[Federal Register Volume 62, Number 78 (Wednesday, April 23, 1997)]
[Notices]
[Pages 19770-19776]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-10435]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Rural Telemedicine Grant Program

AGENCY: Health Resources and Services Administration (HRSA), HHS.

ACTION: Notice of availability of funds.

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SUMMARY: The Office of Rural Health Policy, HRSA, announces that 
applications are being accepted for Rural Telemedicine Grants to 
facilitate development of rural health care networks through the use of 
telemedicine and develop a baseline of information for the systematic 
evaluation of telemedicine systems serving rural areas.

DATES: Applications for the program must be received by the close of 
business on June 20, 1997. Applications shall be considered as meeting 
the deadline if they are either (1) received on or before the deadline 
date at the address noted below; or (2) postmarked on or before the 
deadline date and received by the granting agency in time for the 
independent review. Applicants must request a legibly dated U.S. Postal 
Service postmark or obtain a legibly dated receipt from a commercial 
carrier or the U.S. Postal Service in lieu of a postmark. Private 
metered postmarks shall not be acceptable as proof of timely mailing. 
Applications are considered late if they do not meet the above 
criteria; late applications will be returned to the sender.

ADDRESSES: Completed applications must be sent to HRSA GRANTS 
APPLICATION CENTER, 40 West Gude Drive, Suite 100, Rockville, MD 20850.

FOR FURTHER INFORMATION CONTACT: Requests for technical or programmatic 
information on this announcement should be directed to Cathy Wasem or 
Amy Barkin, Office of Rural Health Policy, HRSA, 5600 Fishers Lane, 
Room 9-05, Rockville, MD 20857, (301) 443-0835, [email protected] or 
[email protected]. Requests for information regarding business or 
fiscal issues should be directed to Martha Teague, Office of Grants 
Management, Bureau of Primary Health Care, HRSA, West Tower, 11th 
Floor, 4350 East West Highway, Bethesda, MD 20814, (301) 594-4258.

SUPPLEMENTARY INFORMATION:

Application Packet

    The standard application form and general instructions for 
completing applications (Form PHS-5161-1 [Revised 5/96], OMB #0937-
0189) have been approved by the Office of Management and Budget. To 
receive an application kit call toll-free: HRSA GRANTS APPLICATION 
CENTER at 1-888-300-HRSA. Individuals in rural areas where the 1-888 
number cannot be dialed should call the operator and ask that the 
operator connect them to 1-888-300-4772.

Authority

    Grants for these projects are authorized under section 330A of the 
Public Health Service (PHS) Act as amended by the Health Centers 
Consolidation Act of 1996, Public Law 104-299. Awards will be made from 
funds appropriated under Public Law 104-208 (HHS Appropriation Act for 
FY 1997).

Legislative and Program Background

    Section 330A of the PHS Act, as amended by Pub. L. 104-299, 
authorizes the Rural Health Outreach, Network Development and 
Telemedicine Grant Program. Grants supported under this program are to 
``expand access to, coordinate, restrain the cost of, and improve the 
quality of essential health care services, including preventive and 
emergency services, through the development of integrated health care 
delivery systems or networks in rural areas and regions.'' Two 
approaches to achieve these goals are through projects funded under the 
Rural Health Outreach and the Rural Network Development Program. A 
third approach is through projects funded under the Rural Telemedicine 
Grant Program. This program announcement pertains only to the Rural 
Telemedicine Grant Program. (The Federal Register Notice for the Rural 
Health Outreach and Rural Network Development Program was published 
December 13, 1996. Applications were due March 31, 1997).
    Rural residents in the United States often lack access to a range 
of health services--from basic preventive services to highly 
specialized services--that would enable them to prevent, recover from, 
or cope with disease and disability. Consistent with the legislation, 
the Office of Rural Health Policy (ORHP) views integrated health care 
delivery systems or networks as a means to stabilize and integrate 
fragile rural health care systems with more sustainable, comprehensive 
delivery networks. ORHP believes that telemedicine has the potential to 
facilitate the development of integrated health care networks, thereby 
fostering improved access to quality health care services and reducing 
the isolation of rural practitioners.
    The goal of ORHP's Rural Telemedicine Grant Program is to improve 
access to quality health services for rural residents and reduce the 
isolation of rural practitioners through the use of telemedicine 
technologies.
    The two objectives of the Rural Telemedicine Grant Program are: (1) 
To demonstrate how telemedicine can be used as a tool in developing 
integrated systems of health care, thereby improving access to health 
services for rural individuals across the lifespan and reducing the 
isolation of rural health care practitioners; and (2) to evaluate the 
feasibility, costs, appropriateness, and acceptability of rural 
telemedicine services and technologies. Such evaluation is needed to 
determine how best to organize and provide telemedicine services in a 
sustainable manner.
    Under its Rural Telemedicine Grant Program, ORHP funded eleven 
telemedicine projects in fiscal year 1994 for a period of three years. 
Building on the lessons learned from these first telemedicine grantees, 
new grantees will be expected to further the development of integrated 
health care networks by using telemedicine to increase access to a wide 
range of clinical services based on community need.

