occupational safety and health areas.
    (5) A description of its program for conducting education and 
training of occupational health physicians, occupational health nurses, 
industrial hygienists/engineers and safety personnel. There shall be 
full-time students in each of these core disciplines, with a goal of a 
minimum total of 30 full-time students. Training may also be conducted 
in other occupational safety and health career categories, e.g., 
industrial toxicology, biostatistics, epidemiology, and ergonomics. 
Training programs shall include appropriate field experience including 
experience with public health and safety agencies and labor-management 
health and safety activities.

[[Page 622]]

    (6) A specific plan for making an impact on the curriculum taught by 
relevant medical specialties, including radiology, orthopedics, 
dermatology, internal medicine, neurology, perinatal medicine, and 
pathology.
    (7) A description of its program to assist other institutions or 
agencies located within the applicant's region including schools of 
medicine, nursing and engineering, among others, by providing curriculum 
materials and consultation for curriculum/course development in 
occupational safety and health, and by providing training opportunities 
for faculty members.
    (8) A specific plan for preparing, distributing, and conducting 
courses, seminars and workshops to provide short-term and continuing 
education training courses for physicians, nurses, industrial 
hygienists, safety engineers and other occupational safety and health 
professionals, paraprofessionals and technicians, including personnel of 
labor-management health and safety committees, in the geographical 
region in which the educational resource center is located. The content 
and orientation of the curriculum/courses shall take into consideration 
and address problems relevant to the geographic region served. The goal 
shall be that the training be made available each year to a minimum of 
200-250 trainees representing all of the above categories of personnel 
with priority given to providing occupational safety and health training 
to physicians in family practice, as well as in industrial practice, and 
industrial nurses. These courses shall be structured so that educational 
institutions, public health and safety agencies, professional societies 
or other appropriate agencies can utilize them to provide training at 
the local level to occupational safety and health personnel working in 
the workplace. Further, the educational resource center shall have a 
specific plan and demonstrated capability for implementing such training 
directly and through other institutions or agencies in the region 
including cooperative efforts with labor unions and industry trade 
associations where appropriate.

[40 FR 29076, July 10, 1975, as amended at 42 FR 52401, Sept. 30, 1977]



Sec. 86.14  Evaluation and grant award.

    Within the limits of funds available for such purpose the Secretary 
may award grants to assist in the establishment and operation of those 
projects which will in his judgment best promote the purposes of section 
21(a)(1) of the Act, taking into account:
    (a) In the case of long-term training grants:
    (1) The need for training in the area or areas of study outlined in 
the application;
    (2) The degree to which the proposal represents a strengthening or 
expansion of the applicant's program in such areas;
    (3) The record of the applicant's effectiveness in training in these 
or related areas as indicated, among other things, by the placement of 
its graduates;
    (4) The competence of the project staff in relation to the service 
to be provided;
    (5) The reasonableness of the budget in relation to the proposed 
project;
    (6) The applicant's resources, including equipment, facilities, and 
funds, available for the project;
    (7) The current and potential availability of students in the area 
of study to be offered and their prospective employability as a result 
of the proposed training;
    (8) The extent to which the applicant expects to absorb faculty 
positions initiated as a result of the grant; and
    (9) The degree to which the project adequately provides for the 
requirements set forth in Sec. 86.13(a).
    (b) In the case of short-term training:
    (1) The relationship of the contents of the course to the current 
and emergency training needs to carry out the purposes of the Act;
    (2) The qualifications of the instructional staff;
    (3) The speed with which the training can be put to use by the 
persons proposed to be trained;
    (4) The reasonableness of the budget in relation to the proposed 
project;
    (5) The success of previous offerings of this course, or related 
courses;
    (6) Evidence of ability to recruit trainees and the estimated number 
to be enrolled during each course offering; and

[[Page 623]]

    (7) The degree to which the proposed project adequately provides for 
the requirements set forth in Sec. 86.13(b).
    (c) In the case of educational resource center grants:
    (1) The criteria set forth in paragraphs (a) and (b) of this 
section.
    (2) The degree to which the proposed project adequately provides for 
the requirements set forth in Sec. 86.13(c).
    (d) The amount of any award shall be determined by the Secretary on 
the basis of his estimate of the sum necessary for all or a designated 
portion of direct project costs plus an additional amount for indirect 
costs, if any, which will be calculated by the Secretary either (1) on 
the basis of his estimate of the actual indirect costs reasonably 
related to the project, or (2) on the basis of a percentage, not to 
exceed 8 percent, of all, or a portion of, the estimated direct costs of 
the project when there are reasonable assurances that the use of such 
percentage will not exceed the approximate actual indirect costs. Such 
award may include an estimated provisional amount for indirect costs or 
for designated direct costs (such as travel or supply costs) subject to 
upward (within the limits of available funds) as well as downward 
adjustments to actual costs when the amount properly expended by the 
grantee for provisional items has been determined by the Secretary.
    (e) All grant awards shall be in writing, shall set forth the amount 
of funds granted and the period for which support is recommended.
    (f) Neither the approval of any project nor any grant award shall 
commit or obligate the United States in any way to make any additional, 
supplemental, continuation, or other award with respect to any approved 
project or portion thereof. For continuation support, grantees must make 
separate application annually at such times and in such form as the 
Secretary may direct.

[40 FR 29076, July 10, 1975, as amended at 42 FR 52402, Sept. 30, 1977]



Sec. 86.15  Payments.

    The Secretary shall from time to time make payments to a grantee of 
all or a portion of any grant award, either in advance or by way of 
reimbursement for expenses incurred or to be incurred in the performance 
of the project to the extent he determines such payments necessary to 
promote prompt initiation and advancement of the approved project.



Sec. 86.16  Use of project funds.

    (a) Any funds granted pursuant to this subpart as well as other 
funds to be used in performance of the approved project shall be 
expended solely for carrying out the approved project in accordance with 
section 21(a) of the Act, the regulations of this subpart, the terms and 
conditions of the award, and the applicable cost principles prescribed 
by subpart Q of 45 CFR part 74.
    (b) Prior written approval by the Secretary of revision of the 
budget and project plan is required whenever there is to be a 
significant change in the scope or nature of project activities, which 
in the case of short term training grants, includes any change in the 
course dates or training sites.
    (c) Grant funds are available for trainee stipends and for tuition, 
including fees and instructional materials, for travel costs related to 
training allowances. Stipends and allowances may not be increased or be 
paid beyond the term of the stipend on account of vacation an individual 
might have been entitled to but did not take.
    (d) Stipends may only be paid to a trainee who is a citizen of the 
United States, an alien lawfully admitted to the United States for 
permanent residence, or a permanent resident of Guam, American Samoa, or 
the Trust Territory of the Pacific Islands.
    (e) In the case of short term training grants, stipends may not be 
paid to persons receiving lecture fees, salary, travel expenses, or 
payment in any form as members of the course instructional staff.
    (f) Grant funds used for alterations and renovations shall be 
subject to the condition that the grantee shall comply with the 
requirements of Executive Order 11246, as amended, and with the 
applicable regulations prescribed pursuant thereto.



Sec. 86.17  Nondiscrimination.

    (a) Attention is called to the requirements of title VI of the Civil 
Rights Act of 1964 (78 Stat. 252, 42 U.S.C. 2000d

[[Page 624]]

et seq.) and in particular section 601 of such Act which provides that 
no person in the United States shall on the grounds of race, color, or 
national origin be excluded from participation in, be denied the 
benefits of, or be subjected to, discrimination under any program or 
activity receiving Federal financial assistance. A regulation 
implementing such title VI, which applies to grants made under this 
subpart, has been issued by the Secretary of Health and Human Services 
with the approval of the President (45 CFR part 80).
    (b) Attention is called to the requirements of title IX of the 
Education Amendments of 1972 (86 Stat. 373, 20 U.S.C. 1681 et seq.) and 
in particular to section 901 of such Act which provides that no person 
in the United States shall, on the basis of sex, be excluded from 
participation in, be denied the benefits of, or be subjected to 
discrimination under any education program or activity receiving Federal 
financial assistance.
    (c) Attention is called to the requirements of section 504 of the 
Rehabilitation Act of 1973, as amended, which provides that no otherwise 
qualified handicapped individual in the United States shall, solely by 
reason of his handicap, be excluded from participation in, be denied the 
benefits of, or be subjected to discrimination under any program or 
activity receiving Federal financial assistance.



Sec. 86.18  Grantee accountability.

    (a) Accounting for grant award payments. All payments made by the 
Secretary shall be recorded by the grantee in accounting records 
separate from the records of all other grant funds, including funds 
derived from other grant awards. With respect to each approved project 
the grantee shall account for the sum total of all amounts paid by 
presenting or otherwise making available evidence satisfactory to the 
Secretary of expenditures for direct and indirect costs meeting the 
requirements of this part: Provided, however, That when the amount 
awarded for indirect costs was based on a predetermined fixed-percentage 
of estimated direct costs, the amount allowed for indirect costs shall 
be computed on the basis of such predetermined fixed-percentage rates 
applied to the total, or a selected element thereof, of the reimbursable 
direct costs incurred.
    (b) Accounting for interest earned on grant funds. Pursuant to 
section 203 of the Intergovernmental Cooperation Act of 1968 (42 U.S.C. 
4213), a State will not be held accountable for interest earned on grant 
funds, pending their disbursement for grant purposes. A State, as 
defined in section 102 of the Intergovernmental Cooperation Act, means 
any one of the several States, the District of Columbia, Puerto Rico, 
any territory or possession of the United States, or any agency or 
instrumentality of a State, but does not include the governments of the 
political sudivisions of the State. All grantees other than a State, as 
defined in this section, must return all interest earned on grant funds 
to the Federal Government.
    (c) Grant closeout--(1) Date of final accounting. A grantee shall 
render, with respect to each approved project, a full account, as 
provided herein, as of the date of termination of grant support. The 
Secretary may require other special and periodic accounting.
    (2) Final settlement. There shall be payable to the Federal 
Government as final settlement with respect to each approved project the 
total sum of:
    (i) Any amount not accounted for pursuant to paragraph (a) of this 
section; and
    (ii) Any credits for earned interest pursuant to paragraph (b) of 
this section; and
    (iii) Any other amounts due pursuant to subparts F, M, and O of 45 
CFR part 74.

Such total sum shall constitute a debt owed by the grantee to the 
Federal Government and shall be recovered from the grantee or its 
successors or assignees by setoff or other action as provided by law.



Sec. 86.19  Human subjects; animal welfare.

    No grant award may be made under this subpart unless the applicant 
has complied with:
    (a) 45 CFR part 46 pertaining to the protection of human subjects; 
and

[[Page 625]]

    (b) Chapter 1-43 of the Department Grants Administration Manual 
2 concerning animal welfare.
---------------------------------------------------------------------------

    2  The Department Grants Administration Manual is 
available for inspection at the Public Information Office of the several 
Department Regional Offices and available for purchase at the Government 
Printing Office, GPO Document No. 894-523.
---------------------------------------------------------------------------



Sec. 86.20  Additional conditions.

    The Secretary may with respect to any grant award impose additional 
conditions prior to or at the time of any award when in his judgment 
such conditions are necessary to assure or protect advancement of the 
approved project, the interests of public health, or the conservation of 
grant funds.



Sec. 86.21  Applicability of 45 CFR part 74.

    The provisions of 45 CFR part 74, establishing uniform 
administrative requirements and cost principles, shall apply to all 
grants under this part to States and local governments as those terms 
are defined in subpart A of that part 74. The relevant provisions of the 
following subparts of part 74 shall also apply to grants to all grantee 
organizations under this part:

                             45 CFR Part 74

Subpart and Subject
A  General.
B  Cash depositories.
C  Bonding and insurance.
D  Retention and custodial requirements for records.
F  Grant-related income.
G  Matching and cost sharing.
K  Grant payment requirements.
L  Budget revision procedures.
M  Grant closeout: Suspension, and termination.
O  Property.
Q  Cost principles.



      Subpart C--Occupational Safety and Health Direct Traineeships



Sec. 86.30  Nature and purpose of direct traineeships.

    A direct traineeship is an award of funds directly from the Federal 
Government to an individual (herein called the ``trainee'') for his 
subsistence and other expenses during a period in which he is acquiring 
training (a) in the occupational safety and health professions, (b) for 
research relating to occupational safety and health, or (c) for teaching 
in occupational safety and health.



Sec. 86.31  Eligibility; minimum requirements.

    In order to be eligible for an award under this subpart an applicant 
must:
    (a) Have been accepted by a public or private institution for the 
purpose of the activity for which the traineeship is sought.
    (b) Be a U.S. citizen, an alien lawfully admitted to the United 
States for permanent residence or a permanent resident of Guam, American 
Samoa, or the Trust Territory of the Pacific Islands.

[40 FR 29076, July 10, 1975, as amended at 47 FR 53012, Nov. 24, 1982]



Sec. 86.32  Application for direct traineeship.

    An application for a direct traineeship under this subpart shall be 
submitted to the Secretary at such times and in such form and manner as 
he may prescribe.1 In addition to the information supplied by 
the applicant in his application, such further information may be 
required as is necessary to determine his or her qualifications.
---------------------------------------------------------------------------

    1 Applications and instructions may be obtained from the 
Procurement and Grants Office, Centers for Disease Control, Atlanta, GA 
30333.

[40 FR 29076, July 10, 1975, as amended at 49 FR 38117, Sept. 27, 1984]



Sec. 86.33  Human subjects; animal welfare.

    Where the application is for training at a non-Federal institution, 
no award may be made under this subpart unless said institution has 
complied with:
    (a) 45 CFR part 46 pertaining to the protection of human subjects; 
and
    (b) Chapter 1-43 of the Department Grants Administration Manual 
2068 concerning animal welfare.
---------------------------------------------------------------------------

    2 See footnote 2 to Sec. 86.19.
---------------------------------------------------------------------------



Sec. 86.34  Evaluation and award of direct traineeships.

    Within the limits of funds available for such purpose and subject to 
the regulations of this part, the Secretary

[[Page 626]]

may award direct traineeships to those qualified applicants who are in 
his judgment best able to carry out the purpose of the traineeships 
taking into consideration the need for training in the area of study 
specified in the application.



Sec. 86.35  Payments.

    (a) Individuals receiving awards shall be entitled to such stipends 
and allowances as the Secretary may designate, taking into account such 
factors as the needs of the program, the cost of living, and the 
availability of funds.

    (Note: These are prescribed in chapter 3-140 of the Department 
Grants Administration Manual 2).

    (b) Payments of stipends and allowances will, at the discretion of 
the Secretary, be made directly to the trainee or to the sponsoring 
institution for payment directly to the trainee.



Sec. 86.36  Duration and continuation.

    Direct traineeship awards may be made for varying periods not in 
excess of 2 years. The Secretary may make one or more continuation 
awards for an additional period if he finds that satisfactory progress 
is being made toward accomplishment of the purpose of the initial 
traineeship award. Additional support may be provided on appropriate 
justification after expiration of the period of support in the previous 
award.



Sec. 86.37  Terms and conditions.

    All direct traineeship awards shall be subject to the following 
terms and conditions:
    (a) Training must be carried out at an institution found by the 
Secretary to provide a well-rounded course of instruction in the 
particular area of training for which the traineeship is awarded.
    (b) No direct traineeship may be utilized to compensate any trainee 
for personal services or employment on behalf of the United States or 
any person.



Sec. 86.38  Accountability.

    Accountability for payments will be subject to such requirements as 
may be specified by the Secretary.



Sec. 86.39  Termination of direct traineeship.

    (a) The Secretary may terminate a direct traineeship at any time 
upon request of the trainee.
    (b) After reasonable notice to the trainee and an opportunity for 
the presentation of the trainee's views and relevant evidence, the 
Secretary may terminate any direct traineeship prior to the date it 
would otherwise expire upon a determination that the trainee's 
performance is unsatisfactory, that the trainee is no longer attending 
the sponsoring institution, or that he or she is unfit or unable to 
carry out the purpose of the traineeship.
    (c) The views and evidence of the trainee shall be presented in 
writing unless the Secretary determines that an oral presentation is 
desirable.



PART 87--NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND DEMONSTRATION GRANTS--Table of Contents




Sec.
87.1  To which programs does this regulation apply?
87.2  Definitions.
87.3  Who is eligible to apply for a grant under this part?
87.4  For what purposes may grants be awarded?
87.5  What information must be included in the grant application?
87.6  How will grant applications be evaluated and the grants awarded?
87.7  For what period of time will grants be awarded?
87.8  How may a grantee use grant funds?
87.9  Which other HHS regulations apply?

    Authority: Sec. 8(g), 84 Stat. 1600 (29 U.S.C. 657(g)), sec. 508, 83 
Stat. 803 (30 U.S.C. 957).

    Source: 46 FR 58676, Dec. 3, 1981, unless otherwise noted.



Sec. 87.1  To which programs does this regulation apply?

    This regulation applies to research and demonstration project grants 
under:
    (a) Section 20(a)(1) of the Occupational Safety and Health Act of 
1970 (29 U.S.C. 669(a)(1)) for the support of studies related to 
occupational safety and health, and

[[Page 627]]

    (b) Section 501 of the Federal Mine Safety and Health Act of 1977 
(30 U.S.C. 951) for the support of health research in mining. These 
grants are awarded and administered by the National Institute for 
Occupational Safety and Health, Centers for Disease Control, of the 
Public Health Service.



Sec. 87.2  Definitions.

    As used in this regulation:
    Demonstration project grant means an award of funds to an eligible 
applicant to assist in meeting the cost of conducting a demonstration, 
either on a pilot or full-scale basis, of the technical or economic 
feasibility or application of a new or improved procedure, method, 
technique, or approach that will further the research purposes described 
in Sec. 87.4.
    Principal investigator for a research project, or project director 
for a demonstration project, means a single individual who is 
responsible for the scientific and technical direction of the project.
    Research project grant means an award of funds to an eligible 
applicant to assist in meeting the costs of conducting an identified 
research activity or program, study, or experiment that will further the 
research purposes described in Sec. 87.4.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.



Sec. 87.3  Who is eligible to apply for a grant under this part?

    Any public or private agency or institution is eligible to apply for 
a grant under this part, except Federal agencies or institutions not 
specifically authorized by law to receive such a grant.



Sec. 87.4  For what purposes may grants be awarded?

    (a) The Occupational Safety and Health Act authorizes grants for 
research, experiments, and demonstrations relating to occupational 
safety and health, including studies of the psychological factors 
involved. This authority includes projects to develop innovative 
methods, techniques, and approaches for dealing with occupational safety 
and health problems.
    (b) The Federal Mine Safety and Health Act authorizes grants for 
research projects designed to:
    (1) Improve working conditions and practices affecting health in 
coal or other mines and to prevent occupational diseases originating in 
the mining industry.
    (2) Develop epidemiological information to (i) identify and define 
positive factors involved in occupational diseases of miners, (ii) 
provide information on the incidence and prevalence of pneumoconiosis 
and other respiratory ailments of miners, and (iii) improve health 
standards.
    (3) Develop techniques for the prevention and control of 
occupational diseases of miners, including tests for hypersusceptibility 
and early detection.
    (4) Evaluate the effect on bodily impairment and occupational 
disability of miners afflicted with an occupational disease.
    (5) Study the relationship between coal or other mine environments 
and occupational diseases of miners.
    (6) Study matters involving the protection of life and the 
prevention of diseases in connection with persons who, although not 
miners, work with or around the products of coal or other mines in areas 
outside of such mines and under conditions which may adversely affect 
the health and well-being of such persons.
    (7) Develop effective respiratory equipment.



Sec. 87.5  What information must be included in the grant application?

    The application must contain a complete description of the objective 
of the project and the plan for carrying out the research or 
demonstration, the name and qualifications of the principal investigator 
or project director and principal staff members, the total resources and 
facilities that will be available, and a justification of the amount of 
grant funds requested.



Sec. 87.6  How will grant applications be evaluated and the grants awarded?

    (a) The Secretary may award grants to those applicants whose 
approved

[[Page 628]]

projects will best promote the purposes of either the Occupational 
Safety and Health Act or the Federal Mine Safety and Health Act on the 
basis of an evaluation conducted by experts or consultants engaged for 
this purpose.
    (b) This evaluation will take into account the scientific merit and 
significance of the project, the competency of the proposed staff in 
relation to the type of research or demonstration involved, the 
feasibility of the project, the likelihood of its producing meaningful 
results, the proposed project period, the adequacy of the applicant's 
resources available for the project, the amount of grant funds necessary 
for completion, and for mining grant applications, the recommendations 
of the Mine Health Research Advisory Committee.
    (c) The Secretary may evaluate and approve two or more concurrent 
applications, each dealing with one or more specified aspects of the 
project, and make two or more concurrent grant awards for the project. 
This may be necessary when a project involves a number of different but 
related problems, activities, or disciplines which would require 
evaluation by different groups, or when support for a project could be 
more effectively administered by separate handling of various aspects of 
the project.



Sec. 87.7  For what period of time will grants be awarded?

    (a) The notice of grant award specifies how long the Secretary 
intends to support the project without requiring the project to 
recompete for funds. This period, called the project period, will 
usually be for 3-5 years.
    (b) Generally, the grant will initially be for 1 year and subsequent 
continuation awards will also be for 1 year at a time. A grantee must 
submit a separate application to have the support continued for each 
subsequent year. Decisions regarding continuation awards and the funding 
level of such awards will be of such factors as the grantee's progress 
and management practices, and the availability of funds. In all cases, 
continuation awards require a determination by the Secretary that 
continued funding is in the best interest of the Federal Government.
    (c) Neither the approval of any application, nor the award of any 
grant commits or obligates the Federal Government in any way to make any 
additional, supplemental, continuation, or other award with respect to 
any approved application or portion of an approved application.



Sec. 87.8  How may a grantee use grant funds?

    A grantee shall only spend funds it receives under this part 
according to the approved application and budget, the authorizing 
legislation, the terms and conditions of the grant award, the applicable 
cost principles specified in subpart Q of 45 CFR part 74, and the 
regulations of this part.



Sec. 87.9  Which other HHS regulations apply?

    Several other regulations apply to grants under this part. These 
include, but are not limited to:

42 CFR part 50, subpart D--Public Health Service grant appeals procedure
45 CFR part 16--Procedures of the Departmental Grant Appeals Board
45 CFR part 46--Protection of human subjects
45 CFR part 74--Administration of grants
45 CFR part 75--Informal grant appeals procedures
45 CFR part 80--Nondiscrimination under programs receiving Federal 
assistance through the Department of Health and Human Services 
effectuation of title VI of the Civil Rights Act of 1964
45 CFR part 81--Practice and procedure for hearing under part 80 of this 
Title
45 CFR part 84--Nondiscrimination on the basis of handicap in programs 
and activities receiving or benefiting from Federal financial assistance
45 CFR part 91--Nondiscrimination on the basis of age in HHS programs or 
activities receiving Federal financial assistance

[49 FR 38117, Sept. 27, 1984]

[[Page 629]]



SUBCHAPTER H--HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS 
                   SUBSTANCES RELEASES AND FACILITIES





PART 90--ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES--Table of Contents




Sec.
90.1  Purpose and applicability.
90.2  Definitions.
90.3  Procedures for requesting health assessments.
90.4  Contents of requests for health assessments.
90.5  Acting on requests.
90.6  Notification of determination to conduct a health assessment in 
          response to a request from the public.
90.7  Decision to conduct health effects study.
90.8  Conduct of health assessments and health effects studies.
90.9  Public health advisory.
90.10  Notice and comment period.
90.11  Reporting of results of health assessments and health effects 
          studies.
90.12  Confidentiality of information.
90.13  Recordkeeping requirements.
90.14  Documentation and cost recovery.

    Authority: 42 U.S.C. 9615; 42 U.S.C. 6939a(c).

    Source: 55 FR 5138, Feb. 13, 1990, unless otherwise noted.



Sec. 90.1  Purpose and applicability.

    The provisions of this part set forth the policies and procedures of 
the Agency for Toxic Substances and Disease Registry (ATSDR) with 
respect to its conduct of health assessments and health effects studies 
under section 104(i) of Comprehensive Environmental Response, 
Compensation, and Liability Act, as amended by the Superfund Amendments 
and Reauthorization Act of 1986, and section 3019 of the Resource 
Conservation and Recovery Act. These provisions apply to ATSDR, as well 
as its contractors, agents, and those carrying out health assessments 
and health effects studies pursuant to agreements with ATSDR, such as 
other Federal agencies and States.



Sec. 90.2  Definitions.

    Administrator means the Administrator of the Agency for Toxic 
Substances and Disease Registry or designee.
    ATSDR means the Agency for Toxic Substances and Disease Registry, 
Public Health Service, U.S. Department of Health and Human Services.
    CERCLA means the Comprehensive Environmental Response, Compensation, 
and Liability Act of 1980 (42 U.S.C. 9601 et seq., Pub. L. 96-520), as 
amended by the Superfund Amendments and Reauthorization Act of 1986 
(Pub. L. 99-499).
    EPA means the U.S. Environmental Protection Agency.
    Facility is defined in 42 U.S.C. 9601(9).
    Hazardous substance is defined in 42 U.S.C. 9601(14). In addition, 
the term includes any pollutant or contaminant which the Administrator 
determines is appropriate for the purposes of carrying out his or her 
responsibilities under CERCLA.
    Health assessment means the evaluation of data and information on 
the release of hazardous substances into the environment in order to 
assess any current or future impact on public health, develop health 
advisories or other recommendations, and identify studies or actions 
needed to evaluate and mitigate or prevent human health effects.
    Health effects study means research, investigation, or study 
performed by ATSDR or other parties pursuant to an agreement with ATSDR 
to evaluate the health effects of exposure to hazardous substances at 
specific sites. This term includes, but is not limited to, 
epidemiological studies, exposure and disease registries, and health 
surveillance programs. This term does not include health assessments.
    Owner or operator is defined in 42 U.S.C. 9601(20).
    Peer review means review for scientific quality by a panel 
consisting of no less than three nor more than seven members, who shall 
be disinterested scientific experts selected by the Administrator of 
ATSDR on the basis of their reputation for scientific objectivity and 
the lack of institutional ties

[[Page 630]]

with any person involved in the conduct of the study or research under 
review.
    Person means an individual, firm, corporation, association, 
partnership, consortium, joint venture, commercial entity, United States 
Government, State, municipality, commission, political subdivision of a 
State, Indian tribe, or any interstate body.
    Pollutant or contaminant is defined in 42 U.S.C. 9601(33).
    Public health advisory is a statement by ATSDR containing a finding 
that a release poses a significant risk to human health and recommending 
measures to be taken to reduce exposure and eliminate or substantially 
mitigate the significant risk to human health.
    Release is defined in 42 U.S.C. 9601(22).



Sec. 90.3  Procedures for requesting health assessments.

    (a) ATSDR will accept requests to perform health assessments for a 
particular facility or release from any person or group of persons.
    (b) All requests to ATSDR to perform health assessments should be 
addressed to: Assistant Administrator, Agency for Toxic Substances and 
Disease Registry, 1600 Clifton Road NE., Atlanta, GA 30333.



Sec. 90.4  Contents of requests for health assessments.

    (a) Each request for a health assessment shall contain:
    (1) The name, address (including zip code), and telephone number of 
the requestor;
    (2) The organization or group the requestor represents, if any;
    (3) The name, location, and description of the facility or release 
of concern;
    (4) A statement providing information that individuals have been 
exposed to a hazardous substance and that the probable source is a 
release, or sufficient information to allow the Administrator to make 
such a finding;
    (5) A statement requesting ATSDR to perform a health assessment.
    (b) At his or her discretion, consistent with the requirements of 
CERCLA, the Administrator may decide not to require the preceding 
information be submitted with a request for a health assessment.
    (c) Each request for a health assessment should include, where 
possible:
    (1) Any other information pertaining to the facility or release, 
such as the nature and amount of the hazardous substances of concern or 
the identities of parties believed to be potentially responsible for the 
release;
    (2) Potential pathways for human exposure, including a description 
of the media contaminated (e.g. soil, groundwater, air, etc.);
    (3) The demographic nature and proximity of the potentially affected 
human population; and
    (4) Other Federal, State, or local governmental agencies which were 
notified or that investigated the facility or release.
    (d) This data collection has been reviewed and approved by OMB in 
accordance with the Paperwork Reduction Act and assigned the control 
number 0920-0204.



Sec. 90.5  Acting on requests.

    (a) Upon receipt of a request for a health assessment submitted 
under this part, ATSDR will determine, in its discretion, whether or not 
there is a reasonable basis to justify conducting a health assessment. 
ATSDR will base this determination on, among other factors:
    (1) Whether individuals have been exposed to a hazardous substance, 
for which the probable source of such exposure is a release;
    (2) The location, concentration, and toxicity of the hazardous 
substances;
    (3) The potential for further human exposure;
    (4) The recommendations of other governmental agencies; and
    (5) The ATSDR resources available and other ATSDR priorities, such 
as its responsibilities to conduct other health assessments and health 
effects studies.
    (b) Where appropriate, ATSDR will request information from other 
Federal, State, and local governmental agencies, as well as other 
persons, pertaining to a facility or release which is the subject of a 
request from the public to ATSDR to conduct a health assessment.

[[Page 631]]

    (c) The requestor will be notified in writing of ATSDR's 
determination that either a health assessment will be performed, a 
health assessment will not be performed, or that further information 
concerning the facility or release is required before a decision can be 
made whether a health assessment will be performed.
    (d) If a health assessment is not initiated in response to a request 
from the public, ATSDR shall provide a written explanation to the 
requestor of why a health assessment is not appropriate.



Sec. 90.6  Notification of determination to conduct a health assessment in response to a request from the public.

    (a) Following a determination by ATSDR to conduct a health 
assessment in response to a request from the public, ATSDR shall notify 
in writing, at a minimum, the following parties of its intent to perform 
a health assessment:
    (1) The U.S. Environmental Protection Agency;
    (2) The appropriate State government environmental agency;
    (3) The appropriate State and local health departments;
    (4) The requestor;
    (5) The owner or operator of the facility of concern, if their 
identity is readily available to ATSDR.

In addition, ATSDR will notify, in writing or by telephone, other 
potentially responsible parties, if their identity is readily available 
to ATSDR.
    (b) At its discretion, ATSDR may notify any other persons which it 
feels may be affected by the release or have information pertaining to 
the release.



Sec. 90.7  Decision to conduct health effects study.

    (a) ATSDR may decide, in its discretion, based upon the results of a 
health assessment or other available information, to conduct a health 
effects study for a particular site or sites. Such a decision may, in 
appropriate circumstances, be made prior to the completion of a health 
assessment for a site or sites. When deciding whether to conduct a 
health effects study, ATSDR will consider such factors as the results 
and recommendations of a health assessment for the site or sites and the 
need for additional information to determine whether individuals have 
been exposed to hazardous substances, the degree to which such exposure 
has occurred, and any possible health effects resulting from such 
exposure.
    (b) Should ATSDR decide, in its discretion, to conduct a health 
effect study, it will notify the parties as specified in Sec. 90.6.



Sec. 90.8  Conduct of health assessments and health effects studies.

    (a) Any interested person or persons may submit data or information 
to ATSDR for it to consider in its conduct of a health assessment or a 
health effects study. In performing a health assessment or a health 
effects study, ATSDR will consider data and information it has 
independently generated or received from other parties, such as EPA, 
other Federal agencies, State and local governmental agencies, 
businesses, citizen organizations, and community groups.
    (b) ATSDR may determine it is necessary to conduct a site visit in 
connection with a health assessment or health effects study. The ATSDR 
representative may allow the participation of any person in the site 
visit which he or she, at his or her discretion, determines will aid in 
the conduct of the health assessment or health effects study.
    (c) In the event that the information necessary to perform a health 
assessment or health effects study is not readily available from other 
sources, ATSDR may arrange for sampling or additional data gathering at 
a facility or release for the limited purpose of determining the 
existence of current or potential health problems.



Sec. 90.9  Public health advisory.

    ATSDR may issue a public health advisory based on the findings of a 
health assessment, health effects, study, or other ATSDR involvement.



Sec. 90.10  Notice and comment period.

    Following internal review by ATSDR and external peer review of a 
draft final report of the results of a health effects study, ATSDR will 
publish a notice that the draft final report is available for public 
review and comment. At

[[Page 632]]

a minimum, the notice shall be published in at least one newspaper of 
general distribution in the local where the site is located. The notice 
shall describe how copies of the draft final report of the health 
effects study can be obtained and set a reasonable time period for 
interested persons to submit comments concerning the study. ATSDR may, 
at its discretion, respond in writing to comments it receives.



Sec. 90.11  Reporting of results of health assessments and health effects studies.

    (a) ATSDR shall provide a report of the results of a health 
assessment or health effects study to EPA, the appropriate State and 
local governmental agencies, any person requesting ATSDR to conduct the 
health assessment, and parties potentially responsible for the release, 
if their identity is readily available to ATSDR. In addition, such 
reports shall be available to the general public upon request.
    (b) In the event that ATSDR or its representatives conduct medical 
examinations of individuals in the course of a health effects study and 
the examination reveals a positive significant medical finding, the 
individual, and a physician if designated by the individual, will be 
promptly notified of that significant medical finding by ATSDR.
    (c) A summary of the findings of all medical examinations for each 
individual will be sent by ATSDR to that individual.
    (d) All studies and results of research conducted under this part 
(other than health assessments) shall be reported or adopted only after 
appropriate peer review.



Sec. 90.12  Confidentiality of information.

    (a) ATSDR shall consider any medical information in individually 
identifiable form to be confidential information and shall release such 
information only in accordance with the Privacy Act (5 U.S.C. 552a) or 
other applicable Federal law.
    (b) As provided under section 104(e)(7) of CERCLA, any records, 
reports, or information obtained from any person under this section 
shall be available to the public, except that upon a showing 
satisfactory to ATSDR by any person that records, reports, or 
information, or particular part thereof (other than health or safety 
effects data), to which any officer, employee, or representative of 
ATSDR has access under this part if made public would divulge 
information entitled to protection under the Trade Secrets Act (18 
U.S.C. 1905), such information or particular portion thereof shall be 
considered confidential in accordance with the purposes of that section, 
except that such record, report, document, or information may be 
disclosed to other officers, employees, or authorized representatives of 
the United States concerned with carrying out statutorily mandated 
duties.
    (c) In submitting data to ATSDR, a person may designate the data 
which such person believes is entitled to protection under paragraph (b) 
of this section and submit such designated data separately from other 
data submitted under this part. A designation under this paragraph shall 
be made in writing to the Administrator. However, should ATSDR at any 
time question such designation, not less than 15 days notice to the 
person sumitting the information shall be given of the intention to 
remove such trade secret designation from such information. The person 
may submit a request to the Administrator to reconsider this intention 
and may provide additional information in support of the trade secret 
designation. The Administrator shall notify the person in writing of the 
decision which will become effective no sooner than 15 days after the 
date of such notice.



Sec. 90.13  Recordkeeping requirements.

    (a) ATSDR shall maintain a record of all health assessments and 
health effects studies. The Administrator shall, at his or her 
discretion, determine the contents of the record. At a minimum, the 
record shall include:
    (1) The final ATSDR report of the health assessment or health 
effects study;
    (2) Nonconfidential data and other information upon which that 
report is based or which was considered by ATSDR;

[[Page 633]]

    (3) Nonconfidential data or other information submitted by 
interested persons pertaining to the health assessment or health effects 
study;
    (4) The protocol for the health effects study;
    (5) A list of the individuals responsible for external peer review 
of the report of a health effects study, their comments, and ATSDR's 
response to the comments; and
    (6) For health effects study, the notice announcing the availability 
of a draft final report for public review and comment, all comments 
received in response to the notice, and any responses to the comments by 
ATSDR.
    (b) The record may contain a confidential portion which shall 
include all information determined to be confidential by the 
Administrator under this part.
    (c) The Administrator may determine other documents are appropriate 
for inclusion in the record for health assessments or health effects 
studies.
    (d) Predecisional documents, including draft documents, are not 
documents upon which ATSDR bases its conclusions in health assessments 
or health effects studies, and are not usually included in the record 
for health assessments or health effects studies.
    (e) The record for ATSDR health assessments and health effects 
studies will be available for review, upon prior request, at ATSDR 
headquarters in Atlanta, Georgia.
    (f) Nothing in this section is intended to imply that ATSDR's 
decisions to conduct health assessments or health effects studies, or 
the reports of health assessments or health effects studies, are subject 
to judicial review.



Sec. 90.14  Documentation and cost recovery.

    (a) During all phases of ATSDR health assessments and health effects 
studies, documentation shall be completed and maintained to form the 
basis for cost recovery, as specified in section 107 of CERCLA.
    (b) Where appropriate, the information and reports compiled by ATSDR 
pertaining to costs shall be forwarded to the appropriate EPA regional 
office for cost recovery purposes.

[[Page 634]]



                         SUBCHAPTER I [RESERVED]





                         SUBCHAPTER J--VACCINES





PART 100--VACCINE INJURY COMPENSATION--Table of Contents




Sec.
100.1  Applicability.
100.2  Average cost of a health insurance policy.
100.3  Vaccine injury table.

    Authority: Sec. 215 of the Public Health Service Act (42 U.S.C. 
216); sec. 2115 of the PHS Act; 100 Stat. 3767, as revised (42 U.S.C. 
300aa-15); Sec. 100.3 Vaccine Injury Table, issued under secs. 312 and 
313 of Pub. L. 99-660, 100 Stat. 3779-3782 (42 U.S.C. 300aa-1 note); and 
sec. 2114(c) and (e) of the PHS Act, 100 Stat. 3766 and 107 Stat. 645 
(42 U.S.C. 300aa-14(c) and (e)); and sec. 904(b) of Pub. L. 105-34, 111 
Stat. 873.



Sec. 100.1  Applicability.

    This part applies to the National Vaccine Injury Compensation 
Program (VICP) under subtitle 2 of title XXI of the Public Health 
Service (PHS) Act.

[60 FR 7693, Feb. 8, 1995]



Sec. 100.2  Average cost of a health insurance policy.

    For purposes of determining the amount of compensation under the 
VICP, section 2115(a)(3)(B) of the PHS Act, 42 U.S.C. 300aa.15(a)(3)(B), 
provides that certain individuals are entitled to receive an amount 
reflecting lost earnings, less certain deductions. One of the deductions 
is the average cost of a health insurance policy, as determined by the 
Secretary of Health and Human Services. The Secretary has determined 
that the average cost of a health insurance policy is $158.00 per month. 
This amount will be revised to reflect the changes in the medical care 
component of the Consumer Price Index (All Urban Consumers, U.S. City 
Average), published by the United States Bureau of Labor Statistics, 
plus 2 percent per year. The revised amounts will be effective upon 
their delivery by the Secretary to the United States Claims Court, and 
the amounts will be published in a notice in the Federal Register from 
time to time as determined by the Secretary.

[57 FR 28099, June 24, 1992, as amended at 60 FR 7693, Feb. 8, 1995]



Sec. 100.3  Vaccine injury table.

    (a) In accordance with section 312(b) of the National Childhood 
Vaccine Injury Act of 1986, title III of Pub. L. 99-660, 100 Stat. 3779 
(42 U.S.C. 300aa-1 note) and section 2114(c) of the Public Health 
Service Act (42 U.S.C. 300aa-14(c)), the following is a table of 
vaccines, the injuries, disabilities, illnesses, conditions, and deaths 
resulting from the administration of such vaccines, and the time period 
in which the first symptom or manifestation of onset or of the 
significant aggravation of such injuries, disabilities, illnesses, 
conditions, and deaths is to occur after vaccine administration for 
purposes of receiving compensation under the Program:

                          Vaccine Injury Table
------------------------------------------------------------------------
                                                       Time period for
                                                      first symptom or
                                                      manifestation of
                              Illness, disability,       onset or of
           Vaccine             injury or condition       significant
                                     covered          aggravation after
                                                           vaccine
                                                       administration
------------------------------------------------------------------------
I. Vaccines containing        A. Anaphylaxis or     4 hours.
 tetanus toxoid (e.g., DTaP,   anaphylactic shock.  2-28 days.
 DTP, DT, Td, or TT).         B. Brachial Neuritis
                              C. Any acute          Not applicable.
                               complication or
                               sequela (including
                               death) of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed.

