[Federal Register Volume 62, Number 47 (Tuesday, March 11, 1997)]
[Notices]
[Pages 11202-11211]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-5956]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention
[Announcement 718]


Cooperative Agreement for 1997 National Breast and Cervical 
Cancer Early Detection Program

Introduction

    The Centers for Disease Control and Prevention (CDC) announces the 
availability of funds in fiscal year (FY) 1997 for cooperative 
agreements to develop State, territorial, and tribal comprehensive 
breast and cervical cancer early detection programs.
    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 to improve the quality of life. 
This announcement is related to the priority area of Cancer. (To order 
a copy of ``Healthy People 2000,'' see the section ``Where to Obtain 
Additional Information.'')

Authority

    This program is authorized by sections 1501, 1502 and 1507 (42 
U.S.C. 300k, 42 U.S.C. 300l, and 42 U.S.C. 300n-3) of the Public Health 
Service Act, as amended.

Smoke-Free Workplace

    CDC strongly encourages all grant recipients to provide a smoke-
free workplace and to promote the non-use of all tobacco products, and 
Pub. L. 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

    Assistance will be provided only to the official health departments 
of States, or their bona fide agents or instrumentalities and to 
American Indian tribes. This includes American Samoa, the Commonwealth 
of Puerto Rico, the Federated States of Micronesia, Guam, the Republic 
of the Marshall Islands, and federally recognized Indian tribal 
governments (this includes Indian tribes, tribal organizations, and 
urban Indian organizations, hereby referred to as tribes).
    1. The following States and territories are excluded:
    a. Alabama, Delaware, Hawaii, Idaho, Indiana, Kentucky, 
Mississippi, Montana, New Hampshire, Nevada, North Dakota, Northern 
Mariana Islands, Republic of Palau, South Dakota, Tennessee, Virgin 
Islands, Virginia, Washington, DC, and Wyoming, which were funded in 
September of 1996, under Program Announcement 623 entitled ``1996 
National Breast and Cervical Cancer Early Detection Program.''
    b. New York, Pennsylvania, Ohio, Wisconsin, Massachusetts, and 
Washington, which were funded in September 1993, under Program 
Announcement 321 entitled ``Early Detection and Control of Breast and 
Cervical Cancer.''
    c. Florida, Oklahoma and Utah, which were funded in September 1994, 
under Program Announcement 321 entitled ``Early Detection and Control 
of Breast and Cervical Cancer.''
    d. Alaska, Georgia, Maine, Oregon, and Rhode Island, which were 
funded in September 1994, under Program Announcement 474 entitled 
``Early Detection and Control of Breast and Cervical Cancer.''
    e. Arizona, Arkansas, Connecticut, Iowa, Illinois, Kansas, 
Louisiana, New Jersey, and Vermont, which were funded in March 1995, 
under Program Announcement 474 entitled ``Early Detection and Control 
of Breast and Cervical Cancer.''
    2. The following tribes are excluded:
    a. Arctic Slope Native Association, Limited, AK; Cherokee Nation, 
OK; Cheyenne River Sioux Tribe, SD; Eastern Band of Cherokee Indians, 
NC; Maniilaq Association, AK; Pleasant Point Passamaquoddy, ME; Poarch 
Band of Creek Indians, AL; South Puget Planning Agency, WA; and 
Southcentral Foundation, AK, which were funded under the American 
Indian Initiative Program Announcement 442.

[[Page 11203]]

    b. Hopi Tribe, AZ; Native American Rehabilitation Association of 
the NW, OR; Indian Community Health Service; AZ; and the Navajo 
Division of Health, AZ, which were funded in September of 1996, under 
Program Announcement 623 entitled ``1996 National Breast and Cervical 
Cancer Early Detection Program.''
    States currently receiving CDC funds under Program Announcement 121 
and 122, entitled ``Early Detection and Control of Breast and Cervical 
Cancer,'' are eligible to apply for funding under this announcement. 
Additionally, those programs currently funded under Program 
Announcement 425 (Puerto Rico and American Samoa) are eligible to apply 
under this announcement. If currently funded under Program Announcement 
425, no additional new funding will be available at the end of the 
current 12-month budget period. Thereafter, a 12-month no-cost 
extension may be approved to complete capacity-building activities that 
have been initiated.

Availability of Funds

    Approximately $37 million is available in FY 1997 to fund 
approximately fourteen awards to States/territories/tribes. It is 
expected that the average award will be $1,500,000 ranging from 
$200,000 to $3,000,000.
    It is expected that these awards will begin on August 15, 1997, and 
will be made for 12-month budget periods within a project period of up 
to five years. Funding estimates may vary and are subject to change.
    Continuation awards within the project period will be made on the 
basis of satisfactory progress and the availability of funds.
    At the request of the applicant, Federal personnel may be assigned 
to a project in lieu of a portion of the financial assistance.

Recipient Financial Participation

    Section 1502 (a) and (b)(1), (2), and (3) of the PHS Act, as 
amended, states that matching funds are required from non-Federal 
sources in an amount not less than $1 for each $3 of Federal funds 
awarded under this program.
    The matching funds may be in cash or its equivalent in-kind or 
donated services, including equipment, fairly evaluated. The 
contributions may be made directly or through donations from public or 
private entities.
    In some States/territories/tribes, non-Federal funds from a variety 
of sources may presently be used to support one or more of the breast 
and cervical cancer early detection activities described in this 
program announcement. Maintenance of Effort (MOE)--Non-Federal funds in 
excess of the average amount expended during the two years preceding 
the first fiscal year that a State/territory/tribe applies for funding 
may be used as match. Supplantation of existing program efforts funded 
through other Federal or non-Federal sources is unallowable. Applicants 
may also include, as State/territory/tribe matching funds, any non-
Federal amounts expended pursuant to Title XIX of the Social Security 
Act for the screening, follow-up and referral of women for breast and 
cervical cancer.
    Matching funds may not include: (1) The payment for treatment 
services or the donation of treatment services (see note below); (2) 
services assisted or subsidized by the Federal Government; or (3) the 
indirect or overhead costs of an organization.

