[Federal Register Volume 62, Number 138 (Friday, July 18, 1997)]
[Notices]
[Pages 38541-38545]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-18948]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Program Announcement Number 781]
Cooperative Agreement To Provide Information Concerning the
Diagnosis, Prevention and Treatment of Viral Hepatitis-Related Liver
Disease
Introduction
The Centers for Disease Control and Prevention (CDC) announces the
availability of funds beginning in fiscal year (FY) 1997 for a
cooperative agreement program with one or more national organizations
to develop and distribute materials to educate the general public,
affected patients, risk groups, physicians, and other health care
providers about the prevention, diagnosis and medical management of
acute and chronic liver disease due to all types of viral hepatitis,
with initial emphasis on hepatitis C.
CDC is committed to achieving the health promotion and disease
prevention objectives of ``Healthy People 2000,'' a national activity
to reduce morbidity and mortality and improve the quality of life. This
announcement is related to the priority area of Immunization and
Infectious Diseases. (To order a copy of Healthy People 2000, see WHERE
TO OBTAIN ADDITIONAL INFORMATION.)
Authority
This program is authorized under sections 301 (42 U.S.C. 241) and
317(k)(2) (42 U.S.C. 247b(k)(2)) of the Public Health Service Act, as
amended.
Smoke-Free Workplace
CDC strongly encourages all grant recipients to provide a smoke-
free workplace and promote the nonuse 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.
Eligible Applicants
Eligible applicants are limited to national nonprofit organizations
which devote a major portion of their activities to educating the
public, patients, and health care providers about the diagnosis,
prevention, and medical management of viral hepatitis-related liver
disease. Eligible applicants must also have established collaboration
with diverse national organizations and groups that represent health
care professionals, minority populations, volunteers, consumers,
patients, community organizations, groups at risk of infection with
hepatitis viruses, government entities, and others.
Organizations that meet these eligibility requirements are the most
appropriate applicants because:
1. They have the expertise and experience needed to produce
effective health education materials and messages and develop
strategies to maximize health care professionals and public awareness
and education about the risk factors, preventive measures, and
treatment options for viral hepatitis, including hepatitis C.
2. They have demonstrated interest in providing accurate, pertinent
information on viral hepatitis-related liver disease to the public,
populations at risk of infection, patients, and health care
professionals.
3. They have the ability to collaborate with health professional
schools (medical, dental, public health, nursing, allied health),
medical and health professional societies, blood banks, health care
facilities, community organizations, at-risk populations, and local,
State, and Federal government agencies to increase awareness of how
viral hepatitis, in general, and hepatitis C virus (HCV) infections
specifically, can be identified, treated, and prevented.
4. They can conduct formative research, pilot test potential
messages and materials, and evaluate their effectiveness in increasing
knowledge and motivating behavior change.
Availability of Funds
Approximately $250,000 is available in FY 1997 to fund up to two
cooperative agreements. It is expected that the awards will begin on or
about September 1, 1997, for a 12-month budget period within a project
period of up to three years. Continuation awards within the project
period will be made on the basis of satisfactory progress and the
availability of funds. Funding estimates may vary and are subject to
change.
[[Page 38542]]
Use of Funds
Restrictions on Lobbying
Applicants should be aware of restrictions on the use of Department
of Health and Human Services (HHS) funds for lobbying of Federal or
State legislative bodies. Under the provisions of 31 U.S.C. Section
1352 (which has been in effect since December 23, 1989), recipients
(and their subtier contractors) are prohibited from using appropriated
Federal funds (other than profits from a Federal contract) for lobbying
Congress or any Federal agency in connection with the award of a
particular contract, grant, cooperative agreement, or loan. This
includes grants/cooperative agreements that, in whole or in part,
involve conferences for which Federal funds cannot be used directly or
indirectly to encourage participants to lobby or to instruct
participants on how to lobby.
In addition, the FY 1997 Departments of Labor, HHS, and Education,
and Related Agencies Appropriations Act, which became effective October
1, 1996, expressly prohibits the use of 1997 appropriated funds for
indirect or ``grass roots'' lobbying efforts that are designed to
support or defeat legislation pending before State legislatures.