Funds Available

    Approximately $4 million is available for the Rural Telemedicine 
Grant program in FY 1997. The Office of Rural

[[Page 19771]]

Health Policy expects to make approximately 10-14 new awards. 
Applicants may propose project periods of up to three years. However, 
applicants are advised that continued funding of grants beyond FY 1997 
is subject to the availability of funds and grantee performance. No 
project will be supported for more than three years. The budget period 
for new projects will begin September 30, 1997.

Size of Awards

    Individual grant awards under this notice will be limited to 
$400,000 (including direct and indirect costs) per year. It is 
anticipated that existing telemedicine networks would come in for 
smaller grant awards, because the network would already have some 
equipment and would be supporting some personnel. Overall, applications 
for smaller amounts are strongly encouraged.

Definitions

    For the purposes of this grant program the following definitions 
apply:
    Telemedicine: Telemedicine is the use of telecommunication and 
information technologies for the clinical care of patients, including 
patient counseling and clinical supervision/preceptorship of medical 
residents and health professions students, when such supervising or 
precepting involves direct patient care.
    The definition does not include didactic distance education, such 
as lectures that are designed solely to instruct health care students, 
personnel or patients, and in which no clinical care is provided.
    Telemedicine Clinical Consultation: A telemedicine clinical 
consultation is a person-to-person interaction relating to the clinical 
condition or treatment of a patient. It is the process by which a 
clinical service is delivered. The consultation may be interactive 
(i.e., in real-time) or asynchronous (i.e., using store-and-forward 
technology).
    Professionals from a variety of health care disciplines may be 
involved in providing and/or receiving consultations including, but not 
limited to: physicians, physician assistants, nurses, nurse 
practitioners, nurse-midwives, clinical nurse specialists, dentists, 
dental hygienists, physical therapists, occupational therapists, speech 
therapists, clinical psychologists, clinical social workers, substance 
abuse counselors, podiatrists, optometrists, dieticians/nutritionists, 
pharmacists, optometrists, EMTs, etc.
    Telemedicine Network: A telemedicine network is comprised of hubs 
(i.e., entities whose health care professionals provide consultations 
or whose faculty supervise or precept health professions students for 
clinical care at rural facilities) and spokes (i.e., entities whose 
professionals or patients receive consultations). Some entities may 
function as both a hub and a spoke. The network may have additional 
members who do not directly receive or provide consultations, but who 
foster access to and coordination of services, such as area agencies on 
aging and providers under the WIC program.
    Rural spokes may be health care facilities or places in which 
health care is provided such as schools and homes. Examples of spoke 
sites include rural hospitals, clinics, nursing homes, mental health 
centers, homes, public health clinics, school-based clinics, assisted 
living facilities, senior citizen housing, and centers for the 
developmentally disabled.