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

Background

Breast Cancer

    In the United States, approximately 500,000 women will die this 
decade from breast and cervical cancer. Among women, breast cancer 
accounts for 29 percent of all new cancer cases and is the second 
leading cause of cancer related deaths. An estimated one of every eight 
women in the United States will develop breast cancer in her lifetime. 
The American Cancer Society estimated that in 1996, 184,300 women would 
be diagnosed with invasive breast cancer and 44,300 women would die of 
this disease. Death rates from the disease are highest among women aged 
40 or more years, and among black women as compared to white women for 
those aged less than 70 years.
    It is not currently known how to prevent breast cancer from 
occurring. Thus, detecting carcinoma of the breast at an early stage is 
the key to more treatment options, improved survival, and decreased 
mortality. Research has shown that the use of mammography can reduce 
the mortality due to breast cancer among women 50 years and older by 30 
percent.
    The percent of women who are regularly screened for breast cancer 
decreases with age. The baseline data on mammography use from the 1987 
National Health Interview Survey show that only 23 percent of women 50 
years and older reported having received a mammogram within the past 
three years. This proportion was lower for racial and ethnic minority 
women, for women who had less than a high school education, for women 
who were over age 75 years, and for women who were living below the 
poverty level. In Healthy People 2000, the Public Health Service (PHS) 
recommended that by the year 2000, 60 percent of women aged 50 years 
and older should receive a mammogram every two years.

Cervical Cancer

    The overall incidence of invasive cervical cancer has decreased 
steadily over the last several decades, but in recent years, this rate 
has increased among women who are less than 50 years old. In 1996, 
invasive cervical cancer was diagnosed in approximately 15,700 women, 
and carcinoma in situ was diagnosed in about 65,000 women, and about 
4,900 women died of cervical cancer.
    The primary goal of cervical cancer screening is to increase 
detection and treatment of precancerous cervical lesions and thus 
prevent the occurrence of cervical cancer. Although no clinical trials 
have studied the efficacy of Papanicolaou (Pap) test in reducing 
cervical cancer mortality, experts agree that it is an effective 
technology. Since the introduction of the Pap test in the 1940s, 
cervical cancer mortality rates have decreased by 75 percent.
    In 1991, the PHS established that by the year 2000, 85 percent of 
women should be receiving a Pap test within the preceding one to three 
years. Baseline data on the use of the Pap test from the 1987 National 
Health Interview Survey (NHIS) showed that only 65 percent of women 
aged 18 years and older reported having received a Pap test within the 
past three years. As with mammography screening, this proportion was 
lower for racial and ethnic minority women, for women who had less than 
a high school education, for women who were over age 75 years, and for 
women who had low incomes.

National Breast and Cervical Cancer Early Detection Program

    In 1990, the U.S. Congress passed ``The Breast and Cervical Cancer 
Mortality Prevention Act,'' Pub. L. 101-354. This legislation enables 
CDC, in partnership with State health agencies and territories, to make 
breast and cervical cancer screening, referral, tracking and follow-up 
services available and accessible to women, with priority for services 
given to low income, and uninsured and under-insured women. Many women 
do not have access to a well-coordinated and integrated health care 
system that provides screening, follow-up, and

[[Page 11204]]

treatment services because of social, financial, and geographic 
barriers.
    In accordance with Pub. L. 101-354, a comprehensive program 
includes the following program components: (1) Breast and cervical 
cancer screening; (2) referral and follow-up; (3) public education; (4) 
professional education; (5) quality assurance; (6) surveillance and 
program evaluation; and (7) partnership development and community 
involvement. The importance of these program components and a 
systematic, coordinated approach is universally appreciated as 
necessary to ensure maintenance of quality, comprehensive, state/
territory-/tribe-wide services. This comprehensive effort offers an 
opportunity to build a State/territorial/tribal infrastructure for 
breast and cervical cancer control.
    Program success is enhanced when State/territorial/tribal resources 
and efforts are combined with those of other State/territorial/tribal 
programs, voluntary organizations, private sector organizations, and 
community-based organizations through partnership development. State/
territorial/tribal comprehensive breast and cervical cancer control 
programs can make a vital contribution to the nationwide effort to 
reduce morbidity and mortality and improve quality of life.

Purpose

    The purpose of this program is to establish a State/territorial/
tribal comprehensive public health approach to reduce breast and 
cervical cancer morbidity and mortality through screening, referral and 
follow-up, public education and outreach, professional education, 
quality assurance, surveillance, evaluation, partnership development 
and community involvement. The program is established to provide for 
comprehensive breast and cervical cancer screening services for all 
women who are unable to afford them. Criteria for priority populations 
are uninsured or under-insured older women who are racial, ethnic and 
cultural minorities, such as American Indians, Alaskan Natives, 
African-Americans, Hispanics, Asian/Pacific Islanders, Lesbians, women 
with disabilities, or women who live in hard-to-reach communities in 
urban and rural areas. Priority populations, as defined above, will be 
used throughout this document.

