[Federal Register Volume 61, Number 14 (Monday, January 22, 1996)]
[Notices]
[Pages 1589-1595]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-641]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Program Announcement for Cooperative Agreements for Basic/Core 
Area Health Education Center Programs, and Model State-Supported Area 
Health Education Center Programs and Grants for Health Education and 
Training Centers for Fiscal Year 1996

    The Health Resources and Services Administration (HRSA) announces 
that applications will be accepted for fiscal year (FY) 1996 
Cooperative Agreements for Basic/Core Area Health Education Center 
(AHEC) Programs authorized under section 746(a)(1), and Model State-
Supported Area Health Education Center Programs authorized under 
section 746(a)(3), and Grants for Health Education and Training Center 
(HETC) Programs authorized under section 746(f), title VII of the 
Public Health Service Act, as amended by the Health Professions 
Education Extension Amendments of 1992, Public Law 102-408, dated 
October 13, 1992.
    This program announcement for the above stated programs is subject 
to reauthorization of the legislative authority and to the 
appropriation of funds. Applicants are advised that this program 
announcement is a contingency action being taken to assure that should 
authority and funds become available for these purposes, awards can be 
made in a timely fashion consistent with the needs of the programs as 
well as to provide for even distribution of funds throughout the fiscal 
year. At this time, given a continuing resolution and the absence of FY 
1996 appropriations for title VII programs, the amount of funds 
available for these specific cooperative agreement and grant programs 
cannot be estimated.
    Funding factors may be applied in determining the funding of 
approved applications for these programs. A funding preference is 
defined as the funding of a specific category or group of approved 
applications ahead of other categories or groups of applications. A 
funding priority is defined as the favorable adjustment of aggregate 
review scores of individual approved applications when applications 
meet specified objective criteria. It is not required that applicants 
request consideration for a funding factor. Applications which do not 
request consideration for funding factors will be reviewed and given 
full consideration for funding.

Cooperative Agreements for Basic/Core Area Health Education Center 
(AHEC) Program; Section 746(a)(1)

    Purpose: Section 746(a)(1) of the PHS Act authorizes Federal 
assistance to schools of medicine (allopathic and osteopathic) which 
have cooperative arrangements with one or more public or nonprofit 
private area health education centers for the planning, development and 
operation of area health education center programs.
    Eligibility: To be eligible to receive support for an area health 
education center cooperative agreement, the applicant must be a public 
or nonprofit private accredited school of medicine (allopathic or 
osteopathic) or 