Section 503 of this new law, as enacted by the Omnibus Consolidated
Appropriations Act, 1997, Division A, Title I, Section 101(e), Pub. L.
No. 104-208 (September 30, 1966), provides as follows:
Sec. 503(a) No part of any appropriation contained in this Act
shall be used, other than for normal and recognized executive-
legislative relationships, for publicity or propaganda purposes, for
the preparation, distribution, or use of any kit, pamphlet, booklet,
publication, radio, television, or video presentation designed to
support or defeat legislation pending before the Congress, * * *
except in presentation to the Congress or any State legislative body
itself.
(b) No part of any appropriation contained in this Act shall be
used to pay the salary or expenses of any grant or contract
recipient, or agent acting for such recipient, related to any
activity designed to influence legislation or appropriations pending
before the Congress or any State legislature.
Background
Hepatitis C virus (HCV) is an important cause of acute and chronic
hepatitis in the United States. The CDC estimates 30,000 persons were
infected with HCV in 1995, with most infections occurring among young
adults with high-risk behaviors or lifestyles. The most efficient mode
of transmission of HCV is through direct percutaneous exposures, such
as from sharing of contaminated needles among injection drug users or
from blood transfusion. Exposures associated with acquiring HCV
infection include blood transfusion prior to 1990, receipt of clotting
factor concentrates that were not virally inactivated, injection drug
use, snorting cocaine, hemodialysis, health care work involving
frequent exposure to blood (in particular, accidental needle sticks),
sexual contact with a partner infected with HCV, multiple sex partners
(heterosexual or homosexual), and birth to a HCV-infected woman.
Currently, most HCV infections are acquired by high-risk drug use (60
percent) and sexual behaviors (20 percent). There is no evidence that
transmission of HCV is associated with commercial use of equipment for
tattooing, body piercing, hair cutting (razors), or manicures.
The most important feature of hepatitis C is the high rate of
progression to chronic infection, even in the absence of active liver
disease. About 70 percent of HCV infected persons develop chronic
hepatitis that can progress to cirrhosis and hepatocellular carcinoma,
with an estimated 8-10,000 HCV-related chronic liver disease deaths
each year. A national survey conducted in the U.S. from 1988 to 1994
found that 1.8 percent of a representative sample of the civilian
population had antibody to HCV, corresponding to 3.9 million HCV-
infected Americans. Infection rates were higher in males than in
females, and higher in African Americans than in Caucasians. The
highest rates of HCV infection were found in adults aged 30-49 years.
Because of the large degree of confusion and lack of accurate
information about hepatitis C, educational materials are necessary for
both health care providers and the general public about the risks of
acquiring HCV infection, indications for serological testing and other
diagnostic methods, treatment issues, and means to prevent the spread
of infection. Prevention strategies to identify, treat and counsel
persons with chronic infection and measures to reduce transmission in
high-risk groups are needed. For health care providers, these should
include information on identifying patients with a history of high-risk
exposures, interpretation of diagnostic test results, discussion of
treatment options, guidelines for counseling patients, and the
importance of appropriate disease reporting.
Hepatitis A virus (HAV) infection is a major cause of acute
hepatitis in the United States (U.S.). At least 150,000 persons are
newly infected each year with 75,000 developing clinical illness
associated with substantial morbidity and medical and work-loss costs.
Up to 20 percent of persons with hepatitis A are hospitalized with an
average 27 days of work loss. Direct and indirect costs were estimated
to be more than $200 million in 1991. Most cases of hepatitis A occur
by person-to-person transmission in community-wide outbreaks. The
highest rates of disease occur in children, adolescents and young
adults, and among American Indians/Alaska Natives and Hispanics.
Children may be the major reservoir for transmission of HAV; nearly 30
percent of reported cases occur among children less than 15 years of
age, and many more children probably have unrecognized or asymptomatic
infection that is not recognized until transmission to older household
contacts occurs.
Hepatitis A vaccines are licensed for persons over two years of
age, with virtually 100 percent of children, adolescents, and adults
developing protective levels of antibody after the vaccine series.