Program Requirements

    In accordance with Pub. L. 101-354, an award may not be made unless 
the State/territory/tribe involved agrees that:
    1. Not less than 60 percent of cooperative agreement funds will be 
expended for screening, appropriate referral for medical treatment, 
and, to the extent practicable, the provision of appropriate follow-up 
services. The remaining 40 percent will be expended to support public 
education, professional education, quality assurance, surveillance, 
program evaluation, partnership development and community involvement, 
and related program activities. (Section 1503(a) (1) and (4) of the PHS 
Act, as amended.) Of the proportion of funds required for screening and 
diagnostic services, the majority should be directed toward breast 
health. Refer to the most current CDC National Breast and Cervical 
Cancer Early Detection Program Administrative Requirements and 
Guidelines for more information.
    2. States, territories, and tribes are required to implement all 
program components by the schedule that follows:
    a. States presently receiving comprehensive funding:
    All program components should be operational at this time.
    b. Territories/tribes presently receiving capacity funding:
    Comprehensive breast and cervical cancer screening, referral, 
follow-up and tracking services should be initiated within the first 
twelve months of the first budget year. The capacity building program 
components (not the screening, referral, follow-up and tracking system) 
should be fully operational by the end at this time.
    c. Territories/tribes not presently receiving capacity funds and 
applying for comprehensive funding:
    The application should outline plans for the operation of all 
program components. The screening, follow-up and referral services 
should be initiated within twelve months of the award date. (Section 
1503(a) (1) and (3) of the PHS Act, as amended.)
    3. Cooperative agreement funds will not be expended to provide 
inpatient hospital or treatment services. (Section 1504(g) of the PHS 
Act, as amended.) Treatment is defined as any service recommended by a 
clinician, including medical and surgical intervention provided in the 
management of a diagnosed condition. Also, cooperative agreement funds 
will not be used for the specific diagnostic procedures of breast 
biopsy and Loop Electrosurgical Excisional Procedure (LEEP).
    4. Not more than 10 percent of funds will be expended annually for 
administrative expenses. These administrative expenses are in lieu of 
and replace indirect costs. (Section 1504(f) of the PHS Act, as 
amended.)
    5. Matching funds are required from non-Federal sources in an 
amount not less than $1 for each $3 of Federal funds awarded under this 
program. (Section 1502 (a) and (b) of the PHS Act, as amended.)
    6. Costs used to satisfy matching requirements are subject to the 
same prior approval requirements and rules of allowability as those 
which govern project costs supported by Federal funds (Office of 
Management and Budget (OMB) Circular A-87 ``Cost Principles for State, 
Local and Indian Tribal Governments'' and PHS Grants Policy Statement, 
Section 6).
    7. All costs used to satisfy matching requirements must be 
documented by the applicant and will be subject to audit.
    8. If a new or improved, and superior, screening procedure becomes 
widely available and is recommended for use, this superior procedure 
will be utilized in the program. (Section 1503(b) of the PHS Act, as 
amended.)
    9. An award may not be made unless the State Medicaid Program 
provides coverage for:
    a. In the case of breast cancer, a clinical breast examination and 
screening mammography.
    b. In the case of cervical cancer, both a pelvic examination and 
Pap test screening. (Section 1502A of the PHS Act, as amended.)
    10. In 1993, congressional amendments to the National Breast and 
Cervical Cancer Early Detection Program included the following changes:
    a. States/territories/tribes may enter into contracts with private 
for-profit entities to provide screening and diagnostic services only. 
Contracts for other kinds of services with for-profit agencies are not 
allowed.
    b. The amount paid by a State/territory/tribe for a screening 
procedure may not exceed the amount that would be paid under part B of 
title XVIII of the Social Security Act (Medicare).
    c. All facilities conducting mammography screening procedures 
funded by the Program must meet the regulations for mammography quality 
assurance developed by the Food and Drug Administration (FDA).
    d. For cervical cancer activities, facilities will meet the 
standards and regulations developed by the Health Care Financing 
Administration (HCFA) implementing the Clinical Laboratory Improvement 
Amendments (CLIA) of 1988.
    In accordance with section 1504 (c)(2) of the PHS Act, as amended, 
CDC may waive the requirements for specific

[[Page 11205]]