[[Page 1590]]
consortium of such schools, or the parent institution on behalf of such 
school(s).
    Period of Support: Applicants may request up to 3 years of support 
with the expectation that AHECs planned and developed in years 1 and 2 
would be fully operational no later than the 3rd year. The period of 
Federal support should not exceed 12 years for an area health education 
center program and 6 years for an area health education center.
    General Requirements: As provided in section 746(b), a medical 
school (allopathic or osteopathic) may not receive an award for 
operational expenses under the existing basic AHEC award authority 
unless the program:
    (a) Maintains preceptorship educational experiences for health 
science students;
    (b) Maintains community-based primary care residency programs or is 
affiliated with such programs;
    (c) Maintains continuing education programs for health 
professionals or coordinates with such programs;
    (d) Maintains learning resource and dissemination systems for 
information identification and retrieval;
    (e) Has agreements with community-based organizations for the 
delivery of education and training in the health professions;
    (f) Is involved in the training of health professionals (including 
nurses and allied health professionals), except to the extent 
inconsistent with the law of the State in which the training is 
conducted; and
    (g) Carries out recruitment programs for the health science 
professions, or programs for health-career awareness, among minority 
and other elementary or secondary students from the areas the program 
has determined to be medically underserved;
    Provisions Regarding Funding:
    1. Section 746(e)(1)(B) of the Act requires that not more than 75 
percent of total operating funds of a program in any year shall be 
provided by the Federal Government. However, as provided in section 
746(e)(2), for an AHEC center developed as part of an AHEC program 
first funded under the basic AHEC authority on or after October 13, 
1992, a ceiling of 55 percent of any fifth or sixth year of the 
development or operation of a center is established.
    2. The participating medical schools must provide for the active 
participation of at least two schools or programs of other health 
professions (including a school of dentistry) if there is one 
affiliated with the medical school's university and a graduate program 
of mental health practice, if there is one affiliated with the 
university.
    3. At least 75 percent of the total funds provided to a school 
under any AHEC program authority (Basic/Core AHEC Program(s), or Model 
State-Supported AHEC Program(s)) must be expended by the AHEC program 
in AHEC centers and the school is required to enter into an agreement 
with each of such centers for purposes of specifying the allocation of 
the 75 percent of funds.
    Review Criteria: The following review criteria apply to the Basic/
Core AHEC Programs, section 746(a)(1) and the Model State-Supported 
AHEC Programs, section 746(a)(3). These review criteria were 
established after public comment at 60 FR 24638, dated May 9, 1995.
    The review of applications will take into consideration the 
following criteria:
    1. The degree to which the proposed project adequately provides for 
the program requirements set forth in sections 746(a)(1) and 746(a)(3);
    2. The capability of the applicant to carry out the proposed 
project activities in a cost-efficient manner;
    3. The extent of the need which the proposed AHEC program is 
addressing in the area to be served by the area health education 
