[Federal Register Volume 69, Number 84 (Friday, April 30, 2004)]
[Notices]
[Pages 23763-23768]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-9809]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention


Prevention Epicenter Program

    Announcement Type: Competitive Supplemental.
    Funding Opportunity Number: 04100.
    Catalog of Federal Domestic Assistance Number: 93.283.
    Key Dates: Application Deadline: June 14, 2004.
    Executive Summary: This announcement encompasses two distinct 
projects.
    (1) Microbiology laboratory errors. Errors in the laboratory can 
occur during the pre-analytical, analytical, and post analytical phases 
of specimen management. Most studies on laboratory errors focus on the 
analytical (testing) phase; however, preliminary data from a pilot 
study conducted by CDC suggests that there are a significant numbers of 
errors that occur with antimicrobial susceptibility testing results in 
the post analytical reporting phase. This program focuses on assessing 
the impact of both testing and reporting errors on patient management 
and outcomes.
    (2) C. difficile associated disease. C. difficile associated 
disease (CDAD) is an important, yet under recognized, public health 
problem that results in significant patient morbidity and

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increased healthcare costs. Recent estimates of the scope and magnitude 
of CDAD suggest its incidence among acute care hospital patients, 
results in over 500 million dollars in excess healthcare costs 
annually. Moreover, various data sources suggest its incidence is 
increasing. It is hypothesized that changing antimicrobial use patterns 
and resistance may be contributing to this increasing incidence. In 
addition, programs that include new methods of infection control (such 
as novel methods of environmental disinfection, novel strain typing 
methods and hand washing using alcohol-base products) as well as 
improved laboratory detection and reporting methods may be impacting 
the incidence of CDAD.

I. Funding Opportunity Description

    Authority: Section 317(k)(2) of the Public Health Service Act 
[42 U.S.C. 247b(k)(2)], as amended.