services/activities if it is determined that compliance by the State/
territory/tribe would result in an inefficient allocation of resources 
with respect to carrying out a comprehensive breast and cervical cancer 
early detection program (as described in section 1501(a)). A request 
from the recipient outlining appropriate and detailed justification 
would be required before the waiver is approved.
    In conducting activities to achieve the purpose of this program, 
the recipient will be responsible for the activities under A.(Recipient 
Activities), and CDC will be responsible for conducting activities 
under B.(CDC Activities).
A. Recipient Activities
    1. Establish a system for screening women for breast and cervical 
cancer as a preventive health measure. (Section 1501(a)(1) of the PHS 
Act, as amended.)
    This program is to increase the utilization of screening services 
for breast and cervical cancer among all women with emphasis being 
given to identified priority populations as described under the 
``Purpose'' section.
    a. Ensure that screening procedures are available for both breast 
and cervical cancer and provided to women participating in the program, 
including a clinical breast exam, mammography, pelvic exam, and Pap 
smear. (Section 1503(a)(2)(A) and (B).)
    b. Screening services should be made available according to the 
following guidelines:
    Breast Health:
    (1) The most important risk factors for breast cancer are being 
female and older age. Programs should place emphasis on screening women 
50 years and older. Specific screening guidelines that outline age 
eligibility are provided in the Official Program Guidelines Age 
Eligibility for Mammography Screening (included in the application 
kit). Eligible women can receive an annual clinical breast examination 
and screening mammogram.
    The following exceptions apply:
    (a) Women who have an abnormal clinical breast exam may be referred 
for a physician consultation, diagnostic mammogram and/or other 
diagnostic procedures reimbursed by the program (see ``(b)'' below).
    (b) Among asymptomatic women ages 40-49 who are screened for the 
first time by the program, priority should be given to those who have a 
personal history of breast cancer or a first-degree relative with pre-
menopausal breast cancer.
    (2) For diagnostic services following an abnormal screening result, 
cooperative agreement funds may be expended for additional mammogram 
views, fine-needle aspiration, ultrasound, and office visits for 
evaluation of abnormal clinical breast examinations.
    a. Provide priority for screening, referral, tracking, and follow-
up services to women who are uninsured or under-insured. (Section 
1504(a) of the PHS Act, as amended.)
    An award may not be made under this announcement unless the State/
territory/tribe involved agrees to give priority to the provision of 
screening, follow-up, and referral services to women who are 
underserved and low-income.
    b. Establish breast and cervical cancer screening services 
throughout the State/territory/tribe. (Section 1504(c)(1) of the PHS 
Act, as amended.)
    Funds may not be awarded under this announcement, unless the State/
territory/tribe involved agrees that services and activities will be 
made available throughout the State/territory/ tribe, including 
availability to members of any Indian tribe or tribal organization (as 
such terms are defined in Section 4 of the Indian Self-Determination 
and Education Assistance Act).
    c. Provide allowances for items and services reimbursed under other 
programs. (Section 1504(d)(1) and (2) of the PHS Act, as amended.)
    Funds may not be awarded under this announcement, unless the State/
territory/ tribe involved agrees that funds will not be expended to 
make payment for any item or service that will be paid or can 
reasonably be expected to be paid by:
    (1) Any State/territory/tribe compensation program, insurance 
policy, or Federal or State/territory/tribe health benefits program.
    (2) An entity that provides health services on a prepaid basis.
    d. Establish a schedule of fees/charges for services. (Section 
1504(b)(1), (2), and (3) of the PHS Act, as amended.)
    Funds may not be awarded under this announcement unless the State/
territory/tribe involved agrees that if charges are to be imposed for 
the provision of services or program activities, the fees/charges for 
allowable screening and follow-up services will be:
    (1) Made according to a schedule of fees that is made available to 
the public. (Section 1504(b)(1) of the PHS Act, as amended.)
    (2) Adjusted to reflect the income of the woman screened. (Section 
1504(b)(2) of the PHS Act, as amended.)
    (3) Totally waived for any woman with an income of less than 100 
percent of the official poverty line as established by the Director of 
the Office of Management and Budget and revised by the Secretary of the 
Department of Health and Human Services in accordance with section 
673(2) of the Omnibus Budget Reconciliation Act of 1981. (Section 
1504(b)(3) of the PHS Act, as amended.)
    Additionally, the schedule of fees/charges should not exceed the 
maximum allowable charges established by the Medicare Program 
administered by the Health Care Financing Administration (HCFA). Fee/
charge schedules should be developed in accordance with guidelines 
described in the interim final rule (42 CFR parts 405 and 534) which 
implements Section 4163 of the Omnibus Budget Reconciliation Act of 
1990 (Pub. L. 101-508) which provides limited coverage for screening 
mammography services.
    Cervical Health:
    (1) Women who are 18 years and older, with an intact cervix, are 
eligible for an annual Pap test and pelvic examination. While the 
incidence of precancerous lesions and cancer are higher among younger 
women, older women have higher mortality rates and are less likely to 
be screened regularly. Hence, programs should provide a balanced 
distribution in the ages of women receiving Pap tests.
    The following exceptions apply:
    (a) After a woman has had three consecutive, normal, annual 
examinations, the Pap test may be performed less frequently at the 
discretion of her health care provider.
    (b) Women who have had a total hysterectomy that was performed for 
cervical neoplasia are eligible to receive Pap screening.
    (2) For diagnostic services following an abnormal screening result, 
cooperative agreement funds may be expended for colposcopy and 
colposcopy-directed biopsy.
    2. Provide appropriate referrals for medical treatment of women 
screened in the program and ensure, to the extent practicable, the 
provision of appropriate diagnostic and treatment services. (Section 
1501(a)(2) of the PHS Act, as amended.)
    A system for providing the appropriate diagnostic and treatment 
services for women whose screening test results are abnormal or 
suspicious is an essential component of any comprehensive breast and 
cervical cancer early detection program. Priority for diagnostic 
services should be given to women participating in the screening 
program who have abnormal screening results. The operational plan and 
budget for diagnostic services should reflect the projected number of 
women to be