[[Page 635]]

 
II. Vaccines containing       A. Anaphylaxis or     4 hours.
 whole cell pertussis          anaphylactic shock.  72 hours.
 bacteria, extracted or       B. Encephalopathy     Not applicable.
 partial cell pertussis        (or encephalitis).
 bacteria, or specific        C. Any acute
 pertussis antigen(s) (e.g.,   complication or
 DTP, DTaP, P, DTP-Hib).       sequela (including
                               death) of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed.
III. Measles, mumps, and      A. Anaphylaxis or     4 hours.
 rubella vaccine or any of     anaphylactic shock.  5-15 days (not less
 its components (e.g., MMR,   B. Encephalopathy      than 5 days and not
 MR, M, R).                    (or encephalitis).    more than 15 days).
                              C. Any acute          Not applicable.
                               complication or
                               sequela (including
                               death) of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed.
IV. Vaccines containing       A. Chronic arthritis  7-42 days.
 rubella virus (e.g., MMR,    B. Any acute          Not applicable.
 MR, R).                       complication or
                               sequela (including
                               death) of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed.
V. Vaccines containing        A. Thrombocytopenic   7-30 days.
 measles virus (e.g., MMR,     purpura.             6 months.
 MR, M).                      B. Vaccine-Strain
                               Measles Viral
                               Infection in an
                               immunodeficient
                               recipient.
                              C. Any acute          Not applicable.
                               complication or
                               sequela (including
                               death) of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed.
VI. Vaccines containing       A. Paralytic Polio
 polio live virus (OPV).
                                --in a non-         30 days.
                                 immunodeficient
                                 recipient.
                                --in an             6 months.
                                 immunodeficient
                                 recipient.
                                --in a vaccine      Not applicable.
                                 associated
                                 community case.
                              B. Vaccine-Strain
                               Polio Viral
                               Infection
                                --in a non-         30 days.
                                 immunodeficient
                                 recipient.
                                --in an             6 months.
                                 immunodeficient
                                 recipient.
                                --in a vaccine      Not applicable.
                                 associated
                                 community case.
                              C. Any acute          Not applicable.
                               complication or
                               sequela (including
                               death) of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed.
VII. Vaccines containing      A. Anaphylaxis or     4 hours
 polio inactivated virus       anaphylactic shock.
 (e.g., IPV).
                              B. Any acute          Not applicable.
                               complication or
                               sequela (including
                               death of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed..
VIII. Hepatitis B. vaccines.  A. Anaphylaxis or     4 hours.
                               anaphylactic shock.
                              B. Any acute          Not applicable.
                               complication or
                               sequela (including
                               death) of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed.

[[Page 636]]

 
IX. Hemophilus influenzae     A. Early-onset Hib    7 days.
 type b polysaccharide         disease.             Not applicable.
 vaccines (unconjugated, PRP  B. Any acute
 vaccines).                    complication or
                               sequela (including
                               death) of an
                               illness,
                               disability, injury,
                               or condition
                               referred to above
                               which illness,
                               disability, injury,
                               or condition arose
                               within the time
                               period prescribed.
X. Hemophilus influenzae      No Condition          Not applicable.
 type b polysaccharide         Specified.
 conjugate vaccines.
XI. Varicella vaccine.......  No Condition          Not applicable.
                               Specified.
XII. Rotavirus vaccine......  No condition          Not applicable.
                               specified.
XIII. Any new vaccine         No Condition          Not applicable.
 recommended by the Centers    Specified.
 for Disease Control and
 Prevention for routine
 administration to children,
 after publication by the
 Secretary of a notice of
 coverage.
------------------------------------------------------------------------

    (b) Qualifications and aids to interpretation. The following 
qualifications and aids to interpretation shall apply to the Vaccine 
Injury Table to paragraph (a) of this section:
    (1) Anaphylaxis and anaphylactic shock. For purposes of paragraph 
(a) of this section, Anaphylaxis and anaphylactic shock mean an acute, 
severe, and potentially lethal systemic allergic reaction. Most cases 
resolve without sequelae. Signs and symptoms begin minutes to a few 
hours after exposure. Death, if it occurs, usually results from airway 
obstruction caused by laryngeal edema or bronchospasm and may be 
associated with cardiovascular collapse. Other significant clinical 
signs and symptoms may include the following: Cyanosis, hypotension, 
bradycardia, tachycardia, arrhythmia, edema of the pharynx and/or 
trachea and/or larynx with stridor and dyspnea. Autopsy findings may 
include acute emphysema which results from lower respiratory tract 
obstruction, edema of the hypopharynx, epiglottis, larynx, or trchea and 
minimal findings of eosinophilia in the liver, spleen and lungs. When 
death occurs within minutes of exposure and without signs of respiratory 
distress, there may not be significant pathologic findings.
    (2) Encephalopathy. For purposes of paragraph (a) of this section, a 
vaccine recipient shall be considered to have suffered an encephalopathy 
only if such recipient manifests, within the applicable period, an 
injury meeting the description below of an acute encephalopathy, and 
then a chronic encephalopathy persists in such person for more than 6 
months beyond the date of vaccination.
    (i) An acute encephalopathy is one that is sufficiently severe so as 
to require hospitalization (whether or not hospitalization occurred).
    (A) For children less than 18 months of age who present without an 
associated seizure event, an acute encephalopathy is indicated by a 
significantly decreased level of consciousness lasting for at least 24 
hours. Those children less than 18 months of age who present following a 
seizure shall be viewed as having an acute encephalopathy if their 
significantly decreased level of consciousness persists beyond 24 hours 
and cannot be attributed to a postictal state (seizure) or medication.
    (B) For adults and children 18 months of age or older, an acute 
encephalopathy is one that persists for at least 24 hours and 
characterized by at least two of the following:
    (1) A significant change in mental status that is not medication 
related; specifically a confusional state, or a delirium, or a 
psychosis;
    (2) A significantly decreased level of consciousness, which is 
independent of a seizure and cannot be attributed to the effects of 
medication; and
    (3) A seizure associated with loss of consciousness.
    (C) Increased intracranial pressure may be a clinical feature of 
acute encephalopathy in any age group.

[[Page 637]]

    (D) A ``significantly decreased level of consciousness'' is 
indicated by the presence of at least one of the following clinical 
signs for at least 24 hours or greater (see paragraphs (b)(2)(i)(A) and 
(b)(2)(i)(B) of this section for applicable timeframes):
    (1) Decreased or absent response to environment (responds, if at 
all, only to loud voice or painful stimuli);
    (2) Decreased or absent eye contact (does not fix gaze upon family 
members or other individuals); or
    (3) Inconsistent or absent responses to external stimuli (does not 
recognize familiar people or things).
    (E) The following clinical features alone, or in combination, do not 
demonstrate an acute encephalopathy or a significant change in either 
mental status or level of consciousness as described above: Sleepiness, 
irritability (fussiness), high-pitched and unusual screaming, persistent 
inconsolable crying, and bulging fontanelle. Seizures in themselves are 
not sufficient to constitute a diagnosis of encephalopathy. In the 
absence of other evidence of an acute encephalopathy, seizures shall not 
be viewed as the first symptom or manifestation of the onset of an acute 
encephalopathy.
    (ii) Chronic Encephalopathy occurs when a change in mental or 
neurologic status, first manifested during the applicable time period, 
persists for a period of at least 6 months from the date of vaccination. 
Individuals who return to a normal neurologic state after the acute 
encephalopathy shall not be presumed to have suffered residual 
neurologic damage from that event; any subsequent chronic encephalopathy 
shall not be presumed to be a sequela of the acute encephalopathy. If a 
preponderance of the evidence indicates that a child's chronic 
encephalopathy is secondary to genetic, prenatal or perinatal factors, 
that chronic encephalopathy shall not be considered to be a condition 
set forth in the Table.
    (iii) An encephalopathy shall not be considered to be a condition 
set forth in the Table if in a proceeding on a petition, it is shown by 
a preponderance of the evidence that the encephalopathy was caused by an 
infection, a toxin, a metabolic disturbance, a structural lesion, a 
genetic disorder or trauma (without regard to whether the cause of the 
infection, toxin, trauma, metabolic disturbance, structural lesion or 
genetic disorder is known). If at the time a decision is made on a 
petition filed under section 2111(b) of the Act for a vaccine-related 
injury or death, it is not possible to determine the cause by a 
preponderance of the evidence of an encephalopathy, the encephalopathy 
shall be considered to be a condition set forth in the Table.
    (iv) In determining whether or not an encephalopathy is a condition 
set forth in the Table, the Court shall consider the entire medical 
record.
    (3) Residual Seizure Disorder. (i) A petitioner may be considered to 
have suffered a residual seizure disorder for purposes of paragraph (a) 
of this section, if the first seizure or convulsion occurred 5-15 days 
(not less than 5 days and not more than 15 days) after administration of 
the vaccine and 2 or more additional distinct seizure or convulsion 
episodes occurred within 1 year after the administration of the vaccine 
which were unaccompanied by fever (defined as a rectal temperature equal 
to or greater than 101.0 degrees Fahrenheit or an oral temperature equal 
to or greater than 100.0 degrees Fahrenheit). A distinct seizure or 
convulsion episode is ordinarily defined as including all seizure or 
convulsive activity occurring within a 24-hour period, unless competent 
and qualified expert neurological testimony is presented to the contrary 
in a particular case.
    (ii) For purposes of paragraph (a) of this section, a petitioner 
shall not be considered to have suffered a residual seizure disorder, if 
the petitioner suffered a seizure or convulsion unaccompanied by fever 
(defined as a rectal temperature equal to or greater than 101.0 degrees 
Fahrenheit or an oral temperature equal to or greater than 100.0 degrees 
Fahrenheit) before the fifth day after the administration of the vaccine 
involved.
    (4) Seizure and convulsion. For purposes of paragraphs (b) (2) and 
(3) of this section, the terms, ``seizure'' and ``convulsion'' include 
myoclonic, generalized tonic-clonic (grand mal), and simple and complex 
partial seizures. Absence (petit mal) seizures shall not

[[Page 638]]

be considered to be a condition set forth in the Table. Jerking 
movements or staring episodes alone are not necessarily an indication of 
seizure activity.
    (5) Sequela. The term ``sequela'' means a condition or event which 
was actually caused by a condition listed in the Vaccine Injury Table.
    (6) Chronic Arthritis. (i) For purposes of paragraph (a) of this 
section, chronic arthritis may be found in a person with no history in 
the 3 years prior to vaccination of arthropathy (joint disease) on the 
basis of:
    (A) Medical documentation, recorded within 30 days after the onset, 
of objective signs of acute arthritis (joint swelling) that occurred 
between 7 and 42 days after a rubella vaccination;
    (B) Medical documentation (recorded within 3 years after the onset 
of acute arthritis) of the persistence of objective signs of 
intermittent or continuous arthritis for more than 6 months following 
vaccination; and
    (C) Medical documentation of an antibody response to the rubella 
virus.
    (ii) For purposes of paragraph (a) of this section, the following 
shall not be considered as chronic arthritis: Musculoskeletal disorders 
such as diffuse connective tissue diseases (including but not limited to 
rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus 
erythematosus, systemic sclerosis, mixed connective tissue disease, 
polymyositis/determatomyositis, fibromyalgia, necrotizing vascultitis 
and vasculopathies and Sjogren's Syndrome), degenerative joint disease, 
infectious agents other than rubella (whether by direct invasion or as 
an immune reaction) metabolic and endocrine diseases, trauma, neoplasms, 
neuropathic disorders, bone and cartilage disorders and arthritis 
associated with ankylosing spondylitis, psoriasis, inflammatory bowel 
disease, Reiter's syndrome, or blood disorders.
    (iii) Arthralgia (joint pain) or stiffness without joint swelling 
shall not be viewed as chronic arthritis for purposes of paragraph (a) 
of this section.
    (7) Brachial neuritis. (i) This term is defined as dysfunction 
limited to the upper extremity nerve plexus (i.e., its trunks, 
divisions, or cords) without involvement of other peripheral (e.g., 
nerve roots or a single peripheral nerve) or central (e.g., spinal cord) 
nervous system structures. A deep, steady, often severe aching pain in 
the shoulder and upper arm usually heralds onset of the condition. The 
pain is followed in days or weeks by weakness and atrophy in upper 
extremity muscle groups. Sensory loss may accompany the motor deficits, 
but is generally a less notable clinical feature. The neuritis, or 
plexopathy, may be present on the same side as or the opposite side of 
the injection; it is sometimes bilateral, affecting both upper 
extremities.
    (ii) Weakness is required before the diagnosis can be made. Motor, 
sensory, and reflex findings on physical examination and the results of 
nerve conduction and electromyographic studies must be consistent in 
confirming that dysfunction is attributable to the brachial plexus. The 
condition should thereby be distinguishable from conditions that may 
give rise to dysfunction of nerve roots (i.e., radiculopathies) and 
peripheral nerves (i.e., including multiple monoeuropathies), as well as 
other peripheral and central nervous system structures (e.g., cranial 
neuropathies and myelopathies).
    (8) Thrombocytopenic purpura. This term is defined by a serum 
platelet count less than 50,000/mm3. Thrombocytopenic purpura 
does not include cases of thrombocytopenia associated with other causes 
such as hypersplenism, autoimmune disorders (including alloantibodies 
from previous transfusions) myelodysplasias, lymphoproliferative 
disorders, congenital thrombocytopenia or hemolytic uremic syndrome. 
This does not include cases of immune (formerly called idiopathic) 
thrombocytopenic purpura (ITP) that are mediated, for example, by viral 
or fungal infections, toxins or drugs. Thrombocytopenic purpura does not 
include cases of thrombocytopenia associated with disseminated 
intravascular coagulation, as observed with bacterial and viral 
infections. Viral infections include, for example, those infections 
secondary to Epstein Barr virus, cytomegalovirus, hepatitis A and B, 
rhinovirus, human immunodeficiency virus (HIV), adenovirus, and

[[Page 639]]

dengue virus. An antecedent viral infection may be demonstrated by 
clinical signs and symptoms and need not be confirmed by culture or 
serologic testing. Bone marrow examination, if performed, must reveal a 
normal or an increased number of megakaryocytes in an otherwise normal 
marrow.
    (9) Vaccine-strain measles viral infection. This term is defined as 
a disease caused by the vaccine-strain that should be determined by 
vaccine-specific monoclonal antibody or polymerase chain reaction tests.
    (10) Vaccine-strain polio viral infection. This term is defined as a 
disease caused by poliovirus that is isolated from the affected tissue 
and should be determined to be the vaccine-strain by oligonucleotide or 
polymerase chain reaction. Isolation of poliovirus from the stool is not 
sufficient to establish a tissue specific infection or disease caused by 
vaccine-strain poliovirus.
    (11) Early-onset Hib disease. This term is defined as invasive 
bacterial illness associated with the presence of Hib organism on 
culture of normally sterile body fluids or tissue, or clinical findings 
consistent with the diagnosis of epiglottitis. Hib pneumonia qualifies 
as invasive Hib disease when radiographic findings consistent with the 
diagnosis of pneumonitis are accompanied by a blood culture positive for 
the Hib organism. Otitis media, in the absence of the above findings, 
does not qualify as invasive bacterial disease. A child is considered to 
have suffered this injury only if the vaccine was the first Hib 
immunization received by the child.
    (c) Coverage provisions. (1) Except as provided in paragraph (c)(2), 
(3) or (4) of this section, the revised Table of Injuries set forth in 
paragraph (a) of this section and the Qualifications and Aids to 
Interpretation set forth in paragraph (b) of this section apply to 
petitions for compensation under the Program filed with the United 
States Court of Federal Claims on or after March 24, 1997. Petitions for 
compensation filed before such date shall be governed by section 2114(a) 
and (b) of the Public Health Service Act as in effect on January 1, 
1995, or by Sec. 100.3 as in effect on March 10, 1995 (see 60 FR 7678, 
et seq., February 8, 1995), as applicable.
    (2) Hepatitis B, Hib, and varicella vaccines (Items VIII, IX, X, and 
XI of the Table) are included in the Table as of August 6, 1997.
    (3) Rotavirus vaccines (Item XII of the Table) are included in the 
Table as of October 22, 1998.
    (4) Other new vaccines (Item XIII of the Table) will be included in 
the Table as of the effective date of a tax enacted to provide funds for 
compensation paid with respect to such vaccines. An amendment to this 
section will be published in the Federal Register to announce the 
effective date of such a tax.

[60 FR 7694, Feb. 8, 1995, as amended at 62 FR 7688, Feb. 20, 1997; 62 
FR 10626, Mar. 7, 1997; 63 FR 25778, May 11, 1998; 64 FR 40518, July 27, 
1999]

                           PART 110 [RESERVED]

[[Page 640]]



               SUBCHAPTER K--HEALTH RESOURCES DEVELOPMENT





PART 121--ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK--Table of Contents




Sec.
121.1  Applicability.
121.2  Definitions.
121.3  The OPTN.
121.4  OPTN Policies; Secretarial review and appeals.
121.5  Listing requirements.
121.6  Organ procurement.
121.7  Identification of organ recipient.
121.8  Allocation of organs.
121.9  Designated transplant program requirements.
121.10  Reviews, evaluation, and enforcement.
121.11  Record maintenance and reporting requirements.
121.12  Preemption.

    Authority: Sections 215, 371-376 of the Public Health Service Act 
(42 U.S.C. 216, 273-274d); Sections 1102, 1106, 1138 and 1872 of the 
Social Security Act (42 U.S.C. 1302, 1306, 1320b-8 and 1395ii).

    Source: 63 FR 16332, Apr. 2, 1998, unless otherwise noted.



Sec. 121.1  Applicability.

    (a) The provisions of this part apply to the operation of the Organ 
Procurement and Transplantation Network (OPTN) and to the Scientific 
Registry.
    (b) In accordance with Section 1138 of the Social Security Act, 
hospitals in which organ transplants are performed and which participate 
in the programs under titles XVIII or XIX of that Act, and organ 
procurement organizations designated under Section 1138(b)(1)(F) of the 
Social Security Act, are subject to the requirements of this part.



Sec. 121.2  Definitions.

    As used in this part--
    Act means the Public Health Service Act, as amended.
    Designated transplant program means a transplant program that has 
been found to meet the requirements of Sec. 121.9.
    Family member means a family member of a transplant candidate, 
transplant recipient, or organ donor.
    National list means the OPTN computer-based list of transplant 
candidates nationwide.
    OPTN computer match program means a set of computer-based 
instructions which compares data on a cadaveric organ donor with data on 
transplant candidates on the national list and ranks the candidates 
according to OPTN policies to determine the priority for allocating the 
donor organ(s).
    Organ means a human kidney, liver, heart, lung, or pancreas, and for 
purposes of the Scientific Registry, the term also includes bone marrow.
    Organ donor means a human being who is the source of an organ for 
transplantation into another human being.
    Organ procurement organization or OPO means an entity so designated 
by the Secretary under Section 1138(b) of the Social Security Act.
    Organ procurement and transplantation network or OPTN means the 
network established pursuant to Section 372 of the Act.
    Potential transplant recipient or potential recipient means a 
transplant candidate who has been ranked by the OPTN computer match 
program as the person to whom an organ from a specific cadaveric organ 
donor is to be offered.
    Scientific Registry means the registry of information on transplant 
recipients established pursuant to Section 373 of the Act.
    Secretary means the Secretary of Health and Human Services and any 
official of the Department of Health and Human Services to whom the 
authority involved has been delegated.
    Transplant candidate means an individual who has been identified as 
medically suited to benefit from an organ transplant and has been placed 
on the national list by the individual's transplant program.
    Transplant hospital means a hospital in which organ transplants are 
performed.
    Transplant physician means a physician who provides non-surgical 
care and treatment to transplant patients before and after transplant.
    Transplant program means a component within a transplant hospital 
which provides transplantation of a particular type of organ.

[[Page 641]]

    Transplant recipient means a person who has received an organ 
transplant.
    Transplant surgeon means a physician who provides surgical care and 
treatment to transplant recipients.



Sec. 121.3  The OPTN.

    (a) Composition of the Board. (1) The OPTN shall establish a Board 
of Directors of whatever size the OPTN determines appropriate, provided 
that it includes at least the following members:
    (i) Six members representing the following categories (two members 
from each category):
    (A) Transplant coordinators;
    (B) Organ procurement organizations;
    (C) Histocompatibility experts;
    (ii) Eight individuals representing transplant candidates, 
transplant recipients, organ donors, and family members;
    (iii) Ten members from the following categories (two members each):
    (A) Transplant surgeons;
    (B) Transplant physicians;
    (C) Transplant hospitals;
    (D) Voluntary health associations; and
    (E) Other experts from related fields including medical examiners, 
hospital administration, or donor hospital personnel in such fields as 
trauma, emergency medical services, critical care, neurology, or 
neurosurgery; and
    (iv) Six members from the general public from fields such as 
behavioral science, computer science, economics, ethics, health care 
financing, law, policy analysis, sociology, statistics, or theology. 
These members need not have technical expertise in organ donation or 
allocation.
    (2) None of the members who are transplant recipients, transplant 
candidates, organ donors, family members, or general public members 
under paragraph (a)(1) of this section shall be employees of, or have a 
similar relationship with, the categories of members listed in paragraph 
(a)(1)(i) or paragraph (a)(1)(iii) or the OPTN.
    (3) The Board of Directors shall include:
    (i) Individuals representing the diversity of the population of 
transplant candidates and recipients served by the OPTN, including, to 
the extent practicable, minority and gender representation reflecting 
the population of potential transplant candidates served by the OPTN;
    (ii) No more than 50 percent transplant surgeons or transplant 
physicians; and
    (iii) At least 25 percent transplant candidates, transplant 
recipients, organ donors and family members.
    (4) Individuals on the Board shall be elected for a two-year term.
    (b) Duties of the OPTN Board of Directors--(1) Executive Committee. 
The Board of Directors shall elect an Executive Committee from the 
membership of the Board. The Executive Committee shall include at least 
one member who is a transplant candidate, transplant recipient, organ 
donor, or family member; one general public member, one OPO 
representative, and not more than 50 percent transplant surgeons and 
transplant physicians.
    (2) Executive Director. The Board of Directors shall appoint an 
Executive Director of the OPTN. The Executive Director may be 
reappointed upon the Board's determination that the responsibilities of 
this position have been accomplished successfully.
    (3) Committees. The Board of Directors shall establish such other 
committees as are necessary to perform the duties of the OPTN. 
Committees established by the Board of Directors shall include:
    (i) Representation by transplant coordinators, organ procurement 
organizations, and transplant hospitals, and at least one transplant 
candidate, transplant recipient, organ donor or family member; and
    (ii) To the extent practicable, minority and gender representation 
reflecting the diversity of the population of potential transplant 
candidates served by the OPTN.
    (4) The Board of Directors shall develop and propose policies for 
the equitable allocation of organs, as described in Sec. 121.8.
    (c) Membership of the OPTN. (1) The OPTN shall admit and retain as 
members the following:
    (i) All organ procurement organizations;
    (ii) Transplant hospitals participating in the Medicare or Medicaid 
programs; and

[[Page 642]]

    (iii) Other organizations, institutions, and individuals that have 
an interest in the fields of organ donation or transplantation.
    (2) To apply for membership in the OPTN:
    (i) An OPO shall provide to the OPTN the name and address of the 
OPO, and the latest year of designation under section 1138(b) of the 
Social Security Act;
    (ii) A transplant hospital shall provide to the OPTN the name and 
address of the hospital, a list of its transplant programs by type of 
organ; and
    (iii) Any other organization, institution, or individual eligible 
under paragraph (c)(1)(iii) of this section shall demonstrate to the 
OPTN an interest in the fields of organ donation or transplantation.
    (3) The OPTN shall accept or reject as members entities or 
individuals described in paragraph (c)(1)(iii) of this section within 90 
days.
    (4) Applicants rejected for membership in the OPTN may appeal to the 
Secretary. Appeals shall be submitted in writing within 30 days of 
rejection of the application. The Secretary may:
    (i) Deny the appeal; or
    (ii) Direct the OPTN to take action consistent with the Secretary's 
response to the appeal.
    (d) Corporate Status of the OPTN. (1) The OPTN shall be a private, 
not-for-profit entity.
    (2) The requirements of this section do not apply to any parent, 
sponsoring, or affiliated organization of the OPTN, or to any activities 
of the contracting organization that are not integral to the operation 
of the OPTN. Such an organization is free to establish its own corporate 
procedures.
    (3) No OPTN member is required to become a member of any 
organization that is a parent, sponsor, contractor, or affiliated 
organization of the OPTN, to comply with the by-laws of any such 
organization, or to assume any corporate duties or obligations of any 
such organization.
    (e) Effective date. The organization designated by the Secretary as 
the OPTN shall have six months from October 1, 1998, or six months from 
its initial designation as the OPTN, whichever is later, to meet the 
board composition requirements of paragraph (a) of this section. The 
organization designated by the Secretary as the OPTN shall have six 
months from October 1, 1998, or six months from initial designation as 
the OPTN, whichever is later, to meet any other requirements of this 
section, except that the Secretary may extend such period for good 
cause.

[63 FR 16332, Apr. 2, 1998, as amended at 63 FR 35847, July 1, 1998]



Sec. 121.4  OPTN policies: Secretarial review and appeals.

    (a) The OPTN Board of Directors shall be responsible for developing, 
with the advice of the OPTN membership and other interested parties, 
policies within the mission of the OPTN as set forth in section 372 of 
the Act and the Secretary's contract for the operation of the OPTN, 
including:
    (1) Policies for the equitable allocation of cadaveric organs in 
accordance with Sec. 121.8;
    (2) Policies, consistent with recommendations of the Centers for 
Disease Control and Prevention, for the testing of organ donors and 
follow-up of transplant recipients to prevent the spread of infectious 
diseases;
    (3) Policies that reduce inequities resulting from socioeconomic 
status, including, but not limited to:
    (i) Ensuring that patients in need of a transplant are listed 
without regard to ability to pay or source of payment;
    (ii) Procedures for transplant hospitals to make reasonable efforts 
to make available from their own resources, or obtain from other 
sources, financial resources for patients unable to pay such that these 
patients have an opportunity to obtain a transplant and necessary 
follow-up care;
    (iii) Recommendations to private and public payers and service 
providers on ways to improve coverage of organ transplantation and 
necessary follow-up care; and
    (iv) Reform of allocation policies based on assessment of their 
cumulative effect on socioeconomic inequities;
    (4) Policies regarding the training and experience of transplant 
surgeons

[[Page 643]]

and transplant physicians in designated transplant programs as required 
by Sec. 121.9;
    (5) Policies for nominating officers and members of the Board of 
Directors; and
    (6) Policies on such other matters as the Secretary directs.
    (b) The Board of Directors shall:
    (1) Provide opportunity for the OPTN membership and other interested 
parties to comment on proposed policies and shall take into account the 
comments received in developing and adopting policies for implementation 
by the OPTN; and
    (2) Provide, at least 30 days prior to their proposed 
implementation, proposed policies to the Secretary, who may provide 
comments and/or objections within a reasonable time, or may publish the 
policies in the Federal Register to obtain comments from the public. The 
Board of Directors shall indicate which of the proposed policies it 
recommends be enforceable under Sec. 121.10. If the Secretary seeks 
public comments, these comments will be considered and may affect 
subsequent response to the OPTN. The OPTN shall take into account any 
comments the Secretary may provide. If the Secretary objects to a 
policy, the OPTN may be directed to revise the policy consistent with 
the Secretary's direction. If the OPTN does not revise the policy in a 
timely manner or if the Secretary otherwise disagrees with its content, 
the Secretary may take such other action as the Secretary determines 
appropriate.
    (c) The OPTN Board of Directors shall provide the membership and the 
Secretary with copies of the policies as they are adopted, and make them 
available to the public upon request. The Secretary will publish lists 
of these documents in the Federal Register, indicating which ones are 
subject to the special compliance requirements and potential sanctions 
of section 1138 of the Social Security Act. The OPTN shall also 
continuously maintain OPTN policies for public access on the Internet, 
including current and proposed policies.
    (d) The OPTN, or its members, or other individuals, or entities 
objecting to policies developed by the OPTN or the Secretary may submit 
appeals to the Secretary in writing. Any such appeal shall include a 
statement of the basis for the appeal. The Secretary will seek the 
comments of the OPTN on the issues raised in the appeal of an OPTN-
developed policy. Policies remain in effect during the appeal. The 
Secretary may:
    (1) Deny the appeal;
    (2) Direct the OPTN to revise the policies consistent with the 
Secretary's response to the appeal, or
    (3) Take such other action as the Secretary determines appropriate.
    (e) The OPTN shall implement policies and:
    (1) Provide information to OPTN members about these policies and the 
rationale for them.
    (2) Update policies developed in accordance with this section to 
accommodate scientific and technological advances.



Sec. 121.5  Listing requirements.

    (a) A transplant hospital which is an OPTN member may list 
individuals only for a designated transplant program.
    (b) Transplant hospitals shall assure that individuals are placed on 
the national list as soon as they are determined to be candidates for 
transplantation. The OPTN shall advise transplant hospitals of the 
information needed for such listing.
    (c) An OPTN member shall pay a registration fee to the OPTN for each 
transplant candidate it places on the national list. The amount of such 
fee shall be determined by the OPTN with the approval of the Secretary. 
No less often than annually, and whether or not a change is proposed, 
the OPTN shall submit to the Secretary a statement of its proposed 
registration fee, together with such supporting information as the 
Secretary finds necessary to determine the reasonableness or adequacy of 
the fee schedule and projected revenues. This submission is due at least 
three months before the beginning of the OPTN's fiscal year. The 
Secretary will approve, modify, or disapprove the amount of the fee 
within a reasonable time of receiving the OPTN's submission.

[[Page 644]]



Sec. 121.6  Organ procurement.

    The suitability of organs donated for transplantation shall be 
determined as follows:
    (a) Tests. An OPTN member procuring an organ shall assure that 
laboratory tests and clinical examinations of potential organ donors are 
performed to determine any contraindications for donor acceptance, in 
accordance with policies established by the OPTN.
    (b) HIV. Organs from individuals known to be infected with human 
immunodeficiency virus shall not be procured for transplantation.
    (c) Acceptance criteria. Transplant programs shall establish 
criteria for organ acceptance, and shall provide such criteria to the 
OPTN and the OPOs with which they are affiliated.



Sec. 121.7  Identification of organ recipient.

    (a) List of potential transplant recipients. (1) An OPTN member 
procuring an organ shall operate the OPTN computer match program within 
such time as the OPTN may prescribe to identify and rank potential 
recipients for each cadaveric organ procured.
    (2) The rank order of potential recipients shall be determined for 
each cadaveric organ using the organ specific allocation criteria 
established in accordance with Sec. 121.8.
    (3) When a donor or donor organ does not meet a transplant program's 
donor acceptance criteria, as established under Sec. 121.6(c), 
transplant candidates of that program shall not be ranked among 
potential recipients of that organ and shall not appear on a roster of 
potential recipients of that organ.
    (b) Offer of organ for potential recipients. (1) Organs shall be 
offered for potential recipients in accordance with policies developed 
under Sec. 121.8 and implemented under Sec. 121.4.
    (2) Organs may be offered only to potential recipients listed with 
transplant programs having designated transplant programs of the same 
type as the organ procured.
    (3) An organ offer is made when all information necessary to 
determine whether to transplant the organ into the potential recipient 
has been given to the transplant hospital.
    (4) A transplant program shall either accept or refuse the offered 
organ for the designated potential recipient within such time as the 
OPTN may prescribe. A transplant program shall document and provide to 
the OPO and to the OPTN the reasons for refusal and shall maintain this 
document for one year.
    (c) Transportation of organ to potential recipient--(1) 
Transportation. The OPTN member that procures a donated organ shall 
arrange for transportation of the organ to the transplant hospital.
    (2) Documentation. The OPTN member that is transporting an organ 
shall assure that it is accompanied by written documentation of 
activities conducted to determine the suitability of the organ donor and 
shall maintain this document for one year.
    (3) Packaging. The OPTN member that is transporting an organ shall 
assure that it is packaged in a manner that is designed to maintain the 
viability of the organ.
    (d) Receipt of an organ. Upon receipt of an organ, the transplant 
hospital responsible for the potential recipient's care shall determine 
whether to proceed with the transplant. In the event that an organ is 
not transplanted into the potential recipient, the OPO which has a 
written agreement with the transplant hospital must offer the organ for 
another potential recipient in accordance with paragraph (b) of this 
section.
    (e) Wastage. Nothing in this section shall prohibit a transplant 
program from transplanting an organ into any medically suitable 
candidate if to do otherwise would result in the organ not being used 
for transplantation. The transplant program shall notify the OPTN and 
the OPO which made the organ offer of the circumstances justifying each 
such action within such time as the OPTN may prescribe.



Sec. 121.8  Allocation of organs.

    (a) Policy development. The Board of Directors established under 
Sec. 121.3 shall develop, in accordance with the policy development 
process under Sec. 121.4, organ-specific policies (including 
combinations of organs, such as for heart-

[[Page 645]]

lung transplants) for the equitable allocation of cadaveric organs among 
potential recipients. Such policies shall meet the requirements in 
paragraphs (a)(1), (2), (3), (4) and (5) of this section. Such policies 
shall be reviewed periodically and revised as appropriate.
    (1) Minimum listing criteria for including transplant candidates on 
the national list shall be standardized and, to the extent possible, 
shall contain explicit thresholds for listing a patient and be expressed 
through objective and measurable medical criteria.
    (2) Transplant candidates shall be grouped by status categories 
ordered from most to least medically urgent, with a sufficient number of 
categories to avoid grouping together persons with substantially 
different medical urgency. Criteria for status designations shall 
contain explicit thresholds for differentiating among patients and shall 
be expressed, to the extent possible, through objective and measurable 
medical criteria.
    (3) Organ allocation policies and procedures shall be in accordance 
with sound medical judgment and shall be designed and implemented:
    (i) To allocate organs among transplant candidates in order of 
decreasing medical urgency status, with waiting time in status used to 
break ties within status groups. Neither place of residence nor place of 
listing shall be a major determinant of access to a transplant. For each 
status category, inter-transplant program variance in the performance 
indicator ``waiting time in status'' shall be as small as can reasonably 
be achieved, consistent with paragraph (a)(3)(ii) of this section. 
Priority shall be given to reducing the waiting time variance in the 
most medically urgent status categories before reducing the waiting time 
variance in less urgent status categories, if equivalent reductions 
cannot be achieved in all status categories; and
    (ii) To avoid futile transplantation, to avoid wasting organs, and 
to promote efficient management of organ placement.
    (4) The OPTN shall:
    (i) Develop mechanisms to promote and review compliance with each of 
these goals;
    (ii) Develop performance indicators to facilitate assessment of how 
well current and proposed policies will accomplish these goals;
    (iii) Use performance indicators, including indicators described in 
paragraph (a)(4)(iv) of this section, to establish baseline data on how 
closely the results of current policies approach these goals and to 
establish the projected amount of improvement to result from proposed 
policies; and
    (iv) Timely report data to the Secretary on performance by organ and 
status category, including program-specific data, OPO specific data, 
data by program size, and data aggregated by organ procurement area, 
OPTN region, the nation as a whole, and such other geographic areas as 
the Secretary may designate. Such data shall include inter-transplant 
program variation in waiting time in status, total life years pre- and 
post-transplant, patient and graft survival rates following 
transplantation, patients mis-classified by status, and number of 
patients who die waiting for a transplant. Such data shall cover such 
intervals of time, and be presented using confidence intervals or other 
measures of variance, as appropriate to avoid spurious results or 
erroneous interpretation due to small numbers of patients covered.
    (5) Transition--(i) General. When the OPTN revises organ allocation 
policies under this section, it shall consider whether to adopt 
transition procedures that would treat people on the national list and 
awaiting transplantation prior to the adoption or effective date of the 
revised policies no less favorably than they would have been treated 
under the previous policies. The transition procedures shall be 
transmitted to the Secretary for review together with the revised 
allocation policies.
    (ii) Special rule for initial revision of liver allocation policies. 
When the OPTN transmits to the Secretary its initial revision of the 
liver allocation policies, as directed by paragraph (c)(2) of this 
section, it shall include transition procedures that, to the extent 
feasible, treat each individual on the national list and awaiting 
transplantation on April 2, 1998 no less favorably than he or she would 
have been treated had the

[[Page 646]]

revised liver allocation policies not become effective. These transition 
procedures may be limited in duration or applied only to individuals 
with greater than average medical urgency if this would significantly 
improve administration of the list or if such limitations would be 
applied only after accommodating a substantial preponderance of those 
disadvantaged by the change in the policies.
    (b) Secretarial review of policies and performance Indicators. The 
OPTN's transmittal to the Secretary of proposed allocation policies and 
performance indicators shall include such supporting material, including 
the results of model-based computer simulations, as the Secretary may 
require to assess the likely effects of policy changes and as are 
necessary to demonstrate that the proposed policies comply with the 
performance indicators and transition procedures of paragraph (a) of 
this section.
    (c) Deadlines for initial reviews. (1) The OPTN shall conduct an 
initial review of existing allocation policies and, except as provided 
in paragraph (c)(2) of this section, no later than October 1, 1999 
transmit initial revised policies to meet the requirements of Sec. 121.8 
(a), together with supporting documentation to the Secretary for review 
in accordance with Sec. 121.4.
    (2) No later than November 30, 1998 the OPTN shall transmit revised 
policies and supporting documentation for liver allocation to meet the 
requirements of Sec. 121.8 (a) to the Secretary for review in accordance 
with Sec. 121.4. The OPTN may transmit these materials without seeking 
further public comment under Sec. 121.4(b) or (c).
    (d) Variances. The OPTN may develop experimental policies that test 
methods of improving allocation. All such experimental policies shall be 
accompanied by a research design and include data collection and 
analysis plans. Such variances shall be time limited. Entities or 
individuals objecting to variances may appeal to the Secretary under the 
procedures of Sec. 121.4.
    (e) Directed donation. Nothing in this section shall prohibit the 
allocation of an organ to a recipient named by those authorized to make 
the donation.

[63 FR 16332, Apr. 2, 1998, as amended at 63 FR 35847, July 1, 1998]



Sec. 121.9  Designated transplant program requirements.

    (a) To receive organs for transplantation, a transplant program in a 
hospital that is a member of the OPTN shall abide by these rules and 
shall:
    (1) Be a transplant program approved by the Secretary for 
reimbursement under Medicare and Medicaid; or
    (2) Be an organ transplant program which has adequate resources to 
provide transplant services to its patients and agrees promptly to 
notify the OPTN and patients awaiting transplants if it becomes inactive 
and which:
    (i) Has letters of agreement or contracts with an OPO;
    (ii) Has on site a transplant surgeon qualified in accordance with 
policies developed under Sec. 121.4;
    (iii) Has on site a transplant physician qualified in accordance 
with policies developed under Sec. 121.4;
    (iv) Has available operating and recovery room resources, intensive 
care resources and surgical beds and transplant program personnel;
    (v) Shows evidence of collaborative involvement with experts in the 
fields of radiology, infectious disease, pathology, immunology, 
anesthesiology, physical therapy and rehabilitation medicine, 
histocompatibility, and immunogenetics and, as appropriate, hepatology, 
pediatrics, nephrology with dialysis capability, and pulmonary medicine 
with respiratory therapy support;
    (vi) Has immediate access to microbiology, clinical chemistry, 
histocompatibility testing, radiology and blood banking services, as 
well as the capacity to monitor treatment with immunosuppressive drugs; 
and
    (vii) Makes available psychiatric and social support services for 
transplant candidates, transplant recipients and their families; or
    (3) Be a transplant program in a Department of Veterans Affairs 
hospital which is a Dean's Committee hospital which shares a common 
university-based transplant team of a transplant

[[Page 647]]

program which meets the requirements of Sec. 121.9(a) (1) or (2).
    (b) To apply to be a designated transplant program, transplant 
programs shall provide to the OPTN such documents as the OPTN may 
require which show that they meet the requirements of Sec. 121.9(a) (1), 
(2), or (3).
    (c) The OPTN shall, within 90 days, accept or reject applications to 
be a designated transplant program.
    (d) Applicants rejected for designation may appeal to the Secretary. 
Appeals shall be submitted in writing within 30 days of rejection of the 
application. The Secretary may:
    (1) Deny the appeal; or
    (2) Direct the OPTN to take action consistent with the Secretary's 
response to the appeal.



Sec. 121.10  Reviews, evaluation, and enforcement.

    (a) Review and evaluation by the Secretary. The Secretary or her/his 
designee may perform any reviews and evaluations of member OPOs and 
transplant programs which the Secretary deems necessary to carry out 
her/his responsibilities under the Public Health Service Act and the 
Social Security Act.
    (b) Review and evaluation by the OPTN. (1) The OPTN shall design 
appropriate plans and procedures, including survey instruments, a peer 
review process, and data systems, for purposes of:
    (i) Reviewing applications submitted under Sec. 121.3(c) for 
membership in the OPTN;
    (ii) Reviewing applications submitted under Sec. 121.9(b) to be a 
designated transplant program; and
    (iii) Conducting ongoing and periodic reviews and evaluations of 
each member OPO and transplant hospital for compliance with these rules 
and OPTN policies.
    (2) Upon the approval of the Secretary, the OPTN shall furnish 
review plans and procedures, including survey instruments and a 
description of data systems, to each member OPO and transplant hospital. 
The OPTN shall furnish any revisions of these documents to member OPOs 
and hospitals, after approval by the Secretary, prior to their 
implementation.
    (3) At the request of the Secretary, the OPTN shall conduct special 
reviews of OPOs and transplant programs, where the Secretary has reason 
to believe that such entities may not be in compliance with these rules 
or OPTN policies or may be acting in a manner which poses a risk to the 
health of patients or to public safety. The OPTN shall conduct these 
reviews in accordance with such schedules as the Secretary specifies and 
shall make periodic reports to the Secretary of progress on such reviews 
and on other reviews conducted under the requirements of this paragraph.
    (4) The OPTN shall notify the Secretary in a manner prescribed by 
the Secretary within 3 days of all committee and Board of Directors 
meetings in which transplant hospital and OPO compliance with these 
regulations or OPTN policies is considered.
    (c) Enforcement of OPTN rules--(1) OPTN recommendations. The Board 
of Directors shall advise the Secretary of the results of any reviews 
and evaluations conducted under paragraph (b)(1)(iii) or paragraph 
(b)(3) of this section which, in the opinion of the Board, indicate 
noncompliance with these rules or OPTN policies, or indicate a risk to 
the health of patients or to the public safety, and shall provide any 
recommendations for appropriate action by the Secretary. Appropriate 
action may include removal of designation as a transplant program under 
Sec. 121.9, termination of a transplant hospital's participation in 
Medicare or Medicaid, termination of a transplant hospital's 
reimbursement under Medicare and Medicaid, or termination of an OPO's 
reimbursement under Medicare and Medicaid, if the noncompliance is with 
a policy designated by the Secretary as covered by section 1138 of the 
Social Security Act.
    (2) Secretary's action on recommendations. Upon the Secretary's 
review of the Board of Directors' recommendations, the Secretary may:
    (i) Request further information from the Board of Directors or the 
alleged violator, or both;
    (ii) Decline to accept the recommendation;

[[Page 648]]

    (iii) Accept the recommendation, and notify the alleged violator of 
the Secretary's decision; or
    (iv) Take such other action as the Secretary deems necessary.