    Purpose: The purpose of these supplemental awards is twofold: (1) 
To determine the number and types of laboratory errors associated with 
identification and antimicrobial susceptibility testing of bacteria 
isolated from cultures of blood and sterile body sites of hospitalized 
patients; and (2) to determine if recently introduced antimicrobial 
agents and infection control practices are impacting rates of C. 
difficile-associated disease and whether antimicrobial resistance could 
be emerging. This program addresses the ``Healthy People 2010'' focus 
area of Immunization and Infectious Diseases.
    Measurable outcomes of the program will be in alignment with one or 
more of the following performance goal(s) for the National Center for 
Infectious Diseases: Protect Americans from infectious diseases, Reduce 
the spread of antimicrobial resistance, and Protect Americans from 
death and serious harm caused by medical errors and preventable 
complications of healthcare.
    Research Objectives: (1) Microbiology laboratory errors. Errors in 
the laboratory can occur during the pre-analytical, analytical, and 
post analytical phases of specimen management. Most studies on 
laboratory errors focus on the analytical (testing) phase; however, 
preliminary data from a pilot study conducted by CDC on laboratory 
reports concerning bacterial pathogens causing bloodstream infections 
suggest that there are a significant numbers of errors that occur with 
antimicrobial susceptibility testing results in the post analytical 
reporting phase. This program focuses on assessing the impact of both 
testing and reporting errors on patient management and outcomes.
    The knowledge gained through this research will help define what 
interventions need to be made in laboratories to improve the accuracy 
and utility of antimicrobial susceptibility tests reports (such as 
cascading of results) to reduce errors and improve patient outcomes. 
The objectives of this program are to:
     Determine the number and types of microbiology 
laboratory errors associated with processing cultures from blood and 
sterile body sites (such as cerebrospinal fluid (CSF)) of hospitalized 
patients;
     Determine the accuracy of bacterial 
identifications by participating laboratories;
     Determine the accuracy of the antimicrobial 
susceptibility patterns of the bacteria recovered from the blood and 
sterile body sites; and
     Determine the accuracy and appropriateness of 
the reports issued to the patients' charts, along with the outcomes of 
the patients for which errors are noted.
    One possible study design would be to identify a series of positive 
blood and body fluid cultures, to include both Gram-positive and Gram-
negative pathogens, and to track the flow of information from the 
laboratory to the patients' chart, while concomitantly sending the 
isolates and a copy of the microbiology results to a reference 
laboratory for confirmation. The appropriateness of the antimicrobial 
agents tested and reported, given the identification of the organism to 
genus and species level, is critical. Thus, attention should be paid to 
reporting of results for inappropriate antimicrobial agents (e.g., 
nitrofurantoin for blood cultures), or reporting results for fourth 
generation cephalosporins or carbapenems, for organism that are 
susceptible to first generation cephalosporins.
    (2) C. difficile associated disease. (CDAD) According to national 
data from hospital discharges, CDAD rates are increasing and CDAD is 
now responsible for substantial patient morbidity and excess healthcare 
costs. Because antimicrobial agents are a major risk factor for CDAD, 
it is unknown whether the introduction and widespread use of certain 
newer antimicrobials, especially those with anti-anaerobic activity, 
may lead to increased rates of CDAD. In addition, certain infection 
control practices, such as the use of alcohol gels for hand hygiene, 
also may contribute to increasing rates of CDAD, whereas hospitals that 
use bleach as a disinfectant for environmental surfaces may have better 
controlled rates of CDAD. A rationale for introducing new antimicrobial 
use guidelines and/or infection control policies will require knowing 
the excess costs associated with CDAD and cost effectiveness of 
prevention strategies. Finally, it is unknown whether the pathogen C. 
difficile itself may be developing resistance to the antimicrobial 
agents commonly used to treat CDAD (i.e. metronidazole and vancomycin).
    The scientific knowledge to be achieved through this project 
includes addressing each of the above questions and information gaps 
regarding the contemporary epidemiology of CDAD in U.S. hospitals. To 
this end, objectives for this project include the following:
     Identify current antimicrobial agents that may 
be risk factors for CDAD in several U.S. healthcare facilities.
     Determine the antimicrobial susceptibility of at 
least 100 recent isolates of Clostridium difficile.
     Determine whether infection control practices, 
including hand hygiene with alcohol gel (vs. soap and water) and 
environmental cleaning with bleach, are risk or protective factors for 
CDAD.
     Determine the excess healthcare costs of CDAD.
    The types of research and experimental approaches to be considered 
in answering these questions and achieving the objectives include: 
Case-control and/or cohort studies to determine risk factors for CDAD 
and the attributable costs of CDAD; isolation of C. difficile from the 
stool of CDAD patients followed by identification and susceptibility 
testing of isolates; and environmental and hand sampling for C. 
difficile and/or intervention studies to determine the impact of 
different infection control strategies on either surface contamination 
or incidence of CDAD.
    Depending on current capabilities and needs, recipients may request 
support under this supplement for one or both of the following 
projects:
     Microbiology Errors Associated with Processing 
Blood and Sterile Body Site Cultures.
     The Impact of New Forms of Antimicrobial Use, 
Resistance, Laboratory Methods, and Infection Control Practices on the 
Incidence of Clostridium difficile and Associated Patient Morbidity and 
Healthcare Costs.
    Activities: Awardee activities for this program are as follows:

[[Page 23765]]