[[Page 11206]]

screened by the program annually and the estimated number of abnormal 
screening exams expected.
    a. Establish and maintain a system for the timely and appropriate 
referral and follow-up of women with abnormal or suspicious screening 
tests.
    Referral systems should include the regular updating of information 
on local resources available in the community to which health care 
providers can refer women for additional diagnostic procedures not paid 
for by the program, as well as treatment services. Health care 
providers should assist clients in need of treatment services in 
obtaining eligibility for public-supported third party reimbursement 
programs.
    b. Develop and implement a tracking system for women screened in 
the breast and cervical cancer early detection program. (Section 
1501(a)(6) of the PHS Act, as amended.)
    Tracking the women screened is essential to ensure that those who 
have abnormal results receive appropriate and timely follow-up for 
repeat screening, diagnostic procedures, and treatment. Tracking also 
includes reminders and outreach to women with normal results to return 
for timely rescreening. A useful tracking system is one that can be 
effectively integrated into the State/territory/tribe health care 
delivery system. The tracking system should provide women with a unique 
identification number to document the outcome of individual screening 
tests, regardless of the screening cycle or site. It should also 
provide information on needed follow-up. Confidentiality must be 
assured.
    To meet the intent of Pub. L. 101-354 in ensuring the appropriate 
follow-up of women with abnormal screening results, the State/
territory/tribe tracking system must include information on screening 
location (e.g., county, city), demographic characteristics (e.g., race, 
date of birth), and screening procedures and results (e.g., 
mammography, Pap tests) for all women in the program. For women 
identified with abnormal screening results, information on diagnostic 
procedures (e.g., colposcopy) and diagnoses, treatment (e.g., date 
initiated), and stages of disease must be included.
    In collaboration with CDC, States/territories/tribes with currently 
funded comprehensive programs have compiled a list of some of the 
information necessary to ensure the appropriate follow-up of women. 
This list is available for the use of States, territories, and tribes 
awarded new funding under this announcement.
    3. Develop and disseminate public information, education and 
outreach programs for the early detection and control of breast and 
cervical cancer. (Section 1501 (a)(3) of the PHS Act, as amended.)
    Public information, education, and outreach include the systematic 
design and sustained delivery of clear and consistent health messages 
to women using a variety of methods and strategies that contribute to 
the early detection of breast and cervical cancer. Successful public 
education and outreach programs are those that increase women's 
knowledge, and ultimately have an impact on attitudes and screening 
behavior.
    Public education and outreach activities should increase the number 
of women screened especially those who are identified as priority 
populations as defined in the ``Purpose'' section. State/territory/
tribe and local programs should clearly demonstrate, through 
evaluation, the relationship of public education and outreach 
strategies to the number of women screened through the program.
    4. Improve the education, training, and skills of health 
professionals (including allied health professionals) in the detection 
and control of breast and cervical cancer. (Section 1501(a)(4) of the 
PHS Act, as amended.)
    Health care providers (including, but not limited to, primary care 
physicians, radiologists, cytopathologists, surgeons, gynecologists, 
nurse practitioners, physician's assistants, registered nurses, 
radiologic technologists, health educators, and outreach workers) play 
a key role in assuring that women are screened at appropriate 
intervals, that screening tests are performed optimally, and that women 
with abnormal test results receive timely and appropriate diagnostic 
follow-up and treatment. Professional education strategies can be 
focused in two directions. One direction could provide direct 
educational opportunities to those health care professionals who 
provide breast and cervical cancer screening. A second focus is to 
develop clinical systems of practice that promote ongoing appropriate 
screening.
    5. Establish mechanisms through which the State/territory/tribe can 
monitor the quality of screening procedures for breast and cervical 
cancer, including the interpretation of such procedures. (Section 
1501(a)(5) of the PHS Act, as amended.)
    Cooperative agreement funds may not be awarded (under Section 1501 
of the PHS Act, as amended, Pub. L. 101-354) unless the State/
territory/tribe involved agrees to assure the implementation of quality 
assurance procedures for mammography and cervical cytology. (Section 
1503(c) and (d) of the PHS Act, as amended.)
    a. Develop and implement a quality assurance system for breast 
cancer screening. The mammography services provided to women screened 
in the program must be conducted in accordance with the following 
guidelines issued by the Secretary of the Department of Health and 
Human Services. (Section 1503(e) of the PHS Act, as amended):
    (1) All facilities conducting mammography screening procedures 
funded by the program must meet the requirements for mammography 
quality assurance developed by the Food and Drug Administration (FDA).
    (2) Radiologists participating in the program will record their 
findings using the second edition American College of Radiology (ACR) 
Breast Imaging Reporting and Data System (BI-RADS). The BI-RADS' 
reporting categories are as follows:
    (1) Negative; (2) Benign finding; (3) Probably benign finding--
short interval follow-up suggested; (4) Suspicious finding; (5) Highly 
suggestive of malignancy; (6) Assessment incomplete.
    (3) A report of the results of a mammogram performed through this 
program will be placed in a woman's permanent medical records that are 
maintained by her health care provider.
    b. Develop and implement a quality assurance system for cervical 
cancer screening. The laboratory services provided to women for 
cytological screening must be conducted in accordance with the 
following guidelines issued by the Secretary of the Department of 
Health and Human Services. (Section 1503(e) of the PHS Act, as 
amended):
    (1) Facilities will meet the standards and regulations promulgated 
by the Health Care Financing Administration (HCFA) under the Clinical 
Laboratory Improvement Act (CLIA) of 1988.
    (2) All cervical cytology interpretation is required to be done on 
the premises of a qualified laboratory.
    (3) A report of the results of a Pap test performed through this 
program will be placed in the woman's permanent medical records that 
are maintained by her health care provider.
    (4) Pathologists participating in the program will record their Pap 
test findings using the Bethesda System which specifies specimen 
adequacy and incorporates these categories:
    (1) Within Normal Limits; (2) Infection/Inflammation/Reactive 
Changes; (3) Atypical squamous cells; (4) Low Grade Squamous Intra 
epithelial Neoplasia (SIL); (5) High Grade SIL; (6) Squamous Cell 
Carcinoma; (7) Other.