Sec. 121.11  Record maintenance and reporting requirements.

    (a) Record maintenance. Records shall be maintained and made 
available subject to OPTN policies and applicable limitations based on 
personal privacy as follows:
    (1) The OPTN and the Scientific Registry, as appropriate, shall:
    (i) Maintain and operate an automated system for managing 
information about transplant candidates, transplant recipients, and 
organ donors, including a computerized national list of individuals 
waiting for transplants;
    (ii) Maintain records of all transplant candidates, all organ donors 
and all transplant recipients;
    (iii) Operate, maintain, receive, publish, and transmit such records 
and information electronically, to the extent feasible, except when hard 
copy is requested; and
    (iv) In making information available, provide manuals, forms, flow 
charts, operating instructions, or other explanatory materials as 
necessary to understand, interpret, and use the information accurately 
and efficiently.
    (2) Organ procurement organizations and transplant programs--(i) 
Maintenance of records. All OPOs and transplant programs shall maintain 
such records pertaining to each potential donor identified, each organ 
retrieved, each recipient transplanted and such other transplantation-
related matters as the Secretary deems necessary to carry out her/his 
responsibilities under the Act. The OPO or transplant program shall 
maintain these records for seven years.
    (ii) Access to facilities and records. OPOs and transplant hospitals 
shall permit the Secretary and the Comptroller General, or their 
designees, to inspect facilities and records pertaining to any aspect of 
services performed related to organ donation and transplantation.
    (b) Reporting requirements. (1) The OPTN and the Scientific 
Registry, as appropriate, shall:
    (i) In addition to special reports which the Secretary may require, 
submit to the Secretary a report not less than once every fiscal year on 
a schedule prescribed by the Secretary. The report shall include the 
following information in a form prescribed by the Secretary:
    (A) Information that the Secretary prescribes as necessary to assess 
the effectiveness of the Nation's organ donation, procurement and 
transplantation system;
    (B) Information that the Secretary deems necessary for the report to 
Congress required by Section 376 of the Act; and,
    (C) Any other information that the Secretary prescribes.
    (ii) Provide to the Scientific Registry data on transplant 
candidates and recipients, and other information that the Secretary 
deems appropriate. The information shall be provided in the form and on 
the schedule prescribed by the Secretary;
    (iii) Provide to the Secretary any data that the Secretary requests;
    (iv) Make available to the public timely and accurate program-
specific information on the performance of transplant programs. This 
shall include free dissemination over the Internet, and shall be 
presented, explained, and organized as necessary to understand, 
interpret, and use the information accurately and efficiently. These 
data shall be updated no less frequently than every six months and shall 
include three month, one year, three year and five year graft and 
patient survival rates, both actual and statistically expected, and 
shall be presented no more than six months later than the period to 
which they apply. Data presented shall include confidence intervals or 
other measures that provide information on the extent to which chance 
may influence transplant program-specific results. Such data shall also 
include such other cost or performance information as the Secretary may 
specify, including but not limited to transplant program-specific 
information on waiting time within medical status, organ wastage, and 
refusal of

[[Page 649]]

organ offers. These data shall also be presented no more than six months 
later than the period to which they apply;
    (v) Respond to reasonable requests from the public for data needed 
for bona fide research or analysis purposes, to the extent that the 
OPTN's or Scientific Registry's resources permit, or as directed by the 
Secretary. The OPTN or the Scientific Registry may impose reasonable 
charges for the separable costs of responding to such requests. Patient-
identified data may be made available to bona fide researchers upon a 
showing that the research design requires such data for matching or 
other purposes, and that appropriate confidentiality protections, 
including destruction of patient identifiers upon completion of 
matching, will be followed. All requests shall be processed 
expeditiously, with data normally made available within 30 days from the 
date of request;
    (vi) Respond to reasonable requests from the public for data needed 
to assess the performance of the OPTN or Scientific Registry, to assess 
individual transplant programs, or for other purposes. The OPTN or 
Scientific Registry may impose charges for the separable costs of 
responding to such requests. An estimate of such charges shall be 
provided to the requester before processing the request. All requests 
should be processed expeditiously, with data normally made available 
within 30 days from the date of request; and
    (vii) Provide data to an OPTN member, without charge, that has been 
assembled, stored, or transformed from data originally supplied by that 
member.
    (2) An organ procurement organization or transplant hospital shall, 
as specified from time to time by the Secretary, submit to the OPTN, to 
the Scientific Registry, as appropriate, and to the Secretary 
information regarding transplantation candidates, transplant recipients, 
donors of organs, transplant program performance, and other information 
that the Secretary deems appropriate. Such information shall be in the 
form required and shall be submitted in accordance with the schedule 
prescribed. No restrictions on subsequent redisclosure may be imposed by 
any organ procurement organization or transplant hospital.
    (c) Public access to data. The Secretary may release to the public 
information collected under this section when the Secretary determines 
that the public interest will be served by such release. The information 
which may be released includes, but is not limited to, information on 
the comparative costs and patient outcomes at each transplant program 
affiliated with the OPTN, transplant program personnel, information 
regarding instances in which transplant programs refuse offers of organs 
to their patients, information regarding characteristics of individual 
transplant programs, information regarding waiting time at individual 
transplant programs, and such other data as the Secretary determines 
will provide information to patients, their families, and their 
physicians that will assist them in making decisions regarding 
transplantation.



Sec. 121.12  Preemption.

    No State or local governing entity shall establish or continue in 
effect any law, rule, regulation, or other requirement that would 
restrict in any way the ability of any transplant hospital, OPO, or 
other party to comply with organ allocation policies of the OPTN or 
other policies of the OPTN that have been approved by the Secretary 
under this part.



PART 124--MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION--Table of Contents




 Subpart A--Project Grants for Public Medical Facility Construction and 
                              Modernization

Sec.
124.1  Applicability.
124.2  Definitions.
124.3  Eligibility.
124.4  Application.
124.5  Grant evaluation and award.
124.6  Grant payments.
124.7  Use of grant funds.
124.8  Grantee accountability.
124.9  Nondiscrimination.
124.10  Additional conditions.
124.11  Applicability of 45 CFR part 74.

[[Page 650]]

Subparts B-E  [Reserved]

Subpart F--Reasonable Volume of Uncompensated Services to Persons Unable 
                                 to Pay

124.501  Applicability.
124.502  Definitions.
124.503  Compliance level.
124.504  Notice of availability of uncompensated services.
124.505  Eligibility criteria.
124.506  Allocation of services; plan requirement.
124.507  Written determinations of eligibility.
124.508  Cessation of uncompensated services.
124.509  Reporting requirements.
124.510  Record maintenance requirements.
124.511  Investigation and determination of compliance.
124.512  Enforcement.
124.513  Public facility compliance alternative.
124.514  Compliance alternative for facilities with small annual 
          obligations.
124.515  Compliance alternative for community health centers, migrant 
          health centers and certain National Health Service Corps 
          sites.
124.516  Charitable facility compliance alternative.
124.517  Agreements with State agencies.

                      Subpart G--Community Service

124.601  Applicability.
124.602  Definitions.
124.603  Provision of services.
124.604  Posted notice.
124.605  Reporting and record maintenance requirements.
124.606  Investigation and enforcement.
124.607  Agreements with State agencies.

Appendix to Subpart G--Interim Procedures and Criteria for Review by 
          Health Systems Agencies of Applications under Section 1625 of 
          the Public Health Service Act

                   Subpart H--Recovery of Grant Funds

124.701  Applicability.
124.702  Definitions.
124.703  Federal right of recovery.
124.704  Notification of sale, transfer, or change of use.
124.705  Amount of recovery.
124.706  Calculation of interest.
124.707  Waiver of recovery where facility is sold or transferred to a 
          proprietary entity.
124.708  Waiver of recovery--good cause for other use of facility.
124.709  Withdrawal of waiver.

    Authority: Secs. 215, 1602, 1625, Public Health Service Act (42 
U.S.C. 216, 300o-1, 300r), unless otherwise noted.

    Source: 42 FR 62270, Dec. 9, 1977, unless otherwise noted.



 Subpart A--Project Grants for Public Medical Facility Construction and 
                              Modernization



Sec. 124.1  Applicability.

    The regulations of this subpart are applicable to grants under 
section 1625 of the Public Health Service Act for construction and 
modernization projects designed to:
    (a) Eliminate or prevent imminent safety hazards as defined by 
Federal, State or local fire, building, or life safety codes or 
regulations, or
    (b) Avoid noncompliance with State or voluntary licensure or 
accreditation standards.



Sec. 124.2  Definitions.

    As used in this subpart:
    (a) Act means the Public Health Service Act, as amended.
    (b) Construction means construction of new buildings and initial 
equipment of such buildings and, in any case in which it will help to 
provide a service not previously provided in the community, equipment of 
any buildings. It includes architect's fees, but excludes the cost of 
off-site improvements and, except with respect to public health centers, 
the cost of the acquistion of land.
    (c) Cost means the amount found by the Secretary to be necessary for 
construction or modernization under a project, except that such term 
does not include any amount found by the Secretary to be attributable to 
expansion of the bed capacity of any facility.
    (d) Equipment means those items which are necessary for the 
functioning of the facility but does not include items of current 
operating expense such as food, fuel, pharmaceuticals, dressings, paper, 
printed forms, and housekeeping supplies.
    (e) Facility for long-term care means a facility (including a 
skilled nursing care or intermediate care facility), providing inpatient 
care for convalescent or chronic disease patients who require skilled 
nursing or intermediate care and related medical services:

[[Page 651]]

    (1) Which is a hospital (other than a hospital primarily for the 
care and treatment of mentally ill or tuberculosis patients) or is 
operated in connection with a hospital, or
    (2) In which such care and medical services are prescribed by, or 
are performed under the general direction of, persons licensed to 
practice medicine or surgery in the State.
    (f) Health systems agency means an agency which has been 
conditionally or fully designated pursuant to section 1515 of the Act 
and 42 CFR part 122.
    (g) Hospital includes general, tuberculosis, and other types of 
hospitals, and related facilities such as laboratories, outpatient 
departments, nurses' home facilities, extended care facilities, 
facilities related to programs for home health services, self-care 
units, and central service facilities, operated in connection with 
hospitals, and education or training facilities for health professional 
personnel operated as an integral part of a hospital, but does not 
include any facility furnishing primarily domiciliary care.
    (h) Major repair means those repairs to an existing building, 
excluding routine maintenance, which restore the building to a sound 
state, the cost of which is a least 10 percent of plant value or 
$200,000, whichever is greater. Plant value means the historic book 
value of the building at the time of application for assistance under 
this subpart.
    (i) Medical facility means a hospital, public health center, 
outpatient medical facility, rehabilitation facility, or a facility for 
long-term care.
    (j) Modernization means the alteration, expansion (excluding 
expansion which increases bed capacity), major repair, remodeling, 
replacement, and renovation of existing buildings (including initial 
equipment thereof), and the replacement of obsolete equipment of 
existing buildings, including energy conservation projects.
    (k) Outpatient medical facility means a facility, located in or 
apart from a hospital, for the diagnosis or diagnosis and treatment of 
ambulatory patients (including ambulatory inpatients):
    (1) Which is operated in connection with a hospital, or
    (2) In which patient care of a specialized nature (such as in an eye 
clinic, dental clinic, or ambulatory surgical center) is provided under 
the professional supervision of persons licensed to practice medicine or 
surgery in the State, or in the case of dental diagnosis or treatment, 
under the professional supervision of persons licensed to practice 
dentistry in the State, or
    (3) Which offers to patients not requiring hospitalization the 
services of licensed physicians in various medical specialties, and 
which provides to its patients a reasonably full range of diagnostic and 
treatment services.
    (l) Public health center means a publicly owned facility for the 
provision of public health services, including related facilities such 
as laboratories, clinics, and administrative offices operated in 
connection with such a facility.
    (m) Quasi-public corporation means a private, nonprofit corporation 
which has been formally given one or more governmental powers by a 
general-purpose unit of government to enable it to carry out its work.
    (n) Rehabilitation facility means a facility which is operated for 
the primary purpose of assisting in the rehabilitation of disabled 
persons through an integrated program of medical evaluation and 
services, and psychological, social, or vocational evaluation and 
services, under competent professional supervision, and in the case of 
which the major portion of the required evaluation and services is 
furnished within the facility; and either the facility is operated in 
connection with a hospital, or all medical and related health services 
are prescribed by, or are under the general direction of persons 
licensed to practice medicine or surgery in the State.
    (o) Secretary means the Secretary of Health and Human Services and 
any other officer or employee of the Department of Health and Human 
Services to whom the authority involved has been delegated.
    (p) State means any one of the several States, the Commonwealth of 
Puerto Rico, Guam, American Samoa, the Trust Territory of the Pacific 
Islands, the Virgin Islands, and the District of Columbia.

[[Page 652]]

    (q) State health planning and development agency or State Agency 
means the agency of a State government which has been conditionally or 
fully designated under section 1521 of the Act and 42 CFR part 123.
    (r) Title means a fee simple, or such other estate or interest in 
the project site (including a leasehold on which the rental does not 
exceed 4 percent of the value of the land) as the Secretary finds 
sufficient to assure undisturbed use and possession for the purpose of 
construction or modernization and operation of the project for a period 
of not less than twenty years.
    (s) Urban or rural poverty area means a census tract, census county 
division, or minor civil division, as applicable, in which the 
percentage of the residents with incomes below the poverty level, as 
defined by the Secretary of Commerce is not less than the percentage 
derived in accordance with the following sentence. This percentage shall 
be derived so that the percentage of the total population of the United 
States residing in all such areas is equal to the percentage of the 
total population of the United States with incomes below such poverty 
level, plus five percent.



Sec. 124.3  Eligibility.

    (a) Eligible applicants. A grant under section 1625 may only be made 
to a State or political subdivision of a State, including any city, 
town, county, borough, hospital district authority, or public or quasi-
public corporation for a project described in paragraph (b) of this 
section for a medical facility owned, operated, or owned and operated by 
the State or political subdivision.
    (b) Eligible project. A grant under section 1625 may be made only 
for a construction and/or modernization project designed to:
    (1) Eliminate or prevent safety hazards which under Federal, State, 
and/or local fire, building or life safety codes or regulations, will, 
in the judgment of the Secretary result in one or more of the following:
    (i) Loss of licensure for the facility.
    (ii) Closing of all or a substantial part of the facility,
    (iii) Loss of eligibility for reimbursement under title XVIII or 
title XIX of the Social Security Act; or
    (2) Avoid noncompliance with State licensure or voluntary 
accreditation standards where noncompliance will, in the judgment of the 
Secretary, result in one or both of the following:
    (i) Loss of licensure for the facility,
    (ii) Loss of accreditation resulting in loss of eligibility for 
reimbursement under title XVIII or title XIX of the Social Security Act.



Sec. 124.4  Application.

    An application for a grant under this subpart must be submitted 
directly to the Secretary at such time and in such form and manner as 
the Secretary may prescribe. The application must be executed by an 
individual authorized to act for the applicant and assume on behalf of 
the applicant the obligations imposed by the Act, this subpart, and the 
terms and conditions of the grant. The application must contain the 
following:
    (a) A description of the site of the project.
    (b) A full description, with all appropriate documentation, of:
    (1) The imminent safety hazards, licensure and/or accreditation 
problems of the facility;
    (2) The type and amount of assistance sought under this subpart;
    (3) The construction of modernization project for which funds are 
sought, describing how it will remedy the problems described pursuant to 
paragraph (b)(1) of this section, with a complete schedule for the 
proposed construction or modernization; and
    (4) How failure to remedy the problems described pursuant to 
paragraph (b) (1) of this section will affect the population served by 
the facility.
    (c) In the case of a modernization project for continuation of 
existing health services, a finding by the State Agency of the continued 
need for such services. In the case of a construction or modernization 
project for new health services, a finding by the State Agency of the 
need for such services. The finding of need shall be based on the 
following criteria:

[[Page 653]]

    (1) In a State which has a program approved by the Secretary under 
section 1523(a)(4)(B) of the Act, a State certificate of need program, 
or a program under section 1122 of the Social Security Act, the State 
Agency shall use the criteria used in conducting reviews under such 
program. In a State which has more than one such program, the State 
Agency shall use the criteria of one of the programs and notify the 
Secretary of the program criteria used.
    (2) In a State which does not have a program approved by the 
Secretary under section 1523(a)(4)(B) of the Act, a State certificate of 
need program or a program under section 1122 of the Social Security Act, 
the State Agency shall base its finding of need on the following 
criteria:
    (i) Whether the proposed project is needed or projected as necessary 
to meet the needs in the community in terms of health services required; 
Provided, That projects for highly specialized services (such as open-
heart surgery, renal transplantation, or radiation therapy) which will 
draw from patient populations outside the community in which the project 
is situated will receive appropriate consideration;
    (ii) Whether the proposed project can be adquately staffed and 
operated when completed;
    (iii) Whether the proposed capital expenditure is economically 
feasible and can be accommodated in the patient charge structure of the 
health facility without unreasonable increases; and
    (iv) Whether the project will foster cost containment or improved 
quality of care through improved effciency and productivity, including 
promotion of cost-effective factors such as ambulatory care, preventive 
health care services, home health care, and design and construction 
economies, or through increased competition between different health 
services delivery systems.
    (d) [Reserved]
    (e) An assurance that adequate financial support will be available 
for completion of the project, supported by a detailed project budget 
satisfactory to the Secretary which includes all existing and 
anticipated sources of funds for the project.
    (f) An assurance that adequate financial support will be available 
for maintenance and operation of the project when completed, supported 
by budgets and detailed expenditure and revenue information satisfactory 
to the Secretary for both the facility and the applicant for the past 
three fiscal years and budget and projections of expenditures and 
revenue for the future three fiscal years. Where a certificate of need 
or a favorable finding under section 1122 of the Social Security Act is 
required in order for the project to operate and/or receive 
reimbursement from governmental programs for health services provided, 
assurance from the applicant satisfactory to the the Secretary that the 
applicant will submit, consistent with the provisions of Sec. 124.5(d), 
any such required certificates of need and/or section 1122 finding.
    (g) An assurance that the applicant would not be able to complete 
the project without the grant applied for, supported by a description of 
all efforts to obtain funds needed to complete the project and the 
results of such efforts.
    (h) An assurance that all times after the application is approved 
there will be made available in the facility or portion thereof to be 
constructed or modernized, a reasonable volume of services to persons 
unable to pay therefor. The applicant shall comply with the standards 
and procedures of 42 CFR 53.111, except as the Secretary may prescribe 
pursuant to section 1602(6) of the Act. The functions of the State 
Agency designated under section 604 of the Act under 42 CFR 53.111 will 
be performed by the Secretary, except to the extent they are otherwise 
assigned.
    (i) An assurance that at all times after the application is approved 
the facility or portion thereof to be constructed or modernized will be 
made available to all persons residing or employed in the area served by 
the facility. The applicant shall comply with the standards and 
procedures of 42 CFR 53.113, except as the Secretary may prescribe 
pursuant to section 1602(6) of the Act. The functions of the State 
Agency designated under section 604 of the Act under 42 CFR 53.113 will 
be performed by the Secretary, except to the extent they are otherwise 
assigned.

[[Page 654]]

    (j) An assurance that title to the project site is or will be vested 
in one or more of the entities filing the application or in a public or 
other nonprofit entity which is to operate the facility on completion of 
the project, with such documentation as the Secretary may require.
    (k) In the case of an application for construction or modernization 
of an outpatient medical facility, an assurance, supported by a written 
transfer agreement (or written documentation that such agreement will be 
obtained) with identified hospitals, that the services of a general 
hospital will be available to patients at such facility who are in need 
of hospital care.
    (l) Evidence that: (1) The appropriate health systems agency has 
been given the opportunity to review the application in accordance with 
section 1513(e) of the Act and the requirements of the appendix to this 
subpart, with the result of any such review.
    (2) The application has been reviewed in accordance with the 
applicable requirements of OMB Circular A-95.
    (m) An analysis satisfactory to the Secretary and such other 
information and materials as the Secretary may require concerning the 
environmental impact of the proposed construction or modernization 
project.
    (n) An assessment satisfactory to the Secretary of the project site 
in light of the considerations set forth in Executive Order 11296 (31 FR 
10663, August 10, 1966) concerning the evaluation of flood hazards in 
locating Federally supported facilities.
    (o) In the case of a project which involves the displacement of 
persons or businesses, an assurance that the applicant will comply with 
the applicable provisions of the Uniform Relocation Assistance and Real 
Property Acquisition Policies Act of 1970 (42 U.S.C. 4601 et seq.).
    (p)(1) An assurance that all laborers and mechanics employed by 
contractors or subcontractors in the performance of work on a project 
will be paid wages at rates not less than those prevailing on similar 
construction in the locality as determined by the Secretary of Labor in 
accordance with the Act of March 3, 1931 (40 U.S.C. 276a-276a-5, known 
as the Davis-Bacon Act); and
    (2) An assurance that the following conditions and provisions will 
be included in all construction contracts:
    (i) The provisions of ``DHHS Requirements for Federally Assisted 
Construction Contracts Regarding Labor Standards and Equal Employment 
Opportunity,'' Form DHHS 514 (rev. July 1976) (issued by the Office of 
Grants and Procurement Management, U.S. Department of Health and Human 
Services) pertaining to the Davis-Bacon Act, the Contract Work Hours 
Standards Act, and the Copeland Act (Anti-Kickback) regulations except 
in the case of contracts in the amount of $2,000 or less; and pertaining 
to Executive Order 11246, September 24, 1965 (30 FR 12319), relating to 
nondiscrimination in construction contract employment except in the case 
of contracts in the amount of $10,000 or less, and
    (ii) Representatives of the Secretary will have access at all 
reasonable times to work wherever it is in preparation or progress, and 
the contractor shall provide proper facilities for such access and 
inspection.
    (q) Such other information as the Secretary may require.

[42 FR 62270, Dec. 9, 1977, as amended at 49 FR 33021, Aug. 20, 1984]



Sec. 124.5  Grant evaluation and award.

    (a)(1) Within the limits of funds available for such purpose, the 
Secretary may award grants under this subpart for project costs to 
applicants with approvable applications therefor which will, in his 
judgment, best promote the purposes of section 1625 of the Act, taking 
into consideration:
    (i) The severity and seriousness of the safety hazard, licensure or 
accreditation problem or problems.
    (ii) The relative need of the population to be served for the 
services to be provided, including the availability of alternatives for 
meeting the need.
    (iii) The financial need of the applicant.
    (iv) The extent to which the facility will serve persons below the 
poverty level, as determined by the Secretary of Commerce.

[[Page 655]]

    (v) The extent to which the project will foster cost containment or 
improve the quality of care through enhanced efficiency and 
productivity.
    (2) Priority for funding shall be based on the extent to which 
services will be made available relative to the cost of the project.
    (b) The amount of any grant under this subpart may not exceed 75 
percent of the cost of the project for which the grant is made unless 
the project is located in an area determined by the Secretary to be an 
urban or rural poverty area, in which case the grant may, as determined 
by the Secretary, cover up to 100 percent of such costs.
    (c) If an applicant has not entered into a legally enforceable fixed 
price contract for the project for which funds are awarded under this 
subpart within 180 days of the date of the grant award, the grant award 
will automatically become null and void.
    (d) Where a grant has been awarded to an applicant under this 
subpart on the condition that any applicable certificates of need and 
section 1122 finding required under Sec. 124.4(f) will be provided, if 
such certificates and finding have not been received by the Secretary 
within 180 days of the grant award, the grant award will automatically 
become null and void.



Sec. 124.6  Grant payments.

    Grant payments shall be made to the applicant in accordance with the 
requirements of subpart K of 45 CFR part 74.



Sec. 124.7  Use of grant funds.

    Any funds granted pursuant to this subpart, as well as funds assured 
by the applicant for the project, shall be expended solely for carrying 
out the approved project in accordance with section 1625 of the Act, the 
regulations of this subpart, the terms and conditions of the grant 
award, and the applicable cost principles prescribed by subpart Q of 45 
CFR part 74.



Sec. 124.8  Grantee accountability.

    (a) Records requirements. (1) Applicants who have received Federal 
assistance under this subpart shall maintain, in accounting records 
which are separate from the records of all other funds, records which 
fully disclose the following:
    (i) The amount of all payments received from the Secretary under 
this subpart,
    (ii) Amounts and sources of all funds, in addition to funds received 
under this subpart, applied to the construction or modernization project 
funded under this subpart,
    (iii) Disposition of all funds for the construction or modernization 
project funded under this subpart,
    (iv) Total cost of the project approved under this subpart, and
    (2) Upon request, applicants shall make such records, books, papers, 
or other documents available to the Secretary and the Comptroller 
General of the United States or any of their duly authorized 
representatives which, in their opinion, may be related or pertinent to 
the grant under this subpart.
    (b) Annual financial statement. An applicant who receives grant 
assistance under this subpart shall, not later than 120 days after the 
end of its fiscal year, unless a longer period is approved by the 
Secretary for good cause shown, file an annual financial statement which 
meets the requirements of section 1634 of the Act.



Sec. 124.9  Nondiscrimination.

    (a) Attention is called to the requirements of title VI of the Civil 
Rights Act of 1964 (78 Stat. 252, 42 U.S.C. 2000d et seq.) and in that 
particular section 601 of such Act which provides that no person in the 
United States shall, on the grounds of race, color or national origin be 
excluded from participation in, be denied the benefits of, or be 
subjected to discrimination under any program or activity receiving 
Federal financial assistance. A regulation implementing such title VI, 
which is applicable to grants made under this subpart, has been issued 
by the Secretary with the approval of the President (45 CFR part 80).
    (b) Attention is called to the requirements of section 504 of the 
Rehabilitation Act of 1973, as amended, which provides that no otherwise 
qualified handicapped individual in the United States shall, solely by 
reason of the handicap, be excluded from participation in, be denied the 
benefits of, or be

[[Page 656]]

subjected to discrimination under any program or activity receiving 
Federal financial assistance. A regulation implementing section 504 has 
been issued (45 CFR part 84 (42 FR 22676, May 4, 1977)).
    (c) All portions and services of the entire facility for the 
construction or modernization of which, or in connection with which aid 
under the Act is sought must be made available without discrimination on 
account of creed and the applicant may not discriminate against any 
qualified person on account of creed with respect to the privilege of 
professional practice in the facility.
    (d) Attention is also called to the requirements of title IX of the 
Education amendments of 1972 and in particular to section 901 of such 
Act (20 U.S.C. 1681) which provides that no person in the United States 
shall, on the basis of sex be excluded from participation in, be denied 
the benefits of, or be subjected to discrimination under any education 
program or activity receiving Federal financial assistance (45 CFR part 
86).
    (e) Each construction contract is subject to the condition that the 
applicant shall comply with the requirements of section 321 of the 
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and 
Rehabilitation Act of 1970, as amended, which provides that alcohol 
abusers and alcoholics who are suffering from medical conditions shall 
not be discriminated against in admission or treatment, solely because 
of their alcohol abuse or alcoholism by any private or public general 
hospital that receives support in any form from any federally funded 
program.
    (f) Each construction contract is subject to the condition that the 
applicant shall comply with the requirements of section 407 of the Drug 
Abuse Office and Treatment Act of 1972, as amended, which provides that 
drug abusers who are suffering from medical conditions shall not be 
discriminated against because of their drug abuse or drug dependence, by 
any private or public general hospital that receives support in any form 
from any federally funded program.



Sec. 124.10  Additional conditions.

    The Secretary may impose additional conditions prior to or at the 
time of any grant award when in the Secretary's judgment such conditions 
are necessary to assure or protect advancement of the project in 
accordance with the purposes of the Act and the regulations of this 
subpart or the conservation of grant funds.



Sec. 124.11  Applicability of 45 CFR part 74.

    The provisions of 45 CFR part 74, establishing uniform 
administrative requirements and cost principles, shall apply to all 
grants under this subpart to State and local governments as those terms 
are defined in subpart A of that part 74, except to the extent 
inconsistent with this subpart. The relevant provisions of the following 
subparts of part 74 shall also apply to grants to all other grantee 
organizations under this subpart.

                             45 CFR Part 74

Subpart:
A  General.
B  Cash depositories.
C  Bonding and insurance.
F  Grant-related income.
G  Matching and cost sharing.
L  Budget revision procedures.
M  Grant closeout, suspension, and termination.
O  Property.
P  Procurement standards.
Q  Cost principles.

Subparts B-E  [Reserved]



Subpart F--Reasonable Volume of Uncompensated Services to Persons Unable 
                                 to Pay

    Authority: 42 U.S.C. 216; 42 U.S.C. 300s(3).

    Source: 52 FR 46031, Dec. 3, 1987, unless otherwise noted.



Sec. 124.501  Applicability.

    (a) The provisions of this subpart apply to any recipient of Federal 
assistance under title VI or XVI of the Public Health Service Act that 
gave an assurance that it would make available, in the facility or 
portion of the facility constructed, modernized or

[[Page 657]]

converted with that assistance, a reasonable volume of services to 
persons unable to pay for the services.
    (b) The provisions of this subpart apply to facilities for the 
following periods:
    (1) Facilities assisted under title VI. Except as otherwise herein 
provided, a facility assisted under title VI of the Act shall provide 
uncompensated services at the annual compliance level required by 
Sec. 124.503(a) for:
    (i) Twenty years after the completion of construction, in the case 
of a facility for which the Secretary provided grant assistance under 
section 606 of the Act; or
    (ii) The period from completion of construction until the amount of 
a direct loan under sections 610 and 623 of the Act, or the amount of a 
loan with respect to which the Secretary provided a guarantee and 
interest subsidy under section 623 of the Act, is repaid, in the case of 
a facility for which such a loan was made.
    (iii) ``Completion of construction'' means:
    (A) The date on which the Secretary determines the facility was 
opened for service;
    (B) If the opening date is not available, it means the date on which 
the Secretary approved the final part of the facility's application for 
assistance under title VI of the Act;
    (C) If the date of final approval is not available, it means 
whatever date the Secretary determines most reasonably approximates the 
date of final approval.
    (2) Facilities assisted under title XVI. The provisions of this 
subpart apply to a facility assisted under title XVI of the Act at all 
times following the Secretary's approval of the facility's application 
for assistance under title XVI, except that if the facility does not at 
the time of that approval provide health services, the assurance applies 
at all times following the facility's initial provision of health 
services to patients, as determined by the Secretary.



Sec. 124.502  Definitions.

    As used in this subpart--
    (a) Act means the Public Health Service Act, as amended.
    (b) Allowable credit for services provided to a specific patient 
means the lesser of the facility's usual charge for those services, or 
the usual charge multiplied by the percentage which the total allowable 
cost as reported by the facility in the facility's preceding fiscal year 
under title XVIII of the Social Security Act (42 U.S.C. 1395, et seq.) 
and the implementing regulations (42 CFR part 413) bears to the 
facility's total patient revenues for the year.
    (c) Applicant means a person who requests uncompensated services or 
on whose behalf uncompensated services are requested.
    (d) CPI means the National Consumer Price Index for medical care.
    (e) Facility means an entity that received assistance under title VI 
or XVI of the Act and provided an assurance that it would provide a 
reasonable volume of services to persons unable to pay for the services.
    (f) Federal assistance means assistance received by the facility 
under title VI or title XVI of the Act and any assistance supplementary 
to that title VI or title XVI assistance received by the facility under 
any of the following acts: the District of Columbia Medical Facilities 
Construction Act of 1968, 82 Stat. 631 (Pub. L. 90-457); the Public 
Works Acceleration Act of 1962 (42 U.S.C. 2641, et seq.); the Public 
Works and Economic Development Act of 1965 (42 U.S.C. 3121, et seq.); 
the Appalachian Regional Development Act of 1965, as amended (40 U.S.C. 
App.); the Local Public Works Capital Development and Investment Act of 
1976 (Pub. L. 94-369). In the case of a loan guaranteed by the Secretary 
with an interest subsidy, the amount of Federal assistance under title 
VI or title XVI for a fiscal year is the total amount of the interest 
subsidy that the Secretary will have paid by the close of that fiscal 
year, as well as any other payments which the Secretary has made as of 
the beginning of the fiscal year on behalf of the facility in connection 
with the loan guarantee or the direct loan which has been sold.
    (g) Fiscal year means the facility's fiscal year.
    (h) Nursing home means a facility which received Federal assistance 
for and operates as a facility for long-term

[[Page 658]]

care as defined at, as applicable, section 645(h) or section 1624(6) of 
the Act.
    (i) Operating costs for any fiscal year means the total operating 
expenses of a facility as set forth in an audited financial statement, 
minus the amount of reimbursement, if any, received (or if not received, 
claimed) in that year under titles XVIII and XIX of the Social Security 
Act.
    (j) Persons unable to pay means persons who meet the eligibility 
criteria set out in Sec. 124.505.
    (k) Request for uncompensated services means any indication by or on 
behalf of an individual seeking services of the facility of the 
individual's inability to pay for services. A request for uncompensated 
services may be made at any time, including following institution of a 
collection action against the individual.
    (l) Secretary means the Secretary of Health and Human Services or 
[his or her] delegatee.
    (m) Uncompensated services means:
    (1) For facilities other than those certified under Sec. 124.513, 
Sec. 124.514, Sec. 124.515, or Sec. 124.516, health services that are 
made available to persons unable to pay for them without charge or at a 
charge which is less than the allowable credit for those services. The 
amount of uncompensated services provided in a fiscal year is the total 
allowable credit for services less the amount charged for the services 
following an eligibility determination. Excluded are services provided 
more than 96 hours following notification to the facility by a peer 
review organization that it disapproved the services under section 
1155(a)(1) or section 1154(a)(1) of the Social Security Act.
    (2) For facilities certified under Sec. 124.513, Sec. 124.514, 
Sec. 124.515, or Sec. 124.516, services as defined in paragraph (m)(1) 
of this section and services that are made available to persons unable 
to pay for them under programs described by the documentation provided 
under Sec. 124.513(c)(2), Sec. 124.514(c)(2), or Sec. 124.516(c)(2), as 
applicable, or pursuant to the terms of the applicable grant or 
agreement as provided in Sec. 124.515. Except as provided in 
Sec. 124.516, excluded are services reimbursed by Medicare, Medicaid, or 
other third party programs, including services for which reimbursement 
was provided as payment in full, and services provided more than 96 
hours following notification to the facility by a peer review 
organization that it disapproved the services under section 1155(a)(1) 
or section 1154(a)(1) of the Social Security Act.

[52 FR 46031, Dec. 3, 1987, as amended at 59 FR 44639, Aug. 30, 1994]



Sec. 124.503  Compliance level.

    (a) Annual compliance level. Subject to the provisions of this 
subpart, a facility is in compliance with its assurance to provide a 
reasonable volume of services to persons unable to pay if it provides 
for the fiscal year uncompensated services at a level not less than the 
lesser of--
    (1) Three percent of its operating costs for the most recent fiscal 
year for which an audited financial statement is available;
    (2) Ten percent of all Federal assistance provided to or on behalf 
of the facility, adjusted by a percentage equal to the percentage change 
in the CPI between the year in which the facility received assistance or 
1979, whichever is later, and the most recent year for which a published 
index is available.
    (b) Deficits. If in any fiscal year a facility fails to meet its 
annual compliance level, it shall provide uncompensated services in an 
amount sufficient to make up that deficit in subsequent years, and its 
period of obligation shall be extended until the deficit is made up.
    (1) Types of deficits. For purposes of determining the timing and 
amount of any deficit make-up, there are two types of deficits:
    (i) Justifiable deficits. A justifiable deficit is one in which the 
facility did not meet its annual compliance level due to either 
financial inability (as determined under Sec. 124.511(c)) or, although 
otherwise in compliance with this subpart, a lack of eligible applicants 
for uncompensated services during the fiscal year.
    (ii) Noncompliance deficits. A noncompliance deficit is one in which 
the facility failed to meet its annual compliance level due to 
noncompliance with this subpart.
    (2) Timing of deficit make-up--(i) Justifiable deficits. (A) A 
facility assisted

[[Page 659]]

under title VI of the Act may make up a justifiable deficit at any time 
during its period of obligation or in the year (or years, if necessary) 
immediately following its period of obligation.
    (B) A facility assisted under title XVI of the Act is not required 
to make up a justifiable deficit.
    (ii) Noncompliance deficits. (A) A facility must begin to make up a 
noncompliance deficit in the fiscal year following the finding of 
noncompliance by the Secretary.
    (B) A facility which claimed financial inability under 
Sec. 124.509(a)(2)(iii) and is found by the Secretary, pursuant to 
Sec. 124.511(c), to have been financially able to provide uncompensated 
services in the year in which the deficit was incurred shall begin to 
make up the deficit beginning in the fiscal year following the 
Secretary's finding.
    (C) A facility required to make up a noncompliance deficit but which 
is determined by the Secretary, pursuant to Sec. 124.511(c), to be 
financially unable to do so in the year following the Secretary's 
finding of noncompliance shall make up the deficit in accordance with a 
schedule set by the Secretary.
    (3) Deficit make-up amount. (i) The amount of a deficit in any 
fiscal year is the difference between the facility's annual compliance 
level for that year and the amount of uncompensated services provided in 
that year.
    (ii) The amount of a justifiable deficit must be adjusted by a 
percentage equal to the percentage change in the CPI between the CPI 
available in the fiscal year in which the deficit was incurred and the 
CPI available in the fiscal year in which it was made up.
    (iii) An amount equal to the result of dividing the amount of any 
noncompliance deficit for a fiscal year by the number of years of 
obligation remaining and adjusting it by a percentage equal to the 
percentage change in the CPI between the CPI available in the fiscal 
year in which the deficit was incurred and the CPI available in the 
fiscal year in which it was made up shall be added to a facility's 
annual compliance level for each fiscal year following the fiscal year 
of the finding of noncompliance.
    (4) Affirmative action plan for precluding future deficits. Except 
where a facility reports to the Secretary in accordance with 
Sec. 124.509(a)(2)(iii) that it was financially unable to provide 
uncompensated services at the annual compliance level, a facility that 
fails to meet its annual compliance level in any fiscal year shall, in 
the following year, develop and implement a plan of action that can 
reasonably be expected to enable the facility to meet its annual 
compliance level. Such actions may include special notice to the 
community through newspaper, radio, and television, or expansion of 
service to Category B, or, with respect to nursing homes, Category C, 
persons. The Secretary may require changes to the plan. Where a facility 
fails to comply with this section, the Secretary may require it to make 
up the deficit in the fiscal year following the year in which it was 
required to institute the plan.
    (c) Excesses. (1) Except for facilities certified under 
Sec. 124.513, Sec. 124.514, or Sec. 124.515, if a facility provides in a 
fiscal year uncompensated services in an amount exceeding its annual 
compliance level, it may apply the amount of excess to reduce its annual 
compliance level in any subsequent fiscal year. The facility may use any 
excess amount to reduce its annual compliance level only if the services 
in excess of the annual compliance level are provided in accordance with 
the requirements of this subpart.
    (2) Calculation and adjustment of excess. (i) The amount of an 
excess in uncompensated services in any fiscal year is the difference 
between the amount of uncompensated services the facility provided in 
that year and the facility's annual compliance level for that year.
    (ii) The amount of any excess compliance applied to reduce a 
facility's annual compliance level must be adjusted by a percentage 
equal to the percentage change in the CPI between the CPI available in 
the fiscal year in which the facility provided the excess, and the CPI 
available in the fiscal year in which the facility applies the excess to 
reduce its annual compliance level or satisfy its remaining obligation.
    (3) Except as provided in subparagraph (1) of this paragraph, a 
facility assisted under title VI may in any fiscal year apply the amount 
of excess

[[Page 660]]

credited under this paragraph to satisfy the remainder of its obligation 
to provide uncompensated services. A facility's remaining obligation is 
determined as follows:
    (i) Where the annual compliance level in such fiscal year is 
established under paragraph (a)(2) of this section, the remaining 
obligation is:
    (A) For grant assistance, 10 percent of each grant under obligation, 
multiplied by the number of years remaining in its period of obligation, 
adjusted as provided for in paragraph (a)(2) of this section, plus any 
deficits required to be made up and less any unused excesses accrued in 
prior years; and
    (B) For loan assistance, the facility's annual compliance level 
multiplied by the number of years remaining in the scheduled life of the 
loan, plus the sum of 10 percent of each yearly cumulative total of 
additional interest subsidy or other payments (which the Secretary will 
have made in connection with the guaranteed loan or a direct loan which 
has been sold) in each subsequent year remaining in the scheduled life 
of the loan, plus any deficits required to be made up, and less any 
unused excesses accrued in prior years; or
    (ii) Where the annual compliance level in such fiscal year is 
established under paragraph (a)(1) of this section, the remaining 
obligation is the average of the facility's annual compliance levels in 
the previous three years, multiplied by the number of years remaining in 
its period of obligation, plus any deficits required to be made up under 
this section, and less any unused excesses accrued in prior years.

