[Federal Register Volume 59, Number 57 (Thursday, March 24, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-6865]


[[Page Unknown]]

[Federal Register: March 24, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
RIN 0905-ZA24

 

HIV/AIDS Mental Health Services Demonstration Program (Includes 
Cooperative Agreements for Services Demonstration Projects and One 
Coordinating Center)

AGENCY: Center for Mental Health Services, Substance Abuse and Mental 
Health Services Administration, HHS.

ACTION: Request for applications.

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SUMMARY: The Center for Mental Health Services (CMHS), Substance Abuse 
and Mental Health Services Administration (SAMHSA), in collaboration 
with the Health Resources and Services Administration (HRSA) and the 
National Institutes of Health (NIH), announces the availability of 
fiscal year (FY) 1994 funds for a new HIV/AIDS Mental Health Services 
Demonstration Program.
    Because of the complexity of this program, a cooperative agreement 
mechanism is being utilized to allow for substantial Federal 
programmatic participation in the conduct of the program, and to 
facilitate communication and coordination in the overall implementation 
and evaluation of the program. The program will include cooperative 
agreements for services demonstration projects to provide mental health 
services to people affected by and living with HIV/AIDS and a 
coordinating center which, in conjunction with the services 
demonstration projects, will design and implement the overall 
evaluation of the HIV/AIDS Mental Health Services Demonstration 
Program. A steering committee will be established to facilitate 
coordination and cooperation among the services demonstration projects 
and the coordinating center, and to oversee the cooperative agreements.
    The HRSA Bureau of Health Resources Development (BHRD) and the NIH 
National Institute of Mental Health (NIMH) also will provide funding 
support for certain aspects of these cooperative agreements, will 
recommend reviewers for the review of applications, will participate on 
the steering committee, and will otherwise be involved in the 
implementation of the HIV/AIDS Mental Health Services Demonstration 
Program.
    This notice consists of three parts:
    Part I covers information on the legislative authority and the 
applicable regulations and policies related to the HIV/AIDS Mental 
Health Services Demonstration Program.
    Part II describes the purpose, goals and scope of the program and 
discusses eligibility, availability of funds, period of support and the 
receipt date for applications.
    Part III describes special requirements of the program, the 
application process, the review and award criteria and lists contacts 
for additional information.

Part I--Legislative Authority and Other Applicable Regulations and 
Policies

    Cooperative Agreements awarded under this RFA are authorized under 
Sections 520B (42 U.S.C. 290bb-33), 520 (42 U.S.C. 290bb-31), 501 (42 
U.S.C. 290aa), 405 (42 U.S.C. 284), and 464R (42 U.S.C. 285p) of the 
PHS Act and 42 U.S.C. 300ff-28.
    Federal regulations at Title 45 CFR parts 74 and 92, generic 
requirements concerning the administration of grants, are applicable to 
these awards.
    Cooperative Agreements must be administered in accordance with the 
PHS Grants Policy Statement (Rev. April 1, 1994).
    The Catalog of Federal Domestic Assistance (CFDA) number for this 
program is 93.215.
    Interim and final progress reports and financial status and 
expenditure reports will be required and specified to cooperative 
agreement awardees in accord with PHS Grant Policy requirements.
    Healthy People 2000: The Public Health Service (PHS) is committed 
to achieving the health promotion and disease prevention objectives of 
Healthy People 2000, a PHS-led activity to reduce morbidity and 
mortality and improve the quality of life. This Request for 
Applications (RFA), HIV/AIDS Mental Health Services Demonstration 
Program, is related to the priority of HIV/AIDS infection. Potential 
applicants may obtain a copy of Healthy People 2000 (Full Report: Stock 
No. 017-001-0474-0; or Summary Report: Stock No. 017-001-00473-1) 
through the Superintendent of Documents, Government Printing Office, 
Washington, DC 20402-9325 (Telephone: 202-783-3238).
    Promoting Nonuse of Tobacco: Studies have clearly established that 
the use of tobacco products increases mortality and morbidity, not only 
for the primary users of these products but for those in close 
proximity to the user. Statistics published by the National Cancer 
Institute indicate that cigarette smoking and chewing of tobacco are 
responsible for as many as 1,500 deaths per day in the United States. 
Recent studies conducted by the Environmental Protection Agency 
indicate that prolonged exposure to second-hand smoke significantly 
increases the probability of developing heart and lung disease. 
Therefore, the CMHS strongly encourages all awardees to provide smoke-
free project and work environments.
    A number of the goals of this program are consistent with the 
President's Health Care Reform initiative (e.g., providing quality 
mental health services, reducing the number of unnecessary inpatient 
and outpatient medical visits, and increasing productive work capacity 
as a result of receiving these services) and support the DHHS 
Secretary's themes of fostering independence through empowering the 
people, preventing future problems, and improving services to our 
customers.