[[Page 11207]]

    6. Establish mechanisms which enhance the State/territory/tribe 
cancer surveillance system (i.e., the Central Cancer Registry and other 
databases) and facilitate program planning and evaluation. (Section 
1501(a)(5)) of the PHS Act, as amended.)
    Monitoring the distribution and determinants of breast and cervical 
cancer incidence and mortality is necessary to effectively plan, 
implement, and evaluate a comprehensive early detection program. 
Linkages with, and in some cases enhancements of, State/territory/tribe 
vital statistics, the Central Cancer Registry, the Behavioral Risk 
Factor Surveillance System and other State/territory/tribe and local 
surveys are needed to evaluate the status of program process (i.e., 
management, professional education, public education and outreach), 
impact (i.e., changes in participant screening behavior or screening 
practices of providers) and outcome (i.e., State/territory/tribe 
program screening data, cancer staging, morbidity, mortality).
    a. To do this, surveillance systems should be established or 
enhanced which will:
    (1) Collect State/territory/tribal population-based information on 
the demographics, incidence, staging at diagnosis, and mortality from 
breast and cervical cancer.
    (2) Identify segments of the population at higher risk for disease 
and for the failure to be screened.
    (3) Identify factors contributing to the disease burden, such as 
behavioral risk factors and limited or inequitable access to early 
detection and treatment services.
    (4) Monitor the number and characteristics of women screened in the 
program and the outcome of screening by analyzing data from the State/
territory/tribe tracking system.
    (5) Monitor screening resources, including the number of available 
mammography facilities, cytology laboratories, and providers of 
cervical cancer screening.
    (6) When appropriate, develop linkages between the above-mentioned 
data bases.
    b. Measuring the effectiveness of program activities to modify the 
screening behavior of women (impact evaluation) and on morbidity and 
mortality (outcome evaluation) is important for the identification of 
successful intervention strategies for the early detection of breast 
and cervical cancer. Equally important is process evaluation or the 
assessment of factors that contributed to the successful or 
unsuccessful establishment and implementation of program activities.
    The design of each program component should ensure that there can 
be meaningful process, impact, and outcome evaluation. The evaluation 
plan should assess the implementation and effectiveness of each program 
component. At a minimum, the evaluation plan should identify those 
program activities that will be evaluated, the process, impact, and 
outcome indicators to be measured, how they will be measured, the 
proposed program time-lines, and resources needed. Activities could 
include:
    (1) An inventory of specific services provided and a systematic 
description of the infrastructure developed with cooperative agreement 
funds;
    (2) A description of the women who received services, including the 
number of women and demographic information such as age, race and 
ethnicity;
    (3) An assessment of the referral system including the number of 
women referred for diagnostic and treatment services, number who 
received these services, and the capacity of the system to identify 
community resources to assist women in obtaining access to available 
services;
    (4) An assessment of the availability and accessibility of breast 
and cervical cancer screening services and an estimation of the number 
of uninsured women by age and racial/ethnic distribution in the State/
territory/tribe to be served by the program;
    (5) An assessment of the planning, development, implementation, and 
accomplishment of program activities (e.g., goals, objectives, time 
lines, recruiting, hiring, and retaining staff; training staff; 
establishing and maintaining contracts with provider agencies, and 
assuring the quality of contractor performance);
    (6) An assessment of changes in participant and provider knowledge, 
attitudes, behaviors, and practices related to screening for breast and 
cervical cancer;
    (7) An assessment of the quality of screening tests provided by the 
program.
    7. Ensure the coordination of services and program activities with 
other similar programs and establish a broad-based council to advise 
and support the program. (Section 1504(e) of the PHS Act, as amended.)
    Coordination with other similar programs maximizes the availability 
of services and program activities, promotes consistency in screening 
procedures and educational messages, and reduces duplication. An award 
may not be made under this program announcement unless the State/
territory/tribe agrees that the services and activities provided in 
this program are coordinated with other Federal, State/territory/tribe, 
and local breast and cervical cancer early detection programs through 
the development of collaborative partnerships. (Section 1504(e) of the 
PHS Act, as amended.)
    The success of a comprehensive breast and cervical cancer early 
detection program is improved by broad-based support in the community 
and active public and private sector involvement. Partnership 
development with a broad range of stakeholders, including consumers, 
brings valuable knowledge, skills, and financial resources to the 
program, and provides access to, and information about, populations of 
women who have been missed by traditional screening systems.
    Linkages should be established with federally funded programs such 
as the Regional Offices of the National Cancer Institute/Cancer 
Information Service (NCI/CIS), the Health Resources and Services 
Administration (HRSA) community/migrant health centers, Title X Family 
Planning programs, State Offices for Aging and Minority Health, the 
Indian Health Service (IHS) and the Medicare Program of the Health Care 
Financing Administration (HCFA).
    Linkages and active collaboration are strongly encouraged with 
private sector organizations such as the American Cancer Society (ACS), 
the Young Women's Christian Association (YWCA), the Susan G. Komen 
Breast Cancer Foundation, the National Breast Cancer Coalition (NBCC), 
the National Alliance of Breast Cancer Organizations (NABCO), the 
American Association of Retired Persons (AARP), professional 
organizations, private physicians, survivors of breast and cervical 
cancer, local women's support groups, community leaders, managed care 
organizations, and other agencies and businesses in the community that 
provide health care and related support services to women.
    8. Develop an operational and management plan for the 
implementation of a comprehensive breast and cervical cancer screening 
program.
    The success of a comprehensive breast and cervical cancer early 
detection program is increased by the existence of a comprehensive, 
integrated, and realistic plan to address these diseases among all 
women, with emphasis given to women identified as priority populations 
under the ``Purpose'' section. All program components of the 
comprehensive program should be addressed.