[52 FR 46031, Dec. 3, 1987; 52 FR 48362, Dec. 21, 1987, as amended at 60 
FR 16756, Mar. 31, 1995]



Sec. 124.504  Notice of availability of uncompensated services.

    (a) Published notice. A facility shall publish in a newspaper of 
general circulation in its area notice of its uncompensated services 
obligation before the beginning of its fiscal year. The notice shall 
include:
    (1) The plan of allocation the facility proposes to adopt;
    (2) The amount of uncompensated services the facility intends to 
make available in the fiscal year or a statement that the facility will 
provide uncompensated services to all persons unable to pay who request 
uncompensated services;
    (3) An explanation, if the amount of uncompensated services the 
facility intends to make available in a fiscal year is less than the 
annual compliance level. If a facility has satisfied its remaining 
uncompensated services obligation since the last published notice under 
this paragraph, or will satisfy the remaining obligation during the 
fiscal year, the explanation must include this information; and
    (4) A statement inviting interested parties to comment on the 
allocation plan.
    (b) Posted notice. (1) The facility shall post notices, which the 
Secretary supplies in English and Spanish, in appropriate areas in the 
facility, including but not limited to the admissions areas, the 
business office, and the emergency room.
    (2) If in the service area of the facility the ``usual language of 
households'' of ten percent or more of the population according to the 
most recent figures published by the Bureau of the Census is other than 
English or Spanish, the facility shall translate the notice into that 
language and post the translated notice on signs substantially similar 
in size and legibility to and posted with those supplied under paragraph 
(b)(1) of this section.
    (3) The facility shall make reasonable efforts to communicate the 
contents of the posted notice to persons who it has reason to believe 
cannot read the notice.
    (c) Individual written notice. (1) In any period during a fiscal 
year in which uncompensated services are available in the facility, the 
facility shall provide individual written notice of the availability of 
uncompensated services to each person who seeks services in the facility 
on behalf of himself or another. The individual written notice must:
    (i) State that the facility is required by law to provide a 
reasonable amount of care without or below charge to people who cannot 
afford care;
    (ii) Set forth the criteria the facility uses for determining 
eligibility for uncompensated services (in accordance with the financial 
eligibility criteria and the allocation plan);

[[Page 661]]

    (iii) State the location in the facility where anyone seeking 
uncompensated services may request them; and
    (iv) State that the facility will make a written determination of 
whether the person will receive uncompensated services, and the date by 
or period within which the determination will be made.
    (2) The facility shall provide the individual written notice before 
providing services, except where the emergency nature of the services 
provided makes prior notice impractical. If this exception applies, the 
facility shall provide the individual written notice to the next of kin 
or to the patient as soon as practical, but not later than when first 
presenting a bill for services.
    (3) The facility shall make reasonable efforts to communicate the 
contents of the individual written notice to persons who it has reason 
to believe cannot read the notice.



Sec. 124.505  Eligibility criteria.

    (a) A person unable to pay for health services is a person who--
    (1) Is not covered, or receives services not covered, under a third-
party insurer or governmental program, except where the person is not 
covered because the facility fails to participate in a program in which 
it is required to participate by Sec. 124.603(c);
    (2) Falls into one of the following categories:
    (i) Category A--A person whose annual individual or family income, 
as applicable, is not greater than the current poverty line issued by 
the Secretary pursuant to 42 U.S.C. 9902 that applies to the individual 
or family. The facility shall provide uncompensated services to persons 
in Category A without charge.
    (ii) Category B--A person whose annual individual or family income, 
as applicable, is greater than but not more than twice the poverty line 
issued by the Secretary pursuant to 42 U.S.C. 9902 that applies to the 
individual or family. If persons in Category B are included in the 
allocation plan, the facility shall provide uncompensated services to 
these persons without charge, or in accordance with a schedule of 
charges as specified in the allocation plan.
    (iii) Category C--With respect only to persons seeking or receiving 
nursing home services, a person whose annual or family income, as 
applicable, is more than twice but not greater than three times the 
poverty line issued by the Secretary pursuant to 42 U.S.C. 9902 that 
applies to the individual or family. If persons in Category C are 
included in the allocation plan, the facility shall provide 
uncompensated services to these persons without charge, or in accordance 
with a schedule of charges as specified in the allocation plan; and
    (3) Requests services within the facility's allocation plan in 
effect at the time of the request.
    (b) For purposes of determining eligibility for uncompensated 
services, revisions of the poverty line are effective 60 days from the 
date of their publication in the Federal Register.
    (c) A person is eligible for uncompensated services if the person's 
individual or family annual income, as applicable, is at or below the 
level established under paragraph (a)(2) of this section, when 
calculated by either of the following methods:
    (1) Multiplying by four the person's or family's income, as 
applicable, for the three months preceding the request for uncompensated 
services;
    (2) Using the person's or family's income, as applicable, for the 
twelve months preceding the request for uncompensated services.

[52 FR 46031, Dec. 3, 1987, as amended at 60 FR 16756, Mar. 31, 1995]



Sec. 124.506  Allocation of services; plan requirement.

    (a)(1) A facility shall provide its uncompensated services in 
accordance with a plan that sets out the method by which the facility 
will distribute its uncompensated services among persons unable to pay. 
The plan must:
    (i) State the type of services that will be made available;
    (ii) Specify the method, if any, for distributing those services in 
different periods of the year;

[[Page 662]]

    (iii) State whether Category B or, in the case of nursing homes 
only, Category C persons will be provided uncompensated services, and if 
so, whether the services will be available without charge or at a 
reduced charge;
    (iv) If services will be made available to Category B persons at a 
reduced charge, specify the method used for reducing charges, and 
provide that the method is applicable to all persons in Category B;
    (v) With respect to nursing homes only, if services will be made 
available to Category C persons at a reduced charge, specify the method 
used for reducing charges, provided that such method may not result in 
greater reductions than those afforded to Category B persons, and 
provide that this method is applicable to all persons in Category C; and
    (vi) Provide that the facility provides uncompensated services to 
all persons eligible under the plan who request uncompensated services.
    (2) A facility must adopt an allocation plan that meets the 
requirements of paragraph (a) by publishing the plan in a newspaper of 
general circulation in its area. The plan may take effect no earlier 
than 60 days following the date of publication.
    (b)(1) If in any fiscal year a facility fails to adopt and publish a 
plan in accordance with paragraph (a) of this section, it shall provide 
uncompensated services in accordance with the last plan it published in 
a newspaper of general circulation in its area.
    (2) If no plan was previously published in accordance with paragraph 
(a)(2) of this section, the facility must provide uncompensated services 
without charge to all applicants in Category A and Category B, and, with 
respect to nursing homes, Category C, who request service in the 
facility. This requirement applies until the facility ceases to provide 
uncompensated services under Sec. 124.508 or until an allocation plan 
published in accordance with paragraph (a)(2) of this section becomes 
effective.
    (c) A facility may revise its allocation plan during the fiscal year 
by publishing the revised plan in a newspaper of general circulation in 
the area it serves. A revised plan may take effect no earlier than 60 
days following the date of publication.

[52 FR 46031, Dec. 3, 1987, as amended at 60 FR 16756, Mar. 31, 1995]



Sec. 124.507  Written determinations of eligibility.

    (a) Determinations of eligibility must be in writing, be made in 
accordance with this section, and a copy of the determination must be 
provided to the applicant promptly.
    (b) Content of determinations--(1) Favorable determinations. A 
determination that an applicant is eligible must indicate:
    (i) That the facility will provide uncompensated services at no 
charge or at a specified charge less than the allowable credit for the 
services;
    (ii) The date on which services were requested;
    (iii) The date on which the determination was made;
    (iv) The applicant's individual or family income, as applicable, and 
family size; and
    (v) The date on which services were or will be first provided to the 
applicant.
    (2) Conditional determinations. (i) As a condition to providing 
uncompensated services, a facility may:
    (A) Require the applicant to furnish any information that is 
reasonably necessary to substantiate eligibility; and
    (B) Require the applicant to apply for any benefits under third 
party insurer or governmental programs to which he/she is or could be 
entitled upon proper application.
    (ii) A conditional determination must:
    (A) Comply with paragraph (b)(1) of this section; and
    (B) State the condition(s) under which the applicant will be found 
eligible.
    (iii) When a facility determines that the condition(s) upon which a 
conditional determination was made has been met, or will not be met, it 
shall make a favorable determination or denial on the request, as 
appropriate, in accordance with this section.
    (3) Denials. A facility must provide to each applicant denied the 
uncompensated services requested, in whole or in

[[Page 663]]

part, a dated statement of the reasons for the denial.
    (c) Timing of determinations--(1) Preservice determinations. (i) 
Facilities other than nursing homes shall make a determination of 
eligibility within two working days following a request for 
uncompensated services which is made before receipt of outpatient 
services or before discharge for inpatient services;
    (ii) Nursing homes shall make a determination of eligibility within 
ten working days, but no later than two working days following the date 
of admission, following a request for uncompensated services made prior 
to admission.
    (2) Postservice determinations. All facilities shall make a 
determination of eligibility not later than the end of the first full 
billing cycle following a request for uncompensated services which is 
made after receipt of outpatient services, discharge for inpatient 
services, or admission for nursing home services.

[52 FR 46031, Dec. 3, 1987; 52 FR 48362, Dec. 21, 1987]



Sec. 124.508  Cessation of uncompensated services.

    (a) Facilities not certified under Sec. 124.513, Sec. 124.514, 
Sec. 124.515 or Sec. 124.516. Where a facility, other than a facility 
certified under Sec. 124.513, Sec. 124.514, Sec. 124.515, or 
Sec. 124.516, has maintained the records required by Sec. 124.510(a) and 
determines based thereon that it has met its annual compliance level for 
the fiscal year or the appropriate level for the period specified in its 
allocation plan, it may, for the remainder of that year or period:
    (1) Cease providing uncompensated services;
    (2) Cease providing individual notices in accordance with 
Sec. 124.504(c);
    (3) Remove the posted notices required by Sec. 124.504(b); and
    (4) Post an additional notice stating that it has satisfied its 
obligation for the fiscal year or appropriate period and when additional 
uncompensated services will be available.
    (b) Facilities certified under Sec. 124.514. Where a facility 
certified under Sec. 124.514 has maintained the records required by 
Sec. 124.510(c) and determines based thereon that it has met its 
compliance level, under Sec. 124.514(d), for the fiscal year, it may, 
for the remainder of the fiscal year:
    (1) Cease providing uncompensated services; and
    (2) Discontinue providing notice pursuant to Sec. 124.514(b)(2).

[52 FR 46031, Dec. 3, 1987, as amended at 59 FR 44639, Aug. 30, 1994]



Sec. 124.509  Reporting requirements.

    (a) Facilities not certified under Sec. 124.513, Sec. 124.514, 
Sec. 124.515, or Sec. 124.516--(1) Timing of reports. (i) A facility 
shall submit to the Secretary a report to assist the Secretary in 
determining compliance with this subpart once every three fiscal years, 
on a schedule to be prescribed by the Secretary.
    (ii) A facility shall submit the required report more frequently 
than once every three years under the following circumstances:
    (A) If the facility determines that in the preceding fiscal year it 
did not provide uncompensated services at the annual compliance level, 
it shall submit a report.
    (B) If the Secretary determines, and notifies the facility in 
writing that a report is needed for proper administration of the 
program, the facility shall submit a report within 90 days after 
receiving notice from the Secretary, or within 90 days after the close 
of the fiscal year, whichever is later.
    (iii) Except as specified in paragraph (a)(1)(ii)(B) of this 
section, the reports required by this section shall be submitted within 
90 days after the close of the fiscal year, unless a longer period is 
approved by the Secretary for good cause.
    (2) Content of report. The report must include the following 
information in a form prescribed by the Secretary:
    (i) Information that the Secretary prescribes to permit a 
determination of whether a facility has met the annual compliance level 
for the fiscal years covered by the report;
    (ii) The date on which the notice required by Sec. 124.504(a) was 
published, and the name of the newspaper that printed the notice;
    (iii) If the amount of uncompensated services provided by the 
facility in the preceding fiscal year was lower than

[[Page 664]]

the annual compliance level, an explanation of why the facility did not 
meet the required level. If the facility claims that it failed to meet 
the required compliance level because it was financially unable to do 
so, it shall explain and provide documentation prescribed by the 
Secretary;
    (iv) If the facility is required to submit an affirmative action 
plan, a copy of the plan.
    (v) Other information that the Secretary prescribes.
    (3) Institution of suit. Not later than 10 days after being served 
with a summons or complaint the facility shall notify the HHS Regional 
Health Administrator \1\ for the Region in which it is located of any 
legal action brought against it alleging that it has failed to comply 
with the requirements of this subpart.
---------------------------------------------------------------------------

    \1\ The addresses of the HHS Regional Offices are set out in 45 CFR 
5.31.
---------------------------------------------------------------------------

    (b) Facilities certified under Sec. 124.513 or Sec. 124.516. A 
facility certified under Sec. 124.513 or Sec. 124.516 shall comply with 
paragraph (a)(3) of this section and shall submit within 90 days after 
the close of its fiscal year, as appropriate:
    (1) A certification, signed by the responsible official of the 
facility, that there has been no material change in the factors upon 
which the certification was based; or
    (2) A certification, signed by the responsible official of the 
facility and supported by appropriate documentation, that there has been 
a material change in the factors upon which the certification was based.
    (c) Facilities certified under Sec. 124.514. A facility certified 
under Sec. 124.514 shall comply with paragraph (a)(3) of this section 
and shall submit within 90 days after the close of its fiscal year, as 
appropriate:
    (1)(i) A certification, signed by the responsible official of the 
facility, that there has been no material change in the factors upon 
which the certification was based; or
    (ii) A certification, signed by the responsible official of the 
facility and supported by appropriate documentation, that there has been 
a material change in the factors upon which the certification was based; 
and
    (2) A certification, signed by the responsible official of the 
facility, of the amount of uncompensated services provided in the 
previous fiscal year.
    (d) Facilities certified under Sec. 124.515. A facility certified 
under Sec. 124.515 shall submit such reports as are required by the 
terms of its grant under section 329 or 330 or by its agreement under 
section 334 of the Act, as applicable, at such intervals as the 
Secretary may require.

(Approved by the Office of Management and Budget under control number 
0915-0077)

[52 FR 46031, Dec. 3, 1987, as amended at 52 FR 48362, Dec. 21, 1987; 54 
FR 52939, Dec. 26, 1989; 59 FR 44639, Aug. 30, 1994]



Sec. 124.510  Record maintenance requirements.

    (a) Facilities not certified under Sec. 124.513, Sec. 124.514, 
Sec. 124.515, or Sec. 124.516. (1) A facility shall maintain, make 
available for public inspection consistent with personal privacy, and 
provide to the Secretary on request, any records necessary to document 
its compliance with the requirements of this subpart in any fiscal year, 
including:
    (i) Any documents from which the information required to be reported 
under Sec. 124.509(a) was obtained;
    (ii) Accounts which clearly segregate uncompensated services from 
other accounts; and
    (iii) Copies of written determinations of eligibility under 
Sec. 124.507.
    (2) A facility shall retain the records maintained pursuant to 
paragraph (a)(1) for three years after submission of the report required 
by Sec. 124.509(a)(1), except where a longer period is required by the 
Secretary, or until 180 days following the close of the Secretary's 
assessment investigation under Sec. 124.511(b), whichever is less.
    (3) A facility shall, within 60 days of the end of each fiscal year, 
determine the amount of uncompensated services it provided in that 
fiscal year. Documents that support the facility's determination shall 
be made available to the public on request. If a report is or will be 
filed under Sec. 124.509(a)(1), a facility may respond to a request by 
providing a copy of the report to the requester.
    (b) Facilities certified under Sec. 124.513, Sec. 124.514, or 
Sec. 124.516. A facility certified

[[Page 665]]

under Sec. 124.513, Sec. 124.514, or Sec. 124.516 shall maintain, make 
available for public inspection consistent with personal privacy, and 
provide to the Secretary on request, any records necessary to document 
its compliance with the applicable requirements of this subpart in any 
fiscal year, including those documents submitted to the Secretary under 
Sec. 124.513(c), Sec. 124.514(c), or Sec. 124.516(c). A facility shall 
maintain these records for three years, except where a longer period is 
required as a result of an investigation by the Secretary. In such 
cases, records must be kept until 180 days following the close of the 
Secretary's assessment investigation under Sec. 124.511(b).
    (c) Facilities certified under Sec. 124.515. A facility certified 
under Sec. 124.515 shall maintain the records required by its grant 
under section 329 or section 330 or its agreement under section 334 of 
the Act, as applicable, for such period of time as the grant agreement 
may require.

(Information collection requirements in paragraphs (a) and (b) approved 
by the Office of Management and Budget under control number 0915-0103)

[52 FR 46031, Dec. 3, 1987; 52 FR 48362, Dec. 21, 1987; 59 FR 44639, 
Aug. 30, 1994]



Sec. 124.511  Investigation and determination of compliance.

    (a) Complaints. A complaint that a facility is out of compliance 
with the requirements of this subpart may be filed with the Secretary by 
any person.
    (1) A complaint is considered to be filed with the Secretary on the 
date the following information is received in the Office of the HHS 
Regional Health Administrator for the Region in which the facility is 
located:
    (i) The name and address of the person making the complaint or on 
whose behalf the complaint is made;
    (ii) The name and location of the facility;
    (iii) The date or approximate date on which the event occurred; and
    (iv) A statement of what actions the complainant considers to 
violate the requirements of this subpart.
    (2) The Secretary promptly provides a copy of the complaint to the 
facility named in the complaint.
    (3) When the Secretary investigates a facility, the facility, 
including a facility certified under Sec. 124.513, Sec. 124.514, 
Sec. 124.515, or Sec. 124.516, shall provide to the Secretary on request 
any documents, records and other information concerning its operation 
that relate to the requirements of this subpart. A facility will be 
presumed to be out of compliance with its assurance unless it supplies 
documentation sufficient to show compliance with the applicable 
provisions of this subpart.
    (4) Section 1627 of the Act provides that if the Secretary dimisses 
a complaint or the Attorney General has not brought an action for 
compliance within six months from the date on which the compliant is 
filed, the person filing it may bring a private action to effectuate 
compliance with the assurance. If the Secretary determines that he/she 
will be unable to issue a decision on a complaint or otherwise take 
appropriate action within the six month period, the Secretary may, based 
on priorities for the disposition of complaints that are established to 
promote the most effective use of enforcement resources, or on the 
request of the applicant, dismiss the complaint without a finding as to 
compliance prior to the end of the six month period, but no earlier than 
45 days after the complaint is filed.
    (b) Assessments. The Secretary periodically investigates and 
assesses facilities to ascertain compliance with the requirements of 
this subpart, including certification of the amount of uncompensated 
services provided in a fiscal year or years, and provides guidance and 
prescribes corrective action to correct noncompliance.
    (1) Compliance after February 1, 1988. (i) The Secretary may certify 
that a facility has substantially complied with its assurance for a 
fiscal year or years, and such certification shall establish that the 
facility provided the amount of uncompensated services certified for the 
period covered by the certification.
    (ii) A certification of substantial compliance shall be based on the 
amount properly claimed by the facility pursuant to Sec. 124.509(a), 
utilizing procedures determined by the Secretary to be sufficient to 
establish that the facility has substantially complied

[[Page 666]]

with its assurance for the period covered by the certification. The 
procedures will include examination of individual account data to the 
extent deemed necessary by the Secretary.
    (iii) A certification of substantial compliance will be made where 
the Secretary determines that, for the period covered by the 
certification, the facility provided uncompensated services to eligible 
persons who had equal opportunity to apply therefor. In making this 
determination, the Secretary will consider, in descending order of 
importance, whether--
    (A) Corrective action prescribed pursuant to Sec. 124.512(b) has 
been taken by the facility;
    (B) Any noncompliance with the requirements of this subpart may be 
remedied by corrective action under Sec. 124.512(b);
    (C) The facility had procedures in place that complied with the 
requirements of Secs. 124.504(c), 124.505, 124.507, 124.509, 124.510, 
124.513(b)(2), 124.514(b)(2), 124.515, and 124.516 (b)(1) or (b)(2), as 
applicable, and systematically correctly followed such procedures.
    (2) Compliance prior to February 1, 1988. The Secretary will 
determine the amount of creditable services provided prior to the 
effective date of these rules using the compliance standards applicable 
under the rules as promulgated on May 18, 1979, based on procedures 
determined by the Secretary to be sufficient to establish that the 
facility provided such amounts of uncompensated services in the 
period(s) being assessed.
    (c) Determinations of financial inability. In determining whether a 
facility was or is financially able to meet its annual compliance level, 
the Secretary will consider any comments submitted by interested 
parties. In making this determination, the Secretary will consider 
factors such as:
    (1) The ratio of revenues to expenses;
    (2) The occupancy rate;
    (3) The ratio of current assets to current liabilities;
    (4) The average cost per patient day;
    (5) The number of days of operating expenses in accounts payable;
    (6) The number of days of revenues in accounts receivable;
    (7) The sinking fund (or depreciation fund) balance;
    (8) The debt coverage ratio; and
    (9) The availability of restricted or unrestricted funds (such as an 
endowment) available for charitable use.

[52 FR 46031, Dec. 3, 1987; 52 FR 48362, Dec. 21, 1987; 53 FR 5576, Feb. 
25, 1988; 59 FR 44639, Aug. 30, 1994]



Sec. 124.512  Enforcement.

    (a) If the Secretary finds, based on his/her investigation under 
Sec. 124.511, that a facility did not comply with the requirements of 
this subpart, the Secretary may take any action authorized by law to 
secure compliance, including but not limited to, voluntary agreement or 
a request to the Attorney General to bring an action against the 
facility for specific performance.
    (b) A facility, including a facility certified under Sec. 124.513, 
Sec. 124.514, or Sec. 124.516, that has denied uncompensated services to 
any person because it failed to comply with the requirements of this 
subpart will not be in compliance with its assurance until it takes 
whatever steps are necessary to remedy fully the noncompliance, 
including:
    (1) Provision of uncompensated services to applicants improperly 
denied;
    (2) Repayment of amounts improperly collected from persons eligible 
to receive uncompensated services; and
    (3) Other corrective actions prescribed by the Secretary.
    (c) The Secretary may disallow all of the uncompensated services 
claimed in a fiscal year where the Secretary finds that the facility was 
in substantial noncompliance with its assurance because it failed to:
    (1) Have a system for providing notice to eligible persons as 
required by Sec. 124.504(c), Sec. 124.513(b)(2), Sec. 124.514(b)(2), or 
Sec. 124.516(b)(2)(ii)(A), as applicable;
    (2) Comply with the applicable reporting requirements of 
Sec. 124.509;
    (3) Have a system for maintaining records of uncompensated services 
provided in accordance with Sec. 124.510; or
    (4) Take corrective action prescribed pursuant to paragraph (b) of 
this section.

[[Page 667]]

    (d) In the absence of a finding of substantial compliance or 
substantial noncompliance in a fiscal year, the Secretary may disallow 
uncompensated services claimed by a facility in that fiscal year to the 
extent that the Secretary finds that such services are not documented as 
uncompensated services under Sec. 124.510 or are subject to disallowance 
under Sec. 124.513(d) or Sec. 124.514(d), as applicable.

[52 FR 46031, Dec. 3, 1987, as amended at 59 FR 44639, Aug. 30, 1994]



Sec. 124.513  Public facility compliance alternative.

    (a) Effect of certification. The Secretary may certify a facility 
which meets the requirements of paragraphs (b) and (c) of this section 
as a ``public facility''. A facility which is so certified is not 
required to comply with this subpart except as otherwise herein 
provided.
    (b) Criteria for qualification. A public facility may qualify for 
certification under this section if all of the following criteria are 
met:
    (1) It is a facility which is owned and operated by a unit of State 
or local government or a quasi-public corporation as defined at 42 CFR 
124.2(m).
    (2) It provides health services without charge or at a substantially 
reduced rate to persons who are determined by the facility to qualify 
therefor under a program of discounted health services. A ``program of 
discounted health services'' must provide for financial and other 
objective eligibility criteria and procedures, including notice prior to 
nonemergency service, that assure effective opportunity for all persons 
to apply for and obtain a determination of eligibility for such 
services, including a determination prior to service where requested; 
provided that, such criteria and procedures are not required where the 
facility makes all services available to all persons at no or nominal 
charge.
    (3)(i) It received, for the three most recent fiscal years, at least 
10 percent of its total operating revenue (net patient revenue plus 
other operating revenue, exclusive of any amounts received, or if not 
received, claimed, as reimbursement under titles XVIII and XIX of the 
Social Security Act) from State and local tax appropriations or other 
State and local government revenues, or from a quasi-public corporation 
as defined at 42 CFR 124.2(m), to cover operating deficits attributable 
to the provision of discounted services; or
    (ii) If provided, in each of the three most recent fiscal years, 
uncompensated services under this subpart or under programs described by 
the documentation provided under Sec. 124.513(c)(2) in an amount not 
less than twice the annual compliance level computed under 
Sec. 124.503(a).
    (c) Procedures for certification. To be certified under this 
section, a facility must submit to the Secretary, in addition to other 
materials that the Secretary may from time to time require, copies of 
the following:
    (1) Audited financial statements or official State or local 
government documents (such as annual reports or budget documents), for 
the three most recent fiscal years, sufficient to show that the facility 
meets the criteria in paragraph (b)(3)(i) or (ii) of this section.
    (2) A complete description of its program(s) of discounted health 
services, including charging and collection policies of the facility, 
and eligibility criteria and notice and determination procedures used 
under its program(s) of discounted services.
    (d) Period of effectiveness. (1) A certification by the Secretary 
under this section remains in effect until withdrawn. The Secretary may 
disallow credit under this subpart when the Secretary determines that 
there has been a material change in any factor upon which certification 
was based or substantial noncompliance with this subpart. The Secretary 
may withdraw certification where the change or noncompliance has not 
been adequately remedied or otherwise continues.
    (2) Deficits--(i) Title VI-assisted facilities with assessed 
deficits. Where a facility assisted under title VI of the Act has been 
assessed as having a deficit under Sec. 124.503(b) that has not been 
made up prior to certification under this section, the facility may make 
up that deficit by either--
    (A) Demonstrating to the Secretary's satisfaction, that it met the 
requirements of paragraph (b) of this section

[[Page 668]]

for each year in which a deficit was assessed; or
    (B) Providing an additional period of service under this section on 
the basis of one (or portion of a) year of certification for each year 
(or portion of a year) of deficit assessed. The period of obligation 
applicable to the facility under Sec. 124.501(b) shall be extended until 
the deficit is made up in accordance with the preceding sentence.
    (ii) Title VI-assisted facilities which have not been assessed. 
Where any period of compliance under this subpart of a facility assisted 
under title VI of the Act has not been assessed, the facility will be 
presumed to have no allowable credit for such period. The facility may 
either--
    (A) Make up such deficit in accordance with paragraph (d)(2)(i) of 
this section; or
    (B) Submit an independent certified audit, conducted in accordance 
with procedures specified by the Secretary, of the facility's records 
maintained pursuant to Sec. 124.510. If the audit establishes to the 
Secretary's satisfaction that no, or a lesser, deficit exists for the 
period in question, the facility will receive credit for the period so 
justified. Any deficit which the Secretary determines still remains must 
be made up in accordance with paragraph (d)(2)(i) of this section.
    (iii) Title XVI-assisted facilities. (A) A facility assisted under 
title XVI of the Act which has an assessed deficit which was not made up 
prior to certification under this section shall make up that deficit in 
accordance with paragraph (d)(2)(i)(A) of this section. If it cannot 
make the showing required by that paragraph, it shall make up the 
deficit when its certification under this section is withdrawn.
    (B) A facility assisted under title XVI of the Act whose compliance 
with this subpart has not been completely assessed will be presumed to 
have no allowable credit for the unassessed period. The facility may 
make up the deficit by--
    (1) Following the procedure of subparagraph (d)(2)(iii)(A) of this 
section; or
    (2) Submitting an independent certified audit, conducted in 
accordance with procedures specified by the Secretary, of the facility's 
records maintained pursuant to Sec. 124.510. If the audit establishes to 
the Secretary's satisfaction that no, or a lesser, deficit exists for 
the period in question, the facility will receive credit for the period 
so justified. Any deficit which the Secretary determines still remains 
must be made up in accordance with paragraph (d)(2)(iii)(A) of this 
section.

(Approved by the Office of Management and Budget under control number 
0915-0103)

[52 FR 46031, Dec. 3, 1987; 52 FR 48362, Dec. 21, 1987]



Sec. 124.514  Compliance alternative for facilities with small annual obligations.

    (a) Effect of certification. The Secretary may certify a facility 
which meets the requirements of paragraphs (b) and (c) of this section 
as a ``facility with a small annual obligation.'' A facility which is so 
certified is not required to comply with this subpart except as 
otherwise herein provided.
    (b) Criteria for qualification. A facility may qualify for 
certification under this section if all of the following criteria are 
met:
    (1)(i) Title VI-assisted facilities. (A) For the facility's fiscal 
year in which this section becomes effective, the level, computed under 
Sec. 124.503(c) (3), divided by the number of years remaining in its 
period of obligation (including an additional year or portion of a year 
for each year or portion of a year in which a deficit was incurred and 
has not been made up), is not more than $10,000;
    (B) For a subsequent fiscal year, the level computed under paragraph 
(A) of this paragraph (b)(1)(i), is at or less than $10,000, adjusted by 
a percentage equal to the percentage change in the CPI available in the 
year in which this section becomes effective and the most recent year 
for which a published index is available.
    (ii) Title XVI-assisted facilities. (A) For the facility's fiscal 
year in which this section becomes effective, the level under 
Sec. 124.503(a), plus the amount of any noncompliance deficits which 
have not been made up, is at or less than $10,000.
    (B) For a subsequent fiscal year, the level, computed under 
paragraph (A) of

[[Page 669]]

this paragraph (b)(1)(ii), is at or less than $10,000, adjusted as 
provided in paragraph (b)(1)(i)(B) of this section.
    (2) It provides health services without charge or at a substantially 
reduced rate to persons who are determined by the facility to qualify 
threrefor under a program of discounted health services. A ``program of 
discounted health services'' must provide for financial and other 
objective eligibility criteria and procedures, including notice prior to 
nonemergency service, that assure effective opportunity for all persons 
to apply for and obtain a determination of eligibility for such 
services, including a determination prior to service where requested; 
Provided that, such criteria and procedures are not required where the 
facility makes all services available to all persons at no or nominal 
charge.
    (c) Procedures for certification. To be certified under this 
section, a facility must submit to the Secretary, in addition to other 
materials that the Secretary may from time to time require, a complete 
description of its program(s) of discounted health services, including 
charging and collection policies of the facility, and eligibility 
criteria and notice and determination precedures used under its 
program(s) of discounted services.
    (d) Period of effectiveness. A certification by the Secretary under 
this section remains in effect until withdrawn. During the period in 
which such certification is in effect, the facility must provide 
uncompensated services in an amount not less than the level applicable 
under paragraph (b)(1) of this section for each fiscal year. The 
Secretary may disallow credit under this subpart when the Secretary 
determines that there has been a material change in any factor upon 
which certification was based or substantial noncompliance with this 
subpart. The Secretary may withdraw certification where the change or 
noncompliance cannot be or has not been adequately remedied or 
noncompliance otherwise continues.
    (e) Deficits. (1) Where the compliance level of a facility assisted 
under title VI of the Act is computed under paragraph (b)(1)(i)(A) of 
this section as including additional year(s) or a portion of a year, the 
facility's period of obligation under this subpart shall be extended by 
such additional period, until certification is withdrawn.
    (2) Where a facility has been assessed as having a deficit under 
Sec. 124.503(b) that has not been made up prior to withdrawal of 
certification under this section or fails to provide services as 
required by paragraph (d) of this section, the facility must make up the 
deficit in accordance with Sec. 124.503(b) following withdrawal of 
certification.

(Approved by the Office of Management and Budget under control number 
0915-0077)

[52 FR 46031, Dec. 3, 1987, as amended at 52 FR 48362, Dec. 21, 1987; 54 
FR 52939, Dec. 26, 1989]



Sec. 124.515  Compliance alternative for community health centers, migrant health centers and certain National Health Service Corps sites.

    (a) Period of effectiveness. For each fiscal year for which a 
facility that receives a grant to operate a community health center 
under section 330 of the Act or a migrant health center under section 
329 of the Act is in substantial compliance with the terms and 
conditions of such grant relating to the provision of services at a 
discount, the facility shall be certified as having met its annual 
compliance level in accordance with the requirements of this subpart and 
shall not be required otherwise to comply with the requirements of this 
subpart for that fiscal year. This provision also applies to any 
facility that has signed a memorandum of agreement with the Secretary 
under section 334 of the Act if the services provided by the National 
Health Service Corps professional(s) assigned pursuant to that agreement 
constitute all of the medical services provided by the facility.
    (b) Deficits--(1) Title VI-assisted facilities with assessed 
deficits. Where a facility assisted under title VI of the Act has been 
assessed as having a deficit under Sec. 124.503(b) that has not been 
made up prior to certification under this section, the facility may make 
up that deficit by either--
    (i) Demonstrating to the Secretary's satisfaction that it met the 
requirements of paragraph (a) of this section

[[Page 670]]

for each year in which a deficit was assessed; or
    (ii) Providing an additional period of service under this section on 
the basis of one (or portion of a) year of certification for each year 
(or portion of a year) of deficit assessed. The period of obligation 
applicable to the facility under Sec. 124.501(b) shall be extended until 
the deficit is made up in accordance with the preceding sentence.
    (2) Title VI-assisted facilities which have not been assessed. Where 
any period of compliance under this subpart of a facility assisted under 
title VI of the Act has not been assessed, the facility will be presumed 
to have no allowable credit for such period. The facility may either--
    (i) Make up such deficit in accordance with paragraph (b)(1) of this 
section; or
    (ii) Submit an independent certified audit, conducted in accordance 
with procedures specified by the Secretary, of the facility's records 
maintained pursuant to Sec. 124.510. If the audit establishes to the 
Secretary's satisfaction that no, or a lesser, deficit exists for the 
period in question, the facility will receive credit for the period so 
justified. Any deficit which the Secretary determines still remains must 
be made up in accordance with paragraph (b)(1) of this section.
    (3) Title XVI-assisted facilities. (i) A facility assisted under 
title XVI of the Act which has an assessed deficit which was not made up 
prior to certification under this section shall make up that deficit in 
accordance with paragraph (b)(1)(i) of this section. If it cannot make 
the showing required by that paragraph, it shall make up the deficit 
when it is no longer certified under this section.
    (ii) A facility assisted under title XVI of the Act whose compliance 
with this subpart has not been completely assessed will be presumed to 
have no allowable credit for the unassessed period. The facility may 
make up the deficit by--
    (A) Following the procedure of paragraph (b)(3)(i) of this section; 
or
    (B) Submitting an independent certified audit, conducted in 
accordance with procedures specified by the Secretary, of the facility's 
records maintained pursuant to Sec. 124.510. If the audit establishes to 
the Secretary's satisfaction that no, or a lesser, deficit exists for 
the period in question, the facility will receive credit for the period 
so justified. Any deficit which the Secretary determines still remains 
must be made up in accordance with paragraph (b)(3)(i) of this section.

(Approved by the Office of Management and Budget under control number 
0915-0077)

[52 FR 46031, Dec. 3, 1987, as amended at 52 FR 48362, Dec. 21, 1987; 54 
FR 52939, Dec. 26, 1989]



Sec. 124.516  Charitable facility compliance alternative.

    (a) Effect of certification. The Secretary may certify a facility 
which meets the requirements of paragraphs (b) and (c) of this section 
as a ``charitable facility.'' A facility which is so certified is not 
required to comply with this subpart except as otherwise herein 
provided.
    (b) Criteria for qualification. A facility may qualify for 
certification under this section if it meets the criteria of either 
paragraph (b)(1) or paragraph (b)(2) of this section:
    (1)(i) For facilities that are nursing homes: It received, for the 
three most recent fiscal years, no monies directly from patients with 
incomes up to triple the current poverty line issued by the Secretary 
pursuant to 42 U.S.C. 9902, exclusive of amounts charged or received for 
purposes of claiming reimbursement under third party insurance or 
governmental programs, such as Medicaid or Medicare deductible or 
coinsurance amounts;
    (ii) For all other facilities. It received, for the three most 
recent fiscal years, no monies directly from patients with incomes up to 
double the current poverty line issued by the Secretary pursuant to 42 
U.S.C. 9902, exclusive of amounts charged or received for purposes of 
claiming reimbursement under third party insurance or governmental 
programs, such as Medicaid or Medicare deductible or coinsurance 
amounts; or
    (2)(i) It received, for the three most recent fiscal years, at least 
10 percent

[[Page 671]]

of its total operating revenue (net patient revenue plus other operating 
revenue, exclusive of any amounts received, or if not received, claimed, 
as reimbursement under titles XVIII and XIX of the Social Security Act) 
from philanthropic sources to cover operating deficits attributable to 
the provision of discounted services. Philanthropic sources include 
private trusts, foundations, churches, charitable organizations, state 
and/or local funding, and individual donors; and either--
    (ii) (A) Provides health services without charge or at a 
substantially reduced rate (exclusive of amounts charged or received for 
purposes of claiming reimbursement under third party insurance or 
governmental programs, such as Medicaid or Medicare deductible or 
coinsurance amounts) to persons who are determined by the facility to 
qualify therefor under a program of discounted health services. A 
``program of discounted health services'' must provide for financial and 
other objective eligibility criteria and procedures, including notice 
prior to nonemergency service, that assure effective opportunity for all 
persons to apply for and obtain a determination of eligibility for such 
services including a determination prior to service where requested; or
    (B) Makes all services of the facility available to all persons at 
no more than a nominal charge, exclusive of amounts charged or received 
for purposes of claiming reimbursement under third party insurance or 
governmental programs, such as Medicaid or Medicare deductible or 
coinsurance amounts.
    (c) Procedures for certification. To be certified under this 
section, a facility must submit to the Secretary, in addition to other 
materials that the Secretary may from time to time require, copies of 
the following:
    (1) Audited financial statements for the three most recent fiscal 
years or other documents prescribed by the Secretary, sufficient to show 
that the facility meets the criteria of paragraph (b)(1) or (b)(2) of 
this section.
    (2)(i) Where the facility claims qualification under paragraph 
(b)(2)(ii)(A) of this section, a complete description, and documentation 
where requested, of its program of discounted health services, including 
charging and collection policies of the facility, and eligibility 
criteria and notice and determination procedures used under its 
program(s) of discounted health services.
    (ii) Where the facility claims qualification under paragraph (b)(1) 
or paragraph (b)(2)(ii)(B) of this section, a complete description, and 
documentation where requested, of its admission, charging, and 
collection policies.
    (d) Period of effectiveness. (1) A certification by the Secretary 
under this section remains in effect until withdrawn. The Secretary may 
disallow credit under this subpart when the Secretary determines that 
there has been a material change in any factor upon which certification 
was based or substantial noncompliance with this subpart. The Secretary 
may withdraw certification where the change or noncompliance has not 
been in the Secretary's judgment adequately remedied or otherwise 
continues.
    (2) Deficits--(i) Title VI-assisted facilities with assessed 
deficits. Where a facility assisted under title VI of the Act has been 
assessed as having a deficit under Sec. 124.503(b) that has not been 
made up prior to certification under this section, the facility may make 
up that deficit by either--
    (A) Demonstrating to the Secretary's satisfaction that it met the 
applicable requirements of paragraph (b) of this section for each year 
in which a deficit was assessed; or
    (B) Providing an additional period of service under this section on 
the basis of one year (or portion of a year) of certification for each 
year (or portion of a year) of deficit assessed. The period of 
obligation applicable to the facility under Sec. 124.501(b) shall be 
extended until the deficit is made up in accordance with the preceding 
sentence.
    (ii) Where any period of compliance under this subpart of a facility 
assisted under title VI of the Act has not been assessed, the facility 
will be presumed to have no allowable credit for such period. The 
facility may either--
    (A) Make up such deficit in accordance with paragraph (d)(2)(i) of 
this section; or
    (B) Submit an independent certified audit, conducted in accordance 
with

[[Page 672]]

procedures specified by the Secretary, of the facility's records 
maintained pursuant to Sec. 124.510. If the audit establishes to the 
Secretary's satisfaction that no, or a lesser, deficit exists for the 
period in question, the facility will receive credit for the period so 
justified. Any deficit which the Secretary determines still remains must 
be made up in accordance with paragraph (d)(2)(i) of this section.
    (iii) Title XVI-assisted facilities. (A) A facility assisted under 
title XVI of the Act which has an assessed deficit which was not made up 
prior to certification under this section shall make up that deficit in 
accordance with paragraph (d)(2)(i)(A) of this section. If it cannot 
make the showing required by that paragraph, it shall make up the 
deficit when its certification under this section is withdrawn.
    (B) A facility assisted under title XVI of the Act whose compliance 
with this subpart has not been completely assessed will be presumed to 
have no allowable credit for the unassessed period. The facility may 
make up the deficit by--
    (1) Following the procedure of paragraph (d)(2)(iii)(A) of this 
section; or
    (2) Submitting an independent certified audit, conducted in 
accordance with procedures specified by the Secretary, of the facility's 
records maintained pursuant to Sec. 124.510. If the audit establishes 
that no, or a lesser, deficit exists for the period in question, the 
facility will receive credit for the period so justified. Any deficit 
which the Secretary determines still remains must be made up in 
accordance with paragraph (d)(2)(iii)(A) of this section.