Part II--Programmatic Purpose, Goals and Scope, Eligibility and 
Application Receipt Date

    Services Demonstration Projects: CMHS will award competitive 
cooperative agreements under Section 520B of the Public Health Service 
(PHS) Act to develop or expand programs to provide mental health 
services for individuals, their families and others who experience 
serious psychological reactions as a result of HIV/AIDS antibody 
testing, and to provide mental health services for people with HIV/
AIDS. The services demonstration projects will be responsible for an 
evaluation that includes collection of both process and outcome data 
and that will document the extent to which the objectives set forth in 
the application have been met.
    The services demonstration projects will also participate in the 
development of an overall evaluation of the HIV/AIDS Mental Health 
Services Demonstration Program by the coordinating center, as described 
below.
    Coordinating Center: CMHS will award one competitive cooperative 
agreement to a recipient which, in conjunction with the services 
demonstration projects, will design and implement the overall 
evaluation of the HIV/AIDS Mental Health Services Demonstration 
Program. This will include evaluating the effectiveness and efficiency 
of the different approaches or models used for organizing and providing 
the mental health services. The coordinating center will also provide 
the overall coordination and management of the program data.
    Steering Committee: The project directors of the coordinating 
center and the services demonstration projects, and CMHS, BHRD and NIMH 
representatives, will work collaboratively via a steering committee to 
facilitate coordination and communication among the parties. The 
steering committee will have the responsibility for overseeing the 
cooperative agreements to develop consensus on major decisions and to 
facilitate the accomplishment of the HIV/AIDS Mental Health Services 
Demonstration Program goals.

Program Description

    Purpose: The purposes of the cooperative agreement program are to: 
1) Provide a range of high quality mental health services to people 
affected by or living with HIV/AIDS; 2) Evaluate the effectiveness and 
efficiency of the different approaches or models used for organizing 
and providing those services; and 3) Determine the outcome of those 
services on the quality of life of the individuals served.
    Program Goals and Scope: The goals of this cooperative agreement 
program are to:
     Provide a range of quality mental health services.
     Change risk behaviors and prevent further HIV 
transmission.
     Increase compliance with medical treatment and enhance 
access to existing services.
     Reduce the number of unnecessary inpatient and outpatient 
medical visits.
     Decrease the risk of suicide.
     Improve the quality of life for those individuals affected 
by and living with HIV/AIDS.
     Increase productive work capacity as a result of receiving 
these services.
     Develop and rigorously evaluate models for replication and 
integration into HIV/AIDS delivery systems.
     Disseminate information about successful service models.

A. Applications for Services Demonstration Projects Funding

    Target Populations: The target population includes people affected 
by or living with HIV/AIDS. Within the target population, gay and 
bisexual men, racial and ethnic minorities, women, injection drug 
users, children and adolescents, adults with serious mental illnesses, 
children and adolescents with serious emotional disturbances, the 
incarcerated, and people who are homeless are of particular interest.
    Demonstrated Need: Unmet need will be a primary criterion in the 
review of applications under this announcement. Methodology used to 
compile local needs assessment data must be described.
    Recommended Approach: Applicants should address, in the 
``Approach'' section of the application, the specific mental health 
services listed below, and the development of an infrastructure that 
includes the additional project elements also described below. The 
services may be provided directly or through contract.