While the most effective means of achieving control of HAV infection
would be to include routine hepatitis A vaccination in the childhood
vaccination schedule, the vaccine is not licensed, as yet, for children
under two years of age. Current recommendations are for pre-exposure
vaccination of groups at increased risk for HAV infection (e.g.,
persons traveling to countries with high rates of HAV infection, men
who have sex with men, drug users) and routine vaccination of children
and adults in communities with high or intermediate rates of HAV
infection.
Acute and chronic hepatitis B virus (HBV) infections are a major
cause of morbidity and mortality in the United States, consuming a
large amount of health care resources. Approximately 60,000 new
infections with HBV continue to occur each year in spite of the
availability of an effective vaccine. The existing pool of 1.25 million
persons with chronic HBV infection are potentially infectious to others
and are at risk of long-term sequelae that include chronic active
hepatitis, cirrhosis and primary hepatocellular carcinoma.
Approximately 6,000 deaths occur annually from HBV-related chronic
liver disease. Antiviral therapy is moderately effective in eliminating
chronic HBV infection. However, most chronically infected persons are
not being identified, counseled, or treated. Patients with chronic HBV
infection need to be counseled about treatment options and health care
interventions that can be used to prevent HBV transmission to others.
The most effective means of preventing new HBV infections and HBV-
related acute and chronic liver
[[Page 38543]]
disease is by immunizing susceptible persons with hepatitis B vaccine.
A comprehensive strategy to eliminate HBV transmission in the U.S. has
been developed and includes prevention of perinatal HBV infection,
routine vaccination of infants, catch-up vaccination of young children
at high risk of HBV infection, routine vaccination of adolescents, and
vaccination of adolescents or adults at high risk of infection.
Currently, routine maternal screening to prevent perinatal HBV
infection and routine vaccination of infants and adolescents have been
widely implemented throughout the U.S. However, high levels of
vaccination coverage have not been achieved for childhood populations
at high risk of infection and for adults and adolescents in groups at
high risk of infection.
Purpose
The purpose of this cooperative agreement program is to assist
national organizations in fulfilling their goals of developing and
disseminating accurate information on viral hepatitis to target
audiences that include health care providers, at-risk populations,
patients, and the general public. Specifically, the objectives are to:
(1) improve health care provider knowledge about the diagnosis,
prevention, health consequences, and medical management of viral
hepatitis (with initial emphasis on hepatitis C), and (2) improve
community, risk group, and patient awareness of the importance of and
the means for the prevention of viral hepatitis (with initial emphasis
on hepatitis C) by collecting, developing, and disseminating
information and educational materials.
Program Requirements
In conducting activities to achieve the purpose of this program,
the recipient will be responsible for the activities described under A.
below, and CDC will be responsible for the activities described under
B. below:
A. Recipient Activities
1. Review existing available educational information on the
diagnosis, prevention, health consequences, and medical management of
viral hepatitis. Such materials may be available from the recipient and
others (e.g., nonprofit organizations, pharmaceutical and vaccine
manufacturers, provider organizations, Federal and State governments,
etc.). Determine gaps and in information and efforts to effectively
reach groups targeted by these available materials. For example, review
the materials for accuracy, completeness, and appropriateness for
target audiences which include various professional groups (i.e.,
physician, nursing, dental), at-risk groups, and racial/ethnic groups
with high rates of the various types of viral hepatitis.
2. Develop and evaluate new educational materials that will fill
identified gaps through collaboration with organizations and groups
that represent the target audiences. Use formative research to develop
various types of health education materials (e.g., fact sheets,
brochures, pamphlets, videos, public service announcements, letters to
the editor, posters, articles for the lay press) that will fill the
identified gaps in health education materials needed for the various
disease-specific target audiences. Such materials should target both
the general public and at-risk populations. Messages for at-risk groups
should be appropriate for the specific diseases (HAV, HBV, HCV) and
risk groups should include men who have sex with men and injection drug
users where appropriate. Evaluation of the effectiveness of newly
developed materials should employ methods such as:
a. Focus groups and/or intercept interviews with the public and
specific at-risk populations to determine acceptance and clarity of
messages.
b. Pilot testing messages with representative audiences for appeal,
effectiveness in increasing knowledge, and motivating behavior change.