Program Requirements

Telemedicine Network

    In order to compete for the program, applicants must participate in 
a telemedicine network that includes at least three members: (1) a 
multispecialty entity (i.e., hub) located in an urban or rural area 
that can provide 24-hour-a-day access to a range of specialty health 
care; and (2) at least two rural health facilities (i.e., spokes), 
which may include small rural hospitals (fewer than 100 staffed beds), 
rural physician offices, rural health clinics, rural community health 
centers and rural nursing homes. For the purposes of this grant 
program, a multispecialty entity may be a tertiary care hospital, a 
multispecialty clinic, or a collection of facilities that, combined, 
could provide 24-hour-a-day specialty consultations.
    A telemedicine network is characterized by a partnership among its 
members that is evidenced by each member's: (1) resource contribution; 
(2) specific network role; (3) active planning and programmatic 
participation; (4) long-term commitment to the project; and (5) 
signature on a signed, dated memorandum of agreement.
    Applicants are encouraged to include other types of members in 
their network such as mental health clinics, public health clinics and 
departments, school-based clinics, emergency service providers, health 
professions schools, home health providers, and social service programs 
such as area agencies on aging and providers under the WIC program. 
Preference will be given to applicants whose networks meet the 
statutory preference noted in the ``Statutory Preference Section.''

Clinical Services

    An applicant must meet the following programmatic requirements for 
clinical services:
    (1) It must provide a minimum of seven (7) clinical telemedicine 
services over the network, one of which must be the stabilization of 
patients in emergency situations. Not all services need be provided to 
all sites.
    (2) The applicant and its network members should select the other 
six (6) services to be provided. These services must be based on 
documented needs of the communities to be served.
    (3) In addition to emergency stabilization services, at least two 
of the grant-funded services provided by the telemedicine network must 
be consultant services provided by physician specialists.
    (4) All services provided with funding from this grant program must 
be available from the multispecialty entity on a 24-hour-a-day basis 
unless there is a strong justification for services being available 
less than 24 hours-a-day. An entity is considered capable of providing 
specialty consultations 24-hours-a-day if they have specialists on-
call.

System Design

    All members of a telemedicine network will be required to be 
electronically linked, for at least e-mail services, by the ninth month 
of the first budget period.
    Whenever possible, telemedicine systems should be designed with an 
open architecture, fostering interoperability with other telemedicine 
systems.
    Telemedicine systems should be designed using the least costly, 
most efficient technology to meet the identified need(s).
    ORHP grant recipients will be expected, during the first nine 
months of the first budget period, to develop a set of protocols for 
each of the clinical services to be provided using telemedicine.

Evaluation and Data Collection

    An applicant must submit a plan for evaluating the telemedicine 
services it provides and monitoring its own performance, as well as 
participate in an ORHP-sponsored evaluation of telemedicine services. 
The ORHP-sponsored activities may include maintaining a data-log 
provided by ORHP and collecting data, completing surveys, and 
participating in on-site observations by independent evaluators. The 
ORHP-sponsored data activities will be subject to OMB approval under 
the Paperwork Reduction Act of 1995.

[[Page 19772]]

Funding Requirements

Use of Grant Funds

    Grant funds may be used to support the operating costs of the 
telemedicine system, including compensation for consulting and 
referring practitioners.
    Grant funding must be used for services provided to or in rural 
communities. Fifty percent (50%) or more of the grant award must be 
spent for: transmission costs and clinician compensation payments; 
costs incurred in rural communities, including rural staff salaries and 
equipment maintenance; and equipment placed in rural communities, 
irrespective of where the equipment is purchased.
    Grant dollars may not be used to support didactic distance 
education activities. However, equipment purchased to provide clinical 
services may be used for a variety of non-clinical purposes, including 
didactic education, administrative meetings, etc.
    No more than forty percent (40%) of the total grant award each year 
may be used to purchase, lease or install equipment (i.e., equipment 
used inside the health care facility for providing telemedicine 
services such as codecs, cameras, monitors, computers, multiplexers, 
etc.).
    Grant funds may not be used to purchase or install transmission 
equipment, such as microwave towers, satellite dishes, amplifiers, 
digital switching equipment or laying cable or telephone lines.
    Grant funds may not be used to build or acquire real property, or 
for construction or renovation, except for minor renovations related to 
the installation of equipment.
    Grant funds may be used to pay for transmission costs such as the 
cost of satellite time or the use of phone lines. However, those 
applicants who anticipate very high transmission rates for all or some 
of their sites should consider activities to achieve more sustainable 
rates.
    If ORHP funds are used for clinician compensation payments, 
payments can be up to a maximum of $60 per practitioner per consult. If 
a third-party payer, including Medicaid or Medicare, can be billed for 
a consult, the grantee may not provide the practitioner with an ORHP-
funded compensation payment. This requirement applies even if the 
grantee has not yet established its own internal procedure to bill 
Medicaid or Medicare.

