[Federal Register Volume 59, Number 124 (Wednesday, June 29, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-15747]


[[Page Unknown]]

[Federal Register: June 29, 1994]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement Number 442]
RIN 0905-ZA41

 

1994 National Breast and Cervical Cancer Early Detection Program 
American Indian Initiative

Introduction

    The Centers for Disease Control and Prevention (CDC) announces the 
availability of fiscal year (FY) 1994 funds for new competing 
cooperative agreements to initiate tribal and American Indian 
community-based comprehensive breast and cervical cancer early 
detection programs for American Indians.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of ``Healthy People 
2000,'' a PHS-led national activity to reduce morbidity and mortality 
and to improve the quality of life. This announcement relates to the 
priority area of Cancer. (To order a copy of ``Healthy People 2000,'' 
see the section Where To Obtain Additional Information.)

    Authority: This program is authorized by Sections 1501, 1507 and 
1509 [42 U.S.C. 300k and 42 U.S.C. 300n-3] of the Public Health 
Service Act, as amended by Pub. L. 101-354, and Public Law 103-183, 
the Breast and Cervical Cancer Mortality Prevention Act of 1990.

Smoke-Free Workplace

    The Public Health Service strongly encourages all grant recipients 
to provide a smoke-free workplace and promote the non-use of all 
tobacco products. This is consistent with the PHS mission to protect 
and advance the physical and mental health of the American people.

Eligible Applicants

    Eligible applicants are Indian tribes and tribal organizations. The 
target populations for this announcement are the approximately 1.5 
million American Indian, and Alaska Native women living in U.S. 
territory.
    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 (85 Stat. 688), 
which is recognized as eligible for the special programs and services 
provided by the United States to Indians because of their status as 
Indians.
    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.
    CDC considers it essential, where possible, for multiple and key 
American Indian community organizations and groups to work collectively 
in the design and implementation of this program. CDC recognizes the 
heterogeneity of American Indian women and their unique status of being 
from Sovereign Nations.
    States and territories were recognized as eligible applicants for 
funding for breast and cervical cancer early detection programs under 
Program Announcement 321.

Availability of Funds

    Approximately $1,500,000 is available in FY 1994 to fund 
approximately six organizations. It is expected that the average award 
will be $250,000, ranging from $200,000 to $300,000. It is expected 
that awards will begin on or about September 15, 1994, and will be made 
for a 12-month budget period within a project period of up to five 
years. Funding estimates may vary and are subject to change.
    Continuation awards within the project period will be based on 
satisfactory progress and the availability of funds.

Purpose

    The purpose of these awards is to establish a comprehensive public 
health approach to reduce breast and cervical cancer morbidity and 
mortality through screening, follow-up and referral, public education, 
professional education, quality assurance, surveillance and evaluation, 
coalition-building and cancer plan development, and to pay for the 
screening of women who are unable to afford these services, i.e., 
uninsured, underinsured, and geographically isolated American Indian 
populations. Program activities should be coordinated with IHS, Health 
Resources and Services Administration (HRSA) primary care centers, 
State health departments and Title X Family Planning organizations.