center(s);
    4. The potential of the proposed AHEC program and participating 
center(s) to continue on a self-sustaining basis; and
    5. The extent to which the proposed project adequately responds to 
AHEC Program performance measures and outcome indicators.
    Basic AHEC and Model AHEC Programs Performance Measures and Outcome 
Indicators: The development of outcome measures and other types of 
effectiveness measures is stressed in the title VII authorization 
legislation, the Health Professions Education Extension Amendments of 
1992, Pub. L. 102-408. The Division of Medicine of the Bureau of Health 
Professions is continuing to identify and develop outcome measures for 
ongoing programs. Applicants are encouraged to respond in their 
applications to the following performance measures and outcome 
indicators:
    A. State/local Funding (100 points). The current level of State 
funding or local funding for the proposed or ongoing AHEC program, and 
the percentage of funds from non-Federal sources which make up the 
annual budget of the AHEC program and/or AHEC center(s).
    B. AHEC Program Elements (280 points).
    (1) 10 percent Clinical Training with an emphasis on Ambulatory 
Care Settings (40 points). The anticipated number of medical students 
trained annually in AHEC-supported remote ambulatory care sites, and 
the percentage (10 percent or more) of clinical undergraduate training 
of the medical school provided at AHEC-supported sites.
    (2) Primary Care Residency (40 points). The number of residents 
participating in at least one AHEC affiliated primary care residency 
(in Family Medicine, General Internal Medicine, or General Pediatrics) 
and the percentage of medical school graduates selecting primary care 
specialties over a most recent three-year period.
    (3) PA/NP Training and Recruitment (30 points). The number of 
students participating in at least one AHEC affiliated PA or NP 
training program.
    (4) Linkages to Other Federal Initiatives--Underserved Sites (30 
points). The active working relationships with other federally 
supported primary care oriented programs such as CHCs, MHCs, NHSC, and 
IHS facilities serving the underserved.
    (5) Linkages to other State Initiatives (10 points). Active working 
relationships with State supported programs such as state offices of 
rural health, state loan repayment programs, state health department, 
primary care associations, and other statewide initiatives.
    (6) Statewide Consortium (10 points). Participation within a 
statewide consortium which addresses health professions training needs 
and improvement of access to health services through educational 
interventions, including the supply and distribution of primary care 
personnel to underserved areas.
    (7) Multidisciplinary/Interdisciplinary training (40 points). The 
sites, number of trainees and the expected impact on primary care needs 
of underserved areas by proposed or ongoing AHEC-supported primary care 
multidisciplinary training programs.
    (8) Disadvantaged and/or Minority Recruitment/Retention 
Institutional Performance--Percent Minority Graduates (40 points). The 
relationship of minority recruitment efforts to admission and retention 
at specific health career training programs/institutions, and the 
percentage of disadvantaged and underrepresented minority graduates of 
the programs/institutions.
    (9) Evidence of proposed or existing AHEC(s), and participation in 
community-based decision-making (20 points). Collaboration of 
community-based AHEC centers with medical and other health professions 
training 