Indirect Costs

    In accordance with the law, no more than 20 percent of the amount 
provided under a grant in this grant program can be used to pay for the 
indirect costs associated with carrying out the purposes of such grant.

Cost Participation

    The amount of cost participation will serve as an indicator of 
community and institutional support for the project and of the 
likelihood that the project will continue after federal grant support 
has ended. Cost participation may be in cash or in-kind (e.g., 
equipment, personnel, building space, indirect costs).
    If an award is made, all funds identified as dedicated to this 
project (including funds used for cost participation) will be subject 
to the applicable cost principles, audit and reporting requirements.

Eligible Applicants

    A grant award will be made either (1) to an entity that is a health 
care provider and is a member of an existing or proposed telemedicine 
network, or (2) to an entity that is a consortium of health care 
providers that are members of an existing or proposed telemedicine 
network. The applicant must be a legal entity capable of receiving 
federal grant funds. The grant recipient must be a public (non-federal) 
or private nonprofit entity, located in either a rural or urban area. 
Other telemedicine network members may be public or private, nonprofit 
or for-profit. Health facilities operated by a Federal agency may be 
members of the network but not the applicant.
    All spoke facilities supported by this grant must meet one of the 
two criteria stated below:
    (1) The facility is located outside of a Metropolitan Statistical 
Area (MSA) as defined by the Office of Management and Budget. (A list 
of the cities and counties that are designated as Metropolitan 
Statistical Areas is included in the application kit); or
    (2) The facility is located in one of the specified rural census 
tracts of the MSA counties listed in Appendix I. Although each of these 
counties is an MSA, or part of one, large parts of each county are 
rural. Facilities located in these rural areas are eligible for the 
program. Rural portions of these counties have been identified by 
census tract because this is the only way we have found to clearly 
differentiate them from urban areas in the large counties. Appendix I 
provides a list of these eligible census tracts by county. Appendix II 
includes the telephone numbers for regional offices of the Census 
Bureau. Applicants may call these offices to determine the census tract 
in which they are located.

Statutory Funding Preference

    As provided in section 330A of the PHS Act, as amended by the 
Health Centers Consolidation Act of 1996 (Pub. L. 104-299), an 
applicant will be given preference in the review process if its network 
includes any of the following:
    (a) a majority of the health care providers serving in the rural 
areas or region to be served by the network;
    (b) any federally qualified health centers, rural health clinics, 
and local public health departments serving in the rural area or 
region;
    (c) outpatient mental health providers serving in the rural area or 
region; or
    (d) appropriate social service providers (e.g., agencies on aging, 
school systems, and providers under the Women, Infants, and Children 
[WIC] program) to improve access to and coordination of health care 
services.
    For preference purposes, the following definitions apply:

    ``Health care providers'' in `element (a)' are defined as 
institutions and/or facilities that provide health care. ``Federally 
Qualified Health Centers (FQHCs)'' are defined as those federally 
and nonfederally-funded health centers that have status as federally 
qualified health centers under section 1861(aa)(4) or section 
1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(4) and 
1396d(l)(2)(B), respectively).
    ``Rural health clinics (RHCs)'' are defined as clinics certified 
by HCFA and approved to participate in the Medicare and Medicaid 
programs and receive payments as a Rural Health Clinic as defined 
under section 1861(aa) or 1905(l) of the Social Security Act (42 
U.S.C. 1395x(aa) and 1395d(l), respectively).