3. Evaluate various methods used to disseminate health education
materials/messages to determine the most effective methods for the
target audiences.
4. Disseminate existing and newly developed materials to target
audiences which include individuals at risk for or infected with HCV,
health care providers, and the general public. Recipient may network
with other organizations or groups (professional, voluntary,
governmental, community-based) that represent minority populations with
high rates of viral hepatitis or groups/populations at high risk of
specific types of viral hepatitis, e.g., National Institute for Drug
Abuse (NIDA), American Social Health Association (ASHA).
B. CDC Activities
1. Provide scientific and public health consultation and assistance
in the development of materials and activities related to the
cooperative agreement.
2. Provide scientific collaboration for appropriate aspects of the
activities, including information on disease impact, vaccination
coverage levels, and prevention strategies.
3. Assist in reporting and validating relevant information
concerning viral hepatitis made available to Federal, State, local
health agencies, health care providers, and volunteer organizations.
Technical Reporting Requirements
Narrative progress reports are required semiannually. The first
semiannual report is required with each year's noncompeting
continuation application and should cover program activities from date
of the previous report (or date of award for reporting in the first
year of the project). The second semiannual report is due 90 days after
the end of each budget period and should cover activities from the date
of previous report. Progress reports should address the status of all
recipient activities above, including: (1) A comparison of actual
accomplishments to the objectives established for the funding period;
(2) The reasons for failing to meet any established objectives; (3)
Description and explanation of any modifications of program activities
and protocols; and (4) Other pertinent information such as key staffing
changes or reasons for unexpectedly high or low costs for performance.
An original and two copies of a financial status report are
required no later than 90 days after the end of each budget period. A
final performance report and financial status report are due no later
than 90 days after the end of the project period.
All reports are submitted to the Grants Management Branch, Centers
for Disease Control and Prevention (CDC), Attention: Sharron P. Orum,
Grants Management Officer, Procurement and Grants Office, 255 East
Paces Ferry Road, NE., Mailstop E-18, Room 300, Atlanta, Georgia 30305.
Application Content
All applicants must develop their applications in accordance with
PHS Form 5161-1 (OMB Number 0937-0189) information contained in this
Program Announcement, and the instructions regarding typing, mailing,
and format outlined below.
Typing and Mailing
An original and two copies of the application must be submitted.
Pages must be clearly numbered, and a complete index to the application
and its appendixes must be included. Please begin each separate section
on a new page. The original and each copy of the application must be
submitted unstapled and unbound. All materials must be typewritten,
single-spaced, with unreduced type on 8-\1/2\'' by 11'' paper,
[[Page 38544]]
with at least 1'' margins headers and footers, and printed on one side
only. The application narrative must not exceed 10 single-spaced pages
(excluding budget and appendices). Unless indicated otherwise, all
information requested below must appear in the narrative. Materials or
information that should be part of the narrative will not be accepted
if placed in the appendices.
Format
The application narrative must contain the following sections in
the order presented below:
1. Introduction
Clearly demonstrate that applicant satisfies the eligibility
requirements under Eligible Applicants section above. Briefly provide a
thorough description of the need or problem(s) to be addressed and the
specific and unique contributions that applicant can make in the
development and dissemination of health education materials about viral
hepatitis with initial emphasis on hepatitis C.
2. Capacity and Personnel
Describe applicant's ability to develop health education materials
and to conduct education and awareness campaigns for specific
audiences, including populations at risk for specific types of viral
hepatitis. Describe applicant's resources, facilities, and professional
personnel that will be involved in conducting the activities. Include
in an appendix curriculum vitae for all professional personnel involved
with the project. Describe plans for administration of the project and
identify administrative resources/personnel that will be assigned to
the project. Provide in an appendix letters of support from all key
participating non-applicant organizations which clearly indicate their
commitment to participate as described in the operational plan.