[[Page 1591]]
programs and a network of primary care training sites.
    (10) AHEC Services to enhance the practice environment of program 
area (20 points). The range of AHEC services provided to enhance the 
practice environment (i.e., learning resources, telecommunications as a 
teaching tool), and the number of regional practitioners involved in 
the AHEC as adjunct faculty.
    C. Expected Outcomes in AHEC Geographic Areas (20 points). A system 
is proposed or in place for tracking AHEC-experienced trainees 
(students, residents) who eventually practice in primary care in 
underserved areas.
    Each of the performance measures and outcome indicators presented 
above contributes to overall project performance.
    Substantial Programmatic Involvement:
    The Bureau of Health Professions, within the Health Resources and 
Services Administration, has substantial programmatic involvement in 
the planning, development, and administration of the Basic/Core AHEC 
and Model AHEC projects by:
    1. Reviewing and approving plans upon which continuation of the 
cooperative agreement is contingent in order to permit appropriate 
direction and redirection of activities;
    2. Reviewing and approving all contracts and agreements among 
recipient medical or osteopathic schools, other health professions 
schools and community-based centers;
    3. Participating with project staff in the development of funding 
projections;
    4. Developing, with project staff, individual project data 
collection systems and procedures; and
    5. Participating with project staff in the design of project 
evaluation protocols and methodologies.
    To receive support, these programs must meet the requirements of 
the regulations as set forth in 42 CFR part 57, subpart MM.

Model State-Supported Area Health Education Center Programs Section 
746(a)(3)

    Purpose and Eligibility: Section 746(a)(3) authorizes Federal 
assistance to any school of medicine (allopathic or osteopathic) that 
is operating an area health education centers program and that is not 
receiving financial assistance under section 746(a)(1), title VII of 
the PHS Act. In general, an area health education center program shall 
be a cooperative program of one or more medical (M.D. and D.O.) 
school(s) and one or more public or nonprofit private regional area 
health education centers.
    The statutory authority for the Model State-Supported AHEC Program 
contains explicit language regarding activities and agreements between 
the medical and osteopathic schools of medicine which develop AHEC 
programs and the free-standing, community-based area health education 
centers which provide training sites and resources for the activities. 
To accomplish these specific tasks, a system of subcontracts is 
developed between the health professions schools and the independent 
AHEC centers in the communities.
    Matching Funds Requirement: With respect to the costs of operating 
the Model State-Supported AHEC program, the school will make available 
(directly or through donations from public or private entities) non-
Federal contributions in cash toward such costs in an amount that is 
not less than 50 percent of such costs. These funds must be for the 
express use of the AHEC Program and Centers, and not funds designated 
for other categorical or specific purposes. Amounts provided by the 
Federal Government may not be included in determining the amount of 
non-Federal contributions in cash.
    Section 746(a)(3)(D) states that schools must maintain expenditures 
of non-Federal amounts at a level that is not less than the level of 
such expenditures for the fiscal year preceding the first fiscal year 
for which the school receives an award.
    Programmatic Agreements of Model State-Supported AHEC Programs: 
Certain programmatic agreements are required for the operation of a 
Model State-Supported AHEC Program. In operating this program, the 
school must agree to:
    a. Coordinate the activities of the program with the activities of 
any office of rural health established by the State or States in which 
the program is operating;
    b. Conduct health professions education and training activities 
consistent with national and State priorities in the area served by the 
program in coordination with the National Health Service Corps, 
entities receiving funds under section 329 or 330 and public health 
departments; and
    c. Cooperate with any entities that are in operation in the area 
served by the program and that receive Federal or State funds to carry 
out activities regarding the recruitment and retention of health care 
providers.
    Other Considerations: Applicants in States where more than one 
eligible entity exists are encouraged to collaborate in the submission 
of a single Model State-Supported AHEC Program application, which 
reflects a consortium of Statewide programs to coordinate community-
based health professions training activities.
    The principal objective of this legislation is to encourage State 
coordination and support for AHEC activities. The most effective 
approach for obtaining support from State legislatures is to present a 
unified plan showing how all the programs are working together to 
provide the needed services in the State. Competitive applications from 
one State tend to be divisive rather than unifying in reaching common 
goals.
    Criteria for Allocation of Available Funds: The following criteria 
for allocation of funds were established in the Federal Register on 
September 14, 1993, (at 58 FR 48068) after public comment and are being 
continued in FY 1996.
    As a condition of receiving funding:
    (l) Applicants must meet the eligibility conditions of programs as 
set forth in section 746(b), and the AHEC centers they wish to have 
included must meet eligibility requirements in accordance with section 
746(d);
    (2) The non-Federal contribution to the AHEC program(s) in the 
current year is at least equal to the amount to be received from the 
Federal program as required by section 746(a)(3)(B); and
    (3) The program activities for which support is requested are 
determined by peer reviewers to be qualitatively acceptable. Programs 
that submit acceptable applications, in accordance with the above 
criteria, will receive funding based on the following allocation of 
funds:
    1. Annually, the total amount available for funding under section 
746(a)(3) will be divided by the total number of qualifying AHEC 
centers in approved applications. This will yield the per center 
allocation. The coordinating AHEC applicant for each State will receive 
an amount equal to the number of qualifying centers in the approved 
application times the per center allocation, subject to the amount of 
non-Federal cost contributions and approved program activities.
    2. In accordance with the provisions of section 746(e)(l)(A), the 
award will clearly indicate that 75 percent of the awarded funds are to 
be spent in approved centers. The remaining 25 percent may be allocated 
to the AHEC program office and/or other participating schools. Awardees 
may distribute 75 percent or more of funds to centers according to 
need.
    The State matching provision was included in this legislation to 
promote State funding. The allocation of Federal 