Approved applications that qualify for the statutory funding preference 
will be funded ahead of other approved applications.
    HRSA will consider geographic coverage when deciding which approved 
applications to fund. In addition, HRSA is concerned with assuring that 
grants to new networks, as well as to existing networks, be funded. 
Therefore when making awards, HRSA will consider the balance between 
awards to new telemedicine networks and to existing telemedicine 
networks.

Review Criteria

    Grant applications will be evaluated on the basis of the following 
criteria:
    (1) Extent to which the applicant has documented the need for the 
project, developed measurable project objectives for meeting the need, 
and developed a methodology or plan of activities that will lead to 
attaining the project objectives, including a plan to monitor the 
performance of the project. (20 points)

[[Page 19773]]

    (2) Extent to which the project objectives and related activities 
are consistent with the goal and objectives of the grant program noted 
in the `Legislative and Program Background' section. (35 points)
    (a) Extent to which the proposed project will, using telemedicine 
as a tool, facilitate the development of an integrated rural health 
network, thereby increasing access to health services and decreasing 
practitioner isolation. (20 points)
    (b) Extent to which the proposed project will provide a baseline of 
information and data for the systematic evaluation of telemedicine. (15 
points)
    (3) Demonstrated capability, experience and knowledge (i.e. 
managerial, technical, and clinical) of the applicant and other network 
members to implement the project and to disseminate information about 
the project. (20 points)
    (4) Level of local involvement in defining needs and planning and 
implementing the project. Level of commitment to the project as 
evidenced by cost participation by the applicant, other network members 
and/or other organizations, and realistic plans to sustain the 
telemedicine network after federal grant support ends. (15 points)
    (5) Relevance of the budget to the proposed activities and 
reasonableness of the budget to anticipated outcomes/results. (10 
points)

Other Information

    Applicants must develop projects that address specific, documented 
needs of the rural communities. Applicants should consider (1) the 
health care needs of the rural communities served by the project, (2) 
the information and support needs of rural health care practitioners, 
and (3) the extent to which the project can build upon existing 
telecommunications capacity in the communities. Needs can be 
established through a formal needs assessment, by population specific 
demographic and health data, and by health services data.
    Applicants are advised that the narrative description of their 
program plus the narrative budget justification may not exceed 35 pages 
in length. All applications must be typewritten or printed and legible. 
Pages must have margins no less than one inch on top and one-half inch 
on the sides and bottom. The print font on each page, with the 
exception of the narrative budget pages, must be no smaller than 12 
characters per inch (cpi) or a 12 point scalable font. The narrative 
budget pages must be no smaller than a 12 cpi or a 10 point scalable 
font.
    Any application that is judged nonresponsive because it is 
inadequately developed, in an improper format, exceeds the specified 
page length, or otherwise is unsuitable for peer review and funding 
consideration, will be returned to the applicant. All responsive 
applications will be reviewed by an objective review panel.

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 Rural 
Telemedicine Grant program is related to the priority areas for health 
promotion, health protection, and preventive services. Potential 
applicants may obtain a copy of Healthy People 2000 (Full Report: Stock 
No. 017-001-00474-0) or Healthy People 2000 (Summary Report: Stock No. 
017-001-00473-1) through the Superintendent of Documents, Government 
Printing Office, Washington, DC 20402-9325 (Telephone (202) 783-3238).

Smoke-Free Workplaces

    The PHS 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. In addition, Public 
Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain 
facilities (or in some cases, any portion of a facility) in which 
regular or routine education, library, day care, health care or early 
childhood development services are offered to children.

Public Health System Impact Statement

    This program is subject to the Public Health System Reporting 
Requirements as approved by the OMB--0937-0195. 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 grant 
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 in the area(s) to be impacted: a. A copy of the 
face page of the application (SF 424) b. A summary of the project, 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 of local health agencies.
    This information must be submitted no later than the federal 
application receipt due date.