Microbiology Errors Associated With Processing Blood and Sterile Body 
Site Cultures
     Determine the number and types of microbiology 
laboratory errors associated with processing cultures from the blood 
and sterile body sites (such as CSF) of hospitalized patients.
     Identify the bacteria isolated.
     Identify the accuracy of the antimicrobial 
susceptibility patterns of the bacteria.
     Determine the accuracy of the reports issued to 
the patients' charts. Patients' charts should be reviewed and assessed, 
along with the outcomes of the patients for which errors are noted.
     Identify at least 10 microbiology laboratories 
in different healthcare institutions that can serve as study sites. 
Identify a central reference laboratory for confirmation of the 
identification and antimicrobial susceptibility pattern of the isolates 
(this could include the Division of Healthcare Quality Promotion (DHQP) 
reference laboratories at CDC).
     Prospectively collect at least 10 bacterial 
isolates from each study site (at least 5 gram-positive and 5 gram-
negative organisms) for which routine antimicrobial susceptibility 
tests are typically performed (excludes organisms such as Neisseria 
meningitidis, Group B streptococci, or Haemophilus influenzae). Send 
organisms, along with a copy of the organism's identification and 
antimicrobial susceptibility test report when completed by the study 
site laboratory, to the central laboratory for testing.
     Assess whether the appropriate cultures were 
collected for the suspected infection (i.e., the appropriate number and 
timing of blood cultures, appropriate CSF tubes delivered to 
microbiology laboratory within the designated time period established 
by the laboratory).
     Assess whether the report of culture results and 
antimicrobial susceptibility test results on the patients' charts were 
accurate and appropriate (e.g., no reports of antimicrobial agents that 
are used for urinary tract infections for bacteria from cerebrospinal 
fluid).
     Assess clinician's response to laboratory data 
(i.e., changes in antimicrobial chemotherapy based on susceptibility 
test results).
     Assess adverse patient outcomes based on 
inaccurate or inappropriate reporting of culture and susceptibility 
results.
     Develop an educational program for reducing the 
laboratory errors associated with testing and reporting results for 
bacteria isolates from blood and sterile body fluids.
The Impact of New Forms of Antimicrobial Use, Resistance, Laboratory 
Methods, and Infection Control Practices on the Incidence of 
Clostridium difficile and Associated Patient Morbidity and Healthcare 
Costs
     Determine if recently introduced antimicrobial 
agents (such as fluoroquinolones) or new modes of antimicrobial use 
(such as clindamycin for community-associated Staphylococcus aureus 
infections) constitute risk factors for C. difficile associated disease 
(CDAD).
     Determine whether there is emerging resistance 
to the drugs of choice (i.e., vancomycin and metronidazole) in C. 
difficile that could impede effective treatment.
     Determine if new infection control measures 
(such as hand washing with alcohol-based products or new disinfectants) 
may impact the incidence of CDAD (e.g., risk factors for infection).
     Determine the impact of new laboratory methods 
(such as the use of assays that detect both toxin A and toxin B), 
efforts to reduce turnaround time of assay or culture results, or 
improved reporting methods, impact the incidence of CDAD.
     Determine the patient morbidity and healthcare 
costs associated with the excess or reduced number of cases of CDAD 
resulting from any or all of these factors.
    In a cooperative agreement, CDC staff is substantially involved in 
the program activities, above and beyond routine grant monitoring.
    CDC Activities for the two projects are as follows:
     Collaborate with the recipient in all stages of 
the program, and provide programmatic and technical assistance.
     Collaborate with the recipient in all aspects of 
the science.
     Participate in the dissemination of findings and 
information stemming from the project.
     Participate in improving program performance 
through consultation with recipient.
     Facilitate communication of data and results 
among stakeholders.
     Assist in the development of research protocols 
for IRB review by all cooperating institutions participating in the 
research project. The CDC IRB will review and approve the protocol 
initially and on at least an annual basis until the research project is 
completed.

II. Award Information

    Type of Award: Cooperative Agreement.
    CDC involvement in this program is listed in the Activities Section 
above.
    Fiscal Year Funds: 2004.
    Approximate Total Funding: $634,000.
    Approximate Number of Awards: Four (two per project).
    Approximate Average Award: $158,500 (This amount is for the first 
12-month budget period, and includes both direct and indirect costs).
    Floor of Award Range: $157,000.
    Ceiling of Award Range: $160,000.
    Anticipated Award Date: August 16, 2004.
    Budget Period Length: 12 months.
    Project Period Length: Two years.
    Throughout the project period, CDC's commitment to continuation of 
awards will be conditioned on the availability of funds, evidence of 
satisfactory progress by the recipient (as documented in required 
reports), and the determination that continued funding is in the best 
interest of the Federal Government.

III. Eligibility Information

III.1. Eligible Applicants

    Eligibility is limited to the seven current Prevention Epicenter 
Program grantees. They are: Harvard Pilgrim Health Care, Washington 
University, Northwestern University, University of Iowa, McGuire 
Research Institute, Memorial Sloan-Kettering Institute for Cancer 
Research, and Johns Hopkins University. No other applications are 
solicited.
    Eligibility is limited to the Prevention Epicenters in order to 
maximize the use of available funds by building on existing 
infrastructure for evaluating healthcare-associated infections and 
adverse events and utilizing highly demonstrated expertise in infection 
control procedures and practices. The proposed supplemental projects 
will complement activities associated with the established Prevention 
Epicenter Program, which includes projects designed to develop, 
implement, and evaluate the effectiveness of epidemiologically-based 
strategies to improve healthcare quality and assure patient safety.

III.2. Cost Sharing or Matching

    Matching funds are not required for this program.