[[Page 1592]]
funds to all qualifying AHEC programs is intended to provide as broad 
as possible a base for the accomplishment of this purpose. The number 
of qualifying AHEC centers provides the means for distribution of funds 
because the statute requires that 75 percent of the funds are 
designated to go to these entities.

Health Education and Training Centers

    Eligibility and Purpose: Eligible applicants are public or 
nonprofit private accredited schools of allopathic or osteopathic 
medicine, or the parent institution on behalf of such schools, or a 
consortium of such schools. Assistance is for planning, developing, 
establishing, maintaining, and operating Health Education and Training 
Centers. Such support is designed to improve the supply, distribution, 
quality, and efficiency of personnel providing health services in the 
State of Florida or (in the United States) along the border between the 
United States and Mexico or providing, in other urban and rural areas 
(including frontier areas) of the United States, health services to any 
population group, including Hispanic individuals and recent refugees, 
that has demonstrated serious health care needs. Assistance is also to 
encourage health promotion and disease prevention through public 
education.
    Project Requirements: Each project must meet the following 
statutory requirements:
    (a) Establish an advisory group comprised of health service 
providers, educators and consumers from the service area and of faculty 
from participating schools;
    (b) Develop a plan for carrying out the Health Education and 
Training Centers Program, after consultation with the advisory group 
required in item (a) above;
    (c) Enter into contracts, as needed, with other institutions or 
entities to carry out the plan as required in item (b) above;
    (d) Enter into a contract or other written agreement with one or 
more public or nonprofit private entities in the State which have 
expertise in providing health education to the public;
    (e) Be responsible for the evaluation of the program;
    (f) Evaluate the specific service needs for health care personnel 
in the service area;
    (g) Assist in the planning, development, and conduct of training 
programs to meet the needs determined under item (f) above;
    (h) Conduct or support not less than one training and education 
program for physicians and one program for nurses for at least a 
portion of the clinical training of such students;
    (i) Conduct or support training in health education services, 
including training to prepare community health workers to implement 
health education programs in communities, health departments, health 
clinics, and public schools that are located in the service area;
    (j) Conduct or support continuing medical education programs for 
physicians and other health professionals (including allied health 
personnel) practicing in the service area;
    (k) Support health career educational opportunities designed to 
provide students residing in the service area with counseling, 
education, and training in the health professions;
    (l) With respect to Border HETCs, assist in coordinating their 
activities and programs with any similar activities and programs 
carried out in Mexico along the border between the United States and 
Mexico;
    (m) Make available technical assistance in the service area in the 
aspects of health care organization, financing and delivery;
    (n) In the case of any school of public health located in the 
service area of the HETC, to permit any such school to participate in 
the program of the center if the school makes a request to so 
participate; and
    (o) Encourage health promotion and disease prevention through 
health education in the service area.
    In addition, in order to assure effective program administration 
and assessment, each project must also meet the following requirements 
which were established following public comment at 55 FR 31237, dated 
August 1, 1990 .
    Each grantee must:
    (a) Have a project director who holds a faculty appointment at an 
allopathic or osteopathic medical school and who is responsible for the 
overall direction of the project;
    (b) Provide faculty to assist in the conduct of community-based 
educational programs and training activities;
    (c) Be responsible for the quality of the community-based 
educational programs and training activities, and the evaluation of 
trainees;
    (d) Provide for active participation of individuals who are 
associated with the administration of the medical school, and staff and 
faculty members of departments of family medicine, internal medicine, 
pediatrics, and obstetrics and gynecology; and
    (e) Provide an annual evaluation of the project, including an 
assessment of the educational programs and the trainees.
    Definitions: The following definitions are statutory.
    ``Border Health Education and Training Center'' means an entity 
that is a recipient of an award under section 746(f)(1) and that is 
carrying out (or will carry out) the purpose of the program as 
described under Eligibility and Purpose above.
    ``Community Health Center'' means an entity as defined in section 
330(a) of the Act and in regulations at 42 CFR 51c.102(c).
    ``Health Education and Training Center'' or ``center'' means an 
entity that is the recipient of an HETC grant under section 746(f)(1).
    ``Migrant Health Center'' means an entity as defined in section 329 
(a)(1) of the Act and in regulations at 42 CFR 56.102(g)(1).
    ``Service area'' means the geographic area designated for the 
center to carry out the HETC program, as designated by HRSA.
    It is located entirely within the State in which the center is 
located.
    ``School of Medicine or Osteopathic Medicine'' means a school as 
described in section 799 and which is accredited as provided in section 
799(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, and 
the Republic of Palau, the Republic of the Marshall Islands, and the 
Federated States of Micronesia.
    In addition, the following definitions were established following 
public comment at 55 FR 31237, dated August 1, 1990
    ``Close proximity to the Border'' means a county, in a State, any 
portion of which lies within three hundred (300) miles of the Border 
between the United States and Mexico.
    ``Frontier area'' means those areas with a population density of 
less than seven individuals per square mile.
    ``Health professional'' means any physician, dentist, optometrist, 
podiatrist, pharmacist, nurse, nurse practitioner, nurse mid-wife, 
physician assistant or allied health personnel.
    Review Criteria: The Health Resources and Services Administration 
will review applications taking into consideration the following 
criteria which were established following public comment at 55 FR 
31237, dated August 1, 1990:
    1. The potential effectiveness of the proposed project in carrying 
out the intent of section 746(f); 

[[Page 1593]]