Specific Mental Health Services

    The application should address at least the first four of the 
following services:
     HIV/AIDS risk and transmission reduction counseling.
     A range of mental health treatment services, e.g., group 
therapy, supportive counseling, peer counseling, buddy programs, 
oversight of psychotropic medication, psychotherapy, and family 
therapy, including alternative families, partners, and significant 
others.
     Diagnostic mental health services, including neurological 
consults and psychological testing.
     HIV/AIDS antibody pre-test counseling and appropriate 
post-test counseling for those who test positive for HIV/AIDS antibody 
as well as those who test negative.
     Mental health case management services.
     Counseling to ensure adherence to tuberculosis and other 
treatment regimens.
     Outreach mental health services, e.g., educating the 
community to facilitate referrals to your project.
     Consultation services, e.g., to schools, foster parents, 
day care centers, alternative health care sites and clinics that serve 
special populations described above.
     Home based mental health services.

Additional Project Elements

    Applicants should address the development of an infrastructure that 
includes the following:
     Relationships with or a plan to build relationships with a 
variety of other non-HIV/AIDS health, mental health, and support 
service providers such as, State Mental Health or Substance Abuse Block 
Grant Programs, maternal and child health services, primary health care 
services, financial and other resource supports, legal services, 
spiritual services, and governmental and private programs.
     Relationships with or a plan to build relationships with 
other programs for people with HIV/AIDS, such as, the CDC Counseling 
and Testing Program, the HRSA Ryan White C.A.R.E. Act Program (Title I 
EMAs, Title II States and their consortia, Title III Early Intervention 
providers, and Title IV Pediatric Projects), NIH-supported treatment 
and research programs, etc.
     An appropriate system for determining the eligibility of 
people with HIV/AIDS for financial or other resource assistance.
     Reimbursement for mental health services provided through 
Federal, State, local, or nongovernmental programs of support, e.g., 
Medicaid reimbursement.
     Training for individuals providing the services described 
in the application.
    Funding preference will be given to services demonstration project 
applicants that are based at, or have relationships with, entities 
providing comprehensive health services to people who are infected with 
HIV. For the purposes of this program, comprehensive health services 
include services such as those described above in the ``Specific Mental 
Health Services'' and ``Additional Project Elements'' sections.
    Evaluation: The evaluation should include collection of both 
process and outcome data that will document the extent to which the 
objectives set forth in the application have been met by the project. 
Process evaluations examine the extent to which the project has been 
implemented as designed. Outcome evaluations assess the extent to which 
the projects have achieved the desired effects at the individual level 
as well as the group and community level. The evaluation should 
examine: the implementation of HIV/AIDS specific mental health services 
and additional project elements at the project and client levels; the 
type and frequency of services provided to the individual clients; the 
characteristics and needs of recipients of the services; and the 
outcome of services.
    Services demonstration projects will be expected to participate in 
the development of an overall evaluation of the HIV/AIDS Mental Health 
Services Demonstration Program that would be implemented by the 
coordinating center. The services demonstration project plans may have 
to be refined in light of the overall program evaluation plan. The 
services demonstration projects must agree to cooperate with CMHS and 
the coordinating center on the design and implementation of the overall 
program evaluation plan.
    Applicants should budget 15-20 percent for the evaluation 
activities, and include travel for at least two participants to attend 
up to four meetings in the Washington, D.C. area or at a services 
demonstration project site for each year of the project period (4 
years).