Program Requirements

    In accordance with Sections 1501-1509 of the Public Health Service 
Act, an award may not be made unless the tribe or tribal organization 
involved agrees that:
    1. Not less than 60 percent of cooperative agreement funds will be 
expended for screening, appropriate referral for medical treatment, 
and, to the extent practicable, the provision of appropriate follow-up 
services. The remaining 40 percent will be expended to support public 
education, professional education, quality assurance, surveillance, and 
program evaluation. Section 1503(a) (1) and (4).
    2. The screening, follow-up and referral services are initiated by 
the end of first budget year with the remaining activities of a 
comprehensive breast and cervical cancer early detection program 
(public education, professional education, quality assurance, 
surveillance and program evaluation) fully operational by the end of 
the second budget year. Section 1503(a) (1) and (3).
    3. Cooperative agreement funds will not be expended to provide 
inpatient hospital or treatment services. Section 1504(g). Treatment is 
defined as any service recommended by a clinician, including medical 
and surgical intervention provided in the management of a diagnosed 
condition.
    4. Not more than 10 percent of funds will be expended annually for 
administrative expenses. These administrative expenses are instead of 
and replace indirect costs. Section 1504(f).
    5. Matching funds are required from non-Federal sources in an 
amount not less than $1 for each $3 of Federal funds awarded under this 
program. Section 1502.
    6. If new, or improved, and superior screening procedures become 
widely available and are recommended for use, this superior procedure 
shall be utilized in the program instead of the procedures described in 
1503(a)(2). Section 1503(b).
    7. The tribe or tribal organization will establish such fiscal 
controls and fund accounting procedures as may be necessary to ensure 
the proper disbursal of, and accounting for, amounts received by the 
tribe or tribal organization under this announcement. Section 
1504(h)(1).
    8. Upon request, the tribe or tribal organization will provide 
records maintained for fiscal control and the accounting of funds to 
the Secretary or the Comptroller of the United States for purposes of 
auditing the expenditures of the cooperative agreement received under 
this announcement. Section 1504(h)(2).
    Grantees are encouraged to seek State Medicaid program coverage 
for:
    1. A clinical breast examination and screening mammography in the 
case of breast cancer.
    2. Both a pelvic examination and Pap smear screening in the case of 
cervical cancer.
    In conducting activities to achieve the purpose of this program, 
the recipient will be responsible for the activities under A. 
(Recipient Activities), and CDC will be responsible for the activities 
under B. (CDC Activities).