3. Objectives and Technical Approach
Present specific objectives for the proposed project which are
measurable, time-phased, and clearly address the Purpose and Recipient
Activities for this program. Present a detailed operational plan for
initiating and conducting the project which clearly and adequately
addresses these objectives (if proposing a multi-year project, provide
a detailed description of first-year activities and a brief overview of
subsequent-year activities). Clearly identify specific assigned
responsibilities for all key professional personnel and their time
commitment. Include a clear description of applicant's technical
approach/methods which are directly relevant to the above objectives.
Describe the nature and extent of collaboration with CDC and others
during various phases of the project. Describe in detail a plan for
evaluating the effectiveness of newly developed educational materials
in increasing target audience knowledge and facilitating changes in
their behavior, including assessing the impact of strategies on
professional practice behaviors. Describe plans to evaluate overall
progress toward achieving project objectives.
4. Budget
Provide a line-item budget and accompanying detailed, line-by-line
justification that demonstrates the request is consistent with the
purpose and objectives of this program. If requesting funds for any
contracts, provide the following information for each proposed
contract: (1) Name of proposed contractor, (2) breakdown and
justification for estimated costs, (3) description and scope of
activities to be performed by contractor, (4) period of performance,
and (5) method of contractor selection (e.g., sole-source or
competitive solicitation).
5. Human Subjects
Whether or not exempt from DHHS regulations, if the proposed
project involves human subjects, describe (in an appendix) adequate
procedures for the protection of human subjects. Ensure that women,
racial, and ethnic minority populations are appropriately represented
in applications for research involving human subjects (see the section
OTHER REQUIREMENTS for additional information). A copy of CDC policy is
included in the application kit.
Evaluation Criteria (Total 100 points)
Applications will be reviewed and evaluated according to the
following criteria:
1. Understanding (25 points)
Extent to which the application responds to the objectives of this
cooperative agreement program including: (a) Applicant's understanding
of the objectives of the cooperative agreement, and (b) relevance of
the applicant's plan to the stated objectives.
2. Capacity (25 points)
Extent to which applicant describes adequate resources and
facilities (both technical and administrative) for conducting the
project. Extent to which applicant documents that professional
personnel involved in the project are qualified and have past
experience and achievements related to the proposed activities. Extent
to which applicant includes letters of support from appropriate non-
applicant organizations, individuals, etc., needed to carry out
proposed activities and the extent to which such letters clearly
indicate the author's commitment to participate as described in the
operational plan.
3. Objectives and Technical Approach (45 points total)
a. Extent to which applicant describes objectives of the proposed
project which are consistent with the purpose of this cooperative
agreement program and which are measurable and time-phased. (15 points)
b. Extent to which applicant presents a detailed operational plan
for initiating and conducting the project which clearly and
appropriately addresses all Recipient Activities. Extent to which
applicant clearly identifies specific assigned responsibilities and
time commitment of all key professional personnel. Extent to which the
plan clearly describes applicant's technical approach/methods for
conducting the proposed studies and extent to which the approach/
methods are appropriate and adequate to accomplish the objectives.
Extent to which applicant describes collaboration with CDC and/or
others during various phases of the project. (15 points)
c. Extent to which applicant provides a detailed and adequate plan
for evaluating effectiveness of newly developed educational materials
in increasing target audience knowledge and facilitating changes in
their behavior, including assessing the impact of strategies on
professional practice behaviors. Extent to which applicant describes
plans to evaluate progress toward achieving project objectives. (15
points)
4. Budget (not Scored)
Extent to which the proposed budget is reasonable, clearly
justifiable, and consistent with the intended use of grant/cooperative
agreement funds.
5. Human Subjects (5 Points)
If the proposed project involves human subjects, whether or not
exempt from the Department of Health and Human Services (DHHS)
regulations, the extent to which adequate procedures are described for
the protection of human subjects. Note: Objective Review Group (ORG)
recommendations on the adequacy of protections include: (1) Protections
appear adequate and there are no comments to make or concerns to raise,
(2) protections appear adequate,
[[Page 38545]]
but there are comments regarding the protocol, (3) protections appear
inadequate and the ORG has concerns related to human subjects, (4)
disapproval of the application is recommended because the research
risks are sufficiently serious and protection against the risks are
inadequate as to make the entire application unacceptable, and (5)
protections appear adequate that women, racial and ethnic minority
populations are appropriately represented in applications involving
human research.