B. Applications for the Coordinating Center Funding

    The coordinating center, in conjunction with CMHS and the services 
demonstration projects, will, using input from the services 
demonstration projects, design and implement the overall evaluation of 
the HIV/AIDS Mental Health Services Demonstration Program including: 1) 
A description and evaluation of the various models created under this 
program in an effort to determine which models might be replicated and 
integrated into HIV/AIDS health care delivery systems nationally; and 
2) an analysis of changes in client outcomes.
    The coordinating center will assist the services demonstration 
projects by providing overall evaluation coordination, including data 
management and analysis, training in common procedures, and 
distribution of necessary materials to all projects. Specifically, the 
coordinating center will work with CMHS and the services demonstration 
projects in the planning phase to: 1) Provide advice regarding the 
evaluation personnel needs at the services demonstration project level; 
2) develop criteria for compatible computer equipment; 3) recommend to 
the steering committee common outcome measures; and 4) develop common 
data collection elements. It is anticipated that these tasks will be 
coordinated through a series of meetings of the steering committee to 
commence immediately following issuance of the Notices of Grant Award.
    The coordinating center will develop and maintain a common data 
repository, containing common data files needed by the services 
demonstration projects. It is the intention of CMHS that the data be 
made available to the larger mental health and HIV/AIDS community as 
soon as feasible, in accordance with steering committee recommendations 
and in accordance with participant protection policy.
    The coordinating center will also provide ongoing technical 
assistance on the data collection and evaluation issues to the services 
demonstration projects as needed. The coordinating center budget should 
be consistent with the purpose of the program, and should reflect the 
level of effort anticipated to carry out the proposed tasks.
    The steering committee, working with the coordinating center, will 
prepare reports for submission to the project officer. An annual 
progress report will be prepared by the steering committee.
    Applicants for the coordinating center should present a plan for 
how best to meet the overall responsibilities described above and the 
goals of the HIV/AIDS Mental Health Services Demonstration Program. In 
addition, previous relevant experience in data collection and 
evaluation, as well as facilities and resources available to complete 
the project, should be described.
    Eligibility: Applications may be submitted by public and nonprofit 
private entities, such as community mental health centers, community-
based organizations providing HIV/AIDS care and related services, State 
and local health departments, universities, colleges, hospitals, and 
alternative health and mental health care entities that serve medically 
disenfranchised populations. Entities may apply for either or both 
types of award (services demonstration project and coordinating 
center). Entities staffed largely by women and minorities are 
especially encouraged to apply.
    Availability of funds: It is estimated that approximately $1.2 
million total (direct and indirect costs) will be available in FY 94 
and that additional funding up to a total of $3.4 million may be 
available through further collaboration with other agencies for 
services demonstration projects. It is anticipated that 8-12 services 
demonstration projects will be awarded under this Request for 
Applications (RFA) in FY 94. Actual funding levels will depend upon the 
availability of funds at the time of the award. It is expected that an 
additional $700,000 total (direct and indirect costs) will be available 
for a coordinating center.
    Period of Support: Support may be requested for an initial period 
of up to 4 years. Annual awards will be made subject to continued 
availability of funds and progress achieved.
    Application Receipt and Review Schedule: The schedule for receipt 
and review of applications under this announcement is as follows:

------------------------------------------------------------------------
                                                         Earliest start 
   Receipt date        IRG review      Council review         date      
------------------------------------------------------------------------
May 26, 1994.....  July 1994........  Sept. 1994......  Sept. 1994.     
------------------------------------------------------------------------

    Applications must be received by the published application receipt 
date. An application received after the deadline may be acceptable if 
it carries a legible proof-of-mailing date assigned by the carrier and 
the proof-of-mailing date (private metered postmarks are not acceptable 
as proof of timely mailing) is not later than one week prior to the 
deadline date. If the receipt date falls on a weekend, it will be 
extended to the following Monday; if the date falls on a national 
holiday, it will be extended to the following work day.
    Consequences of Late Submission: Applications received after the 
above receipt date will not be accepted and will be returned to the 
applicant without review.

Part III--Special Requirements, Review/Award Criteria and Contacts for 
Additional Information

    Letter of Intent: Organizations planning to submit an application 
for a services demonstration project and/or the coordinating center are 
encouraged to submit a letter of intent at least 30 days prior to the 
receipt date. Such notification is used by the
    CMHS for purposes of review and program planning. This letter is 
voluntary and does not obligate the person/organization to submit an 
application.
    In addition, the letter should be no longer than one page and 
should succinctly indicate:

--the number and title of the RFA
--the name of the potential applicant organization, city and state
--the name and affiliation of the proposed project director, i.e., the 
individual who will be assigned to coordinate the development and 
implementation of the project
--the overall scope of the proposed project, including a brief 
description of the likely goals and objectives