A. Recipient Activities

    1. Establish a system for screening women for breast and cervical 
cancer as a preventive health measure. Section 1501(a)(1).
    The intent of this program announcement is to increase the use of 
screening services for breast and cervical cancer among American Indian 
women, special efforts should be made, for both breast and cervical 
cancer, to reach low-income, uninsured, and underinsured women. For 
breast cancer, efforts should be made to reach those who are age 50 
years and older.
    a. Ensure that screening procedures are available for both breast 
and cervical cancer and provided to women participating in the program, 
including a clinical breast exam, mammography, pelvic exam, and Pap 
smear. Section 1503(a)(2) (A) and (B).
    Screening services should be made available according to the 
following guidelines:
    (1) Only women age 40 years and older will be eligible for 
screening mammography tests; however, priority for services is given to 
those age 50 and older, because of the proven efficacy of screening 
among these women. At least 75 percent of women screened should be age 
50 years and older.
    (2) Screening will include a clinical breast examination and 
mammography according to the following guidelines:
    (i) Breast Clinical Examination: Annually for all women.
    (ii) Mammography: Every two years for women ages 40-49 years. Every 
one to two years for women ages 50 years and older.
    (3) All women who are, or who have been sexually active, or who 
have reached age 18 years, should have a pelvic examination and a Pap 
smear test annually. After a woman has had three or more consecutive 
normal annual examinations, the Pap smear test may be performed less 
frequently at the discretion of her health care provider.
    (4) For diagnostic services following an abnormal screening result, 
cooperative agreement funds may be expended for the following services 
by using the same eligibility criteria required for screening:
    (i) Cervical Cancer--repeat Pap smear, colposcopy and colposcopy-
directed biopsy.
    (ii) Breast Cancer--repeat screening mammogram, diagnostic 
mammogram, fine needle aspiration, and office visits for clinical 
breast examination and evaluation.
    b. Provide priority for screening, follow-up, and referral services 
to women who are low-income and underserved. Section 1504(a).
    An award may not be made under this announcement unless the tribe 
or tribal organization involved agrees to give priority to the 
provision of screening, follow-up, and referral services to women who 
are underserved and low income.
    c. Provide allowances for items and services reimbursed under other 
programs. Section 1504(d).
    Funds may not be awarded under this announcement unless the tribe 
or tribal organization involved agrees that funds will not be expended 
to make payment for any item or service that will be paid or can 
reasonably be expected to be paid by:
    (1) Any IHS program, State compensation program, including 
Medicaid, Medicare, insurance policy, or other Federal or State health 
benefits program.
    (2) An entity that provides health services on a prepaid basis.
    d. Establish a schedule of fees/charges for services. Section 
1504(b).
    Funds may not be awarded under this announcement, unless the tribe 
or tribal organization involved agrees that if charges are to be 
imposed for the provision of services or program activities, the fees/
charges for allowable screening and follow-up services will be:
    (1) Made according to a schedule of fees made available to the 
public. Section 1504(b)(1).
    (2) Adjusted to reflect the income of the woman screened. Section 
1504(b)(2).
    (3) Totally waived for any woman with an income of less than 100 
percent of the official poverty line as established by the Director of 
the Office of Management and Budget and revised by the Secretary of 
Health and Human Services in accordance with Section 673(2) of the 
Omnibus Budget Reconciliation Act of 1981. Section 1504(b)(3).
    Additionally, the schedule of fees/charges for all services should 
not exceed the maximum allowable charges established by the Medicare 
Program administered by the Health Care Financing Administration 
(HCFA). Fees/charges for services covered by Medicare may vary by 
location, thus, tribes or tribal organizations should determine the 
appropriate reimbursement rates for their areas and use them as the 
maximum allowance. Fee/charge schedules should be developed in 
accordance with guidelines described in the interim final rule (42 CFR 
part 405.534) of the Federal Register, 55 FR 53510, December 31, 1990, 
which implements Section 4163 of the Omnibus Budget Reconciliation Act 
of 1990 (Pub. L. 101-508), which provides limited coverage for 
screening mammography services.
    2. Provide appropriate referrals for medical treatment of women 
screened in the program and ensure, to the extent practicable, the 
provision of appropriate follow-up services. Section 1501(a)(2).
    A system for the follow-up and referral of women whose screening 
test results are abnormal or suspicious is an essential component of 
any comprehensive breast and cervical cancer early detection program.
    a. Establish a system for the appropriate follow-up and referral of 
women with abnormal or suspicious screening tests. Referral systems 
should include the regular updating of information on local resources 
available in the community to which health care providers can refer 
women for additional diagnostic and treatment services. Clients needing 
treatment services should be counseled about their eligibility for 
public-supported third party payment and reimbursement programs.
    b. Develop and implement a tracking system for women screened in 
the breast and cervical cancer early detection program. Section 
1501(a)(6).
    Tracking the women screened is essential to ensure that those who 
have abnormal results receive appropriate and timely referral and 
follow-up for repeat screening and diagnostic procedures, and referral 
for treatment. Tracking also includes reminders and outreach to women 
with normal results to return for regular screening. A useful tracking 
system is one that can be effectively integrated into the existing 