Executive Order 12372

    The Rural Telemedicine Grant program has been determined to be a 
program that is subject to the provisions of Executive Order 12372 
concerning intergovernmental review of federal programs by appropriate 
health planning agencies as implemented by 45 CFR part 100. Executive 
Order 12372 sets up a system for State and local government review of 
proposed federal assistance applications. Applicants (other than 
federally-recognized Indian tribal governments) should contact their 
State Single Point of Contact (SPOCs) as early as possible to alert the 
SPOC to the prospective applications and receive any necessary 
instructions on the State process. For proposed projects serving more 
then one State, the applicant is advised to contact the SPOC of each 
affected State. A list of SPOCs is included in the application kit. All 
SPOC recommendations should be submitted to Pam Hilton, Office of 
Grants Management, Bureau of Primary Health Care, 4350 East West 
Highway, 11th floor, Bethesda, Maryland, 20814, (301) 594-4260. The due 
date for State process recommendations is 60 days after the application 
deadline of June 20, 1997 for competing applications. The granting 
agency does not guarantee to ``accommodate or explain'' for State 
process recommendations it receives after that date. (See Part 148 of 
the PHS Grants Administration Manual, ``Intergovernmental Review of PHS 
Programs under Executive Order 12372 and 45 CFR Part 100,'' for a 
description of the review process and requirements.
    Applicants should notify their State Office of Rural Health (or 
other appropriate State entity) of their intent to apply for this grant 
program and to consult with such agency regarding the content of the 
application. The State Office can provide information and technical 
assistance. A list of State Offices of Rural Health is included with 
the application kit.

[[Page 19774]]

    OMB Catalog of Federal Domestic Assistance number is 93.211.
Claude Earl Fox,
Acting Administrator.

Appendix I

    Census tract numbers are shown below each county name.
    For a spoke health care facility to be eligible as `rural' under 
criterion #2, the facility must be located in one of the census tracts 
(CTs) or block numbered areas (BNAs) that is listed below the following 
counties. If a facility is classified as rural under this criterion, 
the CT number or BNA number must be included next to the county name 
when identifying the facility in the `Telemedicine Network 
Identification' portion of the application.

State, County and Tract Number

Alabama

Baldwin

101-102
106
110
114-116

Mobile

59
62
66
72.02

Tuscaloosa

107

Arizona

Coconino

16-25

Maricopa

101
405.02
507
611
822.02
5228
7233

Mohave* *

* *See Below

Pima

44.05
48-49

Pinal

01-02
04-12

Yuma

105-107
110
112-113
115-116

California

Butte

24-36

El Dorado

301.01-301.02
302-303
304.01-304.02
305.01-305.03
306
310-315

Fresno

40
63
64.01
64.03
65-68
71-74
78-83
84.01-84.02

Kern

33.01-33.02
34-37
40-50
51.01
52-54
55.01-55.02
56-61
63

Los Angeles

5990
5991
9001-9002
9004
9012.02
9100-9101
9108.02
9109-9110
9200.01
9201
9202
9203.03
9301

Madera

01.02-01.05
02-04
10
11.98
12.98

Merced

01-02
03.01
04
05.01-05.02
06-08
19.98
20
21.98
22
23.01
24
24.75-24.98

Monterey

109
112-0113
114.01-0114.02
115

Placer

201.01-201.02
202-204
216-217
219-220

Riverside

421
427.02-427.03
429-432
444
452.02
453-455
456.01-456.02
457.01-457.02
458-462

San Bernardino

89.01-89.02
90.01-90.02
91.01-91.02
93-95
96.01-96.03
97.01
97.03-97.04
98-99
100.01-100.02
102.01-102.02
103
104.01-104.03
105-107