[59 FR 44639, Aug. 30, 1994, as amended at 60 16756, FR Mar. 31, 1995]



Sec. 124.517  Agreements with State agencies.

    (a) Where the Secretary finds that it will promote the purposes of 
this subpart and the State agency is able and willing to do so, the 
Secretary may enter into an agreement with an agency of a State to 
assist in administering this subpart in the State. An agreement may be 
terminated by the Secretary or the State agency on 60 days notice.
    (b) Under an agreement the State agency will provide any assistance 
the Secretary requests in any one or more of the following areas, as set 
out in the agreement:
    (1) Investigation of complaints regarding noncompliance;
    (2) Monitoring compliance of facilities with the requirements of 
this subpart;
    (3) Review of reports submitted under Sec. 124.509, including 
affirmative action plans;
    (4) Making initial decisions for the Secretary with respect to 
compliance, subject to appeal by any party to the Secretary, or review 
by the Secretary on the Secretary's initiative; and
    (5) Application of any sanctions available to it under State law 
(such as license revocation or termination of State assistance) against 
facilities determined to be out of compliance with the requirements of 
this subpart.
    (c) Nothing in this subpart precludes any State from taking any 
action authorized by State law regarding the provision of uncompensated 
services by facilities in the State as long as the action taken does not 
prevent the Secretary from enforcing the requirements of this subpart.

[52 FR 46031, Dec. 3, 1987. Redesignated at 59 FR 44639, Aug. 30, 1994]



                      Subpart G--Community Service

    Authority: Secs. 215, 1525, 1602(6), Public Health Service Act as 
amended; 58 Stat 690, 88 Stat. 2249, 2259; 42 U.S.C. 216, 300m-4, 300o-
1(6).

    Source: 44 FR 29379, May 18, 1979, unless otherwise noted.



Sec. 124.601  Applicability.

    The provisions of this subpart apply to any recipient of Federal 
assistance under title VI or XVI of the Public Health Service Act that 
has given an assurance that it would make the facility or portion 
thereof assisted available to all persons residing (and, in the case of 
title XVI assisted applicants, employed), in the territorial area it 
serves. This assurance is referred to in this subpart as the ``community 
service assurance.''

[[Page 673]]



Sec. 124.602  Definitions.

    As used in this subpart:
    Act means the Public Health Service Act, as amended.
    Facility means the an entity that received assistance under title VI 
or title XVI of the Act and provided a community service assurance.
    Fiscal year means facility's fiscal year.
    Secretary means the Secretary of Health and Human Services or his 
delegatee.
    Service area means the geographic area designated as the area served 
by the facility in the most recent State plan approved by the Secretary 
under title VI, except that, at the request of the facility, the 
Secretary may designate a different area proposed by the facility when 
he determines that a different area is appropriate based on the criteria 
in 42 CFR 53.1(d).
    State agency means the agency of a state fully or conditionally 
designated by the Secretary as the State health planning and development 
agency of the State under section 1521 of the Act.



Sec. 124.603  Provision of services.

    (a) General. (1) In order to comply with its community service 
assurance, a facility shall make the services provided in the facility 
or portion thereof constructed, modernized, or converted with Federal 
assistance under title VI or XVI of the Act available to all persons 
residing (and, in the case of facilities assisted under title XVI of the 
Act, employed) in the facility's service area without discrimination on 
the ground of race, color, national origin, creed, or any other ground 
unrelated to an individual's need for the service or the availability of 
the needed service in the facility. Subject to paragraph (b) (concerning 
emergency services) a facility may deny services to persons who are 
unable to pay for them unless those persons are required to be provided 
uncompensated services under the provisions of Subpart F.
    (2) A person is residing in the facility's service area for purposes 
of this section if the person:
    (i) Is living in the service area with the intention to remain there 
permanently or for an indefinite period;
    (ii) Is living in the service area for purposes of employment; or
    (iii) Is living with a family member who resides in the service 
area.
    (b) Emergency services. (1) A facility may not deny emergency 
services to any person who resides (or, in the case of facilities 
assisted under title XVI of the Act, is employed) in the facility's 
service area on the ground that the person is unable to pay for those 
services.
    (2) A facility may discharge a person that has received emergency 
services, or may transfer the person to another facility able to provide 
necessary services, when the appropriate medical personnel determine 
that discharge or transfer will not subject the person to a substantial 
risk of deterioration in medical condition.
    (c) Third party payor programs. (1) The facility shall make 
arrangements, if eligible to do so, for reimbursement for services with:
    (i) Those principal State and local governmental third-party payors 
that provide reimbursement for services that is not less than the actual 
costs, as determined in accordance with accepted cost accounting 
principles; and
    (ii) Federal governmental third-party programs, such as medicare and 
medicaid.
    (2) The facility shall take any necessary steps to insure that 
admission to and services of the facility are available to beneficiaries 
of the governmental programs specified in paragraph (c)(1) of this 
section without discrimination or preference because they are 
beneficiaries of those programs.
    (d) Exclusionary admissions policies. A facility is out of 
compliance with its community service assurance if it uses an admission 
policy that has the effect of excluding persons on a ground other than 
those permitted under paragraph (a) of this section. Illustrative 
applications of this requirement are described in the following 
paragraphs:
    (1) A facility has a policy or practice of admitting only those 
patients who are referred by physicians with staff privileges at the 
facility. If this policy or practice has the effect of excluding persons 
who reside (or for title XVI facilities, are employed) in the community 
from the facility because they do

[[Page 674]]

not have a private family doctor with staff privileges at the facility, 
the facility would not be in compliance with its assurance. The facility 
is not required to abolish its staff physician admissions policy as a 
usual method for admission. However, to be in compliance with its 
community service assurance it must make alternative arrangements to 
assist area residents who would otherwise be unable to gain admission to 
obtain services available in the facility. Examples of alternative 
arrangements a facility might use include:
    (i) Authorizing the individual's physician, if licensed and 
otherwise qualified, to treat the patient at the facility even though 
the physician does not have staff privileges at the facility;
    (ii) For those patients who have no physician, obtaining the 
voluntary agreement of physicians with staff privileges at the facility 
to accept referrals of such patients, perhaps on a rotating basis;
    (iii) If an insufficient number of physicians with staff privileges 
agree to participate in a referral arrangement, requiring acceptance of 
referrals as a condition to obtaining or renewing staff privileges;
    (iv) Establishing a hospital-based primary care clinic through which 
patients needing hospitalization may be admitted; or
    (v) Hiring or contracting with qualified physicians to treat 
patients who do not have private physicians.
    (2) A facility, as required, is a qualified provider under the title 
XIX medicaid program, but few or none of the physicians with staff 
privileges at the facility or in a particular department or sub-
department of the facility will treat medicaid patients. If the effect 
is that some medicaid patients are excluded from the facility or from 
any service provided in the facility, the facility is not in compliance 
with its community service assurance. To be in compliance a facility 
does not have to require all of its staff physicians to accept medicaid. 
However, it must take steps to ensure that medicaid beneficiaries have 
full access to all of its available services. Examples of steps that may 
be taken include:
    (i) Obtaining the voluntary agreement of a reasonable number of 
physicians with staff privileges at the facility and in each department 
or sub-department to accept referral of medicaid patients, perhaps on a 
rotating basis;
    (ii) If an insufficient number of physicians with staff privileges 
agree to participate in a referral arrangement, requiring acceptance of 
referrals as a condition to obtaining or renewing staff privileges;
    (iii) Establishing a clinic through which medicaid beneficiaries 
needing hospitalization may be admitted; or
    (iv) Hiring or contracting with physicians to treat medicaid 
patients.
    (3) A facility requires advance deposits (pre-admission or pre-
service deposits) before admitting or serving patients. If the effect of 
this practice is that some persons are denied admission or service or 
face substantial delays in gaining admission or service solely because 
they do not have the necessary cash on hand, this would constitute a 
violation of the community service assurance. While the facility is not 
required to forego the use of a deposit policy in all situations, it is 
required to make alternative arrangements to ensure that persons who 
probably can pay for the services are not denied them simply because 
they do not have the available cash at the time services are requested. 
For example, many employed persons and persons with other collateral do 
not have savings, but can pay hospital bills on an installment basis, or 
can pay a small deposit. Such persons may not be excluded from admission 
or denied services because of their inability to pay a deposit.



Sec. 124.604  Posted notice.

    (a) The facility shall post notices, which the Secretary supplies in 
English and Spanish, in appropriate areas of the facility, including but 
not limited to the admissions area, the business office and the 
emergency room.
    (b) If in the service area of the facility the ``usual language of 
households'' of ten percent or more of the population, according to the 
most recent figures published by the Bureau of the

[[Page 675]]

Census, is other than English or Spanish, the facility shall translate 
the notice into that language and post the translated notice on signs 
substantially similar in size and legibility to, and posted with, those 
supplied under paragraph (a) of this section.
    (c) The facility shall make reasonable efforts to communicate the 
contents of the posted notice to persons who it has reason to believe 
cannot read the notice.



Sec. 124.605  Reporting and record maintenance requirements.

    (a) Reporting requirements--(1) Timing of reports.(i) A facility 
shall submit to the Secretary a report to assist the Secretary in 
determining compliance with this subpart once every three fiscal years, 
on a schedule to be prescribed by the Secretary. The report required by 
this section shall be submitted not later than 90 days after the end of 
the fiscal year, unless a longer period is approved by the Secretary for 
good cause shown.
    (ii) A facility shall also submit the required report whenever the 
Secretary determines, and so notifies the facility in writing, that a 
report is needed for proper administration of the program. In this 
situation the facility shall submit the report specified in this section 
for the filing of reports, within 90 days after receiving notice from 
the Secretary, or within 90 days after the close of the fiscal year, 
whichever is later.
    (2) Content of report. The report must be submitted on a form 
prescribed by the Secretary and must include information that the 
Secretary prescribes to permit a determination of whether a facility has 
met its obligations under this subpart.
    (3) The facility shall provide a copy of any report to the HSA for 
the area when submitting it to the Secretary.
    (4) Institution of suit. Not later than 10 days after being served 
with a summons or complaint, the applicant shall notify the Regional 
Health Administrator for the Region of HHS in which it is located of any 
legal action brought against it alleging that it has failed to comply 
with the requirements of this subpart.1
---------------------------------------------------------------------------

    1 The addresses of the Regional Office of HHS are set out in 
45 CFR 5.31.
---------------------------------------------------------------------------

    (b) Record maintenance requirements. (1) A facility shall maintain, 
make available for public inspection consistent with personal privacy, 
and provide to the Secretary on request, any records necessary to 
document its compliance requirements of this subpart in any fiscal year, 
including documents from which information required to be reported under 
paragraph (a) of this section was obtained. A facility shall maintain 
these records until 180 days following the close of the Secretary's 
investigation under Sec. 124.606(a).



Sec. 124.606  Investigation and enforcement.

    (a) Investigations. (1) The Secretary periodically investigates the 
compliance of facilities with the requirements of this subpart, and 
investigates complaints.
    (2)(i) A complaint is filed with the Secretary on the date on which 
the following information is received in the Office of the Regional 
Health Administrator for the Region of HHS in which the facility is 
located:
    (A) The name and address of the person making the complaint or on 
whose behalf the complaint is made;
    (B) The name and location of the facility;
    (C) The date or approximate date on which the event complained of 
occurred, and
    (D) A statement of what actions the complainant considers to violate 
the requirements of this subpart.
    (ii) The Secretary promptly provides a copy of the complaint to each 
facility named in the complaint.
    (3) When the Secretary investigates a facility, the facility shall 
provide to the Secretary on request any documents, records and other 
information concerning its operations that relate to the requirements of 
this subpart.
    (4) The Act provides that if the Secretary dismisses a complaint or 
the Attorney General has not brought an action for compliance within six 
months from the date on which the complaint is filed, the person filing 
it may bring

[[Page 676]]

a private action to effectuate compliance with the assurance. If the 
Secretary determines that he will be unable to issue a decision on a 
complaint or otherwise take appropriate action within the six month 
period, he may, based on priorities for the disposition of complaints 
that are established to promote the most effective use of enforcement 
resources, or on the request of the complainant, dismiss the complaint 
without a finding as to compliance prior to the end of the six month 
period, but no earlier than 45 days after the complaint is filed.
    (b) Enforcement. (1) If the Secretary finds, based on his 
investigation under paragraph (a) of this section, that a facility did 
not comply with the requirements of this subpart, he may take any action 
authorized by law to secure compliance, including but not limited to 
voluntary agreement or a request to the Attorney General to bring an 
action against the facility for specific performance.
    (2) If the Secretary finds, based on his investigation under 
paragraph (a) of this section, that a facility has limited the 
availability of its services in a manner proscribed by this subpart, he 
may, in addition to any other action that he is authorized to take in 
accordance with the Act, require the facility to establish an effective 
affirmative action plan that in his judgment is designed to insure that 
its services are made available in accordance with the requirements of 
this subpart.



Sec. 124.607  Agreements with State agencies.

    (a) Where the Secretary finds that it will promote the purposes of 
this subpart, and the State agency is able and willing to do so, he may 
enter into an agreement with the State agency for the State agency to 
assist him in administering this subpart in the State.
    (b) Under an agreement, the State agency will provide the Secretary 
with any assistance he requests in any one or more of the following 
areas, as set out in the agreement:
    (1) Investigation of complaints of noncompliance;
    (2) Monitoring the compliance of facilities with the requirements of 
this subpart;
    (3) Review of affirmative action plans submitted under 
Sec. 124.606(b);
    (4) Review of reports submitted under Sec. 124.605;
    (5) Making initial decisions for the Secretary with respect to 
compliance, subject to appeal by any party to the Secretary or review by 
the Secretary on his own initiative; and
    (6) Application of any sanctions available to it under State law 
(such as license revocation or termination of State assistance) against 
facilities determined to be out of compliance with the requirements of 
this subpart.
    (c) A State agency may use funds received under section 1525 of the 
Act to pay for expenses incurred in the course of carrying out this 
agreement.
    (d) Nothing in this subpart precludes any State from taking any 
action authorized by State law regarding the provision of services by 
any facility in the State as long as the action taken does not prevent 
the Secretary from enforcing the requirements of this subpart.

  Appendix to Subpart G--Interim Procedures and Criteria for Review by 
Health Systems Agencies of Applications Under Section 1625 of the Public 
                           Health Service Act

    In performing reviews under section 1513 (e) of the Public Health 
Service Act (42 U.S.C. 3001-2(c)) of applications for grants under 
section 1625 of the Act, health systems agencies shall use the 
procedures and criteria stated below. A health systems agency may not 
conduct such reviews until the procedures and criteria to be used in 
conducting the reviews have been adopted by the agency and published in 
newspapers of general circulation within the health service area or 
other public information channels.

                               procedures

    The procedures adopted and utilized by a health systems agency for 
conducting reviews of applications for grants under section 1625 of the 
Act shall include at least the following: 1. Except as provided below, 
notification of the beginning of a review within seven days of the 
receipt by the health systems agency of the application. Where the 
application was received by the health systems agency prior to 
publication of this subpart in the Federal Register, notification must 
be made within seven days of the date on which the health systems agency 
adopts its procedures and criteria. The notification shall include the 
proposed schedule for the

[[Page 677]]

review, the period within which a public hearing during the course of 
the review may be requested (which must be a reasonable period from the 
transmittal of the written notification required above), and the manner 
in which notification will be provided of the time and place of any 
hearings so requested. Written notification to members of the public may 
be provided through newspapers of general circulation in the area and 
public information channels. Notification to the applicant whose 
application is being reviewed and all other applicants for assistance 
under section 1625 of the Act providing health service in the health 
service area shall be by mail (which may be as part of a newsletter). 
The health systems agency must simultaneously notify the Federal funding 
agency of the beginning of the review.
    2. Schedules for reviews which provide that such reviews shall not 
exceed 60 days from the date of notification made in accordance with 
paragraph 1 of this section to the date of the written findings made in 
accordance with paragraph 4 of this section. This does not preclude a 
health systems agency from conducting its review in less than 60 days.
    3. Provision for applicants to submit to the health systems agency 
(in such form and manner as the agency shall require) such information 
as the agency deems necessary in order to conduct its review.
    4. Written findings which state the basis for the approval or 
disapproval of the application by the health systems agency. Such 
findings shall be sent to the applicant, the State health planning and 
development agency (or agencies), and the Secretary, and shall be 
available to other upon request.
    5. Access by the general public to all such applications reviewed by 
the health systems agency and to all other written materials pertinent 
to the agency review.
    6. Public hearings in the course of agency review, if requested by 
one or more persons directly affected by the review. For purposes of 
this paragraph, a ``person directly affected by the review'' is as 
defined in 42 CFR 122.306 (a)(7).

                                criteria

    The specific criteria adopted and utilized by a health systems of 
this agency to conduct reviews of applications for grants under section 
1625 of the Act shall include at least the following:
    1. The relationship of the health services of the facility to the 
applicable health systems plan and annual implementation plan.
    2. The relationship of the health services of the facility to the 
long-range development plan (if any) of the applicant.
    3. The need that the population served or to be served by the 
facility has for the health services of such facility.
    4. The availability of alternative, less costly, or more effective 
methods of providing the health services which the facility provides.
    5. The relationship of the health services provided by the facility 
to the existing health care system of the area.
    6. The availability of resources (including health manpower, 
management personnel, and funds for capital and operating needs) for the 
provision of services by the facility and the availability of 
alternative uses of such resources for the provision of other health 
services.
    7. The special needs and circumstances of those entities which 
provide a substantial portion of their services or resources, or both, 
to individuals not residing in the health service area in which the 
entities are located or in adjacent health service areas. Such entities 
may include medical and other health professions schools, 
multidisciplinary clinics, and other speciality centers.
    8. The special needs and circumstances of health maintenance 
organizations for which assistance may be provided under title XIII.
    9. The costs and methods of the proposed construction or 
modernization, including the costs and methods of energy provision.
    10. The probable impact of the project reviewed on the applicant's 
costs of providing health services.



                   Subpart H--Recovery of Grant Funds

    Authority: Secs. 609 and 1622 of the Public Health Service Act as 
amended 98 Stat. 112 (42 U.S.C. 291i and 300s-1a).

    Source: 51 FR 7939, Mar. 7, 1986, unless otherwise noted.



Sec. 124.701  Applicability.

    The provisions of this subpart apply to facilities with respect to 
which grant funds were paid for construction or modernization--
    (a) Under title VI or XVI of the Public Health Service Act; or
    (b) Pursuant to the authority of the Secretary under any of the 
following statutes:
    (1) The Public Works Acceleration Act of 1962, Pub. L. 87-658 (42 
U.S.C. 2641 et seq.);
    (2) The District of Columbia Medical Facilities Construction Act of 
1968, 82 Stat. 631 (Pub. L. 90-457);
    (3) The Appalachian Regional Development Act of 1965, as amended (40 
U.S.C. App.).



Sec. 124.702  Definitions.

    As used in this subpart--

[[Page 678]]

    Act means the Public Health Service Act.
    Department means the Department of Health and Human Services.
    Expected useful life means the period of time during which the 
structure may reasonably be expected to perform the function for which 
it was designed or intended.
    Facility means a facility with respect to which grant funds were 
paid under any of the authorizations listed in Sec. 124.701.
    Fiscal year means the facility's fiscal year.
    Nonprofit, as applied to any facility, means a facility that is 
owned and operated by one or more nonprofit corporations or associations 
no part of the net earnings of which inures, or may lawfully inure, to 
the benefit of any private shareholder or individual.
    Secretary means the Secretary of Health and Human Services and any 
other officer or employee of the Department of Health and Human Services 
to whom the authority involved has been delegated.
    State agency means (1) in the case of a facility with respect to 
which a grant was made under title VI of the Public Health Service Act 
or any of the statutes listed in Sec. 124.701(b), the State agency 
designated pursuant to section 604 of the Public Health Service Act or 
its successor agency, and (2) in the case of a facility with respect to 
which a grant was made under title XVI of the Public Health Service Act, 
the State health planning and development agency designated pursuant to 
title XV of the Public Health Service Act.
    Then value means the value of the facility on the date the facility 
is sold, transferred or ceases to be used for a permissible use as 
described in Sec. 124.704.



Sec. 124.703  Federal right of recovery.

    (a) If any facility is at any time within 20 years after the 
completion of the grant-assisted construction or modernization sold or 
transferred to any entity which is either not qualified for a grant 
under the statute pursuant to which the grant was awarded or not 
approved as a transferee by the State agency, the United States shall be 
entitled to recover on the basis of joint and several liability from any 
transferor, transferee, or successive transferee of the facility an 
amount determined in accordance with this subpart.
    (b) If any facility at any time within 20 years after the completion 
of the grant-assisted construction or modernization ceases to be a 
public or other non-profit facility that would have been eligible for a 
grant under the statute pursuant to which the grant was awarded, the 
United States shall be entitled to recover from the owners of the 
facility an amount determined in accordance with this subpart.



Sec. 124.704  Notification of sale, transfer, or change of use.

    (a) The transferor of a facility that is sold or transferred as 
described in Sec. 124.703(a), or the owner of a facility which ceases to 
be a public or other nonprofit facility as described in Sec. 124.703(b), 
shall provide the Secretary written notice of such sale, transfer, or 
other change not later than 10 days after the date on which the sale, 
transfer, or change occurs.
    (1) Transfer. For purposes of this subpart, a transfer occurs when a 
facility is conveyed to another entity through lease, merger, 
bankruptcy, foreclosure, or other arrangement.
    (2) Cease to be. For purposes of this subpart,
    (i) A facility ``ceases to be'' a facility for which a grant could 
have been made under the statute pursuant to which the grant was awarded 
when it is no longer operated as such a facility; and
    (ii) A facility ``ceases to be a public or nonprofit facility'' when 
an entity that is not a public or other non-profit corporation or 
association assumes management responsibilities with respect to the 
facility which, in the Secretary's judgment, are so pervasive as to 
constitute operation of the facility. The manager will not be deemed to 
be the operator of the facility if the management agreement contains 
both of the following provisions:

    The Board of Directors of the facility retains authority to 
terminate the agreement at any time upon reasonable notice to the 
contractor.
    No employee of the contractor may be a member of the facility's 
Board of Directors.


In the absence of either of these provisions the Secretary will consider 
the

[[Page 679]]

degree of control granted to the managing organization over patient 
admission, determination of what services will be provided, and charges 
for services provided in the facility.
    (b) Content of Notice. The notice required by paragraph (a) of this 
section shall be sent to the Secretary by certified mail, and shall 
contain or be accompanied by
    (1) The date of the sale, transfer, or other event that gives rise 
to the notice;
    (2) Copies of any sales contracts, lease agreements, management 
contracts or other documents pertinent to the event giving rise to the 
notice;
    (3) Estimates of current assets, current liabilities, book value of 
equipment, the expected value of land on the new owner's books, and the 
remaining depreciation for all fixed assets involved in the transaction 
calculated on a straight line basis using commonly adopted expected 
useful lifetimes.
    (c) Failure to provide notice. Failure to provide the information 
required by paragraph (b) of this section, will be considered failure to 
provide the notice required by this section. In any case in which such 
information has not been provided, the Secretary will, promptly upon 
receiving an incomplete notice or otherwise discovering that a sale, 
transfer or other event giving rise to a recovery may have occurred, 
send a letter to the owner of the facility requesting the information 
needed to calculate a recovery amount.

(Approved by the Office of Management and Budget under control number 
0915-0099)



Sec. 124.705  Amount of recovery.

    (a) Except as provided in Sec. 124.706, the amount that the United 
States shall be entitled to recover under this subpart is that amount 
bearing the same ratio to the then value of so much of the facility as 
constituted an approved project (or projects) as the amount of Federal 
participation bore to the cost of the construction or modernization 
under such project (or projects).
    (b) The then value of the facility will be based on:
    (1) The transaction value in the case of an arms-length sale or 
transfer, or
    (2) A depreciated reproduction value in the absence of an arms-
length sale or transfer or if the buyer fails to provide, within 60 days 
after the date of the Secretary's letter described in Sec. 124.704(c), 
the information which, in the judgment of the Secretary, is necessary to 
establish, adjust, and apportion a transaction value. As used in this 
section, ``transaction value'' means in the case of a sale, the sale 
price, and in the case of a lease, the value of the lease plus the 
residual value of the facility at the termination of the lease (i.e., 
the reproduction value or, if appropriate, an alternative use value).
    (c) The transaction value will be adjusted to account for the 
purchase or lease of other assets and the assumption of liabilities 
associated with the transaction. To determine the amount of Federal 
recovery, the adjusted value will be apportioned to the grant-aided 
assets by the ration of the remaining useful lifetime values of those 
assets to the sum of the remaining useful lifetime values of all assets 
not previously accounted for in adjusting the transaction value.
    (d) A depreciated reproduction value will be established by 
calculating a reproduction value using construction cost indexes or 
current costs per square foot for construction, depending on which is 
more relevant to the type of construction associated with the grant. 
This reproduction value will then be adjusted by the ratio of the 
remaining useful life to the total useful life for the assets involved.
    (e) In calculating the recovery amount, the Secretary will include 
as Federal participation any grant assistance received by the facility 
under an authority listed in Sec. 124.701 and any assistance 
supplementary to that assistance received for the construction or 
modernization of the facility under the Public Works and Economic 
Development Act of 1965 (42 U.S.C. 3121, et seq.) or the Local Public 
Works Capital Development Act of 1976 (Pub. L. 94-369).



Sec. 124.706  Calculation of interest.

    (a) In addition to the amount of recovery calculated under 
Sec. 124.705, the United States shall be entitled to recover interest on 
such amount in accordance with this section at the rate determined by 
the Secretary based on

[[Page 680]]

the average of the bond equivalent of the weekly ninety-day U.S. 
Treasury bill auction rate for the quarter previous to the quarter in 
which interest begins to accrue under this section.
    (1) Change of status before July 18, 1984. For facilities that were 
sold or transferred or which ceased to be public or other nonprofit 
facilities before July 18, 1984, interest will be charged beginning 
August 17, 1984, or 180 days after the date of such sale, transfer or 
other, whichever is later, and ending on the date the amount the United 
States is entitled to recover is collected.
    (2) Change of status after July 17, 1984. For facilities that are 
sold or transferred or which cease to be public or other nonprofit 
facilities after July 17, 1984, interest will be charged beginning 180 
days after receipt by the Department of the notice required under 
Sec. 124.704; Provided, That if such notice is not provided as 
prescribed, interest will be charged beginning on the date of the sale, 
transfer, or change of use, and ending on the date the amount which the 
United States is entitled to recover is collected.
    (b) The Secretary may waive interest charges that result from delays 
caused solely by the Department.



Sec. 124.707  Waiver of recovery where facility is sold or transferred to a proprietary entity.

    (a) Conditions of the waiver. The Secretary may waive the recovery 
rights of the United States arising under Sec. 124.703(a) if the entity 
to which the facility was sold or transferred:
    (1) Has filed a written request for the waiver within the time 
limits prescribed by this section;
    (2) Has established an irrevocable trust in accordance with this 
section, in an amount equal to the greater of the amount that would 
otherwise have been recovered pursuant to Sec. 124.705 (including 
accrued interest as calculated under Sec. 124.706) or twice the cost of 
the remaining uncompensated services obligation of the facility as of 
the date of the change of status, that will be used by the entity only 
to provide services to those unable to pay in accordance with the 
requirements of subpart F of this part; and
    (3) Has agreed to comply with the community service regulations set 
out in subpart G of this part.
    (b) Procedures for obtaining waiver. (1) Within 30 days after the 
date of receipt of the information described in Sec. 124.704(b), the 
Secretary will send a letter to the new owner of the facility advising 
of the United States' right of recovery and the opportunity to obtain a 
waiver. For the purpose of advising the new owner of the amount to be 
placed in the irrevocable trust should the owner wish to obtain a 
waiver, the letter will also state the dollar amount of the remaining 
uncompensated care obligation and the amount that would be due under 
Sec. 124.705, computed as follows:
    (i) Computation of uncompensated care obligation. (A) For a facility 
which changes status before the date that subpart F of this part is 
effective for the facility, the remaining uncompensated services 
obligation is zero.
    (B) For a facility which changes status after the date that subpart 
F of this part is effective for the facility, the Secretary will 
multiply the annual compliance level, computed under the 10% method 
specified in 42 CFR 124.503(a)(1)(ii), for the fiscal year in which the 
change of status occurs times the number of years remaining in the 
facility's uncompensated services obligation. From this amount, the 
Secretary will subtract amounts of excess or add amounts of deficit for 
each fiscal year prior to the change of status for which the Secretary 
has previously conducted an audit of uncompensated services accounts. 
Excess and deficits will be adjusted by the percent change in the 
National Consumer Price Index for Medical Care between the year in which 
the excess or deficit occurred and the year in which the status change 
occurred. For each fiscal year prior to the change of status which the 
Secretary has not audited, the Secretary will add to the remaining 
obligation an amount equal to the annual compliance level in each such 
year adjusted by the percent change in the National Consumer Price Index 
for Medical Care between that year and the year of the status change. 
The amount computed as the total remaining obligation will then be 
multiplied by two.

[[Page 681]]

If the transferee chooses to accept the Secretary's calculation, no 
further assessments will be made of uncompensated care provided prior to 
the change of status date. If the transferee does not accept the 
calculation, the transferor or transferee may hire, and may charge 
against the irrevocable trust established under this section, an 
independent auditor to certify the compliance level and any excess or 
deficit for the period from May 18, 1979, up to and including the date 
of the change of status, using standard Departmental procedures 
supplemented with instructions provided by the Secretary, and submit the 
results in accordance with paragraph (b)(2)(ii) of this section. The 
audit may be conducted for any years not included in a previous site 
assessment conducted by the Department. If the Secretary agrees that a 
change is appropriate, the Secretary will use this information to adjust 
the calculation as set out in paragraph (b)(3) of this section. If the 
independent auditor certifies that qualified care was rendered either at 
the facility or at a replacement facility operated by the transferee 
between the date of the change of status and the date of establishment 
of the trust, and the Secretary agrees, the post transfer level of care 
shall not affect the calculation of the total remaining uncompensated 
care obligation to be doubled, but instead shall be recognized as a 
credit to be drawn from the trust as provided in paragraph (c)(1)(ii) of 
this section. In the case of a facility with respect to which a grant 
was made under title XVI of the Act, the remaining period of obligation 
will be the remainder of the expected useful life of the facility, as 
follows: 40 years for buildings, 30 years for additions, 20 years for 
building renovations, 20 years for fixed equipment and 12 years for 
major movable equipment.
    (ii) Computation of recovery amount. The Secretary will determine 
the recovery amount as provided in Sec. 124.705.
    (2) Within 60 days following the date of the Secretary's letter 
provided pursuant to paragraph (b)(1) of this section, the owner of the 
facility shall notify the Secretary in writing that it either:
    (i) Accepts the trust fund amount for the waiver as offered by the 
Secretary;
    (ii) Provides a detailed statement of an alternative determination 
of the recovery amount or an independent audit of the remaining 
uncompensated services obligation as described in paragraph (b)(1)(i) of 
this section; or
    (iii) Does not seek a waiver under Sec. 124.707. Failure to provide 
a timely response to the Secretary under this subparagraph will be 
considered an election not to seek the waiver.
    (3) Within 30 days following the receipt of the owner's views 
concerning the calculation, and after considering those views, the 
Secretary will send a final letter providing the Secretary's 
determination of twice the remaining uncompensated care obligation and 
the recovery amount under Sec. 124.705. The amount to be placed in the 
irrevocable trust will be the higher of those two figures. (See 
paragraph (a)(2) of this section.)
    (4) Within 30 days of the date of the final letter, the owner of the 
facility shall notify the Secretary in writing whether or not it accepts 
the terms of the waiver. Failure to provide timely notice to the 
Secretary under this subparagraph will be considered an election not to 
accept the waiver.
    (c) Establishment of the trust. (1) Within 60 days of the date of 
its acceptance of a waiver under paragraph (b)(2) or (b)(4) of this 
section, the owner shall begin delivering services to those unable to 
pay in accordance with subpart F of this part under an irrevocable trust 
established in the amount calculated pursuant to paragraph (b) of this 
section. Provided, That
    (i) The owner shall provide a copy of the trust documents to the 
Secretary and no trust shall be considered established until the trust 
documents have been approved by the Secretary; and
    (ii) The owner may credit against the trust any uncompensated 
services provided in accordance with subpart F of this part between the 
date of the change of status of the facility and the establishment of 
the trust. For an owner to receive the credit before the establishment 
of the trust and deposit of funds therein, the auditor's report covering 
the post-transfer period shall be submitted with the notification of 
acceptance of the waiver, and in any event, not later than 30 days from 
the

[[Page 682]]

date of the Secretary's final letter described in paragraph (b)(3) of 
this section. Within 30 days following the receipt of the auditor's 
report, the Secretary will notify the owner of the allowable credit, if 
any. If the auditor's report is not timely submitted, the trust must be 
established and fully funded, in accordance with the time limits imposed 
by paragraph (c)(1) of this section, and the Secretary will notify the 
owner of the allowable credit, if any, within 30 days of the date of the 
establishment of the trust or within 30 days of the receipt of the 
report, whichever is later.
    (2) The trust shall be administered by a Trustee who is neither an 
employee of the transferee nor an employee of a subsidiary or of the 
parent institution of the transferee.
    (3) The trust shall provide that the trust corpus and income may be 
invested only in U.S. Government or U.S. Government insured securities.
    (d) Use of the trust. The corpus and income of the irrevocable trust 
shall be used to pay for the costs of uncompensated services, which may 
include reasonable costs of establishing and administering the trust and 
the cost of the independent audit described in paragraph (b)(1)(i) of 
this section, until the trust is exhausted.

(Approved by the Office of Management and Budget under control number 
0915-0099)



Sec. 124.708  Waiver of recovery--good cause for other use of facility.

    The Secretary may for good cause waive the recovery rights of the 
United States arising under Sec. 124.703(b). In determining whether 
there is good cause under this section for releasing the applicant or 
other owner of the facility from its obligation, the Secretary will take 
into consideration the extent to which:
    (a) The facility will be devoted by the applicant or other owner to 
use for another public or nonprofit purpose whch will promote the 
purpose of the Act;
    (b) There are reasonable assurances that for the remainder of the 
20-year period other public or nonprofit facilities not previously 
utilized for the purpose for which the facility was constructed will be 
so utilized and are substantially equivalent in nature and purpose.
    (c) The facility has been acquired from an agency of the United 
States (e.g., the Federal Housing Administration under its mortgage 
insurance commitment program) which has made a reasonable effort to 
dispose of it for operation as a public or nonprofit health care 
facility.

[51 FR 7939, Mar. 7, 1986, as amended at 57 FR 8272, Mar. 9, 1992]



Sec. 124.709  Withdrawal of waiver.

    (a) Any waiver granted under this subpart is conditioned upon the 
recipient of the waiver carrying out the obligations imposed by 
Sec. 124.707 or Sec. 124.708 as applicable.
    (b) The Secretary will monitor compliance with the community service 
and uncompensated care obligations of any entity that receives a waiver.
    (c) Should a recipient of a waiver fail to comply with the 
applicable conditions, the Secretary will withdraw the waiver and seek 
recovery based on the value of the facility on the date the right of 
recovery first arose under Sec. 124.703.
    (d) No waiver will be withdrawn until the recipient has been 
notified in writing by the Secretary of the noncompliance and has failed 
to take corrective action within 90 days after the date of such notice.
    (e) Should the waiver be withdrawn, the amount of the Government's 
recovery will be the amount set out in the Secretary's determination 
letter as described in Sec. 124.707 (b)(1) or (b)(3) as applicable plus 
interest from the date of the notification sent in accordance with 
paragraph (d) of this section.

                        PARTS 125--399 [RESERVED]

                      CHAPTERS II--III  [RESERVED]


[[Page 683]]



                              FINDING AIDS




  --------------------------------------------------------------------

  A list of CFR titles, subtitles, chapters, subchapters and parts and 
an alphabetical list of agencies publishing in the CFR are included in 
the CFR Index and Finding Aids volume to the Code of Federal Regulations 
which is published separately and revised annually.

  Material Approved for Incorporation by Reference
  Table of CFR Titles and Chapters
  Alphabetical List of Agencies Appearing in the CFR
  Redesignation Table
  List of CFR Sections Affected

[[Page 685]]

            Material Approved for Incorporation by Reference

                     (Revised as of October 1, 1999)

  The Director of the Federal Register has approved under 5 U.S.C. 
552(a) and 1 CFR part 51 the incorporation by reference of the following 
publications. This list contains only those incorporations by reference 
effective as of the revision date of this volume. Incorporations by 
reference found within a regulation are effective upon the effective 
date of that regulation. For more information on incorporation by 
reference, see the preliminary pages of this volume.


42 CFR (PARTS 1-399)

PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES
                                                                  42 CFR


American National Standards Institute (ANSI)

  11 West 42nd Street, New York, NY 10036 
  Telephone: (212) 642-4900
ANSI K13.1-1973, American National Standard for         84.113; 84.193; 
  Identification of Air-Purifying Respirator                     84.1154
  Canisters and Cartridges.
American Standards Association, Compressed Gas                     84.81
  Cylinder Valve Outlet and Inlet Connections, 
  B57.1-1965.


American Nurses' Association

  2420 Pershing Rd., Kansas City, MO 64108
  Also available from Emergency Department Nurses' 
  Association, 666 N. Lake Shore Dr., Chicago, IL 
  60611
ANA Publication Code MS-5 10M 9/75 Standards of         57.2106(b)(3)(i)
  Emergency Nursing Practice.


American Society of Heating, Refrigerating and Air Conditioning 
Engineers

  United Engineering Center, 345 E. 47th St., New 
  York, NY 10017
Handbook of Fundamentals, 1977....................          52b.11(b)(1)


Centers for Disease Control and Prevention/National Institutes of Health

  Superintendent of Documents, U.S. Government 
  Printing Office, Washington, DC 20402, Telephone 
  202-512-1800
Biosafety in Microbiological and Biomedical                   72.6(a)(5)
  Laboratories (Third Edition, May 1993).


Compressed Gas Association

  1725 Jefferson Davis Highway, Suite 1004, 
  Arlington, VA 22202
Commodity Specification for Air, G-7.1, 1966......         84.79; 84.141
Pamphlet P-2.1. Standard for Medical-Surgical               52b.11(b)(4)
  Vacuum Systems in Hospitals (1967).


Department of Defense

  DODSSP Standardization Document Order Desk, 700 
  Robbins Avenue, Bldg. 4 D, Philadelphia, PA 
  19111-5098
Military Standards:
  MIL-STD-414, 11 June 1957, Including Change               84.41; 84.43
  Notice 1, Sampling Procedures and Tables for 
  Inspection by Variables for Percent Defective


General Services Administration, Public Buildings Services

  Office of Design and Construction, 18th & F Sts. 
  NW., Washington, DC 20405

[[Page 686]]

GSA Accessibility Standard (PBS (PCD): DG6, Oct.         36.110(b)(10); 
  14, 1980).                                              51c.503(a)(7) 
                                                      (iii)(A); 52b.8(j)


International Conference of Building Officials

  5360 South Workman Mill Rd., Whittier, CA 90601
Uniform Building Code, 1979 Ed....................  52b.11(g); 52b.11(a)


National Association of Plumbing-Heating-Cooling Contractors

  1016 20th St. NW., Washington, DC 20036
National Standard Plumbing Code, 1980 Ed..........          52b.11(b)(2)


National Council on Radiation Protection and Measurement

  P.O. Box 30175, Washington, DC 20014
  Also available for examination at ALOSH, 944 
  Chestnut Ridge Rd., Morgantown, WV 26505 and 
  National Institute for Occupational Safety and 
  Health, 5600 Fishers Ln., Rockville, MD 20857
NCRP Report No. 33, Medical X-ray and Gamma-Ray         37.43; 52b.11(f)
  Protection for Energies Up to 10 MeV--Equipment 
  Design and Use (issued Feb. 1, 1968).
NCRP Report No. 48, Medical Radiation Protection                   37.43
  for Medical and Allied Health Personnel (issued 
  Aug. 1, 1976).
NCRP Report No. 49, Structural Shielding Design         37.43; 52b.11(f)
  and Evaluation for Medical Use of X-rays and 
  Gamma-Rays of up to 10 MeV (issued Sept. 15, 
  1976).


National Fire Protection Association

  1 Batterymarch Park, Quincy, MA 02269-9101, 
  Telephone: (800) 344-3555
NFPA No. 56F, 1977, Standard for Non-Flammable              52b.11(b)(3)
  Medical Gas Systems.


Transportation Department, National Highway Traffic Safety 
Administration

  Washington, DC 20590
  Also available from the Superintendent of 
  Documents, U.S. Government Printing Office, 
  Washington, DC 20402, Telephone 202-512-1800.
Basic Training Course/Emergency Medical Technician      57.2106(b)(1)(i)
  (2nd Ed.) Course Guide 1977 (DOT Pub. No. HS 
  802534 through 536).
National Training Course Guide for Emergency            57.2106(b)(2)(i)
  Medical Technician--Paramedic, 1977 (DOT Pub. 
  No. HS 802437) Appendix A.
National Training Course Guide for Emergency           57.2106(b)(2)(ii)
  Medical Technician--Paramedic, 1977 (DOT Pub. 
  No. HS 802437) Appendices B and C.