health care delivery system for the breast and cervical cancer early 
detection program. The tracking system should be capable of documenting 
the outcome of individual screening tests, provide information on 
needed follow-up, and assure confidentiality. Additionally, the 
capability of monitoring the tracking system's timeliness, accuracy, 
and practical usefulness is important.
    To meet the intent of Sections 1501-1509 to ensure the appropriate 
follow-up of women with abnormal screening results, the applicant's 
tracking system must include information on screening location (e.g., 
State, county, city), demographic characteristics (e.g., race, date of 
birth), and, screening procedures and results (e.g., mammography, Pap 
smear) for all women in the program. For women identified with abnormal 
screening results, additional information on diagnostic procedures and 
diagnoses (e.g., colposcopy), and treatment (e.g., date initiated) must 
be included. In collaboration with CDC, the currently funded 
comprehensive screening programs have compiled a list of information 
necessary to ensure the appropriate follow-up of women. This list is 
available upon request.
    3. Develop and disseminate public information and education 
programs for the early detection and control of breast and cervical 
cancer. Section 1501(a)(3).
    Public information and education include the systematic design and 
sustained delivery of clear and consistent health messages to all of 
the appropriate women, using a variety of creative methods that 
contribute to the early detection of breast and cervical cancer. 
Successful public education programs are those that increase the 
knowledge, attitudes, and practices of the targeted population related 
to breast and cervical cancer screening.
    4. Improve the education, training, and skills of health 
professionals (including allied health professionals) in the detection 
and control of breast and cervical cancer. Section 1501(a)(4).
    Health care providers, including primary care physicians, 
gynecologists, and radiologists, as well as allied health professionals 
play a central and key role in assuring that women are screened at 
appropriate intervals, screening tests are performed optimally, and 
that women with abnormal test results receive timely and appropriate 
diagnostic follow-up and treatment. A health care provider education 
program effectively transmits information on the efficacy and 
appropriate use of screening procedures, influences professional 
practices including the improved performance of screening procedures, 
improves quality of test interpretations, and promotes the timely 
diagnostic and treatment follow-up for abnormal results.
    5. Establish mechanisms through which the applicant can monitor the 
quality of screening procedures for breast and cancer, including the 
interpretation of such procedures. Section 1501(a)(5).
    Cooperative agreement funds may not be awarded under Section 1501, 
Public Law 101-354, unless the tribe or tribal organization involved 
agrees to assure the implementation of quality assurance procedures for 
mammography and cytological screening for breast and cervical cancer. 
Section 1503(c) and (d).
    a. Develop and implement a quality assurance system for breast 
cancer screening. The mammography services provided to women screened 
in the program must be conducted in accordance with the following 
guidelines issued by the Secretary of Health and Human Services. 
Section 1503(e):
    (1) Facilities shall follow the rules for Medicare coverage of 
screening mammography as promulgated by the HCFA.
    (2) Mammography units shall be accredited by the American College 
of Radiology or must have applied for accreditation for the unit(s) 
that will be used for screening or diagnostic mammography. The 
Mammography Quality Standards Act of 1992 requires similar 
accreditation for all mammography units in the United States by October 
1994. Section 354.
    (3) Facilities shall undergo an annual performance evaluation by a 
medical physicist who is board certified by the American Board of 
Radiology or who meets the criteria of the American College of 
Radiology for a medical physicist in mammography. The mammography 
facility must also undergo an annual compliance inspection by an 
individual from the State Radiation Control Program.
    (4) Facilities shall use the American College of Radiology Breast 
Imaging Reporting System for reporting the interpretation of 
mammographies.
    (5) A report of the results of a mammography performed on a woman 
screened in the program shall be placed in her permanent medical 
records maintained by her health service provider.
    b. Develop and implement a quality assurance system for cervical 
cancer screening.
    The laboratory services provided to women in the program as part of 
cytological screening must be conducted in accordance with the 
following guidelines issued by the Secretary of Health and Human 
Services. Section 1503(e):
    (1) Facilities shall meet the standards and regulations promulgated 
by the HCFA implementing the Clinical Laboratory Improvement Act (CLIA) 
of 1988. Section 353.
    (2) All cytological screening is required to be done on the 
premises of a qualified laboratory.
    (3) A report of the results of cervical cancer screening performed 
on a woman through this program shall be placed in her permanent 
medical records that are maintained by her health service provider.
    6. Evaluate activities conducted under Recipient Activities 1 
through 5, above, through appropriate surveillance or program-
monitoring efforts. Section 1501(a)(6).
    Measuring the impact of program activities on the screening 
behavior of women, and on morbidity and mortality, is important for the 
identification of effective intervention strategies for the early 
detection of breast and cervical cancer. Equally important is process 
evaluation or the assessment of factors that contributed to the 
successful or unsuccessful establishment and implementation of a 
comprehensive program and specific program activities.
    a. Assure the implementation of a surveillance system to monitor 
and evaluate program activities. Federal and State governments may 
support tribal efforts in the development of and implementation of 
culturally acceptable data collection techniques which utilize a common 