    2. The extent to which the proposed project adequately provides for 
the project requirements;
    3. The extent to which the proposed project explains and documents 
the need for the project in the geographic area to be served, including 
relevant socio-economic and cultural characteristics of the population 
to be served;
    4. The administrative and management capability of the applicant to 
carry out the proposed project in a cost-effective manner;
    5. The evaluative strategy to assess the project and the trainees 
in terms of effectiveness and proposed outcomes;
    6. The extent of coordination of HETC training and education with 
similar activities in the areas involved; and
    7. The potential of the proposed project to continue on a self-
sustaining basis.
    Statutory Funding Preference: In making awards for FY 1996, the 
Secretary shall make available 50 percent of the appropriated funds for 
approved applications for border health education and training centers 
in the State of Florida and (in the United States) along the border 
between the United States and Mexico. The remaining 50 percent shall be 
made available for approved applications for HETCs from non-border 
areas (both urban and rural). If funds remain available after all 
approved applications in one category are funded, the balance shall be 
utilized for approved applications in the other category. This 
addresses the statutory funding requirements while allowing maximum 
flexibility in the use of funds.
    Established Funding Priorities: The following funding priorities 
were established following public comment at 58 FR 30066, dated May 25, 
1993.
    A funding priority will be given to:
    1. Applicants which propose to implement HETC training programs for 
a minimum of 50 underrepresented minority trainees annually in Sites 
that Serve Medically Underserved. The term ``underrepresented 
minorities'' means, with respect to a health profession, racial and 
ethnic populations that are underrepresented in the health profession 
relative to the number of individuals who are members of the population 
involved. For this program, it means American Indians or Alaskan 
Natives, Blacks, Hispanics, and potentially, various subpopulations of 
Asian individuals.
    2. Applicants which propose to implement a substantial public 
health training experience (of 4 to 8 weeks for a minimum of 25 
trainees, annually) in one or more of the following training sites: (1) 
facilities operated by a State or local health department; (2) a 
Migrant Health Center designated under section 329 (a)(l) of the PHS 
Act; (3) a Community Health Center designated under section 330 (a) of 
the PHS Act; or (4) hospitals or other health care facilities of the 
Indian Health Service. If such training sites are unavailable in a 
proposed HETC service area, applicants may propose comparable public 
health training experiences (e.g., a 4 to 8 week community health 
project supervised by a rural preceptor). Trainees participating in 
activities described in Priorities Nos. 1 and 2 may include: students 
pursuing health professions education, medicine, nursing; students 
pursuing nurse practitioner, certified nurse midwifery, or physician 
assistant training; residents (in family medicine, general internal 
medicine, general pediatrics, or preventive medicine); community health 
worker trainees (indigenous to the area); dentists, nurses, physicians, 
or environmental health personnel pursuing a training program in Public 
Health.
    3. Applicants which propose to have as part of the advisory group, 
as described in section 746(f)(4), a representative from a health 
department from the area being served.
    Grant Funds: Grants are to assist in meeting the costs of the 
program which cannot be met from other sources. The following 
restrictions apply to all funding:
    (a) not less than 75 percent of the total funds provided to a 
school or schools of allopathic or osteopathic medicine must be spent 
in the development and operation of the health education and training 
center in the service area of such program;
    (b) to the maximum extent feasible, the grantee will obtain from 
non-Federal sources the amount of the total operating funds for the 
HETC program which are not provided by HRSA;
    (c) no grant or contract shall provide funds solely for the 
planning or development of an HETC program for a period in excess of 
two years;
    (d) not more than 10 percent of the annual budget of each program 
may be used for the renovation and equipping of clinical teaching 
sites; and
    (e) no grant or contract shall provide funds to be used outside the 
United States except as HRSA may prescribe for travel and 
communications purposes related to the conduct of a border Health 
Education and Training Center.
    Border Area Funding: Section 746(f) requires that certain criteria 
relative to the service area be considered by the Secretary in the 
establishment of a formula for allocating funds for each approved 
application for a border health education and training center. 
Specifically, these criteria are:
    1. the low-income population, including Hispanic individuals, and 
the growth rate of such population in the State of Florida and along 
the border between the United States and Mexico;
    2. the need of the low-income population referenced in Item 1 above 
for additional personnel to provide health care services along such 
border and in the State of Florida; and
    3. the most current information concerning mortality and morbidity 
and other indicators of health status for such population.
    Formula for Allocating Border Area Funds: Considering the criteria 
in the statute, the following formula, which was established following 
public comment at 55 FR 31237, dated August 1, 1990, will be used for 
allocating Border Area funds in FY 1996, to be applied to each of the 
counties included in the service area of the center on behalf of which 
the application is made:

P  x  (1 + C)  x  N  x  I  x  100,000 = F

Where:
(P) = Low-income population in the county
(C) = Percent change of population in the county
(N) = Need for primary care physicians in the county
(I) = Infant mortality rate in the county
(F) = Factor for each county in close proximity to the border, and each 
county in the State of Florida

    For this program (HETC), project support recommended for future 
years will be subject to enabling legislation, appropriations, 
satisfactory progress, adjustment (up or down) based upon changes in 
data utilized in the above formula, and any changes in the scope of the 
project, as approved.
    Formula Definitions and Data Sources:
    (P) ``Low-income population'': The population in the county 
classified by the United States Bureau of the Census as having an 
average income at or below 125 percent of the poverty level.

Data Source: U.S. 1990 Census Population, U. S. Department of Commerce, 
Bureau of the Census

    (C) ``Percent change of population'': The number of births minus 
the number of all deaths, plus or minus net migration in the county, 
divided by the 1990 county population.