III.3. Other

    CDC will accept and review applications with budgets greater than 
the ceiling of the award range.
    If your application is incomplete or non-responsive to the 
requirements listed in this section, it will not be

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entered into the review process. You will be notified that your 
application did not meet submission requirements.
    This program is designed and intended to support research, 
therefore only research will be supported under this cooperative 
agreement. Any applications proposing anything other than research will 
be considered non-responsive.
    Individuals Eligible to Become Principal Investigators: Any 
individual with the skills, knowledge, and resources necessary to carry 
out the proposed research is invited to work with their institution to 
develop an application for support. Individuals from underrepresented 
racial and ethnic groups as well as individuals with disabilities are 
always encouraged to apply for CDC programs.


    Note: Title 2 of the United States Code section 1611 states that 
an organization described in section 501(c)(4) of the Internal 
Revenue Code that engages in lobbying activities is not eligible to 
receive Federal funds constituting an award, grant, or loan.

IV. Application and Submission Information

IV.1. Address To Request Application Package

    To apply for this funding opportunity, use application form PHS 398 
(OMB number 0925-0001 rev. 5/2001). Forms and instructions are 
available in an interactive format on the CDC web site, at the 
following Internet address: http://www.cdc.gov/od/pgo/forminfo.htm.
    Forms and instructions are also available in an interactive format 
on the National Institutes of Health (NIH) web site at the following 
Internet address: http://grants.nih.gov/grants/funding/phs398/phs398.html.
    If you do not have access to the Internet, or if you have 
difficulty accessing the forms on-line, you may contact the CDC 
Procurement and Grants Office Technical Information Management Section 
(PGO-TIM) staff at: 770-488-2700. Application forms can be mailed to 
you.

IV.2. Content and Form of Application Submission

    Application: Follow the PHS 398 application instructions for 
content and formatting of your application. For further assistance with 
the PHS 398 application form, contact PGO-TIM staff at 770-488-2700, or 
contact GrantsInfo, Telephone (301) 435-0714, E-mail: 
[email protected].
    Your research plan should address activities to be conducted over 
the entire project period (through 1/31/2006).
    Submit one application that includes one or both of the proposed 
projects. Each project should be clearly identified in the application. 
Provide a line-item budget and narrative justification for all 
requested costs, and separate line-item budgets for each proposal 
submitted.
    You are required to have a Dun and Bradstreet Data Universal 
Numbering System (DUNS) number to apply for a grant or cooperative 
agreement from the Federal government. Your DUNS number must be entered 
on line 11 of the face page of the PHS 398 application form. The DUNS 
number is a nine-digit identification number, which uniquely identifies 
business entities. Obtaining a DUNS number is easy and there is no 
charge. To obtain a DUNS number, access http://www.dunandbradstreet.com 
or call 1-866-705-5711. For more information, see the CDC web site at: 
http://www.cdc.gov/od/pgo/funding/pubcommt.htm.
    This PA uses just-in-time concepts. It also uses the modular 
budgeting as well as non-modular budgeting formats. See: http://grants.nih.gov/grants/funding/modular/modular.htm for additional 
guidance on modular budgets. Specifically, if you are submitting an 
application with direct costs in each year of $250,000 or less, use the 
modular budget format. Otherwise, follow the instructions for non-
modular budget research grant applications.
    Additional requirements that may require you to submit additional 
documentation with your application are listed in section ``VI.2. 
Administrative and National Policy Requirements.''

IV.3. Submission Dates and Times

    Application Deadline Date: June 14, 2004.
    Explanation of Deadlines: Applications must be received in the CDC 
Procurement and Grants Office by 4 p.m. Eastern Time on the deadline 
date. If you send your application by the United States Postal Service 
or commercial delivery service, you must ensure that the carrier will 
be able to guarantee delivery of the application by the closing date 
and time. If CDC receives your application after closing due to: (1) 
Carrier error, when the carrier accepted the package with a guarantee 
for delivery by the closing date and time, or (2) significant weather 
delays or natural disasters, you will be given the opportunity to 
submit documentation of the carriers guarantee. If the documentation 
verifies a carrier problem, CDC will consider the application as having 
been received by the deadline.
    This announcement is the definitive guide on application submission 
address and deadline. It supersedes information provided in the 
application instructions. If your application does not meet the 
deadline above, it will not be eligible for review, and will be 
discarded. You will be notified that your application did not meet the 
submission requirements.
    CDC will not notify you upon receipt of your application. If you 
have a question about the receipt of your application, first contact 
your courier. If you still have a question, contact the PGO-TIM staff 
at: 770-488-2700. Before calling, please wait two to three days after 
the application deadline. This will allow time for applications to be 
processed and logged.