[[Page 687]]



                    Table of CFR Titles and Chapters




                     (Revised as of October 1, 1999)

                      Title 1--General Provisions

         I  Administrative Committee of the Federal Register 
                (Parts 1--49)
        II  Office of the Federal Register (Parts 50--299)
        IV  Miscellaneous Agencies (Parts 400--500)

                          Title 2--[Reserved]

                        Title 3--The President

         I  Executive Office of the President (Parts 100--199)

                           Title 4--Accounts

         I  General Accounting Office (Parts 1--99)
        II  Federal Claims Collection Standards (General 
                Accounting Office--Department of Justice) (Parts 
                100--299)

                   Title 5--Administrative Personnel

         I  Office of Personnel Management (Parts 1--1199)
        II  Merit Systems Protection Board (Parts 1200--1299)
       III  Office of Management and Budget (Parts 1300--1399)
         V  The International Organizations Employees Loyalty 
                Board (Parts 1500--1599)
        VI  Federal Retirement Thrift Investment Board (Parts 
                1600--1699)
       VII  Advisory Commission on Intergovernmental Relations 
                (Parts 1700--1799)
      VIII  Office of Special Counsel (Parts 1800--1899)
        IX  Appalachian Regional Commission (Parts 1900--1999)
        XI  Armed Forces Retirement Home (Part 2100)
       XIV  Federal Labor Relations Authority, General Counsel of 
                the Federal Labor Relations Authority and Federal 
                Service Impasses Panel (Parts 2400--2499)
        XV  Office of Administration, Executive Office of the 
                President (Parts 2500--2599)
       XVI  Office of Government Ethics (Parts 2600--2699)
       XXI  Department of the Treasury (Parts 3100--3199)
      XXII  Federal Deposit Insurance Corporation (Part 3201)

[[Page 688]]

     XXIII  Department of Energy (Part 3301)
      XXIV  Federal Energy Regulatory Commission (Part 3401)
       XXV  Department of the Interior (Part 3501)
      XXVI  Department of Defense (Part 3601)
    XXVIII  Department of Justice (Part 3801)
      XXIX  Federal Communications Commission (Parts 3900--3999)
       XXX  Farm Credit System Insurance Corporation (Parts 4000--
                4099)
      XXXI  Farm Credit Administration (Parts 4100--4199)
    XXXIII  Overseas Private Investment Corporation (Part 4301)
      XXXV  Office of Personnel Management (Part 4501)
        XL  Interstate Commerce Commission (Part 5001)
       XLI  Commodity Futures Trading Commission (Part 5101)
      XLII  Department of Labor (Part 5201)
     XLIII  National Science Foundation (Part 5301)
       XLV  Department of Health and Human Services (Part 5501)
      XLVI  Postal Rate Commission (Part 5601)
     XLVII  Federal Trade Commission (Part 5701)
    XLVIII  Nuclear Regulatory Commission (Part 5801)
         L  Department of Transportation (Part 6001)
       LII  Export-Import Bank of the United States (Part 6201)
      LIII  Department of Education (Parts 6300--6399)
       LIV  Environmental Protection Agency (Part 6401)
      LVII  General Services Administration (Part 6701)
     LVIII  Board of Governors of the Federal Reserve System (Part 
                6801)
       LIX  National Aeronautics and Space Administration (Part 
                6901)
        LX  United States Postal Service (Part 7001)
       LXI  National Labor Relations Board (Part 7101)
      LXII  Equal Employment Opportunity Commission (Part 7201)
     LXIII  Inter-American Foundation (Part 7301)
       LXV  Department of Housing and Urban Development (Part 
                7501)
      LXVI  National Archives and Records Administration (Part 
                7601)
      LXIX  Tennessee Valley Authority (Part 7901)
      LXXI  Consumer Product Safety Commission (Part 8101)
     LXXIV  Federal Mine Safety and Health Review Commission (Part 
                8401)
     LXXVI  Federal Retirement Thrift Investment Board (Part 8601)
    LXXVII  Office of Management and Budget (Part 8701)

                          Title 6--[Reserved]


[[Page 689]]



                         Title 7--Agriculture

            Subtitle A--Office of the Secretary of Agriculture 
                (Parts 0--26)
            Subtitle B--Regulations of the Department of 
                Agriculture
         I  Agricultural Marketing Service (Standards, 
                Inspections, Marketing Practices), Department of 
                Agriculture (Parts 27--209)
        II  Food and Nutrition Service, Department of Agriculture 
                (Parts 210--299)
       III  Animal and Plant Health Inspection Service, Department 
                of Agriculture (Parts 300--399)
        IV  Federal Crop Insurance Corporation, Department of 
                Agriculture (Parts 400--499)
         V  Agricultural Research Service, Department of 
                Agriculture (Parts 500--599)
        VI  Natural Resources Conservation Service, Department of 
                Agriculture (Parts 600--699)
       VII  Farm Service Agency, Department of Agriculture (Parts 
                700--799)
      VIII  Grain Inspection, Packers and Stockyards 
                Administration (Federal Grain Inspection Service), 
                Department of Agriculture (Parts 800--899)
        IX  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Fruits, Vegetables, Nuts), Department 
                of Agriculture (Parts 900--999)
         X  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Milk), Department of Agriculture 
                (Parts 1000--1199)
        XI  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Miscellaneous Commodities), Department 
                of Agriculture (Parts 1200--1299)
      XIII  Northeast Dairy Compact Commission (Parts 1300--1399)
       XIV  Commodity Credit Corporation, Department of 
                Agriculture (Parts 1400--1499)
        XV  Foreign Agricultural Service, Department of 
                Agriculture (Parts 1500--1599)
       XVI  Rural Telephone Bank, Department of Agriculture (Parts 
                1600--1699)
      XVII  Rural Utilities Service, Department of Agriculture 
                (Parts 1700--1799)
     XVIII  Rural Housing Service, Rural Business-Cooperative 
                Service, Rural Utilities Service, and Farm Service 
                Agency, Department of Agriculture (Parts 1800--
                2099)
      XXVI  Office of Inspector General, Department of Agriculture 
                (Parts 2600--2699)
     XXVII  Office of Information Resources Management, Department 
                of Agriculture (Parts 2700--2799)
    XXVIII  Office of Operations, Department of Agriculture (Parts 
                2800--2899)
      XXIX  Office of Energy, Department of Agriculture (Parts 
                2900--2999)
       XXX  Office of the Chief Financial Officer, Department of 
                Agriculture (Parts 3000--3099)
      XXXI  Office of Environmental Quality, Department of 
                Agriculture (Parts 3100--3199)

[[Page 690]]

     XXXII  Office of Procurement and Property Management, 
                Department of Agriculture (Parts 3200--3299)
    XXXIII  Office of Transportation, Department of Agriculture 
                (Parts 3300--3399)
     XXXIV  Cooperative State Research, Education, and Extension 
                Service, Department of Agriculture (Parts 3400--
                3499)
      XXXV  Rural Housing Service, Department of Agriculture 
                (Parts 3500--3599)
     XXXVI  National Agricultural Statistics Service, Department 
                of Agriculture (Parts 3600--3699)
    XXXVII  Economic Research Service, Department of Agriculture 
                (Parts 3700--3799)
   XXXVIII  World Agricultural Outlook Board, Department of 
                Agriculture (Parts 3800--3899)
       XLI  [Reserved]
      XLII  Rural Business-Cooperative Service and Rural Utilities 
                Service, Department of Agriculture (Parts 4200--
                4299)

                    Title 8--Aliens and Nationality

         I  Immigration and Naturalization Service, Department of 
                Justice (Parts 1--599)

                 Title 9--Animals and Animal Products

         I  Animal and Plant Health Inspection Service, Department 
                of Agriculture (Parts 1--199)
        II  Grain Inspection, Packers and Stockyards 
                Administration (Packers and Stockyards Programs), 
                Department of Agriculture (Parts 200--299)
       III  Food Safety and Inspection Service, Department of 
                Agriculture (Parts 300--599)

                           Title 10--Energy

         I  Nuclear Regulatory Commission (Parts 0--199)
        II  Department of Energy (Parts 200--699)
       III  Department of Energy (Parts 700--999)
         X  Department of Energy (General Provisions) (Parts 
                1000--1099)
      XVII  Defense Nuclear Facilities Safety Board (Parts 1700--
                1799)

                      Title 11--Federal Elections

         I  Federal Election Commission (Parts 1--9099)

                      Title 12--Banks and Banking

         I  Comptroller of the Currency, Department of the 
                Treasury (Parts 1--199)

[[Page 691]]

        II  Federal Reserve System (Parts 200--299)
       III  Federal Deposit Insurance Corporation (Parts 300--399)
        IV  Export-Import Bank of the United States (Parts 400--
                499)
         V  Office of Thrift Supervision, Department of the 
                Treasury (Parts 500--599)
        VI  Farm Credit Administration (Parts 600--699)
       VII  National Credit Union Administration (Parts 700--799)
      VIII  Federal Financing Bank (Parts 800--899)
        IX  Federal Housing Finance Board (Parts 900--999)
        XI  Federal Financial Institutions Examination Council 
                (Parts 1100--1199)
       XIV  Farm Credit System Insurance Corporation (Parts 1400--
                1499)
        XV  Department of the Treasury (Parts 1500--1599)
      XVII  Office of Federal Housing Enterprise Oversight, 
                Department of Housing and Urban Development (Parts 
                1700--1799)
     XVIII  Community Development Financial Institutions Fund, 
                Department of the Treasury (Parts 1800--1899)

               Title 13--Business Credit and Assistance

         I  Small Business Administration (Parts 1--199)
       III  Economic Development Administration, Department of 
                Commerce (Parts 300--399)

                    Title 14--Aeronautics and Space

         I  Federal Aviation Administration, Department of 
                Transportation (Parts 1--199)
        II  Office of the Secretary, Department of Transportation 
                (Aviation Proceedings) (Parts 200--399)
       III  Commercial Space Transportation, Federal Aviation 
                Administration, Department of Transportation 
                (Parts 400--499)
         V  National Aeronautics and Space Administration (Parts 
                1200--1299)

                 Title 15--Commerce and Foreign Trade

            Subtitle A--Office of the Secretary of Commerce (Parts 
                0--29)
            Subtitle B--Regulations Relating to Commerce and 
                Foreign Trade
         I  Bureau of the Census, Department of Commerce (Parts 
                30--199)
        II  National Institute of Standards and Technology, 
                Department of Commerce (Parts 200--299)
       III  International Trade Administration, Department of 
                Commerce (Parts 300--399)
        IV  Foreign-Trade Zones Board, Department of Commerce 
                (Parts 400--499)

[[Page 692]]

       VII  Bureau of Export Administration, Department of 
                Commerce (Parts 700--799)
      VIII  Bureau of Economic Analysis, Department of Commerce 
                (Parts 800--899)
        IX  National Oceanic and Atmospheric Administration, 
                Department of Commerce (Parts 900--999)
        XI  Technology Administration, Department of Commerce 
                (Parts 1100--1199)
      XIII  East-West Foreign Trade Board (Parts 1300--1399)
       XIV  Minority Business Development Agency (Parts 1400--
                1499)
            Subtitle C--Regulations Relating to Foreign Trade 
                Agreements
        XX  Office of the United States Trade Representative 
                (Parts 2000--2099)
            Subtitle D--Regulations Relating to Telecommunications 
                and Information
     XXIII  National Telecommunications and Information 
                Administration, Department of Commerce (Parts 
                2300--2399)

                    Title 16--Commercial Practices

         I  Federal Trade Commission (Parts 0--999)
        II  Consumer Product Safety Commission (Parts 1000--1799)

             Title 17--Commodity and Securities Exchanges

         I  Commodity Futures Trading Commission (Parts 1--199)
        II  Securities and Exchange Commission (Parts 200--399)
        IV  Department of the Treasury (Parts 400--499)

          Title 18--Conservation of Power and Water Resources

         I  Federal Energy Regulatory Commission, Department of 
                Energy (Parts 1--399)
       III  Delaware River Basin Commission (Parts 400--499)
        VI  Water Resources Council (Parts 700--799)
      VIII  Susquehanna River Basin Commission (Parts 800--899)
      XIII  Tennessee Valley Authority (Parts 1300--1399)

                       Title 19--Customs Duties

         I  United States Customs Service, Department of the 
                Treasury (Parts 1--199)
        II  United States International Trade Commission (Parts 
                200--299)
       III  International Trade Administration, Department of 
                Commerce (Parts 300--399)

[[Page 693]]

                     Title 20--Employees' Benefits

         I  Office of Workers' Compensation Programs, Department 
                of Labor (Parts 1--199)
        II  Railroad Retirement Board (Parts 200--399)
       III  Social Security Administration (Parts 400--499)
        IV  Employees' Compensation Appeals Board, Department of 
                Labor (Parts 500--599)
         V  Employment and Training Administration, Department of 
                Labor (Parts 600--699)
        VI  Employment Standards Administration, Department of 
                Labor (Parts 700--799)
       VII  Benefits Review Board, Department of Labor (Parts 
                800--899)
      VIII  Joint Board for the Enrollment of Actuaries (Parts 
                900--999)
        IX  Office of the Assistant Secretary for Veterans' 
                Employment and Training, Department of Labor 
                (Parts 1000--1099)

                       Title 21--Food and Drugs

         I  Food and Drug Administration, Department of Health and 
                Human Services (Parts 1--1299)
        II  Drug Enforcement Administration, Department of Justice 
                (Parts 1300--1399)
       III  Office of National Drug Control Policy (Parts 1400--
                1499)

                      Title 22--Foreign Relations

         I  Department of State (Parts 1--199)
        II  Agency for International Development (Parts 200--299)
       III  Peace Corps (Parts 300--399)
        IV  International Joint Commission, United States and 
                Canada (Parts 400--499)
         V  United States Information Agency (Parts 500--599)
       VII  Overseas Private Investment Corporation (Parts 700--
                799)
        IX  Foreign Service Grievance Board Regulations (Parts 
                900--999)
         X  Inter-American Foundation (Parts 1000--1099)
        XI  International Boundary and Water Commission, United 
                States and Mexico, United States Section (Parts 
                1100--1199)
       XII  United States International Development Cooperation 
                Agency (Parts 1200--1299)
      XIII  Board for International Broadcasting (Parts 1300--
                1399)
       XIV  Foreign Service Labor Relations Board; Federal Labor 
                Relations Authority; General Counsel of the 
                Federal Labor Relations Authority; and the Foreign 
                Service Impasse Disputes Panel (Parts 1400--1499)
        XV  African Development Foundation (Parts 1500--1599)
       XVI  Japan-United States Friendship Commission (Parts 
                1600--1699)
      XVII  United States Institute of Peace (Parts 1700--1799)

[[Page 694]]

                          Title 23--Highways

         I  Federal Highway Administration, Department of 
                Transportation (Parts 1--999)
        II  National Highway Traffic Safety Administration and 
                Federal Highway Administration, Department of 
                Transportation (Parts 1200--1299)
       III  National Highway Traffic Safety Administration, 
                Department of Transportation (Parts 1300--1399)

                Title 24--Housing and Urban Development

            Subtitle A--Office of the Secretary, Department of 
                Housing and Urban Development (Parts 0--99)
            Subtitle B--Regulations Relating to Housing and Urban 
                Development
         I  Office of Assistant Secretary for Equal Opportunity, 
                Department of Housing and Urban Development (Parts 
                100--199)
        II  Office of Assistant Secretary for Housing-Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Parts 200--299)
       III  Government National Mortgage Association, Department 
                of Housing and Urban Development (Parts 300--399)
        IV  Office of Multifamily Housing Assistance 
                Restructuring, Department of Housing and Urban 
                Development (Parts 400--499)
         V  Office of Assistant Secretary for Community Planning 
                and Development, Department of Housing and Urban 
                Development (Parts 500--599)
        VI  Office of Assistant Secretary for Community Planning 
                and Development, Department of Housing and Urban 
                Development (Parts 600--699) [Reserved]
       VII  Office of the Secretary, Department of Housing and 
                Urban Development (Housing Assistance Programs and 
                Public and Indian Housing Programs) (Parts 700--
                799)
      VIII  Office of the Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Section 8 Housing Assistance 
                Programs, Section 202 Direct Loan Program, Section 
                202 Supportive Housing for the Elderly Program and 
                Section 811 Supportive Housing for Persons With 
                Disabilities Program) (Parts 800--899)
        IX  Office of Assistant Secretary for Public and Indian 
                Housing, Department of Housing and Urban 
                Development (Parts 900--999)
         X  Office of Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Interstate Land Sales 
                Registration Program) (Parts 1700--1799)
       XII  Office of Inspector General, Department of Housing and 
                Urban Development (Parts 2000--2099)
        XX  Office of Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Parts 3200--3899)
       XXV  Neighborhood Reinvestment Corporation (Parts 4100--
                4199)

[[Page 695]]

                           Title 25--Indians

         I  Bureau of Indian Affairs, Department of the Interior 
                (Parts 1--299)
        II  Indian Arts and Crafts Board, Department of the 
                Interior (Parts 300--399)
       III  National Indian Gaming Commission, Department of the 
                Interior (Parts 500--599)
        IV  Office of Navajo and Hopi Indian Relocation (Parts 
                700--799)
         V  Bureau of Indian Affairs, Department of the Interior, 
                and Indian Health Service, Department of Health 
                and Human Services (Part 900)
        VI  Office of the Assistant Secretary-Indian Affairs, 
                Department of the Interior (Part 1001)
       VII  Office of the Special Trustee for American Indians, 
                Department of the Interior (Part 1200)

                      Title 26--Internal Revenue

         I  Internal Revenue Service, Department of the Treasury 
                (Parts 1--799)

           Title 27--Alcohol, Tobacco Products and Firearms

         I  Bureau of Alcohol, Tobacco and Firearms, Department of 
                the Treasury (Parts 1--299)

                   Title 28--Judicial Administration

         I  Department of Justice (Parts 0--199)
       III  Federal Prison Industries, Inc., Department of Justice 
                (Parts 300--399)
         V  Bureau of Prisons, Department of Justice (Parts 500--
                599)
        VI  Offices of Independent Counsel, Department of Justice 
                (Parts 600--699)
       VII  Office of Independent Counsel (Parts 700--799)

                            Title 29--Labor

            Subtitle A--Office of the Secretary of Labor (Parts 
                0--99)
            Subtitle B--Regulations Relating to Labor
         I  National Labor Relations Board (Parts 100--199)
        II  Office of Labor-Management Standards, Department of 
                Labor (Parts 200--299)
       III  National Railroad Adjustment Board (Parts 300--399)
        IV  Office of Labor-Management Standards, Department of 
                Labor (Parts 400--499)
         V  Wage and Hour Division, Department of Labor (Parts 
                500--899)
        IX  Construction Industry Collective Bargaining Commission 
                (Parts 900--999)
         X  National Mediation Board (Parts 1200--1299)

[[Page 696]]

       XII  Federal Mediation and Conciliation Service (Parts 
                1400--1499)
       XIV  Equal Employment Opportunity Commission (Parts 1600--
                1699)
      XVII  Occupational Safety and Health Administration, 
                Department of Labor (Parts 1900--1999)
        XX  Occupational Safety and Health Review Commission 
                (Parts 2200--2499)
       XXV  Pension and Welfare Benefits Administration, 
                Department of Labor (Parts 2500--2599)
     XXVII  Federal Mine Safety and Health Review Commission 
                (Parts 2700--2799)
        XL  Pension Benefit Guaranty Corporation (Parts 4000--
                4999)

                      Title 30--Mineral Resources

         I  Mine Safety and Health Administration, Department of 
                Labor (Parts 1--199)
        II  Minerals Management Service, Department of the 
                Interior (Parts 200--299)
       III  Board of Surface Mining and Reclamation Appeals, 
                Department of the Interior (Parts 300--399)
        IV  Geological Survey, Department of the Interior (Parts 
                400--499)
        VI  Bureau of Mines, Department of the Interior (Parts 
                600--699)
       VII  Office of Surface Mining Reclamation and Enforcement, 
                Department of the Interior (Parts 700--999)

                 Title 31--Money and Finance: Treasury

            Subtitle A--Office of the Secretary of the Treasury 
                (Parts 0--50)
            Subtitle B--Regulations Relating to Money and Finance
         I  Monetary Offices, Department of the Treasury (Parts 
                51--199)
        II  Fiscal Service, Department of the Treasury (Parts 
                200--399)
        IV  Secret Service, Department of the Treasury (Parts 
                400--499)
         V  Office of Foreign Assets Control, Department of the 
                Treasury (Parts 500--599)
        VI  Bureau of Engraving and Printing, Department of the 
                Treasury (Parts 600--699)
       VII  Federal Law Enforcement Training Center, Department of 
                the Treasury (Parts 700--799)
      VIII  Office of International Investment, Department of the 
                Treasury (Parts 800--899)

                      Title 32--National Defense

            Subtitle A--Department of Defense
         I  Office of the Secretary of Defense (Parts 1--399)
         V  Department of the Army (Parts 400--699)
        VI  Department of the Navy (Parts 700--799)

[[Page 697]]

       VII  Department of the Air Force (Parts 800--1099)
            Subtitle B--Other Regulations Relating to National 
                Defense
       XII  Defense Logistics Agency (Parts 1200--1299)
       XVI  Selective Service System (Parts 1600--1699)
     XVIII  National Counterintelligence Center (Parts 1800--1899)
       XIX  Central Intelligence Agency (Parts 1900--1999)
        XX  Information Security Oversight Office, National 
                Archives and Records Administration (Parts 2000--
                2099)
       XXI  National Security Council (Parts 2100--2199)
      XXIV  Office of Science and Technology Policy (Parts 2400--
                2499)
     XXVII  Office for Micronesian Status Negotiations (Parts 
                2700--2799)
    XXVIII  Office of the Vice President of the United States 
                (Parts 2800--2899)
      XXIX  Presidential Commission on the Assignment of Women in 
                the Armed Forces (Part 2900)

               Title 33--Navigation and Navigable Waters

         I  Coast Guard, Department of Transportation (Parts 1--
                199)
        II  Corps of Engineers, Department of the Army (Parts 
                200--399)
        IV  Saint Lawrence Seaway Development Corporation, 
                Department of Transportation (Parts 400--499)

                          Title 34--Education

            Subtitle A--Office of the Secretary, Department of 
                Education (Parts 1--99)
            Subtitle B--Regulations of the Offices of the 
                Department of Education
         I  Office for Civil Rights, Department of Education 
                (Parts 100--199)
        II  Office of Elementary and Secondary Education, 
                Department of Education (Parts 200--299)
       III  Office of Special Education and Rehabilitative 
                Services, Department of Education (Parts 300--399)
        IV  Office of Vocational and Adult Education, Department 
                of Education (Parts 400--499)
         V  Office of Bilingual Education and Minority Languages 
                Affairs, Department of Education (Parts 500--599)
        VI  Office of Postsecondary Education, Department of 
                Education (Parts 600--699)
       VII  Office of Educational Research and Improvement, 
                Department of Education (Parts 700--799)
        XI  National Institute for Literacy (Parts 1100--1199)
            Subtitle C--Regulations Relating to Education
       XII  National Council on Disability (Parts 1200--1299)

[[Page 698]]

                        Title 35--Panama Canal

         I  Panama Canal Regulations (Parts 1--299)

             Title 36--Parks, Forests, and Public Property

         I  National Park Service, Department of the Interior 
                (Parts 1--199)
        II  Forest Service, Department of Agriculture (Parts 200--
                299)
       III  Corps of Engineers, Department of the Army (Parts 
                300--399)
        IV  American Battle Monuments Commission (Parts 400--499)
         V  Smithsonian Institution (Parts 500--599)
       VII  Library of Congress (Parts 700--799)
      VIII  Advisory Council on Historic Preservation (Parts 800--
                899)
        IX  Pennsylvania Avenue Development Corporation (Parts 
                900--999)
         X  Presidio Trust (Parts 1000--1099)
        XI  Architectural and Transportation Barriers Compliance 
                Board (Parts 1100--1199)
       XII  National Archives and Records Administration (Parts 
                1200--1299)
       XIV  Assassination Records Review Board (Parts 1400--1499)

             Title 37--Patents, Trademarks, and Copyrights

         I  Patent and Trademark Office, Department of Commerce 
                (Parts 1--199)
        II  Copyright Office, Library of Congress (Parts 200--299)
        IV  Assistant Secretary for Technology Policy, Department 
                of Commerce (Parts 400--499)
         V  Under Secretary for Technology, Department of Commerce 
                (Parts 500--599)

           Title 38--Pensions, Bonuses, and Veterans' Relief

         I  Department of Veterans Affairs (Parts 0--99)

                       Title 39--Postal Service

         I  United States Postal Service (Parts 1--999)
       III  Postal Rate Commission (Parts 3000--3099)

                  Title 40--Protection of Environment

         I  Environmental Protection Agency (Parts 1--799)
         V  Council on Environmental Quality (Parts 1500--1599)
       VII  Environmental Protection Agency and Department of 
                Defense; Uniform National Discharge Standards for 
                Vessels of the Armed Forces (Parts 1700--1799)

          Title 41--Public Contracts and Property Management

            Subtitle B--Other Provisions Relating to Public 
                Contracts

[[Page 699]]

        50  Public Contracts, Department of Labor (Parts 50-1--50-
                999)
        51  Committee for Purchase From People Who Are Blind or 
                Severely Disabled (Parts 51-1--51-99)
        60  Office of Federal Contract Compliance Programs, Equal 
                Employment Opportunity, Department of Labor (Parts 
                60-1--60-999)
        61  Office of the Assistant Secretary for Veterans 
                Employment and Training, Department of Labor 
                (Parts 61-1--61-999)
            Subtitle C--Federal Property Management Regulations 
                System
       101  Federal Property Management Regulations (Parts 101-1--
                101-99)
       105  General Services Administration (Parts 105-1--105-999)
       109  Department of Energy Property Management Regulations 
                (Parts 109-1--109-99)
       114  Department of the Interior (Parts 114-1--114-99)
       115  Environmental Protection Agency (Parts 115-1--115-99)
       128  Department of Justice (Parts 128-1--128-99)
            Subtitle D--Other Provisions Relating to Property 
                Management [Reserved]
            Subtitle E--Federal Information Resources Management 
                Regulations System
       201  Federal Information Resources Management Regulation 
                (Parts 201-1--201-99) [Reserved]
            Subtitle F--Federal Travel Regulation System
       300  General (Parts 300-1--300.99)
       301  Temporary Duty (TDY) Travel Allowances (Parts 301-1--
                301-99)
       302  Relocation Allowances (Parts 302-1--302-99)
       303  Payment of Expenses Connected with the Death of 
                Certain Employees (Part 303-70)
       304  Payment from a Non-Federal Source for Travel Expenses 
                (Parts 304-1--304-99)

                        Title 42--Public Health

         I  Public Health Service, Department of Health and Human 
                Services (Parts 1--199)
        IV  Health Care Financing Administration, Department of 
                Health and Human Services (Parts 400--499)
         V  Office of Inspector General-Health Care, Department of 
                Health and Human Services (Parts 1000--1999)

                   Title 43--Public Lands: Interior

            Subtitle A--Office of the Secretary of the Interior 
                (Parts 1--199)
            Subtitle B--Regulations Relating to Public Lands
         I  Bureau of Reclamation, Department of the Interior 
                (Parts 200--499)
        II  Bureau of Land Management, Department of the Interior 
                (Parts 1000--9999)

[[Page 700]]

       III  Utah Reclamation Mitigation and Conservation 
                Commission (Parts 10000--10005)

             Title 44--Emergency Management and Assistance

         I  Federal Emergency Management Agency (Parts 0--399)
        IV  Department of Commerce and Department of 
                Transportation (Parts 400--499)

                       Title 45--Public Welfare

            Subtitle A--Department of Health and Human Services 
                (Parts 1--199)
            Subtitle B--Regulations Relating to Public Welfare
        II  Office of Family Assistance (Assistance Programs), 
                Administration for Children and Families, 
                Department of Health and Human Services (Parts 
                200--299)
       III  Office of Child Support Enforcement (Child Support 
                Enforcement Program), Administration for Children 
                and Families, Department of Health and Human 
                Services (Parts 300--399)
        IV  Office of Refugee Resettlement, Administration for 
                Children and Families Department of Health and 
                Human Services (Parts 400--499)
         V  Foreign Claims Settlement Commission of the United 
                States, Department of Justice (Parts 500--599)
        VI  National Science Foundation (Parts 600--699)
       VII  Commission on Civil Rights (Parts 700--799)
      VIII  Office of Personnel Management (Parts 800--899)
         X  Office of Community Services, Administration for 
                Children and Families, Department of Health and 
                Human Services (Parts 1000--1099)
        XI  National Foundation on the Arts and the Humanities 
                (Parts 1100--1199)
       XII  Corporation for National and Community Service (Parts 
                1200--1299)
      XIII  Office of Human Development Services, Department of 
                Health and Human Services (Parts 1300--1399)
       XVI  Legal Services Corporation (Parts 1600--1699)
      XVII  National Commission on Libraries and Information 
                Science (Parts 1700--1799)
     XVIII  Harry S. Truman Scholarship Foundation (Parts 1800--
                1899)
       XXI  Commission on Fine Arts (Parts 2100--2199)
     XXIII  Arctic Research Commission (Part 2301)
      XXIV  James Madison Memorial Fellowship Foundation (Parts 
                2400--2499)
       XXV  Corporation for National and Community Service (Parts 
                2500--2599)

[[Page 701]]

                          Title 46--Shipping

         I  Coast Guard, Department of Transportation (Parts 1--
                199)
        II  Maritime Administration, Department of Transportation 
                (Parts 200--399)
       III  Coast Guard (Great Lakes Pilotage), Department of 
                Transportation (Parts 400--499)
        IV  Federal Maritime Commission (Parts 500--599)

                      Title 47--Telecommunication

         I  Federal Communications Commission (Parts 0--199)
        II  Office of Science and Technology Policy and National 
                Security Council (Parts 200--299)
       III  National Telecommunications and Information 
                Administration, Department of Commerce (Parts 
                300--399)

           Title 48--Federal Acquisition Regulations System

         1  Federal Acquisition Regulation (Parts 1--99)
         2  Department of Defense (Parts 200--299)
         3  Department of Health and Human Services (Parts 300--
                399)
         4  Department of Agriculture (Parts 400--499)
         5  General Services Administration (Parts 500--599)
         6  Department of State (Parts 600--699)
         7  United States Agency for International Development 
                (Parts 700--799)
         8  Department of Veterans Affairs (Parts 800--899)
         9  Department of Energy (Parts 900--999)
        10  Department of the Treasury (Parts 1000--1099)
        12  Department of Transportation (Parts 1200--1299)
        13  Department of Commerce (Parts 1300--1399)
        14  Department of the Interior (Parts 1400--1499)
        15  Environmental Protection Agency (Parts 1500--1599)
        16  Office of Personnel Management Federal Employees 
                Health Benefits Acquisition Regulation (Parts 
                1600--1699)
        17  Office of Personnel Management (Parts 1700--1799)
        18  National Aeronautics and Space Administration (Parts 
                1800--1899)
        19  United States Information Agency (Parts 1900--1999)
        20  Nuclear Regulatory Commission (Parts 2000--2099)
        21  Office of Personnel Management, Federal Employees 
                Group Life Insurance Federal Acquisition 
                Regulation (Parts 2100--2199)
        23  Social Security Administration (Parts 2300--2399)
        24  Department of Housing and Urban Development (Parts 
                2400--2499)
        25  National Science Foundation (Parts 2500--2599)
        28  Department of Justice (Parts 2800--2899)
        29  Department of Labor (Parts 2900--2999)

[[Page 702]]

        34  Department of Education Acquisition Regulation (Parts 
                3400--3499)
        35  Panama Canal Commission (Parts 3500--3599)
        44  Federal Emergency Management Agency (Parts 4400--4499)
        51  Department of the Army Acquisition Regulations (Parts 
                5100--5199)
        52  Department of the Navy Acquisition Regulations (Parts 
                5200--5299)
        53  Department of the Air Force Federal Acquisition 
                Regulation Supplement (Parts 5300--5399)
        54  Defense Logistics Agency, Department of Defense (Part 
                5452)
        57  African Development Foundation (Parts 5700--5799)
        61  General Services Administration Board of Contract 
                Appeals (Parts 6100--6199)
        63  Department of Transportation Board of Contract Appeals 
                (Parts 6300--6399)
        99  Cost Accounting Standards Board, Office of Federal 
                Procurement Policy, Office of Management and 
                Budget (Parts 9900--9999)

                       Title 49--Transportation

            Subtitle A--Office of the Secretary of Transportation 
                (Parts 1--99)
            Subtitle B--Other Regulations Relating to 
                Transportation
         I  Research and Special Programs Administration, 
                Department of Transportation (Parts 100--199)
        II  Federal Railroad Administration, Department of 
                Transportation (Parts 200--299)
       III  Federal Highway Administration, Department of 
                Transportation (Parts 300--399)
        IV  Coast Guard, Department of Transportation (Parts 400--
                499)
         V  National Highway Traffic Safety Administration, 
                Department of Transportation (Parts 500--599)
        VI  Federal Transit Administration, Department of 
                Transportation (Parts 600--699)
       VII  National Railroad Passenger Corporation (AMTRAK) 
                (Parts 700--799)
      VIII  National Transportation Safety Board (Parts 800--999)
         X  Surface Transportation Board, Department of 
                Transportation (Parts 1000--1399)
        XI  Bureau of Transportation Statistics, Department of 
                Transportation (Parts 1400--1499)

                   Title 50--Wildlife and Fisheries

         I  United States Fish and Wildlife Service, Department of 
                the Interior (Parts 1--199)

[[Page 703]]

        II  National Marine Fisheries Service, National Oceanic 
                and Atmospheric Administration, Department of 
                Commerce (Parts 200--299)
       III  International Fishing and Related Activities (Parts 
                300--399)
        IV  Joint Regulations (United States Fish and Wildlife 
                Service, Department of the Interior and National 
                Marine Fisheries Service, National Oceanic and 
                Atmospheric Administration, Department of 
                Commerce); Endangered Species Committee 
                Regulations (Parts 400--499)
         V  Marine Mammal Commission (Parts 500--599)
        VI  Fishery Conservation and Management, National Oceanic 
                and Atmospheric Administration, Department of 
                Commerce (Parts 600--699)

                      CFR Index and Finding Aids

            Subject/Agency Index
            List of Agency Prepared Indexes
            Parallel Tables of Statutory Authorities and Rules
            List of CFR Titles, Chapters, Subchapters, and Parts
            Alphabetical List of Agencies Appearing in the CFR



[[Page 705]]





           Alphabetical List of Agencies Appearing in the CFR




                     (Revised as of October 1, 1999)

                                                  CFR Title, Subtitle or 
                     Agency                               Chapter

Administrative Committee of the Federal Register  1, I
Advanced Research Projects Agency                 32, I
Advisory Commission on Intergovernmental          5, VII
     Relations
Advisory Committee on Federal Pay                 5, IV
Advisory Council on Historic Preservation         36, VIII
African Development Foundation                    22, XV
  Federal Acquisition Regulation                  48, 57
Agency for International Development, United      22, II
     States
  Federal Acquisition Regulation                  48, 7
Agricultural Marketing Service                    7, I, IX, X, XI
Agricultural Research Service                     7, V
Agriculture Department
  Agricultural Marketing Service                  7, I, IX, X, XI
  Agricultural Research Service                   7, V
  Animal and Plant Health Inspection Service      7, III; 9, I
  Chief Financial Officer, Office of              7, XXX
  Commodity Credit Corporation                    7, XIV
  Cooperative State Research, Education, and      7, XXXIV
       Extension Service
  Economic Research Service                       7, XXXVII
  Energy, Office of                               7, XXIX
  Environmental Quality, Office of                7, XXXI
  Farm Service Agency                             7, VII, XVIII
  Federal Acquisition Regulation                  48, 4
  Federal Crop Insurance Corporation              7, IV
  Food and Nutrition Service                      7, II
  Food Safety and Inspection Service              9, III
  Foreign Agricultural Service                    7, XV
  Forest Service                                  36, II
  Grain Inspection, Packers and Stockyards        7, VIII; 9, II
       Administration
  Information Resources Management, Office of     7, XXVII
  Inspector General, Office of                    7, XXVI
  National Agricultural Library                   7, XLI
  National Agricultural Statistics Service        7, XXXVI
  Natural Resources Conservation Service          7, VI
  Operations, Office of                           7, XXVIII
  Procurement and Property Management, Office of  7, XXXII
  Rural Business-Cooperative Service              7, XVIII, XLII
  Rural Development Administration                7, XLII
  Rural Housing Service                           7, XVIII, XXXV
  Rural Telephone Bank                            7, XVI
  Rural Utilities Service                         7, XVII, XVIII, XLII
  Secretary of Agriculture, Office of             7, Subtitle A
  Transportation, Office of                       7, XXXIII
  World Agricultural Outlook Board                7, XXXVIII
Air Force Department                              32, VII
  Federal Acquisition Regulation Supplement       48, 53
Alcohol, Tobacco and Firearms, Bureau of          27, I
AMTRAK                                            49, VII
American Battle Monuments Commission              36, IV
American Indians, Office of the Special Trustee   25, VII
Animal and Plant Health Inspection Service        7, III; 9, I
Appalachian Regional Commission                   5, IX

[[Page 706]]

Architectural and Transportation Barriers         36, XI
     Compliance Board
Arctic Research Commission                        45, XXIII
Armed Forces Retirement Home                      5, XI
Army Department                                   32, V
  Engineers, Corps of                             33, II; 36, III
  Federal Acquisition Regulation                  48, 51
Assassination Records Review Board                36, XIV
Benefits Review Board                             20, VII
Bilingual Education and Minority Languages        34, V
     Affairs, Office of
Blind or Severely Disabled, Committee for         41, 51
     Purchase From People Who Are
Board for International Broadcasting              22, XIII
Census Bureau                                     15, I
Central Intelligence Agency                       32, XIX
Chief Financial Officer, Office of                7, XXX
Child Support Enforcement, Office of              45, III
Children and Families, Administration for         45, II, III, IV, X
Christopher Columbus Quincentenary Jubilee        45, XXII
     Commission
Civil Rights, Commission on                       45, VII
Civil Rights, Office for                          34, I
Coast Guard                                       33, I; 46, I; 49, IV
Coast Guard (Great Lakes Pilotage)                46, III
Commerce Department                               44, IV
  Census Bureau                                   15, I
  Economic Affairs, Under Secretary               37, V
  Economic Analysis, Bureau of                    15, VIII
  Economic Development Administration             13, III
  Emergency Management and Assistance             44, IV
  Export Administration, Bureau of                15, VII
  Federal Acquisition Regulation                  48, 13
  Fishery Conservation and Management             50, VI
  Foreign-Trade Zones Board                       15, IV
  International Trade Administration              15, III; 19, III
  National Institute of Standards and Technology  15, II
  National Marine Fisheries Service               50, II, IV, VI
  National Oceanic and Atmospheric                15, IX; 50, II, III, IV, 
       Administration                             VI
  National Telecommunications and Information     15, XXIII; 47, III
       Administration
  National Weather Service                        15, IX
  Patent and Trademark Office                     37, I
  Productivity, Technology and Innovation,        37, IV
       Assistant Secretary for
  Secretary of Commerce, Office of                15, Subtitle A
  Technology, Under Secretary for                 37, V
  Technology Administration                       15, XI
  Technology Policy, Assistant Secretary for      37, IV
Commercial Space Transportation                   14, III
Commodity Credit Corporation                      7, XIV
Commodity Futures Trading Commission              5, XLI; 17, I
Community Planning and Development, Office of     24, V, VI
     Assistant Secretary for
Community Services, Office of                     45, X
Comptroller of the Currency                       12, I
Construction Industry Collective Bargaining       29, IX
     Commission
Consumer Product Safety Commission                5, LXXI; 16, II
Cooperative State Research, Education, and        7, XXXIV
     Extension Service
Copyright Office                                  37, II
Corporation for National and Community Service    45, XII, XXV
Cost Accounting Standards Board                   48, 99
Council on Environmental Quality                  40, V
Customs Service, United States                    19, I
Defense Contract Audit Agency                     32, I
Defense Department                                5, XXVI; 32, Subtitle A; 
                                                  40, VII
  Advanced Research Projects Agency               32, I
  Air Force Department                            32, VII

[[Page 707]]