protocol for collecting and recording cancer data. Monitoring the 
distribution and determinants of breast and cervical cancer incidence 
and mortality is necessary to effectively evaluate a comprehensive 
early detection program. To do this, a surveillance system should:
    (1) Collect tribal and American Indian community-specific 
population-based information on the demographics, incidence, staging at 
diagnosis, and mortality from breast and cervical cancer.
    (2) Identify segments of the population at higher risk for disease 
and for the failure to be screened.
    (3) Identify factors contributing to the disease burden, such as 
behavioral risk factors and limited or inequitable access to early 
detection and treatment services.
    (4) Monitor the number and characteristics of women screened in the 
program and the outcome of screening by analyzing data from the 
applicant's tracking system.
    (5) Monitor screening resources, including the number of available 
mammography facilities, cytology laboratories, and providers of 
cytology screening.
    b. Develop and implement an evaluation plan for each program 
component.
    The design of each program component should ensure that there can 
be meaningful process and outcome evaluation.
    (1) The evaluation plan should assess the implementation and 
effectiveness of each program component including: (a) Screening, (b) 
follow-up and referral, (c) public education, (d) professional 
education, (e) quality assurance, and (f) surveillance and program 
evaluation.
    (2) At a minimum, the evaluation plan should identify program 
activities evaluated, the process and method of measuring outcome 
indicators, proposed time lines, and resources needed. Specific 
evaluation activities should include but not be limited to:
    (a) An inventory of specific services provided with cooperative 
agreement funds.
    (b) A description of outreach services provided and of notification 
procedures implemented.
    (c) A description of whom and how many women received services, 
including demographic information such as age, race, and ethnicity.
    (d) An assessment of the referral system including the number of 
women referred for diagnostic and treatment services, number who 
received services, and the capacity of the system in identifying 
resources in the community and assisting women to access available 
services.
    (e) An assessment of the availability and accessibility of breast 
and cervical cancer screening services and an estimate of the extent of 
unmet needs, particularly for women who are age 50 years and older, 
underserved, and low-income.
    (f) An assessment of the planning, development, implementation, and 
accomplishment of program activities (e.g., goals, objectives, time 
lines, recruiting, hiring, and retaining staff, training staff, 
establishing and maintaining contracts with provider agencies, and 
assuring the quality of contractor performance).
    (g) An assessment of changes in participant and provider knowledge, 
attitudes, behaviors, and practices with respect to screening for 
breast and cervical cancer.
    7. Ensure the coordination of services and program activities with 
other similar programs and establish a broad-based coalition to advise 
and support the program. Section 1504(e).
    Coordination with other similar programs maximizes the availability 
of services and program activities, promotes consistency in screening 
procedures and educational messages, and reduces duplication. An award 
may not be made under this program announcement unless the tribe or 
tribal organization agrees that the services and activities provided in 
this program are coordinated with other Federal, State, and local 
breast and cervical cancer programs. Section 1504(e).
    Linkages should be established with American Indian organizations, 
Federally-funded programs such as Indian Health Service, Health 
Resources and Services Administration primary care programs including 
community health centers, Title X Family Planning programs, State 
Offices for Aging and Minority Health, and appropriate State and local 
health agencies.
    Additionally, the success of a comprehensive breast and cervical 
cancer early detection program is improved by broad-based support in 
the community and active public and private sector involvement. 
Coalition members bring valuable knowledge, skills, expertise, and 
financial resources to the program as well as provide access to 
populations of women who need screening. Effective coalitions are 
diverse, include active community participation, and have well-defined 
objectives, roles, responsibilities, and strong leadership.
    Linkages and active collaboration are strongly encouraged with 
public and private sector organizations such as the American Cancer 
Society (ACS), Young Women's Christian Association (YWCA), and the 
American Association of Retired Persons (AARP), survivors of breast and 
cervical cancer, local women's groups, community leaders, and other 
agencies and businesses in the community that provide health care and 
related support services to women. Formal agreements to collaborate on 
joint breast and cervical cancer early detection activities are 
encouraged, especially with the divisions of ACS located in States. The 
evaluation of coalition activities to ensure the effective 
participation of members is encouraged.
    8. Develop and implement a tribal or tribal organization breast and 
cervical cancer early detection and control plan.
    The success of a comprehensive and realistic plan to reach the 
targeted population and to address these diseases is increased by the 
existence of a well-thought-out, integrated, and realistic plan to 
address these diseases, especially for women who are low income, 
uninsured, or underinsured. A comprehensive breast and cervical cancer 
early detection program should be guided by such a plan, developed with 
coalition involvement, and include an ongoing assessment of total 
screening population, disease burden, unmet needs, and barriers to 
screening. The Program's plan should include measurable objectives, 
implementation strategies with target dates for their achievement, and 
identification of responsible individuals, organizational units, or 
agencies.