IV.4. Intergovernmental Review of Applications

    Your application is subject to Intergovernmental Review of Federal 
Programs, as governed by Executive Order (EO) 12372. This order sets up 
a system for state and local governmental review of proposed federal 
assistance applications. You should contact your state single point of 
contact (SPOC) as early as possible to alert the SPOC to prospective 
applications, and to receive instructions on your state's process. 
Click on the following link to get the current SPOC list: http://www.whitehouse.gov/omb/grants/spoc.html.

IV.5. Funding Restrictions

    Restrictions, which must be taken into account while writing your 
budget, are as follows: None.
    If you are requesting indirect costs in your budget, you must 
include a copy of your indirect cost rate agreement. If your indirect 
cost rate is a provisional rate, the agreement should be less than 12 
months of age.
    Awards will not allow reimbursement of pre-award costs.

IV.6. Other Submission Requirements

    Application Submission Address: Submit the original and five hard 
copies of your application by mail or express delivery service to: 
Technical Information Management--PA4100, CDC Procurement and 
Grants Office, 2920 Brandywine Road, Atlanta, GA 30341.
    Applications may not be submitted electronically at this time.

V. Application Review Information

V.1. Criteria

    You are required to provide measures of effectiveness that will 
demonstrate the accomplishment of the various

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identified objectives of the cooperative agreement. Measures of 
effectiveness must relate to the performance goals stated in the 
``Purpose'' section of this announcement. Measures must be objective 
and quantitative, and must measure the intended outcome. These measures 
of effectiveness must be submitted with the application and will be an 
element of evaluation.
    The goals of CDC-supported research are to advance the 
understanding of biological systems, improve the control and prevention 
of disease and injury, and enhance health. In the written comments, 
reviewers will be asked to evaluate the application in order to judge 
the likelihood that the proposed research will have a substantial 
impact on the pursuit of these goals.
    The scientific review group will address and consider each of the 
following criteria in assigning the application's overall score, 
weighting them as appropriate for each application. The application 
does not need to be strong in all categories to be judged likely to 
have major scientific impact and thus deserve a high priority score. 
For example, an investigator may propose to carry out important work 
that by its nature is not innovative, but is essential to move a field 
forward.
    The criteria that will be used to evaluate each project are as 
follows:
    Significance: Does this study address an important problem? If the 
aims of the application are achieved, how will scientific knowledge be 
advanced? What will be the effect of these studies on the concepts or 
methods that drive this field?
    Approach: Are the conceptual framework, design, methods, and 
analyses adequately developed, well-integrated, and appropriate to the 
aims of the project? Does the applicant acknowledge potential problem 
areas and consider alternative tactics?
    Innovation: Does the project employ novel concepts, approaches or 
methods? Are the aims original and innovative? Does the project 
challenge existing paradigms or develop new methodologies or 
technologies?
    Investigator: Is the investigator appropriately trained and well 
suited to carry out this work? Is the work proposed appropriate to the 
experience level of the principal investigator and other researchers 
(if any)?
    Environment: Does the scientific environment in which the work will 
be done contribute to the probability of success? Do the proposed 
experiments take advantage of unique features of the scientific 
environment or employ useful collaborative arrangements? Is there 
evidence of institutional support?
    Additional Review Criteria: In addition to the above criteria, the 
following items will be considered in the determination of scientific 
merit and priority score: None
    Protection of Human Subjects from Research Risks: Does the 
application adequately address the requirements of Title 45 CFR Part 46 
for the protection of human subjects? This will not be scored; however, 
an application can be disapproved if the research risks are 
sufficiently serious and protection against risks is so inadequate as 
to make the entire application unacceptable.
    Inclusion of Women and Minorities in Research: Does the application 
adequately address the CDC Policy requirements regarding the inclusion 
of women, ethnic, and racial groups in the proposed research? This 
includes: (1) The proposed plan for the inclusion of both sexes and 
racial and ethnic minority populations for appropriate representation; 
(2) The proposed justification when representation is limited or 
absent; (3) A statement as to whether the design of the study is 
adequate to measure differences when warranted; and (4) A statement as 
to whether the plans for recruitment and outreach for study 
participants include the process of establishing partnerships with 
community(ies) and recognition of mutual benefits.
    Budget: The reasonableness of the proposed budget and the requested 
period of support in relation to the proposed research.