Executive Order 12372 Review
This program is not subject to the Executive Order 12372 review.
Public Health System Reporting Requirement
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 92.283.
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.
Human Subjects
If the proposed project involves research on human subjects, the
applicant must comply with the Department of Health and Human Services
Regulations, 45 CFR part 46, regarding the protection of human
subjects. Assurance must be provided to demonstrate that the project
will be subject to initial and continuing review by an appropriate
institutional review committee. The applicant will be responsible for
providing assurance in accordance with the appropriate guidelines and
form provided in the application kit. Should human subjects review be
required, the proposed work plan should incorporate time lines for such
development and review activities.
Women, Racial and Ethnic Minorities
It is the policy of the Centers for Disease Control and Prevention
(CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR)
to ensure that individuals of both sexes and the various racial and
ethnic groups will be included in CDC/ATSDR-supported research projects
involving human subjects, whenever feasible and appropriate. Racial and
ethnic groups are those defined in OMB Directive NO. 15 and include
American Indian, Alaskan Native, Asian, Pacific Islander, Black and
Hispanic. Applicants shall ensure that women, racial and ethnic
minority populations are appropriately represented in applications for
research involving human subjects. Where clear and compelling rationale
exist that inclusion is inappropriate or not feasible, this situation
must be explained as part of the application. This policy does not
apply to research studies when the investigator cannot control the
race, ethnicity and/or sex of subjects. Further guidance to this policy
is contained in the Federal Register, Vol. 60, No. 179, pages 47947-
47951, dated Friday, September 15, 1995.
Application Submission and Deadline
The original and two copies of the application Form PHS-5161-1 (OMB
Number 0937-0189) must be submitted to Sharron P. Orum, Grants
Management Officer, Grants Management Branch, Procurement and Grants
Office, Centers for Disease Control and Prevention (CDC), 255 East
Paces Ferry Road, NE., Room 305, Mailstop E-18, Atlanta, Georgia 30305,
on or before August 19, 1997.
Deadline: Applications shall be considered as meeting the deadline
if they are either:
(a) Received on or before the deadline date; or
(b) Sent on or before the deadline date and received in time for
submission to the objective review group. (Applicants must 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: Applications which do not meet the criteria in
(a) or (b) above are considered late applications. Late applications
will not be considered and will be returned to the applicant.
Where to Obtain Additional Information
A complete program description and information on application
procedures are contained in the application package. Business
management technical assistance may be obtained from Bernice A. Moore,
Grants Management Specialist, Grants Management Branch, Procurement and
Grants Office, Centers for Disease Control and Prevention (CDC), 255
East Paces Ferry Road, NE., Room 305 Mailstop E-18, Atlanta, Georgia
30305, telephone (404) 842-6802, fax (404) 842-6513, or Internet or CDC
WONDER electronic mail at [email protected].
Programmatic technical assistance may be obtained from Louise S.
Barden, Health Educator, Hepatitis Branch, National Center for
Infectious Diseases, Centers for Disease Control and Prevention (CDC),
1600 Clifton Road, Mailstop G-37, Atlanta, Georgia 30333, telephone
(404) 639-2709, (fax) 404-639-1538, or Internet or CDC Wonder
electronic mail [email protected].
To receive an application kit, please call (404) 332-4561. You will
be asked to leave your name, mailing address, and telephone number.
Please reference Announcement Number 781 when requesting information
and submitting your application. You may also obtain this announcement
and other CDC announcements from one of two Internet sites: CDC's
homepage at http://www.cdc.gov or the Government Printing Office
homepage (including free on-line access to the Federal Register at
http://www.access.gpo.gov).
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) 512-1800.
Dated: July 14, 1997.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
[FR Doc. 97-18948 Filed 7-17-97; 8:45 am]
BILLING CODE 4163-18-P