  Army Department                                 32, V; 33, II; 36, III, 
                                                  48, 51
  Defense Intelligence Agency                     32, I
  Defense Logistics Agency                        32, I, XII; 48, 54
  Engineers, Corps of                             33, II; 36, III
  Federal Acquisition Regulation                  48, 2
  National Imagery and Mapping Agency             32, I
  Navy Department                                 32, VI; 48, 52
  Secretary of Defense, Office of                 32, I
Defense Contract Audit Agency                     32, I
Defense Intelligence Agency                       32, I
Defense Logistics Agency                          32, XII; 48, 54
Defense Nuclear Facilities Safety Board           10, XVII
Delaware River Basin Commission                   18, III
Drug Enforcement Administration                   21, II
East-West Foreign Trade Board                     15, XIII
Economic Affairs, Under Secretary                 37, V
Economic Analysis, Bureau of                      15, VIII
Economic Development Administration               13, III
Economic Research Service                         7, XXXVII
Education, Department of                          5, LIII
  Bilingual Education and Minority Languages      34, V
       Affairs, Office of
  Civil Rights, Office for                        34, I
  Educational Research and Improvement, Office    34, VII
       of
  Elementary and Secondary Education, Office of   34, II
  Federal Acquisition Regulation                  48, 34
  Postsecondary Education, Office of              34, VI
  Secretary of Education, Office of               34, Subtitle A
  Special Education and Rehabilitative Services,  34, III
       Office of
  Vocational and Adult Education, Office of       34, IV
Educational Research and Improvement, Office of   34, VII
Elementary and Secondary Education, Office of     34, II
Employees' Compensation Appeals Board             20, IV
Employees Loyalty Board                           5, V
Employment and Training Administration            20, V
Employment Standards Administration               20, VI
Endangered Species Committee                      50, IV
Energy, Department of                             5, XXIII; 10, II, III, X
  Federal Acquisition Regulation                  48, 9
  Federal Energy Regulatory Commission            5, XXIV; 18, I
  Property Management Regulations                 41, 109
Energy, Office of                                 7, XXIX
Engineers, Corps of                               33, II; 36, III
Engraving and Printing, Bureau of                 31, VI
Environmental Protection Agency                   5, LIV; 40, I, VII
  Federal Acquisition Regulation                  48, 15
  Property Management Regulations                 41, 115
Environmental Quality, Office of                  7, XXXI
Equal Employment Opportunity Commission           5, LXII; 29, XIV
Equal Opportunity, Office of Assistant Secretary  24, I
     for
Executive Office of the President                 3, I
  Administration, Office of                       5, XV
  Environmental Quality, Council on               40, V
  Management and Budget, Office of                25, III, LXXVII; 48, 99
  National Drug Control Policy, Office of         21, III
  National Security Council                       32, XXI; 47, 2
  Presidential Documents                          3
  Science and Technology Policy, Office of        32, XXIV; 47, II
  Trade Representative, Office of the United      15, XX
       States
Export Administration, Bureau of                  15, VII
Export-Import Bank of the United States           5, LII; 12, IV
Family Assistance, Office of                      45, II
Farm Credit Administration                        5, XXXI; 12, VI
Farm Credit System Insurance Corporation          5, XXX; 12, XIV
Farm Service Agency                               7, VII, XVIII
Federal Acquisition Regulation                    48, 1

[[Page 708]]

Federal Aviation Administration                   14, I
  Commercial Space Transportation                 14, III
Federal Claims Collection Standards               4, II
Federal Communications Commission                 5, XXIX; 47, I
Federal Contract Compliance Programs, Office of   41, 60
Federal Crop Insurance Corporation                7, IV
Federal Deposit Insurance Corporation             5, XXII; 12, III
Federal Election Commission                       11, I
Federal Emergency Management Agency               44, I
  Federal Acquisition Regulation                  48, 44
Federal Employees Group Life Insurance Federal    48, 21
     Acquisition Regulation
Federal Employees Health Benefits Acquisition     48, 16
     Regulation
Federal Energy Regulatory Commission              5, XXIV; 18, I
Federal Financial Institutions Examination        12, XI
     Council
Federal Financing Bank                            12, VIII
Federal Highway Administration                    23, I, II; 49, III
Federal Home Loan Mortgage Corporation            1, IV
Federal Housing Enterprise Oversight Office       12, XVII
Federal Housing Finance Board                     12, IX
Federal Labor Relations Authority, and General    5, XIV; 22, XIV
     Counsel of the Federal Labor Relations 
     Authority
Federal Law Enforcement Training Center           31, VII
Federal Maritime Commission                       46, IV
Federal Mediation and Conciliation Service        29, XII
Federal Mine Safety and Health Review Commission  5, LXXIV; 29, XXVII
Federal Pay, Advisory Committee on                5, IV
Federal Prison Industries, Inc.                   28, III
Federal Procurement Policy Office                 48, 99
Federal Property Management Regulations           41, 101
Federal Property Management Regulations System    41, Subtitle C
Federal Railroad Administration                   49, II
Federal Register, Administrative Committee of     1, I
Federal Register, Office of                       1, II
Federal Reserve System                            12, II
  Board of Governors                              5, LVIII
Federal Retirement Thrift Investment Board        5, VI, LXXVI
Federal Service Impasses Panel                    5, XIV
Federal Trade Commission                          5, XLVII; 16, I
Federal Transit Administration                    49, VI
Federal Travel Regulation System                  41, Subtitle F
Fine Arts, Commission on                          45, XXI
Fiscal Service                                    31, II
Fish and Wildlife Service, United States          50, I, IV
Fishery Conservation and Management               50, VI
Food and Drug Administration                      21, I
Food and Nutrition Service                        7, II
Food Safety and Inspection Service                9, III
Foreign Agricultural Service                      7, XV
Foreign Assets Control, Office of                 31, V
Foreign Claims Settlement Commission of the       45, V
     United States
Foreign Service Grievance Board                   22, IX
Foreign Service Impasse Disputes Panel            22, XIV
Foreign Service Labor Relations Board             22, XIV
Foreign-Trade Zones Board                         15, IV
Forest Service                                    36, II
General Accounting Office                         4, I, II
General Services Administration                   5, LVII
  Contract Appeals, Board of                      48, 61
  Federal Acquisition Regulation                  48, 5
  Federal Property Management Regulations System  41, 101, 105
  Federal Travel Regulation System                41, Subtitle F
  General                                         41, 300
  Payment From a Non-Federal Source for Travel    41, 304
       Expenses
  Payment of Expenses Connected With the Death    41, 303
       of Certain Employees
  Relocation Allowances                           41, 302

[[Page 709]]

  Temporary Duty (TDY) Travel Allowances          41, 301
Geological Survey                                 30, IV
Government Ethics, Office of                      5, XVI
Government National Mortgage Association          24, III
Grain Inspection, Packers and Stockyards          7, VIII; 9, II
     Administration
Harry S. Truman Scholarship Foundation            45, XVIII
Health and Human Services, Department of          5, XLV; 45, Subtitle A
  Child Support Enforcement, Office of            45, III
  Children and Families, Administration for       45, II, III, IV, X
  Community Services, Office of                   45, X
  Family Assistance, Office of                    45, II
  Federal Acquisition Regulation                  48, 3
  Food and Drug Administration                    21, I
  Health Care Financing Administration            42, IV
  Human Development Services, Office of           45, XIII
  Indian Health Service                           25, V
  Inspector General (Health Care), Office of      42, V
  Public Health Service                           42, I
  Refugee Resettlement, Office of                 45, IV
Health Care Financing Administration              42, IV
Housing and Urban Development, Department of      5, LXV; 24, Subtitle B
  Community Planning and Development, Office of   24, V, VI
       Assistant Secretary for
  Equal Opportunity, Office of Assistant          24, I
       Secretary for
  Federal Acquisition Regulation                  48, 24
  Federal Housing Enterprise Oversight, Office    12, XVII
       of
  Government National Mortgage Association        24, III
  Housing--Federal Housing Commissioner, Office   24, II, VIII, X, XX
       of Assistant Secretary for
  Inspector General, Office of                    24, XII
  Multifamily Housing Assistance Restructuring,   24, IV
       Office of
  Public and Indian Housing, Office of Assistant  24, IX
       Secretary for
  Secretary, Office of                            24, Subtitle A, VII
Housing--Federal Housing Commissioner, Office of  24, II, VIII, X, XX
     Assistant Secretary for
Human Development Services, Office of             45, XIII
Immigration and Naturalization Service            8, I
Independent Counsel, Office of                    28, VII
Indian Affairs, Bureau of                         25, I, V
Indian Affairs, Office of the Assistant           25, VI
     Secretary
Indian Arts and Crafts Board                      25, II
Indian Health Service                             25, V
Information Agency, United States                 22, V
  Federal Acquisition Regulation                  48, 19
Information Resources Management, Office of       7, XXVII
Information Security Oversight Office, National   32, XX
     Archives and Records Administration
Inspector General
  Agriculture Department                          7, XXVI
  Health and Human Services Department            42, V
  Housing and Urban Development Department        24, XII
Institute of Peace, United States                 22, XVII
Inter-American Foundation                         5, LXIII; 22, X
Intergovernmental Relations, Advisory Commission  5, VII
     on
Interior Department
  American Indians, Office of the Special         25, VII
       Trustee
  Endangered Species Committee                    50, IV
  Federal Acquisition Regulation                  48, 14
  Federal Property Management Regulations System  41, 114
  Fish and Wildlife Service, United States        50, I, IV
  Geological Survey                               30, IV
  Indian Affairs, Bureau of                       25, I, V
  Indian Affairs, Office of the Assistant         25, VI
       Secretary
  Indian Arts and Crafts Board                    25, II
  Land Management, Bureau of                      43, II
  Minerals Management Service                     30, II
  Mines, Bureau of                                30, VI

[[Page 710]]

  National Indian Gaming Commission               25, III
  National Park Service                           36, I
  Reclamation, Bureau of                          43, I
  Secretary of the Interior, Office of            43, Subtitle A
  Surface Mining and Reclamation Appeals, Board   30, III
       of
  Surface Mining Reclamation and Enforcement,     30, VII
       Office of
Internal Revenue Service                          26, I
International Boundary and Water Commission,      22, XI
     United States and Mexico, United States 
     Section
International Development, United States Agency   22, II
     for
  Federal Acquisition Regulation                  48, 7
International Development Cooperation Agency,     22, XII
     United States
  International Development, United States        22, II; 48, 7
       Agency for
  Overseas Private Investment Corporation         5, XXXIII; 22, VII
International Fishing and Related Activities      50, III
International Investment, Office of               31, VIII
International Joint Commission, United States     22, IV
     and Canada
International Organizations Employees Loyalty     5, V
     Board
International Trade Administration                15, III; 19, III
International Trade Commission, United States     19, II
Interstate Commerce Commission                    5, XL
James Madison Memorial Fellowship Foundation      45, XXIV
Japan-United States Friendship Commission         22, XVI
Joint Board for the Enrollment of Actuaries       20, VIII
Justice Department                                5, XXVIII; 28, I
  Drug Enforcement Administration                 21, II
  Federal Acquisition Regulation                  48, 28
  Federal Claims Collection Standards             4, II
  Federal Prison Industries, Inc.                 28, III
  Foreign Claims Settlement Commission of the     45, V
       United States
  Immigration and Naturalization Service          8, I
  Offices of Independent Counsel                  28, VI
  Prisons, Bureau of                              28, V
  Property Management Regulations                 41, 128
Labor Department                                  5, XLII
  Benefits Review Board                           20, VII
  Employees' Compensation Appeals Board           20, IV
  Employment and Training Administration          20, V
  Employment Standards Administration             20, VI
  Federal Acquisition Regulation                  48, 29
  Federal Contract Compliance Programs, Office    41, 60
       of
  Federal Procurement Regulations System          41, 50
  Labor-Management Standards, Office of           29, II, IV
  Mine Safety and Health Administration           30, I
  Occupational Safety and Health Administration   29, XVII
  Pension and Welfare Benefits Administration     29, XXV
  Public Contracts                                41, 50
  Secretary of Labor, Office of                   29, Subtitle A
  Veterans' Employment and Training, Office of    41, 61; 20, IX
       the Assistant Secretary for
  Wage and Hour Division                          29, V
  Workers' Compensation Programs, Office of       20, I
Labor-Management Standards, Office of             29, II, IV
Land Management, Bureau of                        43, II
Legal Services Corporation                        45, XVI
Library of Congress                               36, VII
  Copyright Office                                37, II
Management and Budget, Office of                  5, III, LXXVII; 48, 99
Marine Mammal Commission                          50, V
Maritime Administration                           46, II
Merit Systems Protection Board                    5, II
Micronesian Status Negotiations, Office for       32, XXVII
Mine Safety and Health Administration             30, I
Minerals Management Service                       30, II
Mines, Bureau of                                  30, VI

[[Page 711]]

Minority Business Development Agency              15, XIV
Miscellaneous Agencies                            1, IV
Monetary Offices                                  31, I
Multifamily Housing Assistance Restructuring,     24, IV
     Office of
National Aeronautics and Space Administration     5, LIX; 14, V
  Federal Acquisition Regulation                  48, 18
National Agricultural Library                     7, XLI
National Agricultural Statistics Service          7, XXXVI
National Archives and Records Administration      5, LXVI; 36, XII
  Information Security Oversight Office           32, XX
National Bureau of Standards                      15, II
National Capital Planning Commission              1, IV
National Commission for Employment Policy         1, IV
National Commission on Libraries and Information  45, XVII
     Science
National and Community Service, Corporation for   45, XII, XXV
National Council on Disability                    34, XII
National Credit Union Administration              12, VII
National Drug Control Policy, Office of           21, III
National Foundation on the Arts and the           45, XI
     Humanities
National Highway Traffic Safety Administration    23, II, III; 49, V
National Imagery and Mapping Agency               32, I
National Indian Gaming Commission                 25, III
National Institute for Literacy                   34, XI
National Institute of Standards and Technology    15, II
National Labor Relations Board                    5, LXI; 29, I
National Marine Fisheries Service                 50, II, IV, VI
National Mediation Board                          29, X
National Oceanic and Atmospheric Administration   15, IX; 50, II, III, IV, 
                                                  VI
National Park Service                             36, I
National Railroad Adjustment Board                29, III
National Railroad Passenger Corporation (AMTRAK)  49, VII
National Science Foundation                       5, XLIII; 45, VI
  Federal Acquisition Regulation                  48, 25
National Security Council                         32, XXI
National Security Council and Office of Science   47, II
     and Technology Policy
National Telecommunications and Information       15, XXIII; 47, III
     Administration
National Transportation Safety Board              49, VIII
National Weather Service                          15, IX
Natural Resources Conservation Service            7, VI
Navajo and Hopi Indian Relocation, Office of      25, IV
Navy Department                                   32, VI
  Federal Acquisition Regulation                  48, 52
Neighborhood Reinvestment Corporation             24, XXV
Northeast Dairy Compact Commission                7, XIII
Nuclear Regulatory Commission                     5, XLVIII; 10, I
  Federal Acquisition Regulation                  48, 20
Occupational Safety and Health Administration     29, XVII
Occupational Safety and Health Review Commission  29, XX
Offices of Independent Counsel                    28, VI
Operations Office                                 7, XXVIII
Overseas Private Investment Corporation           5, XXXIII; 22, VII
Panama Canal Commission                           48, 35
Panama Canal Regulations                          35, I
Patent and Trademark Office                       37, I
Payment From a Non-Federal Source for Travel      41, 304
     Expenses
Payment of Expenses Connected With the Death of   41, 303
     Certain Employees
Peace Corps                                       22, III
Pennsylvania Avenue Development Corporation       36, IX
Pension and Welfare Benefits Administration       29, XXV
Pension Benefit Guaranty Corporation              29, XL
Personnel Management, Office of                   5, I, XXXV; 45, VIII
  Federal Acquisition Regulation                  48, 17
  Federal Employees Group Life Insurance Federal  48, 21
     Acquisition Regulation
[[Page 712]]

  Federal Employees Health Benefits Acquisition   48, 16
       Regulation
Postal Rate Commission                            5, XLVI; 39, III
Postal Service, United States                     5, LX; 39, I
Postsecondary Education, Office of                34, VI
President's Commission on White House             1, IV
     Fellowships
Presidential Commission on the Assignment of      32, XXIX
     Women in the Armed Forces
Presidential Documents                            3
Presidio Trust                                    36, X
Prisons, Bureau of                                28, V
Procurement and Property Management, Office of    7, XXXII
Productivity, Technology and Innovation,          37, IV
     Assistant Secretary
Public Contracts, Department of Labor             41, 50
Public and Indian Housing, Office of Assistant    24, IX
     Secretary for
Public Health Service                             42, I
Railroad Retirement Board                         20, II
Reclamation, Bureau of                            43, I
Refugee Resettlement, Office of                   45, IV
Regional Action Planning Commissions              13, V
Relocation Allowances                             41, 302
Research and Special Programs Administration      49, I
Rural Business-Cooperative Service                7, XVIII, XLII
Rural Development Administration                  7, XLII
Rural Housing Service                             7, XVIII, XXXV
Rural Telephone Bank                              7, XVI
Rural Utilities Service                           7, XVII, XVIII, XLII
Saint Lawrence Seaway Development Corporation     33, IV
Science and Technology Policy, Office of          32, XXIV
Science and Technology Policy, Office of, and     47, II
     National Security Council
Secret Service                                    31, IV
Securities and Exchange Commission                17, II
Selective Service System                          32, XVI
Small Business Administration                     13, I
Smithsonian Institution                           36, V
Social Security Administration                    20, III; 48, 23
Soldiers' and Airmen's Home, United States        5, XI
Special Counsel, Office of                        5, VIII
Special Education and Rehabilitative Services,    34, III
     Office of
State Department                                  22, I
  Federal Acquisition Regulation                  48, 6
Surface Mining and Reclamation Appeals, Board of  30, III
Surface Mining Reclamation and Enforcement,       30, VII
     Office of
Surface Transportation Board                      49, X
Susquehanna River Basin Commission                18, VIII
Technology Administration                         15, XI
Technology Policy, Assistant Secretary for        37, IV
Technology, Under Secretary for                   37, V
Tennessee Valley Authority                        5, LXIX; 18, XIII
Thrift Supervision Office, Department of the      12, V
     Treasury
Trade Representative, United States, Office of    15, XX
Transportation, Department of                     5, L
  Coast Guard                                     33, I; 46, I; 49, IV
  Coast Guard (Great Lakes Pilotage)              46, III
  Commercial Space Transportation                 14, III
  Contract Appeals, Board of                      48, 63
  Emergency Management and Assistance             44, IV
  Federal Acquisition Regulation                  48, 12
  Federal Aviation Administration                 14, I
  Federal Highway Administration                  23, I, II; 49, III
  Federal Railroad Administration                 49, II
  Federal Transit Administration                  49, VI
  Maritime Administration                         46, II
  National Highway Traffic Safety Administration  23, II, III; 49, V
  Research and Special Programs Administration    49, I
  Saint Lawrence Seaway Development Corporation   33, IV

[[Page 713]]

  Secretary of Transportation, Office of          14, II; 49, Subtitle A
  Surface Transportation Board                    49, X
  Transportation Statistics Bureau                49, XI
Transportation, Office of                         7, XXXIII
Transportation Statistics Brureau                 49, XI
Travel Allowances, Temporary Duty (TDY)           41, 301
Treasury Department                               5, XXI; 12, XV; 17, IV
  Alcohol, Tobacco and Firearms, Bureau of        27, I
  Community Development Financial Institutions    12, XVIII
       Fund
  Comptroller of the Currency                     12, I
  Customs Service, United States                  19, I
  Engraving and Printing, Bureau of               31, VI
  Federal Acquisition Regulation                  48, 10
  Federal Law Enforcement Training Center         31, VII
  Fiscal Service                                  31, II
  Foreign Assets Control, Office of               31, V
  Internal Revenue Service                        26, I
  International Investment, Office of             31, VIII
  Monetary Offices                                31, I
  Secret Service                                  31, IV
  Secretary of the Treasury, Office of            31, Subtitle A
  Thrift Supervision, Office of                   12, V
Truman, Harry S. Scholarship Foundation           45, XVIII
United States and Canada, International Joint     22, IV
     Commission
United States and Mexico, International Boundary  22, XI
     and Water Commission, United States Section
Utah Reclamation Mitigation and Conservation      43, III
     Commission
Veterans Affairs Department                       38, I
  Federal Acquisition Regulation                  48, 8
Veterans' Employment and Training, Office of the  41, 61; 20, IX
     Assistant Secretary for
Vice President of the United States, Office of    32, XXVIII
Vocational and Adult Education, Office of         34, IV
Wage and Hour Division                            29, V
Water Resources Council                           18, VI
Workers' Compensation Programs, Office of         20, I
World Agricultural Outlook Board                  7, XXXVIII

[[Page 715]]

                                     

                                     



                        Redesignation Table No. 1




------------------------------------------------------------------------
                                                            New section
                 Old section (chapter I)                   (chapter IV)
------------------------------------------------------------------------
Subpart A                                                       Part 417
110.101.................................................         417.100
110.102.................................................         417.101
110.103.................................................         417.102
110.104.................................................         417.103
110.105.................................................         417.104
110.106.................................................         417.105
110.107.................................................         417.106
110.108.................................................         417.107
110.109.................................................         417.108
110.110.................................................         417.109
110.201.................................................         417.110
110.202.................................................         417.111
110.203.................................................         417.112
110.204.................................................         417.113
110.205.................................................         417.114
110.206.................................................         417.115
110.207.................................................         417.116
110.208.................................................         417.117
110.209.................................................         417.118
110.210.................................................         417.119
110.401.................................................         417.120
110.402.................................................         417.121
110.403.................................................         417.122
110.404.................................................         417.123
110.405.................................................         417.124
110.406.................................................         417.125
110.407.................................................         417.126
110.501.................................................         417.130
110.502.................................................         417.131
110.503.................................................         417.132
110.504.................................................         417.133
110.505.................................................         417.134
110.506.................................................         417.135
110.507.................................................         417.136
110.508.................................................         417.137
110.601.................................................         417.140
110.602.................................................         417.141
110.603.................................................         417.142
110.604.................................................         417.143
110.605.................................................         417.144
110.801.................................................         417.150
110.802.................................................         417.151
110.803.................................................         417.152
110.804.................................................         417.153
110.805.................................................         417.154
110.806.................................................         417.155
110.807.................................................         417.156
110.808.................................................         417.157
110.809.................................................         417.158
110.810.................................................         417.159
110.901.................................................         417.160
110.902.................................................         417.161
110.903.................................................         417.162
110.904.................................................         417.163
110.905.................................................         417.164
110.906.................................................         417.165
110.907.................................................         417.166
110.1001................................................         417.170
110.1002................................................         417.171
110.1003................................................         417.172
110.1004................................................         417.173
110.1005................................................         417.174
110.1006................................................         417.175
110.1007................................................         417.176
110.1008................................................         417.177
110.1009................................................         417.178
110.1010................................................         417.179
110.1011................................................         417.180
------------------------------------------------------------------------


[[Page 717]]

                                     

                                     



                        Redesignation Table No. 2




                           Distribution Table
------------------------------------------------------------------------
                Old section                          New section
------------------------------------------------------------------------
30 CFR                                      42 CFR
  11.1....................................    84.1
  11.2....................................    Removed.
  11.2-1..................................    Removed.
  11.3....................................    84.2, 84.1101
  11.4....................................    84.3
  11.10...................................    84.10
  11.11...................................    84.11
  11.12...................................    84.12
  11.20...................................    84.20, 84.1102
  11.21...................................    84.21
  11.22...................................    84.22
  11.30...................................    84.30
  11.31...................................    84.31
  11.32...................................    84.32
  11.33...................................    84.33, 84.1103
  11.34...................................    84.34
  11.35...................................    84.35
  11.36...................................    84.36
  11.40...................................    84.40
  11.41...................................    84.41
  11.42...................................    84.42
  11.43...................................    84.43
  11.50...................................    84.50
  11.51...................................    84.51
  11.52...................................    84.52
  11.53...................................    84.53
  11.60...................................    84.60
  11.61...................................    84.61
  11.62...................................    84.62
  11.63...................................    84.63
  11.64...................................    84.64
  11.65...................................    84.65
  11.66...................................    84.66
  11.70...................................    84.70
  11.71...................................    84.71
  11.72...................................    84.72
  11.73...................................    84.73
  11.74...................................    84.74
  11.75...................................    84.75
  11.76...................................    84.76
  11.77...................................    84.77
  11.78...................................    84.78
  11.79...................................    84.79
  11.79-1.................................    84.80
  11.80...................................    84.81
  11.81...................................    84.82
  11.82...................................    84.83
  11.83...................................    84.84
  11.84...................................    84.85
  11.85...................................    Removed.
  11.85-1.................................    84.86
  11.85-2.................................    84.87
  11.85-3.................................    84.88
  11.85-4.................................    84.89
  11.85-5.................................    84.90
  11.85-6.................................    84.91
  11.85-7.................................    84.92
  11.85-8.................................    84.93
  11.85-9.................................    84.94
  11.85-10................................    84.95
  11.85-11................................    84.96
  11.85-12................................    84.97
  11.85-13................................    84.98
  11.85-14................................    84.99
  11.85-15................................    84.100
  11.85-16................................    84.101
  11.85-17................................    84.102
  11.85-18................................    84.103
  11.85-19................................    84.104
  11.90...................................    84.110
  11.91...................................    84.111, 84.1131
  11.92...................................    84.112
  11.93...................................    84.113
  11.94...................................    84.114
  11.95...................................    84.115, 84.1132
  11.96...................................    84.116, 84.1133
  11.97...................................    84.117, 84.1134
  11.98...................................    84.118, 84.1135
  11.99...................................    84.119, 84.1136
  11.100..................................    84.120, 84.1137
  11.101..................................    84.121, 84.1138
  11.102..................................    Removed.
  11.102-1................................    84.122
  11.102-2................................    84.123
  11.102-3................................    84.124
  11.102-4................................    84.125, 84.1130, 84.1153
  11.102-5................................    84.126
  11.110..................................    84.130
  11.111..................................    84.131
  11.112..................................    84.132
  11.113..................................    84.133
  11.114..................................    84.134
  11.115..................................    84.135
  11.116..................................    84.136
  11.117..................................    84.137
  11.118..................................    84.138
  11.119..................................    84.139
  11.120..................................    84.140
  11.121..................................    84.141
  11.122..................................    84.142
  11.123..................................    84.143
  11.124..................................    Removed.
  11.124-1................................    84.144
  11.124-2................................    84.145
  11.124-3................................    84.146
  11.124-4................................    84.147
  11.124-5................................    84.148
  11.124-6................................    84.149
  11.124-7................................    84.150

[[Page 718]]

 
  11.124-8................................    84.151
  11.124-9................................    84.152
  11.124-10...............................    84.153
  11.124-11...............................    84.154
  11.124-12...............................    84.155
  11.124-13...............................    84.156
  11.124-14...............................    84.157
  11.124-15...............................    84.158
  11.124-16...............................    84.159
  11.124-17...............................    84.160
  11.124-18...............................    84.161
  11.124-19...............................    84.162
  11.124-20...............................    84.163
  11.124-21...............................    Removed.
  11.124-22...............................    Removed.
  11.124-23...............................    Removed.
  11.124-24...............................    Removed.
  11.130..................................    84.170, 84.1130
  11.131..................................    84.171, 84.1131
  11.132..................................    84.172, 84.1132
  11.133..................................    84.173, 84.1133
  11.134..................................    84.174, 84.1134
  11.135..................................    84.175, 84.1135
  11.136..................................    84.176, 84.1136
  11.137..................................    84.177, 84.1137
  11.138..................................    84.178, 84.1138
  11.139..................................    84.1139
  11.140..................................    84.1140
  11.140-1................................    84.1141
  11.140-2................................    84.1142
  11.140-3................................    84.1143
  11.140-4................................    84.1144
  11.140-5................................    84.1145
  11.140-6................................    84.1146
  11.140-7................................    84.1147
  11.140-8................................    84.1148
  11.140-9................................    84.180, 84.1149
  11.140-10...............................    84.182, 84.1150
  11.140-11...............................    84.1151
  11.140-12...............................    84.1152
  11.150..................................    84.190
  11.151..................................    84.191
  11.152..................................    84.192
  11.153..................................    84.193
  11.154..................................    84.194
  11.155..................................    84.195
  11.156..................................    84.196
  11.157..................................    84.197
  11.158..................................    84.198
  11.158-1................................    84.199
  11.159..................................    84.200
  11.160..................................    84.201
  11.161..................................    84.202
  11.162..................................    84.1157
  11.162-1................................    84.203, 84.1157
  11.162-2................................    84.204
  11.162-3................................    84.205
  11.162-4................................    84.1157
  11.162-5................................    84.1157
  11.162-6................................    84.1157
  11.162-7................................    84.206, 84.1158
  11.162-8................................    84.207, 84.1157
  11.170..................................    84.1130
  11.171..................................    84.1131
  11.172..................................    84.1154
  11.173..................................    84.1154
  11.174..................................    84.1155
  11.175..................................    84.1132
  11.176..................................    84.1133
  11.177..................................    84.1134
  11.178..................................    84.1135
  11.179..................................    84.1136
  11.180..................................    84.1137
  11.181..................................    84.1138
  11.182..................................    84.1139
  11.183..................................    84.1156
  11.183-1................................    84.1156
  11.183-2................................    Removed.
  11.183-3................................    84.1156
  11.183-4................................    84.1156
  11.183-5................................    84.1156
  11.183-6................................    84.1156
  11.183-7................................    84.1156
  11.200..................................    84.250
  11.201..................................    84.251
  11.202..................................    84.252
  11.203..................................    84.253
  11.204..................................    84.254
  11.205..................................    84.255
  11.206..................................    84.256
  11.207..................................    84.257
  11.208..................................    84.258
------------------------------------------------------------------------


[[Page 719]]



List of CFR Sections Affected



All changes in this volume of the Code of Federal Regulations which were 
made by documents published in the Federal Register since January 1, 
1986, are enumerated in the following list. Entries indicate the nature 
of the changes effected. Page numbers refer to Federal Register pages. 
The user should consult the entries for chapters and parts as well as 
sections for revisions.
For the period before January 1, 1986, see the ``List of CFR Sections 
Affected, 1949-1963, 1964-1972, and 1973-1985,'' published in seven 
separate volumes.

                                  1986

42 CFR
                                                                   51 FR
                                                                    Page
Chapter I
23  Authority citation revised.....................................31947
23.4  (b)(5) revised...............................................31948
23.6  (b) introductory text amended; (b)(2) and flush sentence 
        following (b)(4) removed; (b)(3) and (4) redesignated as 
        (b)(2) and (3).............................................31948
23.7  (a)(3) amended...............................................31948
23.10  (a) introductory text amended; (b) redesignated as (d) and 
        amended; new (b) and (c) added.............................31948
23.21--23.35 (Subpart B)  Added....................................31948
23.41 (Subpart C)  Added...........................................31950
36  Policy statement...............................................23540
51a  Added..........................................................7727
53  Authority citation revised.....................................39376
53.134--53.135 (Subpart M)  Removed.................................7939
53.155  Authority citation removed.................................39376
53.156  Added......................................................39376
57.109  Waiver.....................................................12608
57.409  Waiver.....................................................12608
57.2601--57.2617 (Subpart AA)  Revised.............................25892
57.3001--57.3011 (Subpart EE)  Added (effective date pending in 
        part)......................................................11031
57.3501--57.3510 (Subpart JJ)  Heading and authority citation 
        revised....................................................45768
57.3501  Revised...................................................45768
57.3502  Amended...................................................45768
57.3503  Revised...................................................45769
57.3504  (a) revised; (c) added; OMB number........................45769
57.3505  Removed; new 57.3505 redesignated from 57.3513 and 
        revised....................................................45769
57.3506  Removed; new 57.3506 redesignated from 57.3514 and (b) 
        revised....................................................45769
57.3507  Removed; new 57.3507 redesignated from 57.3515............45769
57.3508  Removed; new 57.3508 redesignated from 57.3516............45769
57.3509  Removed; new 57.3509 redesignated from 57.3517 and 
        revised....................................................45769
57.3510  Removed; new 57.3510 redesignated from 57.3518............45769
57.3511  Removed...................................................45769
57.3512  Removed...................................................45769
57.3513  Redesignated as 57.3505 and revised.......................45769
57.3514  Redesignated as 57.3506 and (b) revised...................45769
57.3515  Redesignated as 57.3507...................................45769
57.3516  Redesignated as 57.3508...................................45769
57.3517  Redesignated as 57.3509 and revised.......................45769
57.3518  Redesignated as 57.3510...................................45769
60  Authority citation revised.....................................30644
60.5  (h) added....................................................30644
60.6  (d) added....................................................30644
60.7  (a)(3) and (c)(4) added......................................30644
60.10  (a)(2) revised..............................................30644
60.11  (a)(1), (b), and (d) revised................................30644
60.12  (a)(2) revised..............................................30644
60.13  (a)(1) revised..............................................30644
60.14  (b), (c) (1) and (2) revised................................30645

[[Page 720]]

60.33  (e)(1)(i) revised...........................................30645
124.501--124.513 (Subpart F)  Authority citation revised...........33213
124.501  (b)(1) amended............................................33214
124.502  Amended...................................................33214
124.510  (a) heading and (b) heading revised; (c) added............33214
124.511  (a)(3) and (b)(2) revised.................................33214
124.513  Added.....................................................33214
124.701--124.709 (Subpart H)  Added.................................7939

                                  1987

42 CFR
                                                                   52 FR
                                                                    Page
Chapter I
2  Revised.........................................................21803
2.12  (b)(3)(ii) corrected.........................................42061
2.17  (a) corrected................................................42061
2.32  (a) designation correctly removed............................41997
2.52  (a)(1) and (2)(ii) corrected; (a)(3) correctly added.........41997
2.61  (b)(2) corrected.............................................42061
2.65  (e)(3) corrected.............................................42061
7  Added...........................................................11073
34  Authority citation revised.....................................32543
34.2  (b) revised...........................................21533, 32543
34.4  (a)(1) introductory text and (iii), (3), and (5) revised; 
        (a)(2) amended; eff. 12-1-87...............................32544
36.1--36.2 (Subpart A)  Heading revised; eff. 3-16-88..............35048
36.1  Removed; new 36.1 redesignated from 36.2; eff. 3-16-88.......35048
36.2  Redesignated as 36.1; new 36.2 redesignated from 36.3; eff. 
        3-16-88....................................................35048
36.3  Redesignated as 36.2; eff. 3-16-88...........................35048
36.10  Redesignated from 36.21 and revised; eff. 3-16-88...........35048
36.11  (d) redesignated from 36.12 (c); eff. 3-16-88...............35048
36.12  (c) redesignated as 36.11 (d); section revised; OMB number; 
        eff. 3-16-88...............................................35048
36.13  Redesignated from 36.24; eff. 3-16-88.......................35048
36.14  Removed; new 36.14 redesignated from 36.25; eff. 3-16-88....35048
    (a) introductory text revised; OMB number; eff. 3-16-88........35049
36.15  Added; OMB number; eff. 3-16-88.............................35049
36.16  Added; OMB number; eff. 3-16-88.............................35050
36.21  Redesignated as 36.10 and revised; eff. 3-16-88.............35048
36.22--36.23 (Subpart C)  Removed; eff. 3-16-88....................35050
36.24  Redesignated as 36.13; eff. 3-16-88.........................35048
36.25  Redesignated as 36.14; eff. 3-16-88.........................35048
36.31--36.34 (Subpart D)  Added; eff. to 9-18-89...................35050
36.41  (e) revised.................................................27806
37.41  (a) and (h)(3) revised.......................................7866
37.52  (b) revised..................................................7866
57.201--57.218 (Subpart C)  Authority citation revised.............20987
57.202  Amended....................................................20987
57.206  (a)(1) (iii) and (iv) revised; (a)(1)(v) added.............20987
57.208  Heading revised; (c) added.................................20987
57.210  (b)(2) revised; (b)(5) added...............................20988
57.216a  Introductory text, (a), (b), and (c)(3) amended...........20988
57.301--57.318 (Subpart D)  Authority citation revised......10194, 19143
57.302  Amended....................................................10195
57.305  (a) revised................................................10195
57.306  (a)(1) (iii) and (iv) revised; (a)(1)(v) added.............19144
57.310  (b)(2) revised; (b)(5) added...............................10195
57.316a  Introductory text, (a), (b), and (c)(3) revised...........10195
57.701--57.712 (Subpart H)  Authority citation revised.............24160
57.702  Amended....................................................24160
57.704  OMB number.................................................24160
57.705  (b) revised; OMB number....................................24160
57.706  (a) (6) and (7) and (b)(1) revised; (b)(2) redesignated as 
        (b)(3); new (a)(8) and (b)(2) added; new (b)(3)(i) amended
                                                                   24160
57.709  (a) and (c) revised........................................24160
57.710  Revised....................................................24161
57.711  Removed; new 57.711 redesignated from 57.712 and OMB 
        number.....................................................24161
57.712  Redesignated as 57.711 and OMB number; new 57.712 
        redesignated from 57.714...................................24161
57.713  Removed....................................................24161

[[Page 721]]

57.714  Redesignated as 57.712.....................................24161
57.801--57.803 (Subpart I)  Authority citation revised.............24159
57.801  (a) revised................................................24159
57.802  Amended....................................................24160
57.803  (a)(1) revised; (f), (g), and (h) redesignated as (g), 
        (h), and (i); new (f) added; new (h) amended...............24160
57.1101--57.1112 (Subpart L)  Heading and authority citation 
        revised....................................................19145
    Heading correctly revised......................................26122
57.1101  Revised...................................................19145
57.1102  Amended...................................................19145
57.1104  (c) revised; OMB number...................................19145
57.1105  (a), (b), (e) and (f) revised; (c) and (d) amended........19145
57.1106  (d) and (e) amended; (f) added............................19146
57.1107  (b) revised...............................................19146
57.1109  (a) and (b) revised.......................................19146
57.1110  Revised...................................................19146
57.1111  Removed; new 57.1111 redesignated from 57.1113 and OMB 
        number.....................................................19146
57.1112  Removed; new 57.1112 redesignated from 57.1114............19146
57.1113  Redesignated as 57.1111 and OMB number....................19146
57.1114  Redesignated as 57.1112...................................19146
57.2401--57.2410 (Subpart Y)  Heading and authority citation 
        revised....................................................27342
57.2401  Revised...................................................27342
57.2402  (e), (h), (i), (k), (l) and (o) revised; (q) redesignated 
        as (r) and revised; new (q) added..........................27342
57.2403  (a)(1), (b) (1), (2) introductory text and (iii) and (3) 
        revised....................................................27343
57.2404  (c)(8) removed; (c)(9) redesignated as (c)(8); (c)(1) 
        (ii), (viii), (ix), and (xii) and (d) revised; OMB number 
                                                                   27343
57.2405  (a), (b), and (c) introductory text revised; OMB number 
                                                                   27343
57.2406  (a)(1)(ii), (2) (i) and (ii), and (3) and (b)(1) revised 
                                                                   27343
57.2408  (b) removed; (c) redesignated as (b) and revised..........27343
57.2409  Revised...................................................27344
57.2410  Removed; new 57.2410 redesignated from 57.2414............27344
57.2411  Removed...................................................27344
57.2412  Removed...................................................27344
57.2413  Removed...................................................27344
57.2414  Redesignated as 57.2410...................................27344
57.2401--57.2410 (Subpart Y)  Appendix heading revised; Appendix 
        text amended...............................................27344
57.2501--57.2510 (Subpart Z)  Heading and authority citation 
        revised....................................................27346
    Correctly designated...........................................28511
57.2501  Revised...................................................27346
57.2502  Amended...................................................27346
57.2503  (a)(1), (b) (1), (2) introductory text, (i), and (iii) 
        and (3) revised............................................27346
57.2504  (c) (1) and (11) and (d) revised; (c) (1) through (10) 
        amended; (c) (12) and (13) revised; OMB number (effective 
        date pending in part)......................................27346
    (c) (12) and (13) effective date note corrected................28511
57.2505  (b) revised...............................................27347
57.2506  (a) (1) through (5) and (8), (b) and (c)(1) revised; 
        (a)(9) added...............................................27347
    (a)(1) introductory text corrected.............................28511
57.2508  (b) revised...............................................27347
57.2509  Revised...................................................27347
57.2510  Removed...................................................27347
    Redesignated from 57.2514......................................27348
57.2511  Removed...................................................27347
57.2512  Removed...................................................27347
57.2513  Removed...................................................27347
57.2514  Redesignated as 57.2510...................................27348
57.2615  (c)(3) corrected..........................................49250
57.2901--57.2915 (Subpart DD)  Removed.............................18675
57.2901--57.2910 (Subpart DD)  Added...............................18675
58.1--58.11 (Subpart A)  Authority citation revised................23180
58.2  Amended......................................................23180
58.4  (a) revised..................................................23180
58.10  OMB number..................................................23180
60.1  (c) revised; (d) added.........................................745
60.5  (g) revised; (h) redesignated as (i); new (h) added............745
60.7  (a)(2) redesignated as (a)(3) and (iii) revised; (a)(3) and 
        (c) (2), (3), and (4) redesignated as (a)(5) and (c) (3), 
        (4), and (5); (a) (2) and (4) and (c) (2) and (6) added......746

[[Page 722]]