V.2. Review and Selection Process

    Applications will be reviewed for completeness by the Procurement 
and Grants Office (PGO), and for responsiveness by the National Center 
for Infectious Diseases. Incomplete applications and applications that 
are non-responsive to the eligibility criteria will not advance through 
the review process. Applicants will be notified that their application 
did not meet submission requirements.
    Applications that are complete and responsive to the PA will be 
evaluated for scientific and technical merit by an appropriate peer 
review group or charter study section convened by National Center for 
Infectious Diseases in accordance with the review criteria listed 
above. As part of the initial merit review, all applications may:
     Undergo a process in which only those 
applications deemed to have the highest scientific merit, generally the 
top half of the applications under review, will be discussed and 
assigned a priority score.
     Receive a written critique.
     Receive a second level review by CDC senior 
staff.
    Award Criteria: Criteria that will be used to make award decisions 
include:
     Scientific merit (as determined by peer review)
     Availability of funds
     Programmatic priorities

V.3. Anticipated Award Date

    Award Date: August 16, 2004.

VI. Award Administration Information

VI.1. Award Notices

    Successful applicants will receive a Notice of Grant Award (NGA) 
from the CDC Procurement and Grants Office. The NGA shall be the only 
binding, authorizing document between the recipient and CDC. The NGA 
will be signed by an authorized Grants Management Officer, and mailed 
to the recipient fiscal officer identified in the application.
    Unsuccessful applicants will receive notification of the results of 
the application review by mail.

VI.2. Administrative and National Policy Requirements

45 CFR Part 74 and Part 92
    For more information on the Code of Federal Regulations, see the 
National Archives and Records Administration at the following Internet 
address: http://www.access.gpo.gov/nara/cfr/cfr-table-search.html.
    The following additional requirements apply to this project:

 AR-1--Human Subjects Requirements
 AR-2--Requirements for Inclusion of Women and Racial 
and Ethnic Minorities in Research
 AR-7--Executive Order 12372
 AR-10--Smoke-Free Workplace Requirements
 AR-11--Healthy People 2010
 AR-12--Lobbying Restrictions
 AR-22--Research Integrity
 AR-25--Release and Sharing of Data

    Additional information on these requirements can be found on the 
CDC web site at the following Internet address: http://www.cdc.gov/od/pgo/funding/ARs.htm.

VI.3. Reporting

    You must provide CDC with an original, plus two hard copies of the 
following reports:
    1. Interim progress report, (use form PHS 2590, OMB Number 0925-
0001, rev. 5/2001 as posted on the CDC website) no less than 90 days 
before the end of the budget period. The progress report will serve as 
your non-competing continuation application, and must contain the 
following elements:

[[Page 23768]]

    a. Current Budget Period Activities Objectives.
    b. Current Budget Period Financial Progress.
    c. New Budget Period Program Proposed Activity Objectives.
    d. Budget.
    e. Additional Requested Information.
    f. Measures of Effectiveness.
    2. Financial status report and annual progress report, no more than 
90 days after the end of the budget period.
    3. Final financial and performance reports, no more than 90 days 
after the end of the project period.
    These reports must be mailed to the Grants Management Specialist 
listed in the ``Agency Contacts'' section of this announcement.

VII. Agency Contacts

    For general questions about this announcement, contact: Technical 
Information Management Section, CDC Procurement and Grants Office, 2920 
Brandywine Road, Atlanta, GA 30341, Telephone: 770-488-2700.
    For scientific/research issues, contact: Dr. Mary Lerchen, Acting 
Director, Office of Extramural Research, Centers for Disease Control 
and Prevention, National Center for Infectious Diseases, 1600 Clifton 
Road, NE., Mailstop C-19, Atlanta, GA 30333, Telephone: 404-639-0043, 
E-mail: [email protected].
    For questions about peer review, contact: Barbara Stewart, Centers 
for Disease Control and Prevention, National Center for Infectious 
Diseases, 1600 Clifton Road, NE., Mailstop C-19, Atlanta, GA 30333, 
Telephone: 404-639-0044, E-mail: [email protected].
    For financial, grants management, or budget assistance, contact: 
Yolanda Sledge, Grants Management Specialist, CDC Procurement and 
Grants Office, 2920 Brandywine Road, Atlanta, GA 30341, Telephone: 
(770) 488-2787, E-mail: [email protected].

    Dated: April 26, 2004.
William P. Nichols,
Acting Director, Procurement and Grants Office, Centers for Disease 
Control and Prevention.
[FR Doc. 04-9809 Filed 4-29-04; 8:45 am]
BILLING CODE 4163-18-P