San Diego

189.01-189.02
190
191.01
208
209.01-209.02
210
212.01-212.02
213

San Joaquin

40
44-45
52.01-52.02
53.02-53.04
54-55

San Luis Obispo

100-106
107.01-107.02
108
114
118-122
124-126
127.01-127.02

Santa Barbara

18
19.03

Santa Clara

5117.04
5118
5125.01
5127

Shasta

126-127
1504

Sonoma

1506.04
1537.01
1541-1543

Stanislaus

01
02.01
32-35
36.05
37-38
39.01-39.02

Tulare

02-07

[[Page 19775]]

26
28
40
43-44

Ventura

01-02
46
75.01

Colorado

Adams

84
85.13
87.01

El Paso

38
39.01
46

Larimer

14
17.02
19.02
20.01
22

Mesa

12
15
18
19

Pueblo

28.04
32
34

Weld

19.02
20
24
25.01-25.02

Florida

Collier

111-114

Dade

115

Marion

02
04-05
27

Osceola

401.01-401.02
402.01-402.02
403.01-403.02
404
405.01-405.02
405.03
405.05
406

Palm Beach

79.01-79.02
80.01-80.02
81.01-81.02
82.01-82.02
82.03-83.01
83.02

Polk

125-127
142-144
152
154-161

Kansas

Butler

201-205
209

Louisiana

Rapides

106
135-136

Terrebonne

122-123

MINNESOTA

Polk*

204-210
*9701-9704

St. Louis

105
112-114
121-135
137.01-137.02
138-139
141
151-155

Stearns

103
105-111

Montana

Cascade

105

Yellowstone

15-16
19

Nevada

Clark

57-59

Washoe

31.04
32
33.01-33.04
34

New Mexico

Dona Ana

14
19

Nye**

**See Below

Sandoval

101-104
105.01

Santa Fe

101-102
103.01

Valencia*

    *9701
    *9703-9706
    *9708
    *9711-9712

New York

Herkimer

101
105.02
107-109
110.01-110.02
111-112
113.01

North Dakota

Burleigh

114-115

Grand Forks

114-116
118

Morton

205

Oklahoma

Osage

103-108

Oregon

Clackamas

235-236
239-241
243

Jackson

24
27

Lane

01
05
07.01-07.02
08
13-16

Pennsylvania

Lycoming

101-102

South Dakota

Pennington

116-117

Texas

Bexar

1720
1821
1916

Brazoria

606
609-619
620.01-620.02
621-624
625.01-625.03
626.01-626.02
627-632

Harris

354
544
546

Hidalgo

223-228
230-231
243

[[Page 19776]]

Washington

Benton

116-120

Franklin

208

King

327-328
330-331

Snohomish

532
536-538

Spokane

101-102
103.01-103.02
133
138
143

Whatcom

110

Yakima

18-26

Wisconsin

Douglas

303

Marathon

17-18
20-23

Wyoming

Laramie

16-18

    *This county is divided into Block Numbered Areas (BNAs), not 
Census Tracts (CTs).
    **This entire county, although part of a large city MSA, is 
eligible as rural.

Appendix II

Bureau of The Census Regional Information Service

Atlanta, GA 404-730-3957
    Alabama, Florida, Georgia
Boston, MA 617-424-0501
    Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, 
Vermont, Upstate New York
Charlotte, NC 704-344-6144
    Kentucky, North Carolina, South Carolina, Tennessee, Virginia
Chicago, IL 708-562-1740
    Illinois, Indiana, Wisconsin
Dallas, TX 214-767-7105
    Louisiana, Mississippi, Texas
Denver, CO 303-969-7750
    Arizona, Colorado, Nebraska, New Mexico, North Dakota, South 
Dakota, Utah, Wyoming
Detroit, MI 313-259-0056
    Michigan, Ohio, West Virginia
Kansas City, KS 913-551-6711
    Arkansas, Iowa, Kansas, Missouri, New Mexico, Oklahoma
Los Angeles, CA 818-904-6339
    California
Philadelphia , PA 215-597-8313
    Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania
Seattle, WA 206-728-5314
    Idaho, Montana, Nevada, Oregon, Washington

[FR Doc. 97-10435 Filed 4-22-97; 8:45 am]
BILLING CODE 4160-15-P