B. CDC Activities

    1. Convene a meeting of the funded grantees for information 
sharing, problem solving, and training at least annually.
    2. Provide grantees with ongoing consultation and technical 
assistance to plan, implement, and evaluate each component of the 
comprehensive program as described under ``Recipient Activities'' 
above. Consultation and technical assistance is defined as advice in 
the:
    (a) Interpretation of current scientific literature related to the 
early detection of breast and cervical cancer;
    (b) Practical application of Sections 1501-1509 and nationally 
recognized clinical and quality assurance guidelines for the assessment 
and diagnosis of breast and cervical cancer including the establishment 
and maintenance of a comprehensive screening program;
    (c) Design and implementation of public education, professional 
education, coalition building, and cancer plan development activities;
    (d) Evaluation of each program component (process and outcome) 
through the analysis and interpretation of surveillance and other 
relevant data; and
    (e) Overall program management including compliance with 
cooperative agreement requirements. Section 1507(a).
    3. Conduct site visits to assess program progress and mutually 
resolve problems, as needed.
    4. Provide consultation for effective program management.

Evaluation Criteria (Total 100 Points)

    Applications will be reviewed and evaluated according to the 
following criteria:

A. Background and Need

    The extent of the disease burden and the need among the targeted 
population as measured by:
    1. The tribe's breast and cervical cancer age-adjusted mortality 
rates averaged over 5 years;
    2. The incidence rates for these cancers;
    3. The number of women, age 40 and older, in the tribe or tribal 
organization, especially those who are low income, uninsured, or 
underinsured; and
    4. Existing access and barriers to early screening and detection 
services, (e.g., cultural, social, financial, geographic).
(20 points)

B. Operational Plan

    The feasibility and appropriateness of the Operational Plan to 
provide:
    1. Screening services for breast and cervical cancer;
    2. Follow-up and referral for medical treatment for women with 
malignant and premalignant conditions, and a tracking system;
    3. Public education;
    4. Professional education;
    5. A quality assurance system; and
    6. A surveillance system and evaluation strategies.
(45 points)

C. Coalition and Community Involvement

    The extent to which the applicant proposes to involve American 
Indian organizations, (e.g., tribal councils, American Indian health 
planning councils/committees, Native Health Boards, 93-638 health 
clinics, the IHS, Indigenous hospitals, cancer centers, State programs, 
etc.). (15 points)

D. Breast and Cervical Cancer Control Plan

    The feasibility and appropriateness of the applicant's current 
breast and cervical cancer control plan or their proposal to develop 
such a plan with coalition input and the commitment to use it for 
program development and management. (10 points)