60.8  (a) (3), (5), and (11), and (b)(3) introductory text and (5) 
        revised......................................................746
60.10  (a) introductory text revised.................................746
60.11  (e) revised...................................................746
60.14  (a) (1) and (2) revised; (a) (3) and (4) redesignated as 
        (a) (4) and (5); new (a)(3) added............................746
60.15  (a) revised...................................................747
60.19  Revised.......................................................747
60.20  Introductory text revised.....................................747
60.31  (a) revised; (c) redesignated as (d); new (c) added...........747
60.32  (a)(2) revised; (c) redesignated as (c)(1); (c) (2) and (3) 
        added........................................................747
60.33  Introductory text revised; (c), (d), and (e) redesignated 
        as (d), (e), and (f); new (c) and (g) added; new (e)(1), 
        (f)(1) (i) and (ii) and (2) revised..........................748
60.34  Heading and (b)(1) revised; introductory text, (c), and (d) 
        added........................................................748
60.35  (a) and (b) revised; (c) and (e) redesignated as (e) and 
        (f); new (c) added; (d) revised..............................749
60.37  (a) and (b) revised; (c)(4) added.............................749
60.38  (a) revised...................................................749
60.40  (a) and (c) revised...........................................750
60.42  Heading and (a)(1) introductory text, (viii), and (ix) 
        revised; (a)(1)(x) and (4), (d) and (e) added................750
60.50  (a)(2)(ii)(F) revised.........................................751
60.51  Revised.......................................................751
60.52  (a) removed; (b) and (c) redesignated as (a) and (b); new 
        (a)(1) revised...............................................751
60.53  Revised.......................................................751
60.56  (a) introductory text and (4) revised; (a) (9) and (10) 
        redesignated as (a) (17) and (18); new (18) revised; new 
        (a) (9) through (16), (c), and (d) added.....................751
60.60  (c) revised...................................................752
60.61  Added.........................................................752
64a.104  (b) and (c) revised; (d) added; OMB number................18359
64a.105  (e)(1)(iii) added; (g) revised............................18359
110  Redesignated as 417.100--417.180 (Subpart A); nomenclature 
        changes; subpart designations removed......................36746
    Redesignation table heading corrected..........................47003
110.101--110.110 (Subpart A)  Authority citation revised...........22321
110.101  Amended...................................................22321
110.601--110.605 (Subpart F)  Authority citation revised...........22321
110.604  Revised...................................................22321
121--124 (Subchapter K)  Heading revised...........................10094
121  Removed.......................................................10094
122  Removed.......................................................10094
123  Removed.......................................................10094
124.501--124.516 (Subpart F)  Revised (effective date pending in 
        part)......................................................46031
124.502  (m)(2) corrected..........................................48362
124.503  (b)(3)(ii) corrected......................................48362
124.507  (b)(2)(i)(B) and (iii) and (c)(2) corrected...............48362
124.509  (d) corrected.............................................48362
124.510  OMB number corrected......................................48362
124.511  (a) introductory text, (1)(iv), and (3) and (b)(1)(iii) 
        introductory text corrected................................48362
124.513  (d)(2)(i)(B) corrected....................................48362
124.514  (d) corrected.............................................48362
124.515  (a) corrected.............................................48362

                                  1988

42 CFR
                                                                   53 FR
                                                                    Page
Chapter I
36  Regulations at 52 FR 35048-35050 effective date deferred to 
        10-15-88...................................................37762
51d  Removed.......................................................27859
51f  Removed.......................................................27859
57.202  Amended....................................................46549
57.204  Heading revised; (c) added.................................46549
57.206  (a)(1)(iv) revised; (d) added..............................46549
57.210  (a)(2) (ii) and (iii) revised; (a) (3) and (4) 
        redesignated as (a) (4) and (5); (a)(2) (iv) and (v) and 
        new (a)(3) added; OMB number................................6092
57.213a  Revised...................................................46549
57.215  (a) revised; OMB number....................................46549
    OMB number corrected...........................................49824

[[Page 723]]

57.216a  (d) revised; OMB number...................................46550
57.302  Amended....................................................46554
57.304  Heading revised; (c) added.................................46554
57.306  (c) added..................................................46554
57.315  (a)(1) revised; OMB number.................................46555
    OMB number corrected...........................................49824
57.316a  (d) revised; OMB number...................................46555
57.501--57.514 (Subpart F)  Added (effective date pending in part)
                                                                    9116
57.706  (b) revised................................................14792
57.1605  (b) revised...............................................14792
57.1901--57.1913 (Subpart T)  Authority citation revised...........14794
57.1902  Amended...................................................14794
57.1903  (b) heading amended; footnote removed; (b) (4) and (5) 
        redesignated as (b) (5) and (6); new (b) (4), (7), (8), 
        and (9) added..............................................14794
57.1904  OMB number................................................14794
57.1905  (e) redesignated as (g) and revised; new (e), (f), (h), 
        (i), and (j) added.........................................14794
57.1906  (a)(1) designation and flush text following (a)(1)(vii) 
        removed; (a)(1) (i) through (vii) redesignated as (a) (1) 
        through (7); (b) and (c) redesignated as (c) and (d); new 
        (c) (1) and (2) revised; new (d) amended; new (b) added....14794
57.1908  Revised...................................................14795
57.1909  Revised...................................................14795
57.1910  Removed; new 57.1910 redesignated from 57.1913............14795
57.1911  Removed...................................................14795
57.1912  Removed...................................................14795
57.1913  Redesignated as 57.1910...................................14795
57.2406  (a)(3) revised............................................14792
57.2506  (b) revised...............................................14792
57.2604  (b) revised...............................................14792
57.3005  (b) revised...............................................14792
57.3101--57.3112 (Subpart FF)  Authority citation and heading 
        revised....................................................50408
57.3101  Revised...................................................50408
57.3102  Amended...................................................50408
57.3103  Revised...................................................50408
57.3104  (a), (d), (e), and (h) revised; (c) amended; OMB numbers 
                                                                   50408
57.3105  Introductory text and (a) through (n) designations 
        revised; (b) added; new (a) (3), (5), (6), (10) 
        introductory text, (iii), (iv), (v)(A), (12), and 
        (13)(ii)(C) amended; parenthetical statement removed.......50409
57.3106  (b) revised...............................................14792
    (a)(4) amended; (a)(5) added; (b) revised......................50409
57.3107  (d) removed; (c) revised..................................50409
57.3109  (c) added.................................................50409
57.3111  OMB number................................................50409
57.3806  (b) revised...............................................14792
59  Court action...................................................49320
59.1--59.13 (Subpart A)  Authority citation revised.................2944
59.2  Amended.................................................2944, 2946
59.5  (a)(5) removed; (a) (6) through (11) redesignated as (a) (5) 
        through (10); (b)(3)(i) revised.............................2944
    (b) introductory text, (3)(iii), (4), (7), and (10) amended.....2946
59.6  (a) amended...................................................2946
59.7  Redesignated as 59.11; new 59.7 added.........................2944
59.8  Redesignated as 59.12.........................................2944
    Added...........................................................2945
59.9  Redesignated as 59.13.........................................2944
    Added...........................................................2945
59.10  Redesignated as 59.14........................................2944
    Added...........................................................2945
59.11  Redesignated as 59.15; new 59.11 redesignated from 59.7......2944
    (a) introductory text and (7), (b), and (c) amended.............2946
59.12  Redesignated as 59.16; new 59.12 redesignated from 59.8......2944
    (a) amended.....................................................2946
59.13  Redesignated as 59.17; new 59.13 redesignated from 59.9......2944
59.14  Redesignated from 59.10......................................2944
59.15  Redesignated from 59.11......................................2944
    Amended.........................................................2946
59.16  Redesignated from 59.12......................................2944
    (a) amended.....................................................2946
59.17  Redesignated from 59.13......................................2944
60.11  (a)(1) revised...............................................6097
60.12  (b) redesignated as (c) and revised; new (b) added 
        (effective date pending in part)............................6097
74.53  Introductory text republished; (b) and (c) revised..........48647
124.511  (b)(1)(iii)(B) corrected...................................5576

[[Page 724]]

                                  1989

42 CFR
                                                                   54 FR
                                                                    Page
Chapter I
5  Appendix A, B, and C amended...............................8737, 8738
36.41  (e) revised.................................................48246
50.101--50.105 (Subpart A)  Added..................................32449
50.401--50.406 (Subpart D)  Revised................................34770
57.1604  (d)(4) revised............................................50374
57.2101--57.2110 (Subpart V)  Revised..............................28067
57.2109  Effective date pending....................................28065
57.3105  (a)(11) revised...........................................51745
57.4001--57.4010 (Subpart OO)  Added................................5617
62.21--62.30 (Subpart B)  Added; interim...........................13462
62.51--62.58 (Subpart C)  Added; interim...........................13464
62.71--62.76 (Subpart D)  Added; interim...........................13466
124.501--124.516 (Subpart F)  Regulations at 52 FR 46031 eff. 12-
        26-89......................................................52939
124.509  (c) regulation at 52 FR 46031 eff. 12-26-89; OMB number 
                                                                   52939
124.514  (c) regulation at 52 FR 46031 eff. 12-26-89; OMB number 
                                                                   52939
124.515  (b)(2)(ii) regulation at 52 FR 46031 eff. 12-26-89; OMB 
        number.....................................................52939
    (b)(3)(ii)(B) regulation at 52 FR 46031 eff. 12-26-89; OMB 
number.............................................................52939

                                  1990

42 CFR
                                                                   55 FR
                                                                    Page
Chapter I
36.10  Amended......................................................4609
36.12  (c) revised..................................................4609
36.61 (Subpart G)  Added............................................4609
57.2601--57.2617 (Subpart AA)  Heading and authority citation 
        revised....................................................10066
57.2601  Revised...................................................10066
57.2602  Amended...................................................10066
57.2603  Revised...................................................10067
57.2604  (a)(2) and (3) revised; (b) removed; (c) redesignated as 
        (b) and revised............................................10067
57.2605  (d) removed; (b) and (c) revised..........................10067
57.2606  Revised...................................................10068
57.2607  (a) revised; (c) added....................................10068
57.2608  (b), (c) and (d) revised..................................10068
57.2609  (a), (b), and (c) revised.................................10068
57.2610  Revised...................................................10068
57.2611  Revised...................................................10069
57.2612  (b) revised...............................................10069
57.2613  Revised...................................................10069
57.2614  Revised...................................................10069
57.2615  Amended (OMB number)......................................10070
57.2616  Amended...................................................10070
57.4101--57.4116 (Subpart PP)  Added...............................37481
65  Added..........................................................42568
74  Removed.........................................................9574
90 (Subchapter H and Part)  Added...................................5138
100  Removed........................................................2652
Chapter III
300--399 (Chapter III)  Removed....................................34261

                                  1991

42 CFR
                                                                   56 FR
                                                                    Page
Chapter I
4  Revised.........................................................29188
34  Authority citation revised.....................................25001
34.1  Revised; interim.............................................25001
34.2  Introductory text, (a) and (c) through (f) revised; (b) 
        introductory text amended; (g) through (p) added; interim 
                                                                   25001
34.3  Revised; interim.............................................25002
34.4  Revised; interim.............................................25003
34.5  Revised; interim.............................................25003
34.6  Revised; interim.............................................25003
34.7  Revised; interim.............................................25003
34.8  Revised; interim.............................................25004
34.9  Removed; interim.............................................25004
34.10  Removed; interim............................................25004
34.11  Removed; interim............................................25004
34.12  Removed; interim............................................25004
34.13  Removed; interim............................................25004
34.14  Removed; interim............................................25004
57  Technical correction...........................................29528
57.201--57.218 (Subpart C)  Authority citation revised......19293, 40725
57.202  Amended....................................................19293
    Corrected......................................................25446
57.203  (a) and (c) amended; OMB number............................19293
57.204  (a) introductory text and (b) amended......................19293
57.205  (a) revised; (c) added.....................................40725

[[Page 725]]

57.206  (a)(1)(i), (b) introductory text and (c) revised; (b)(1) 
        amended; OMB number........................................19293
57.208  (a)(1) and (c)(1)(ii) revised; OMB numbers.................19293
57.210  (a)(2)(iv) and (v) redesignated as (a)(2)(v) and (vi); new 
        (a)(2)(iv) added; (a)(2)(iii) revised; OMB numbers.........19293
    (b)(4) revised; OMB number.....................................40726
57.211  OMB number.................................................19293
57.212  Heading, (a) introductory text and (3) amended; OMB number
                                                                   19293
57.213  Amended....................................................19294
57.213a  OMB number................................................19294
57.215  OMB numbers................................................19294
57.216  Heading and (a) revised....................................19294
57.216a  OMB number................................................19294
57.301--57.318  (Subpart D) Authority citation revised......13770, 40734
57.302  Amended....................................................13771
57.303  (a) footnote 1 amended; OMB number.........................13771
57.305  (a) revised; (c) added.....................................40734
57.306  (a)(1)(v) removed; (b)(2)(i) amended; (a)(1)(i), (iii), 
        (iv) and (b)(1) revised; OMB number........................13771
57.307  Revised....................................................13771
57.308  (a)(1) revised; OMB number.................................13771
57.310  (a)(1) and footnote 2 revised; OMB number..................13771
    (b)(4) revised; OMB number.....................................40734
57.311  OMB number.................................................13772
57.312  Heading amended; footnote 3 removed; (b) redesignated as 
        (c); (a)(3) revised; new (b) added; OMB number.............13772
57.313  (b) amended; OMB number....................................13772
57.314  (c) and (d) removed; (b) amended; (e) and (f) redesignated 
        as (c) and (d); footnote 4 redesignated as footnote 3......13772
    Footnote 3 correctly designated................................14730
57.315  OMB number.................................................13772
57.316  Revised....................................................13772
57.316a  OMB number................................................13772
57.1801--57.1811  (Subpart S) Authority citation revised...........40564
57.1802  Amended...................................................40564
57.1803  (a) revised...............................................40565
57.1804  (a) revised; (b) redesignated as (c); new (b) added.......40565
57.1805  (a)(5) amended; (b) redesignated as (c); new (b) and (d) 
        added......................................................40565
      (d) corrected................................................43648
57.1806  (a) through (f) redesignated as (a)(1) through (6); 
        introductory text designated as (a); concluding text 
        designated as (b) and revised; new (c) added...............40565
    (b) corrected..................................................43648
57.1807  (b) amended; (d) removed; (c) revised.....................40565
57.1808  (b), (c) introductory text, (2), (d) introductory text, 
        (1) and (e) revised........................................40566
57.1809  Amended; footnote 1 redesignated as footnote 2............40566
57.1810  OMB number................................................40566
57.4102  Amended...................................................29194
57.4105  (j) revised...............................................29194
57.4106  (a) introductory text amended.............................29194
57.4110  OMB number................................................29194
57.4112  OMB number................................................29194
57.4115  OMB number................................................29194
59a  Revised.......................................................29189
60.1  (c) revised; (e) added.......................................42700
60.14  (a)(1) revised..............................................42700
60.32  Heading and (a)(1) revised..................................42701
60.35  (g) added...................................................42701
60.38  (d) added...................................................42701
60.40  (c)(1)(ii) and (iii) redesignated as (c)(1)(iii) and (iv); 
        (c)(1) introductory text, (i), new (c)(1)(iii)(D), (E), 
        (iv) and (4) introductory text revised; new (c)(1)(ii), 
        (iii)(F), (4)(vii), (viii) and (ix) added..................42701
60.41  (e)(1) revised..............................................42702
62.71--62.76 (Subpart D)  Revised..................................56597
64  Revised........................................................29192
110 (Subchapter J)  Added..........................................51808
110.103  Corrected.................................................59332
110.101--110.103 (Subpart A)  Appendix corrected............59218, 59332

                                  1992

42 CFR
                                                                   57 FR
                                                                    Page
Chapter I
5  Nomenclature change..............................................2480
    Appendix C amended..............................................2477
    Appendixes A and B amended......................................2480

[[Page 726]]

52a  Revised.......................................................61006
57.203  (a) amended; OMB number....................................45734
57.208  OMB number.................................................45734
57.210  OMB number.................................................45734
57.213a  OMB number................................................45734
57.215  (a)(3) amended; OMB number.................................45734
57.216  (a) amended................................................45734
57.303  (a) amended; OMB number....................................45735
57.308  OMB number.................................................45735
57.310  (a)(1)(iii) and (b)(2)(i) amended; OMB number..............45735
57.313  OMB number.................................................45735
57.314  Amended....................................................45735
57.315  OMB number.................................................45735
57.316  Amended....................................................45735
57.501--57.514 (Subpart F)  Authority citation revised.............45735
57.502  Amended....................................................45735
57.503  Amended....................................................45735
57.505  (b) amended................................................45735
57.507  (c) amended................................................45735
57.508  (b) amended................................................45735
57.509  (a) revised; OMB number....................................45735
57.510  OMB number.................................................45735
57.512  OMB number.................................................45735
57.513  Amended....................................................45736
57.601--57.613 (Subpart G)  Authority citation revised.............45736
57.701--57.712 (Subpart H)  Authority citation revised.............45736
57.701  Revised....................................................45736
    Corrected......................................................53815
57.702  Amended....................................................45736
57.703  Revised....................................................45736
57.704  (c)(4) removed; (c)(1) amended; (a) revised................45736
57.705  (b) revised; OMB number....................................45736
57.706  (a)(2) amended; (a)(4) and (5) revised.....................45736
57.707  (a)(1) amended; (a)(2), (3) and (c) revised................45736
57.709  (a) and (c) amended; (b) revised...........................45736
57.710  Amended....................................................45736
57.711  Amended....................................................45737
57.801--57.803 (Subpart I)  Authority citation revised.............45737
57.802  Amended....................................................45737
57.803  (b), (d), (e), (g) and (h) amended; (a)(2) revised.........45737
57.901--57.913 (Subpart J)  Removed................................45737
57.1001--57.1014 (Subpart K)  Removed..............................45737
57.1101--57.1112 (Subpart L)  Authority citation revised...........45737
57.1101  Introductory text revised.................................45737
57.1102  Amended...................................................45737
57.1103  Revised...................................................45737
57.1104  (a) revised...............................................45737
57.1106  (a) amended...............................................45737
57.1107  (a)(1) amended; (a)(2) through (4) and (b) revised........45737
57.1109  (b) and (c) amended.......................................45738
57.1110  Amended...................................................45738
57.1111  Revised...................................................45738
57.1112  OMB number................................................45738
57.1201--57.1212 (Subpart M)  Removed..............................45738
57.1301--57.1314 (Subpart N)  Removed..............................45738
57.1401--57.1415 (Subpart O)  Removed..............................45738
57.1601--57.1610 (Subpart Q)  Authority citation revised...........45738
57.1601  Revised...................................................45738
57.1602  Amended...................................................45738
57.1603  (a) and (b) amended; (c) added............................45738
57.1604  (b)(3)(iii)(C), (4)(iii)(C) and (d)(5)(ii) amended; 
        (b)(3)(i) revised; OMB number..............................45738
57.1606  (d) removed; (b) and (c) revised..........................45739
57.1607  (c) added.................................................45739
57.1608  Amended...................................................45739
57.1609  OMB number................................................45739
57.1701--57.1710 (Subpart R)  Authority citation revised...........45739
57.1701  Introductory text amended.................................45739
57.1702  Amended...................................................45739
57.1703  Revised...................................................45739
57.1704  (d) through (g) amended; OMB number.......................45739
57.1706  (a) amended; (b) and (c) revised; (d) removed.............45739
57.1707  (c) added.................................................45740
57.1708  Amended...................................................45740
57.1709  OMB number................................................45740
57.1802  Amended...................................................45740
57.1803  (a) footnote 1 removed....................................45740
57.1805  (a)(2) revised............................................45740
57.1807  (a) and (b) amended.......................................45740
57.1809  Footnote amended..........................................45740
57.2101--57.2114 (Subpart V)  Heading revised......................45740

[[Page 727]]

57.2102  Amended...................................................45740
57.2103  Footnote 1 removed........................................45740
57.2107  (b) amended...............................................45740
57.2108  Amended...................................................45740
57.2109  OMB number................................................45740
57.2401  Revised...................................................45740
57.2402  (f) and (o) amended; (j) revised..........................45741
    (f) correctly designated.......................................53815
57.2403  (a)(1) revised............................................45741
57.2404  (a) footnote 1 and (c)(8) removed.........................45741
57.2406  (a)(2)(i) amended.........................................45741
57.2408  (b) amended...............................................45741
57.2409  Amended...................................................45741
57.2410--57.2410 (Subpart Y)  Appendix amended.....................45741
57.2502  Amended...................................................45741
57.2503  (b)(1) amended............................................45741
57.2504  (a) revised; footnote 1 removed...........................45741
57.2508  (b) amended...............................................45741
57.2509  Amended...................................................45742
57.2601  Revised...................................................45742
57.2602  Amended...................................................45742
57.2603  Revised...................................................45742
57.2604  (a)(3) and (b) amended....................................45742
57.2607  (c) amended...............................................45742
57.2610  (b), (d) and (h) amended; OMB number......................45742
57.2613  (a)(1), (2) and (c) amended; OMB number...................45742
57.2615  OMB number................................................45742
57.2616  Amended...................................................45742
57.2801--57.2810 (Subpart CC)  Heading and authority citation 
        revised....................................................45742
57.2801  Amended...................................................45742
57.2802  Amended...................................................45742
57.2803  (a) revised; OMB number...................................45743
57.2804  (a)(2) and (b)(2) amended; (a)(1) revised; OMB number.....45743
57.2805  (a) amended...............................................45743
57.2806  (b) and (c)(1) amended....................................45743
57.2808  Amended...................................................45743
57.2809  OMB number................................................45743
57.2902  Amended...................................................45743
57.2904  (b)(1)(i) amended; (a)(1) revised.........................45743
57.2908  Amended...................................................45743
57.3001--57.3011 (Subpart EE)  Authority citation revised..........45743
57.3001  Amended...................................................45743
57.3002  Amended...................................................45743
57.3003  Revised...................................................45743
57.3004  OMB number................................................45744
57.3005  (a)(1) and (4) amended....................................45744
57.3006  (a) and (b) amended; (c) revised; (d) removed.............45744
57.3007  (b) amended; OMB number...................................45744
57.3008  (c) added.................................................45744
57.3009  Amended...................................................45744
57.3010  OMB number................................................45744
57.3101  Introductory text amended.................................45744
57.3102  Amended...................................................45744
57.3103  Revised...................................................45744
57.3105  (a)(8) amended............................................45744
57.3107  (a) amended; (b) revised..................................45744
57.3109  (c) amended...............................................45745
57.3110  Heading revised; text amended.............................45745
57.3201--57.3202 (Subpart GG)  Authority citation revised..........45745
57.3201  Revised...................................................45745
57.3401--57.3413 (Subpart II)  Removed.............................45745
57.3501--57.3510 (Subpart JJ)  Removed.............................45745
57.3902  Amended...................................................45745
57.3906  (a) amended; (b) and (c) revised; (d) removed.............45745
57.3907  (c) amended...............................................45745
57.3908  Heading revised; introductory text added; text amended....45745
57.4001--57.4010 (Subpart OO)  Authority citation revised..........45745
57.4001  Amended...................................................45746
57.4002  Amended...................................................45746
57.4003  Amended; footnote 1 removed...............................45746
57.4005  (a) introductory text amended.............................45746
57.4007  (c) amended...............................................45746
57.4008  Amended...................................................45746
57.4009  OMB number................................................45746
57.4102  Amended...................................................45746
57.4103  Footnote 1 removed; OMB number............................45746
57.4104  Amended...................................................45746
57.4105  (i) amended...............................................45746
57.4107  (a) amended...............................................45746
57.4111  Amended...................................................45746
57.4113  (c) amended...............................................45746
57.4114  Amended...................................................45746
59  CFR correction.................................................13046
60  Authority citation revised.....................................28793
    Technical correction...........................................30534
60.1  (a) amended..................................................28793

[[Page 728]]

60.5  (a) revised..................................................28793
60.7  (a)(2) and (c)(2) revised; OMB numbers.......................28794
60.8  (a)(1), (2), (4), (5), (9), (11), (b)(2) and (3) 
        introductory text revised; (a)(12) added; OMB number.......28794
    Corrected......................................................41875
60.10  (a)(1) and (b)(2) amended...................................28794
60.11  (a)(1)(ii) and (b)(1) amended; (b) introductory text, (2), 
        (e), (f)(1), (2), (4) and (5) amended; OMB numbers.........28794
60.12  (c) revised; OMB numbers....................................28795
60.13  (b) and (c) revised.........................................28795
60.14  OMB numbers.................................................28795
60.15  (a) and (b) amended.........................................28795
60.18  Introductory text and (a) revised; OMB number...............28795
60.19  Amended.....................................................28795
60.20  (a) and (c) amended.........................................28795
60.21  (b) amended; OMB number.....................................28795
60.30--60.43 (Subpart D)  Heading amended..........................28795
60.30  Heading, (a), (b)(3), (4) and (c) revised; (b)(5) and (d) 
        added......................................................28795
60.31  Heading, (a) and (b)(1) revised; (c) amended; OMB numbers 
                                                                   28796
60.32  (a)(2) and (c)(3) revised; OMB number.......................28796
60.33  OMB numbers.................................................28796
60.34  (a), (b)(1), (3), (c) and (d) revised; OMB numbers..........28796
60.35  Introductory text, (a)(1), (b), (c) introductory text, (3), 
        (d), (e) and (f) revised; (a)(2) amended; OMB numbers......28796
60.36  Revised.....................................................28797
60.37  Revised.....................................................28797
60.38  Introductory text revised; (a) amended; OMB numbers.........28797
60.39  (b)(3) revised; OMB numbers.................................28797
60.40  (a) introductory text, (2), (b), (c) introductory text, 
        (1)(i), (c)(1)(iii) introductory text, (2) and (3) 
        revised; OMB numbers.......................................28797
60.41  (a) and (b) amended; (c)(2), (d) and (e)(2) revised.........28798
60.42  Heading, (a)(1) introductory text, (2), (3), (4) and (b) 
        through (e) revised; OMB numbers...........................28798
60.43  Heading, (a) and (c) revised................................28799
60.50  (a)(1) concluding text revised..............................28799
60.51  (f)(1) amended; OMB numbers.................................28799
60.53  Heading revised; OMB number.................................28799
60.54  OMB number..................................................28799
60.56  OMB number..................................................28799
60.57  Revised.....................................................28799
60.60  (a) revised.................................................28799
60.61  (a)(2) revised; OMB number..................................28799
62.25  (a) amended.................................................56996
100--110 (Subchapter J)  Heading correctly revised.................32447
100  Added.........................................................28099
    Authority citation corrected...................................32447
124.708  (c) added..................................................8272

                                  1993

42 CFR
                                                                   58 FR
                                                                    Page
Chapter I
50.201--50.210 (Subpart B)  Appendix amended.......................33343
52c  Heading and authority citation revised........................61030
52c.1  Revised.....................................................61030
52c.2  Revised.....................................................61030
52c.3  (b) revised.................................................61030
52c.4  Revised.....................................................61030
52c.5  (a)(1) revised..............................................61030
52c.7  Revised.....................................................61031
52e  Authority citation revised....................................54298
52e.1  Heading and (a) revised.....................................54298
52e.2  Revised.....................................................54298
52e.3  Heading revised.............................................54298
52e.4  Heading revised; (a) and (c) introductory text amended......54298
52e.5  Heading revised.............................................54298
    (a) introductory text and (b) amended..........................54299
52e.6  Heading and (a) introductory text revised...................54298
52e.7  Heading revised.............................................54298
    (b) amended....................................................54299
52e.8  Revised.....................................................54298
52e.9  Amended.....................................................54299
57.4001--57.4010 (Subpart OO)  Heading and authority citation 
        revised....................................................66298
57.4001  Amended...................................................66298
57.4002  Amended...................................................66298

[[Page 729]]

57.4004  (a) amended; (b) redesignated as (c); new (b) added.......66299
57.4005  (a) introductory text revised.............................66299
57.4006  (a) revised...............................................66299
59.1--59.17 (Subpart A)  Regulations at 53 FR 2944--2946 suspended
                                                                    7463
60  Authority citation revised.....................................67349
60.33  (h) added; OMB number.......................................67349
60.43  (a) revised; (b) and (c) redesignated as (c) and (d); new 
        (b) added; OMB number......................................67349
60.60  (a) revised; (b) and (c) redesignated as (c) and (d); new 
        (b) added; OMB number......................................67350
60.61  (d) added...................................................67350
110.101--110.103 (Subpart A)  Appendix A nomenclature change.......30123

                                  1994

42 CFR
                                                                   59 FR
                                                                    Page
Chapter I
51a  Authority citation revised....................................36706
51a.1  Revised.....................................................36706
51a.3  Revised.....................................................36706
51a.4  Revised; OMB number.........................................36706
51a.5  Revised.....................................................36706
51a.7  Revised.....................................................36707
51a.8  Added.......................................................36707
52e.1  (a)(1) and (b) revised......................................59372
52e.8  Amended.....................................................59372
57.4101--57.4116 (Subpart PP)  Authority citation revised..........63902
57.4101  Revised...................................................63902
57.4102  Amended...................................................63902
57.4105  (d), (e) and (f) introductory text revised................63902
57.4106  (a) introductory text and (5) revised.....................63902
57.4111  Removed; new 57.4111 redesignated from 57.4112............63902
57.4112  Redesignated as 57.4111...................................63902
    Redesignated from 57.4113......................................63903
57.4113  Redesignated as 57.4112; new 57.4113 redesignated from 
        57.4114....................................................63903
57.4114  Redesignated as 57.4113; new 57.4114 redesignated from 
        57.4115 and revised........................................63903
57.4115  Redesignated as 57.4114; new 57.4115 redesignated from 
        57.4116....................................................63903
57.4116  Redesignated as 57.4115...................................63903
59a.5  (b) introductory text amended...............................59168
60  Authority citation corrected....................................3409
65  Authority citation revised.....................................64141
65.1  (a) and (c) introductory text revised; (b) amended...........64141
65.2  Amended......................................................64141
65.4  (b) revised..................................................64141
65.5  (b) revised..................................................64141
124.502  (m)(1) amended; (m)(2) revised............................44639
124.508  (a) heading and introductory text revised.................44639
124.509  (a) heading, (b) heading and introductory text revised....44639
124.510  (a) heading and (b) heading revised; (b) amended..........44639
124.511  (a)(3) amended; (b)(1)(iii)(C) revised....................44639
124.512  (b) introductory text and (c)(1) revised..................44639
124.516  Redesignated as 124.517; new 124.516 added................44639
124.517  Redesignated from 124.516.................................44639

                                  1995

42 CFR
                                                                   60 FR
                                                                    Page
Chapter I
2  Authority citation revised......................................22297
2.11  Amended......................................................22297
2.12  (e)(1) amended...............................................22297
3  Removed.........................................................36073
6  Added...........................................................22532
6.6  (c) corrected.................................................36073
50.601--50.607 (Subpart F)  Added..................................35815
50.604  Correctly removed..........................................39076
50.605  Correctly removed..........................................39076
50.606  Correctly removed..........................................39076
51g  Removed.......................................................36073
57.1701--57.1710 (Subpart R)  Authority citation revised...........28067
57.1701  Introductory text amended.................................28067
57.1702  Amended...................................................28067
57.1704  (a), (d), (e) and (f) revised; (h) amended................28067
57.1705  Introductory text revised.................................28067
57.1709  Revised...................................................28067
    Correctly revised..............................................38970
63  Revised........................................................10719

[[Page 730]]

84  Added..........................................................30355
100  Authority citation revised.....................................7693
100.1  Revised......................................................7693
100.2  Amended......................................................7693
100.3  Added........................................................7694
110  Removed.......................................................36073
124.503  (b)(4) amended............................................16756
124.505  (a)(2)(ii) revised; (a)(2)(iii) added.....................16756
124.506  (a)(1)(iii), (iv) and (v) revised; (a)(1)(vi) added; 
        (b)(2) amended.............................................16756
124.516  (b)(1) revised............................................16756

                                  1996

42 CFR
                                                                   61 FR
                                                                    Page
Chapter I
24  Added; interim..................................................6557
50.604  Correctly added; CFR correction............................56631
50.605  Correctly added; CFR correction............................56632
50.606  Correctly added; CFR correction............................56632
52  Authority citation revised.....................................55105
52.1  Revised......................................................55105
52.2  Revised......................................................55105
52.3  Revised......................................................55105
52.4  Revised......................................................55105
52.6  (a) amended; (b) through (e) redesignated as (c) through 
        (f); new (b) added; new (c)(2) and new (d) revised.........55105
52.8  Revised......................................................55106
52.9  Heading revised..............................................55106
52a  Authority citation revised....................................55108
52a.1  Revised.....................................................55108
52a.2  Amended.....................................................55108
52a.3  (a) and (b) revised.........................................55109
52a.7  Revised.....................................................55109
52a.8  Amended; heading revised....................................55109
52a.9  Revised.....................................................55110
54a  Removed.......................................................55108
57.101--57.112 (Subpart B)  Removed................................65478
57.201--57.218 (Subpart C)  Authority citation revised..............6122
57.202  Amended.....................................................6123
57.203  (c) amended.................................................6123
57.205  (a)(1)(ii) amended; OMB number..............................6123
57.206  (a)(1)(i) revised; (a)(2) removed; (a)(3) redesignated as 
        new (a)(2)..................................................6123
57.210  (b)(2)(i) and (ii) amended; OMB number......................6123
57.211  (a) and (b) amended.........................................6123
57.212  Removed.....................................................6123
57.213(a)(2) amended................................................6123
57.214  Introductory text amended...................................6123
    Corrected.......................................................9532
57.215  (a)(3) amended..............................................6123
57.216  Amended.....................................................6123
57.301--57.318 (Subpart D)  Authority citation revised..............6123
57.302  Amended.....................................................6123
57.305  OMB number..................................................6123
57.306  (a)(1)(i) revised...........................................6123
57.310  OMB number..................................................6123
57.312  (a)(1) amended..............................................6123
57.313  (b) amended.................................................6123
57.314  Introductory text amended...................................6123
57.316  Amended.....................................................6123
57.501--57.514 (Subpart F)  Authority citation revised..............6124
57.502  Amended.....................................................6124
57.509  (a) revised.................................................6124
57.513  Amended.....................................................6124
57.701--57.712 (Subpart H)  Authority citation revised..............6124
57.701  Amended.....................................................6124
57.702  Amended.....................................................6124
57.704  (c)(1) amended..............................................6124
57.706  (a) introductory text and (2) amended.......................6124
57.707  (a)(1) amended..............................................6124
57.709  (a) amended.................................................6124
57.710  Amended.....................................................6124
57.711  Revised.....................................................6124
    Corrected......................................................51020
57.801--57.803 (Subpart I)  Authority citation revised..............6124
57.801  (a) amended.................................................6124
57.1101--57.1112 (Subpart L)  Authority citation revised............6124
57.1101  Introductory text amended..................................6124
57.1102  Amended....................................................6124
57.1106  Introductory text revised..................................6125
57.1107  (a)(1) amended.............................................6125
57.1110  Amended....................................................6125
57.1111  Revised....................................................6125
    Corrected......................................................51020
57.1601--57.1610 (Subpart Q)  Authority citation revised............6125
57.1601  Amended....................................................6125
57.1602  Amended....................................................6125

[[Page 731]]

57.1605  (a) introductory text revised..............................6125
57.1608  Amended....................................................6125
57.1609  Revised....................................................6125
    Corrected......................................................51020
57.1702  Amended....................................................6125
57.1708  Amended....................................................6125
57.1801--57.1811 (Subpart S)  Authority citation revised............6125
57.1801  Amended....................................................6125
57.1802  Amended....................................................6125
57.1804  (a) and (b) revised........................................6126
57.1806  (a) introductory text revised; (b) amended.................6126
57.1809  Amended....................................................6126
57.1810  Revised....................................................6126
    Corrected......................................................51020
57.1901--57.1910 (Subpart T)  Removed...............................6126
57.2101--57.2110 (Subpart V)  Authority citation revised............6126
57.2101  Amended....................................................6126
57.2102  Amended....................................................6126
57.2103  Amended....................................................6126
57.2105  (a) introductory text revised..............................6126
57.2108  Amended....................................................6126
57.2109  Revised....................................................6126
    (a) corrected..................................................51020
57.2402  (c) and (k) revised........................................6126
57.2405  (c) revised...............................................51788
57.2409  Amended....................................................6126
57.2501--57.2510 (Subpart Z)  Authority citation revised............6127
57.2501  Revised....................................................6127
57.2502  Amended....................................................6127
57.2503  (b)(2) introductory text revised; (b)(3) removed...........6127
57.2504  (c)(1) and (d) revised.....................................6127
57.2506  (b) revised................................................6127
57.2509  Amended....................................................6127
57.2601--57.2617 (Subpart AA)  Removed..............................6127
57.2801--57.2810 (Subpart CC)  Authority citation revised...........6127
57.2801  Amended....................................................6127
57.2802  Amended....................................................6127
57.2804  (a)(1) revised.............................................6127
57.2805  (c) amended................................................6127
57.2808  Amended....................................................6127
57.2809  (a) revised................................................6127
    Corrected......................................................51020
57.2901--57.2910 (Subpart DD)  Authority citation revised...........6128
57.2901  Amended....................................................6128
57.2902  Amended....................................................6128
57.2904  (a)(1) revised; OMB number.................................6128
57.2908  Amended....................................................6128
57.2909  (a) revised; OMB number....................................6128
    (a) corrected..................................................51020
57.3001--57.3011 (Subpart EE)  Authority citation revised...........6128
57.3001  Amended....................................................6128
57.3002  Amended....................................................6128
57.3005  (a) introductory text and (1) revised......................6128
57.3009  Amended....................................................6128
57.3010  Revised....................................................6128
    Corrected......................................................51020
57.3101--57.3112 (Subpart FF)  Authority citation revised...........6128
57.3101  Introductory text amended..................................6128
57.3102  Amended....................................................6128
57.3106  (a) introductory text revised..............................6128
57.3110  Amended....................................................6129
57.3111  Revised....................................................6129
    Corrected......................................................51020
57.3301--57.3303 (Subpart HH)  Removed..............................6129
57.3901--57.3910 (Subpart NN)  Removed..............................6129
57.4002  Amended....................................................6129
57.4008  Amended....................................................6129
57.4009  Revised....................................................6129
    Corrected......................................................51020
57.4102  Amended....................................................6129
57.4109  (a) revised................................................6129
57.4113  Amended....................................................6129
58  Technical correction............................................9532
58.1--58.11 (Subpart A)  Removed....................................6129
58.20--58.29 (Subpart B)  Removed...................................6129
58.201--58.215 (Subpart C)  Authority citation revised..............6129
58.201  Amended.....................................................6129
58.202  Amended.....................................................6129
58.203  (b) amended.................................................6130
58.204  (b) amended.................................................6130
58.205  (a) revised.................................................6130
58.208  (a) through (e) removed; (f) through (i) redesignated as 
        (a) through (d); heading revised; OMB number................6130
58.209  Revised.....................................................6130
58.213  Amended.....................................................6130
58.214  Revised.....................................................6130
    Corrected......................................................51020

[[Page 732]]

58.221--58.235 (Subpart D)  Authority citation revised..............6130
    Heading revised.................................................6130
58.221  Amended.....................................................6130
58.222  Amended.....................................................6130
58.223  Amended.....................................................6130
58.224  Revised (OMB number)........................................6130
58.225  Amended.....................................................6131
58.228  Removed; new 58.228 redesignated from 58.229; new (a) 
        revised.....................................................6131
58.229  Redesignated as 58.228; new 58.229 redesignated from 
        58.230......................................................6131
58.230  Redesignated as 58.229; new 58.230 redesignated from 
        58.231......................................................6131
58.231  Redesignated as 58.230; new 58.231 redesignated from 
        58.232......................................................6131
58.232  Redesignated as 58.231; new 58.232 redesignated from 
        58.233 and amended..........................................6131
58.233  Redesignated as 58.232; new 58.233 redesignated from 
        58.234 and revised..........................................6131
    Corrected......................................................51020
58.234  Redesignated as 58.233; new 58.234 redesignated from 
        58.235......................................................6131
58.235  Redesignated as 58.234......................................6131
58.401--58.414 (Subpart E)  Removed.................................6131
58.501--58.515 (Subpart F)  Removed.................................6131
63a  Added.........................................................55111
65a  Added.........................................................55114
72  Authority citation revised.....................................55197
72.6  Added........................................................55197
72.7  Added........................................................55199
72  Appendix A added...............................................55199

                                  1997

42 CFR
                                                                   62 FR
                                                                    Page
Chapter I
51  Added..........................................................53564
51.8  OMB number pending...........................................53567
51.10  OMB number pending..........................................53567
51.23  OMB number pending..........................................53567
51.25  OMB number pending..........................................53568
57.1104  (c)(1) amended............................................51374
57.1105  Revised...................................................51374
57.1106  Revised...................................................51374
67  Revised........................................................12908
67.15  (d)(2)(i)(A) corrected......................................37124
100  Authority citation revised.....................................7687
100.3  (a) table, (b)(2)(i), (6) and (c) revised; (b)(7) through 
        (11) added..................................................7688
    (b)(10) corrected..............................................10626

                                  1998

42 CFR
                                                                   63 FR
                                                                    Page
Chapter I
50.401  Revised....................................................66062
50.402  Revised....................................................66062
50.403  Amended....................................................66062
50.404  (a) introductory text revised; (b) amended.................66062
50.405  Amended....................................................66063
50.406  (a), (c), (d) and (g) revised; (e) amended.................66063
61.30--61.38 (Subpart B)  Authority citation revised................9950
61.30  Revised; interim.............................................9950
61.33  Revised; interim.............................................9950
61.34  Revised; interim.............................................9950
61.35  Revised; interim.............................................9950
61.36  Revised; interim.............................................9950
61.37  (b)(3) concluding text designated as (b)(4); (a), (b) 
        introductory text and (4) revised; interim..................9950
61.38  Revised; interim.............................................9951
68a  Added.........................................................58312
100  Authority citation revised....................................25778
100.3  (c) heading and (1) amended; (c)(2) revised; (c)(3) added 
                                                                   25778
121  Added.........................................................16332
121.3  (e) amended.................................................35847
121.8  (c)(1) and (2) amended......................................35847

[[Page 733]]

                                  1999

  (Regulations published from January 1, 1999, through October 1, 1999)

42 CFR
                                                                   64 FR
                                                                    Page
Chapter I
100  Authority citation revised....................................40518
100.3  (c)(3) redesignated as (c)(4); (a) table, (c)(1) and (3) 
        added......................................................40518


                                  
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