    Letters of intent should be addressed to: Director, Office of 
Evaluation, Extramural Policy, and Review, Center for Mental Health 
Services, 5600 Fishers Lane, room 18C-07, Rockville, Maryland 20857, 
ATTN: RFA/Letter of Intent. FAX: 301/443-7912.
    Coordination with Other Federal/Non-Federal Programs: Applicants 
seeking support under this announcement are encouraged to coordinate 
with other programs. Program coordination helps to better serve the 
multiple needs of the patient/client population, to maximize the impact 
of available resources, and to eliminate duplication of services. 
Applicants should identify the coordinating organizations by name and 
address and describe the process used/to be used for coordinating 
efforts. Letters of commitment specifying the kind(s) and level of 
support from organizations (both Federal and non-Federal) which have 
agreed to work with the applicant must be included in the application 
appendices. Examples of Federal programs with which applicants may find 
coordination productive are included in the complete application kit.
    Public Health System Reporting Requirements: The services 
demonstration projects are subject to the Public Health Service 
Requirements. Under these requirements, the community-based 
nongovernmental applicant must prepare and submit a Public Health 
System Impact Statement (PHSIS). The PHSIS is intended to provide 
information to State and local health officials to keep them apprised 
of proposed health services applications submitted by community-based 
nongovernmental organizations within their jurisdictions.
    Community-based nongovernmental applicants are required to submit 
the following information to the head of the appropriate State and 
local health agencies, including the State HIV/AIDS directors and the 
State mental health directors, no later than the application receipt 
date of May 26, 1994.
    a. A copy of the face page of the application (Standard Form 424).
    b. A summary of the project (PHSIS), not to exceed one page, which 
provides:
    (1) A description of the population to be served.
    (2) A summary of the services to be provided.
    (3) A description of the coordination planned with the appropriate 
State or local health agencies.
    State and local governments and Indian Tribal Authority applicants 
are not subject to the Public Health Service Reporting Requirements.
    This subsection applies to services demonstration project 
applicants only.
    Intergovernmental Review (E.O. 12372): Applications for services 
demonstration projects, submitted in response to this announcement are 
subject to the intergovernmental review requirements of Executive Order 
12372, as implemented through DHHS regulations at 45 CFR Part 100. E.O. 
12372 sets up a system for State and local government review of 
applications for Federal financial assistance. Applicants (other than 
federally recognized Indian tribal governments) should contact the 
State's Single Point of Contact (SPOC) as early as possible to alert 
them to the prospective application(s) and to receive any necessary 
instructions on the State process. For proposed projects serving more 
than one State, the applicant is advised to contact the SPOC of each 
affected State. A current listing of SPOCs is included in the 
application kit. The SPOC should send any state process recommendations 
to the following address: Director, Office of Evaluation, Extramural 
Policy, and Review, Center for Mental Health Services, 5600 Fishers 
Lane, Room 18C-07, Rockville, MD 20857, Attn: Spoc.
    The due date for State process recommendations is no later than 60 
days after the deadline date for the receipt of applications. The CMHS 
does not guarantee to accommodate or explain SPOC comments that are 
received after the 60-day cut-off. This subsection applies to the 
services demonstration project applicants only.
    Role of Federal Staff in Cooperative Agreements: The Cooperative 
Agreement mechanism includes substantial post-award Federal 
programmatic participation in the conduct of the project. It is 
anticipated that CMHS staff participation in this program will be 
substantial. In addition to the general project officer function of 
monitoring the conduct and progress of the services demonstration 
projects and making recommendations about continuance of the project, 
CMHS staff will be active participants in planning and implementing the 
HIV/AIDS Mental Health Services Demonstration Program through 
participation on the steering committee, promoting exchange of relevant 
information among the services demonstration projects, and 
participating in and/or providing support services for training, 
evaluation, and data collection. CMHS staff will also monitor the 
function and activities of the coordinating center, assuring that 
progress is satisfactory, and required reporting is timely. A program 
representative from CMHS, BHRD and NIMH will participate on the 
steering committee, each with a single vote.
    Application Procedures: All applicants must use application form 
PHS 5161-1 (Rev. 7/92), which contains Standard Form 424 (face page). 
The following information should be typed in Item Number 10 on the face 
page of the application form:

RFA# SM-94-02: HIV/AIDS Services Demonstration (for services 
demonstration projects).
RFA# SM-94-02: HIV/AIDS Coordinating Center (for coordinating center).