E. Capability

    The extent to which the applicant appears likely to succeed in 
implementing the proposed activities as measured by: a) relevant 
experiences; b) feasible program objectives; c) a realistic timetable 
for program implementation; d) a sound management structure; and e) the 
qualifications of management and technical staff, including the 
appropriateness of their proposed roles and responsibilities or job 
descriptions. (10 points)

F. Budget and Justification

    The extent to which the proposed budget is adequately justified, 
reasonable, and consistent with this program announcement. (Not 
Weighted)

Recipient Financial Participation

    The Secretary may not make a grant under section 1501 unless the 
tribe or tribal organization involved agrees, with respect to the costs 
to be incurred in carrying out the purpose described in such section, 
to make available non-Federal contributions toward such costs in an 
amount equal to not less than $1 for each $3 of Federal funds provided 
in the grant. Such contributions may be made directly or through 
donations from public or private entities. Section 1502.
    Non-Federal contributions (``matching funds'') required may be in 
cash or in-kind, fairly evaluated, including equipment or services (and 
excluding indirect or overhead costs). Amounts provided by the Federal 
Government, or services assisted or subsidized to any significant 
extent by the Federal Government, may not be included in determining 
the amount of such non-Federal contributions.
    In making a determination of the amount of non-Federal 
contributions for purposes the matching fund requirement, the Secretary 
may include only non-Federal contributions in excess of the average 
amount of non-Federal contributions made by the tribe involved toward 
the purpose described in section 1501 for the 2-year period preceding 
the first fiscal year for which the tribe or tribal organization is 
applying to receive a cooperative agreement under such section 
(``maintenance of effort requirement'').
    Matching funds may not include: (1) The payment for treatment 
services or the donation of treatment services (see note below); (2) 
services assisted or subsidized by the Federal Government; or (3) the 
indirect or overhead costs of an organization.

    Note: Treatment means any service recommended by a clinician 
including medical and surgical intervention provided in the 
management of a diagnosed condition.

Executive Order 12372 Review

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

Public Health System Reporting Requirements

    This program is not subject to the Public Health System Reporting 
Requirements.

Catalog of Federal Domestic Assistance Number

    The Catalog of Federal Domestic Assistance Number is 93.919.

Other Requirements

Paperwork Reduction Act

    Projects that involve the collection of information from 10 or more 
individuals and funded by the cooperative agreement will be subject to 
review by the Office of Management and Budget (OMB) under the Paperwork 
Reduction Act.

Application Submission and Deadline

    The Program Announcement and application kit were sent to all 
eligible applicants in April 1994.

Where To Obtain Additional Information

    A complete program description, information on application 
procedures, an application package, and business management technical 
assistance may be obtained from Gordon R. Clapp, Grants Management 
Specialist, Grants Management Branch, Procurement and Grants Office, 
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry 
Road, NE., Room 314, Mailstop E-18, Atlanta, GA 30305, telephone (404) 
842-6508.
    Programmatic technical assistance may be obtained from Ron Goodson, 
M.S.W., Program Services Branch, Division of Cancer Prevention and 
Control, National Center for Chronic Disease Prevention and Health 
Promotion, Centers for Disease Control and Prevention (CDC), 4770 
Buford Highway, NE., Mailstop K-57, Atlanta, GA 30341-3724, telephone 
(404) 488-4880.
    Please refer to Announcement 442 when requesting information and 
submitting an application.
    Potential applicants may obtain a copy of ``Healthy People 2000'' 
(Full Report, Stock No. 017-001-00474-0) or ``Healthy People 2000'' 
(Summary Report, Stock No. 017-001-00473-1) referenced in the 
``Introduction'' through the Superintendent of Documents, Government 
Printing Office, Washington, DC 20402-9325, telephone (202) 783-3238.

    Dated: June 23, 1994.
Ladene H. Newton,
Acting Associate Director for Management and Operations, Centers for 
Disease Control and Prevention (CDC).
[FR Doc. 94-15747 Filed 6-28-94; 8:45 am]
BILLING CODE 4163-18-P