[[Page 11208]]

    A comprehensive breast and cervical cancer screening operational 
plan should relate to the State/territory/tribe Year 2000 Objectives 
and to the State/territory/tribe Cancer Control Plan. The operational 
and management plan should also reflect the development of qualified 
and diverse technical, program, and administrative staff, appropriate 
organizational relationships including lines of authority, adequate 
internal and external communication systems, and a system for sound 
fiscal management.
    9. Representation or attendance at CDC sponsored trainings, 
meetings, site visits, and conferences.
B. CDC Activities
    1. Convene a workshop of the funded programs every one to two years 
for information-sharing and problem-solving and hold a Program 
Director's meeting twice a year.
    2. Provide funded States/territories/tribes with ongoing 
consultation and technical assistance to plan, implement, and evaluate 
each component of the comprehensive program as described under 
Recipient Activities above. Consultation and technical assistance will 
be provided in the following areas:
    a. Interpretation of current scientific literature related to the 
early detection of breast and cervical cancer;
    b. Practical application of Pub. L. 101-354, including amendments 
to the law;
    c. Nationally recognized clinical and quality assurance guidelines 
for the assessment and diagnosis of breast and cervical cancer;
    d. Design and implementation of each program component (screening, 
referral, tracking, and follow-up; public education and outreach; 
professional education; collaborative partnerships; quality assurance; 
surveillance; and evaluation);
    e. Evaluation of each program component (process, impact, and 
outcome) through the analysis and interpretation of program outcomes, 
screening data, and surveillance data;
    f. Overall operational planning and program management.
    3. Provide two training opportunities and a video teleconference 
with self-study educational packets on selected topics to State, 
territorial, and tribal program staff through the National Center for 
Chronic Disease Prevention and Health Promotion, Division of Cancer 
Prevention and Control's (DCPC's) National Training Center.
    4. Conduct site visits to assess program progress and mutually 
resolve problems, as needed, and/or coordinate reverse site visits to 
CDC in Atlanta, GA.
    5. At the request of the applicant, and if available, assign 
Federal personnel to a project in lieu of a portion of the financial 
assistance. (Section 1507(b) of the PHS Act, as amended.)

Technical Reporting Requirements

    Semiannual progress reports are required and must be submitted no 
later than 30 days after each semiannual reporting period. The 
semiannual progress reports must summarize the following: (1) Major 
accomplishments including information on women screened; (2) problems 
encountered in program implementation; and (3) efforts or proposed 
strategies to resolve problems. The final progress report is required 
no later than 90 days after the end of the project period. All 
manuscripts published as a result of the work supported in part or 
whole by the cooperative agreement will be submitted with the progress 
reports.
    An annual financial status report (FSR) must be submitted no later 
than 90 days after the end of each budget period. The final financial 
status report is due no later than 90 days after the end of the project 
period.
    An original and two copies of all reports should be submitted to 
the Grants Management Branch, Procurement and Grants Office, CDC.

Application Content

    All applicants must develop their applications in accordance with 
information contained in this program announcement and the instructions 
below. Applications should not exceed 100 pages including budget and 
justification; this does not include appendices.

1. Executive Summary

    The applicant should provide a clear, concise one or two page 
written summary to include: (1) The need for the program; (2) the major 
objectives and activities of the proposed comprehensive breast and 
cervical cancer early detection program; (3) the requested amount of 
Federal funding; and (4) capability to implement the program.

2. Background and Need

    The applicant should describe:
    a. The disease burden by age and race/ethnicity: (1) The State/
territory/tribe breast and cervical cancer age-adjusted mortality rates 
averaged over five years and their ranking nationally, (2) the 
incidence rates for these diseases (where available);
    b. Total number of women in the State/territory/ tribe, including 
those women who are uninsured, by age and racial/ethnic distribution;
    c. Unmet screening and rescreening needs of uninsured and 
underinsured women (where available);
    d. Barriers to early detection screening services;
    e. State/territory/tribe's relevant experiences in the development 
and implementation of a breast and cervical cancer early detection 
program.

3. Implementation Plan

    The applicant should:
    a. Propose measurable, time-phased, and realistic objectives for: 
(1) The overall program, and (2) specific program components as 
described under the ``Recipient Activities'' section, including a 
projection of the number of women to be screened by age, racial and 
ethnic groups, and areas or locality in the State/territory/tribe. 
(Section 1505(2) of the PHS Act, as amended.)
    b. Describe the State/territory/tribe's: (1) Health care delivery 
system; (2) proposed State/ territorial/tribal screening system; (3) 
proposed follow-up and referral system for women requiring diagnostic 
procedures and medical treatment not provided by the program; and (4) 
proposed tracking system for women screened and rescreened by the 
program. (Section 1501(a) (1) and (2) of the PHS Act, as amended.)
    c. Proposed specific outreach strategies to reach women who are 
identified as priority populations as defined under the ``Purpose'' 
section. (Section 1504 (a) of the PHS Act, as amended.)
    d. Document available resources in the State/territory/tribe for 
the payment or reimbursement of breast and cervical cancer screening, 
including the Medicaid Program. [Section 1504 (d) of the PHS Act, as 
amended.]
    e. Describe, in detail, the current or proposed: (1) Professional 
education; (2) public education and outreach activities; and (3) and 
surveillance activities for breast and cervical control. (Section 
1501(a)(3), (4), (5), and (6) of the PHS Act, as amended.) Information 
provided should include program objectives, proposed activities and 
evaluation.
    f. Describe the ability to establish a screening program that meets 
FDA regulations for mammography screening; uses the American College of 
Radiology Breast Imaging Reporting and Data System (BI-RADS); and meet 
the standards and regulations of the Clinical Laboratory Improvement 
Act (CLIA) for cervical cancer screening.
    g. Provide a projected timetable for program implementation that 
displays