    If an entity is applying for both cooperative agreements (services 
demonstration projects and coordinating center), then 2 separate face 
pages and applications should be submitted.
    Application kit (including form PHS 5161-1 with Standard Form 424 
and complete application procedures) may be obtained from: Global 
Exchange, Inc., 7910 Woodmont Avenue, Suite 400, Bethesda, MD 20814-
3015, (301) 656-3100.
    Applicants must submit: (1) an original copy signed by the 
authorized official of the applicant organization, with the appropriate 
appendices; and (2) two additional, legible copies of the application 
and all appendices to the following address: Center for Mental Health 
Services Programs, Division of Research Grants, NIH, Westwood Building, 
room 240, 5333 Westbard Avenue, Bethesda, Maryland 20892.*

    *If an overnight carrier or express mail is used, the Zip Code 
is 20816.

    Review Process: Applications submitted in response to this RFA will 
be reviewed for technical merit in accordance with established PHS/
SAMHSA peer review procedures for grants.
    Applications that are accepted for review will be assigned to an 
Initial Review Group (IRG) composed primarily of non-Federal experts. 
Notification of the IRG recommendation will be sent to the applicant 
upon completion of the initial review. In addition, the IRG 
recommendations on technical merit of applications will undergo a 
second level of review by the appropriate advisory council whose review 
may be based on policy considerations as well as technical merit. 
Applications may be considered for funding only if the advisory council 
concurs with the IRG recommendation for approval.
    Review Criteria: The following criteria will be used in the 
technical merit review of services demonstration project applications. 
The points noted in parentheses for each criterion indicate the maximum 
number of points the reviewers may assign to that criterion. These 
points will be used to calculate a raw score for each application. The 
raw score will be converted to the official priority score.
     adequacy of documentation of unmet need, including a 
description of special population(s) to be served, if applicable, and 
the availability of and access to the current mental health delivery 
system by people affected by and living with HIV/AIDS (30)
     adequacy and appropriateness of the goals and objectives, 
and approach, including the specific mental health services to be 
provided and the additional project elements that assure the 
development of an infrastructure (25);
     appropriateness of the proposed project in terms of (1) 
budget, (2) management plan, (3) personnel, (4) time frame, (5) 
resources, and (6) adequacy, availability, and accessibility of 
facilities (20)
     appropriateness of the proposed evaluation design and 
methodology (15)
     experience of the applicant in delivering mental health 
services (10)
    The following criteria will be used in the technical merit review 
of the coordinating center applications. The points noted in 
parentheses for each criterion indicate the maximum number of points 
the reviewers may assign to that criterion. These points will be used 
to calculate a raw score for each application. The raw score will be 
converted to the official priority score.
     adequacy of the overall plan, addressing structure and 
scientific rigor of the evaluation, and plans for data quality (30)
     adequacy of plans for coordination, technical assistance, 
and training (25)
     qualifications and experience of the principal 
investigator and proposed staff in statistics, data analysis, 
evaluation, and large-scale data collection efforts (25)
     appropriateness of budget, personnel, facilities, 
resources, and time frame (20)
    Award Criteria and Funding Preference: Services demonstration 
project applications recommended for approval by the IRG and the 
appropriate advisory council will be considered for funding on the 
basis of overall technical merit as determined through the review 
process, geographic distribution, evidence of agreement for cooperation 
with the coordinating center in the overall program evaluation, variety 
of settings (e.g., community mental health centers and community-based 
organizations providing HIV/AIDS care and related services), and the 
availability of funds. In addition, funding preference will be given to 
applicants that are based at, or have relationships with, entities 
providing comprehensive health services to people who are infected with 
HIV.
    Coordinating center applications recommended for approval by the 
IRG and the appropriate advisory council will be considered for funding 
on the basis of overall technical merit as determined through the 
review process, suitability for working with the services demonstration 
projects funded, and the availability of funds.
Contacts for Additional Information
    Questions concerning program issues may be directed to: Ms. Elaine 
Corrigan, Program Management Officer, CMHS HIV/AIDS Program, 5600 
Fishers Lane, room 11C-21, Rockville, MD 20857, (301) 443-7817.
    Questions regarding grants management issues may be directed to: 
Ms. Carole Edison, Grants Management Officer, Center for Mental Health 
Services, 5600 Fishers Lane, room 15-87, Rockville, Maryland 20857, 
(301) 443-4456.

    Dated: March 15, 1994.
Richard Kopanda,
Acting Executive Officer, SAMHSA.
[FR Doc. 94-6865 Filed 3-23-94; 8:45 am]
BILLING CODE 4162-20-M