Data Source: County and City Data Book, 1990, U.S. Department of 
Commerce, Bureau of the Census.

    (N) ``Need for primary care physicians'': The ratio derived by 

[[Page 1594]]
    computing the number of primary care physicians per 100,000 population 
in all 236 counties in close proximity to the border, and all 67 
counties in the State of Florida, divided by the ratio of primary care 
physicians to 100,000 population in the county.

Data Source: Area Resource File (ARF) System, U.S. Department of Health 
and Human Services (Year: most recent ARF data available annually)

    (I) ``Infant mortality rate'': The 5-year infant mortality rate for 
the county, divided by the average of the 5-year infant mortality rate 
in all 236 counties in close proximity to the border and all 67 
counties in the State of Florida.

Data Source: Area Resource File (ARF) System, U.S. Department of Health 
and Human Services (most recent data available: annually)

    (F) ``Factor for each county'': A factor for each of the 236 
counties in close proximity to the border and each of the 67 counties 
in the State of Florida is calculated from the formula. The factor will 
be recalculated each year to reflect most recent data available. The 
calculated factor of each county is aggregated for a multi-county 
service area.
    For the purposes of allocating border area funds, the 236 counties 
in close proximity (within 300 miles) of the border between the United 
States and Mexico are located in the four States contiguous to the 
border: Arizona, California, New Mexico, and Texas. All 67 counties 
located in the State of Florida are also included.
    Considerations for Designating Geographic Service Areas: The 
following considerations will be used in designating geographic service 
areas:
    1. Low-income population for the specific county(ies) in the 
service areas;
    2. Percent change in low-income population for the specific 
county(ies);
    3. Ratio of primary care physicians per 100,000 population for the 
specific county(ies); and
    4. Infant mortality rate for the specific county(ies) in the 
service area.

National Health Objectives for the Year 2000

    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 for setting priority areas. The 
Cooperative Agreements for the Basic/Core AHEC Programs and the Model 
State-Supported Area Health Education Center Programs and the Grants 
for Health Education and Training Centers are related to the priority 
area of Educational and Community-Based Programs. Potential applicants 
may obtain a copy of Healthy People 2000 (Full Report; Stock No. 017-
001-00474-0) or Healthy People 2000 (Summary Report; Stock No. 017-001-
00473-1) through the Superintendent of Documents, Government Printing 
Office, Washington, D.C. 20402-9325 (Telephone 202-783-3238).

Education and Service Linkage

    As part of its long-range planning, HRSA will be targeting its 
efforts to strengthening linkages between U.S. Public Health Service 
education programs and programs which provide comprehensive primary 
care services to the underserved.

Smoke-Free Workplace

    The Public Health Service strongly encourages all grant and 
cooperative agreement recipients to provide a smoke-free workplace and 
promote the non-use of all tobacco products and Public Law 103-227, the 
Pro-Children Act of 1994, prohibits smoking in certain facilities that 
receive Federal funds in which education, library, day care, health 
care, and early childhood development services are provided to 
children.

Application Availability

    Application materials are available on the World Wide Web at 
address: http://www.os.dhhs.gov/hrsa/. Click on the file name you want 
to download to your computer. It will be saved as a self-extracting 
WordPerfect 5.1 file. Once the file is downloaded to the applicant's 
PC, it will still be in a compressed state. To decompress the file, go 
to the directory where the file has been downloaded and type in the 
file name followed by a . The file will expand into a 
WordPerfect 5.1 file. Applicants are strongly encouraged to obtain 
application materials from the World Wide Web via the Internet.
    However, for applicants which do not have Internet capability, 
application materials are also available on the BHPr BBS. Use your 
computer and modem to call (301) 443-5913. Set your modem parameters to 
2400 baud, parity to none, data bits to 8, and stop bits to 1. Set your 
terminal emulation to ANSI or VT-100.
    Once you have accessed the BHPr Bulletin Board, you will be asked 
for your first and last name. It will also ask you to choose a 
password. REMEMBER YOUR PASSWORD! The first time you logon you 
``register'' by answering a number of other questions. The next time 
you logon, BHPr's Bulletin Board will know you.
    Press (F) for the (F)iles Menu and (L) to (L)ist Files. Press (L) 
again to see a list of numbered file areas. To see a list of files in 
any area, type the number corresponding to that area. Competitive 
application materials for grant programs administered by the Bureau of 
Health Professions are located in the File Area item ``B'' titled 
Grants Announcements.
    To (R)ead a file or (D)ownload a file, you need to know its exact 
name as listed on BHPr's Bulletin Board. Press (R) to (R)ead a file and 
type the name of the file. Press (D) to (D)ownload a file to your 
computer. You need to know how your communications software 
accomplishes downloading.
    When you have completed your tour of BHPr's Bulletin Board for this 
session, press (G) for (G)oodbye and press .
    If you have difficulty accessing the BHPr BBS, please try the 
Internet address listed above. If you do not have Internet capability 
and need assistance in accessing the BHPr BBS or technical assistance 
with any aspect of the BHPr BBS, please call Mr. Larry DiGiulio, 
Systems Operator for BHPr BBS at (301) 443-2850 or 
``[email protected]''.
    Questions regarding grants policy and business management issues 
should be directed to Ms. Wilma Johnson, Acting Chief, Centers and 
Formula Grants Section ([email protected]), Grants Management 
Branch, Bureau of Health Professions, Health Resources and Services 
Administration, Parklawn Building, Room 8C-26, 5600 Fishers Lane, 
Rockville, Maryland 20857. If you are unable to obtain the application 
materials from the BHPr Bulletin Board, you may obtain application 
materials in the mail by sending a written request to the Grants 
Management Branch at the address above. Written requests may also be 
sent via FAX (301) 443-6343 or via the internet address listed above. 
Completed applications should be returned to the Grants Management 
Branch at the above address.
    If additional programmatic information is needed, please contact 
Louis D. Coccodrilli, M.P.H., Acting Chief, AHEC and Special Programs 
Branch, Division of Medicine, Bureau of Health Professions, Health 
Resources and Services Administration, Parklawn Building, Room 8A-25, 
5600 Fishers Lane, Rockville, Maryland 20857. Telephone: (301) 443-
6950, FAX: (301) 443-8890.

Paperwork Reduction Act

    The standard application form PHS 6025-1, HRSA Competing Training 
Grant Application, General Instructions and supplement for these grant 

[[Page 1595]]
programs have been approved by the Office of Management and Budget 
under the Paperwork Reduction Act. The OMB Clearance Number is 0915-
0060.

Deadline Date

    The deadline date for receipt of applications for each of these 
programs is March 15, 1996. Applications will be considered to be ``on 
time'' if they are either:
    (1) Received on or before the established deadline date, or
    (2) Sent on or before the established deadline date and received in 
time for orderly processing. (Applicants should request a legibly dated 
U.S. Postal Service postmark or obtain a legibly dated receipt from a 
commercial carrier or U.S. Postal Service. Private metered postmarks 
shall not be acceptable as proof of timely mailing.)
    Late applications not accepted for processing will be returned to 
the applicant. In addition, applications which exceed the page 
limitation and/or do not follow format instructions will not be 
accepted for processing and will be returned to the applicant.

                                                     Table 1                                                    
----------------------------------------------------------------------------------------------------------------
                                                                                                       Deadline 
 PHS section #, title, CFDA #, regulation       Type of assistance           Period of support           date   
----------------------------------------------------------------------------------------------------------------
746(a)(1), Basic/Core AHEC, 93.824, 42     Cooperative Agreement......  3 years....................      3/15/96
 CFR part 57 subpart MM.                                                                                        
746(a)(3), State Supported Model AHEC,     Cooperative Agreement......  3 years....................      3/15/96
 93.107.                                                                                                        
746(f) HETC 93.189.......................  Grant......................  3 years....................      3/15/96
----------------------------------------------------------------------------------------------------------------

    These programs are not subject to the provisions of Executive Order 
12372, Intergovernmental Review of Federal Programs (as implemented 
through 45 CFR part 100) or the Public Health System Reporting 
Requirements.

    Dated: January 11, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-641 Filed 1-19-96; 8:45 am]
BILLING CODE 4160-15-P