[[Page 11209]]

dates for the accomplishment of specific proposed activities.
    h. Describe process and outcome evaluation strategies for each 
program component, including how the information will be used to plan, 
develop, and manage the program on an ongoing basis. (Section 1501 
(a)(6) of the PHS Act, as amended.)
    i. Describe how the State/territory/tribe will assure that funds 
will be used in a cost-effective manner. (Section 1505 (4) of the PHS 
Act, as amended.)

4. Collaborative Partnership and Community Involvement

    The applicant should describe:
    a. How the program will develop linkages and coordinate with other 
Federal, State, and local programs, voluntary and professional 
organizations, private physicians, and mammography facilities and other 
groups, agencies, and businesses in the community that provide health 
care and related support services to women. (Section 1504(e) of the PHS 
Act, as amended.)
    b. The current or proposed broad-based council that will advise and 
support the breast and cervical cancer early detection program, 
including the identification of current members or proposed 
representatives, their charge, and their proposed roles and 
responsibilities. Specific subcommittees of the council should be 
described (e.g., clinical services, public education and outreach, and 
professional education).

5. Management and Organizational Structure

    The applicant should submit a description of the structure to 
ensure the implementation of a breast and cervical cancer program that 
describes the development of qualified and diverse technical, program, 
and administrative staff, organizational relationships including lines 
of authority, internal and external communication systems, and a system 
for sound fiscal management. The information should also include the 
following:
    a. Provide a copy of the organizational chart indicating the 
placement of the proposed program in the department/organization.
    b. Document available resources in the State/territory/tribe for 
the payment or reimbursement of breast and cervical cancer screening, 
including the Medicaid and Medicare Programs. (Section 1504 (d) of the 
PHS Act, as amended.)
    c. Submit the proposed schedule of fees and charges for breast and 
cervical cancer screening and diagnostic services, consistent with 
maximum Medicare reimbursement rates, and include a description of its 
use in the program. In States/territories/tribes where there are 
multiple Medicare rates and a single reimbursement rate is being 
proposed, the applicant must provide justification for approval. 
(Section 1504 (b) of the PHS Act, as amended.)
    d. Letters of support (dated within the last three months) from key 
partners, participants, and community leaders should be included in the 
application.

6. Capability for Program Implementation

    The applicant should describe proposed activities as measured by:
    (a) Accomplishments of an existing breast and cervical cancer early 
detection program funded by CDC or relevant past experiences funded by 
other sources:
    (1) States Currently Receiving CDC Comprehensive Funds:
    Accomplishments in establishing a comprehensive breast and cervical 
cancer early detection program, including the total number, age and 
racial/ethnic distribution of women screened; percent of abnormal 
findings by age and race/ethnicity; rate of cancers identified by age; 
follow-up time between screening and diagnosis and between diagnosis 
and treatment initiation; and, percent of women who are routinely 
rescreened by the program.
    Accomplishments in establishing an infrastructure to support a 
breast and cervical cancer screening program and in resolving program 
challenges, such as mammography screening for women 50 years and older, 
the timely follow-up of women with abnormal screening and diagnostic 
results, or the use of the ACR Lexicon final reporting categories by 
radiologists to report mammogram results.
    (2) Territories/Tribes Currently Receiving CDC Capacity Building 
Funds:
    Accomplishments in establishing a comprehensive infrastructure to 
support a breast and cervical cancer screening program including 
screening, referral, tracking, and follow-up, public education and 
outreach, professional education, quality assurance, surveillance, and 
partnership activities.
    (3) Territories/Tribes Not Currently Receiving CDC Breast and 
Cervical Cancer Funds:
    Relevant past experiences of the applicant in conducting screening, 
referral, tracking, and follow-up, public education and outreach, 
professional education, quality assurance, surveillance, partnership 
activities for cancer control, chronic disease control or other 
relevant areas.

7. Source Data for Matching Requirement

    Identify and describe:
    a. Maintenance of Effort (MOE)--The average amount of non-Federal 
dollars expended for breast and cervical cancer programs and activities 
made by a State/territory/tribe for the two year period preceding the 
first Federal fiscal year of the program funding for breast and 
cervical cancer early detection activities. This amount will be used to 
establish the maintenance of effort baseline for current and future 
match requirements;
    b. State/territory/tribe allowable sources of matching funds for 
the program and the estimated amounts from each;
    c. Procedures for documenting the value of non-cash matching funds;
    d. Procedures for documenting the actual amount of match received.

8. Budget with Justification

    Provide a detailed budget request and complete line item 
justification (for both Federal and non-Federal funds) of all proposed 
operating expenses consistent with the program activities described in 
this announcement. Not less than 60 percent of Federal funds will be 
expended for screening, tracking, and follow-up services. Not more than 
10 percent of Federal funds will be expended for administrative 
expenses.
    The applicant should submit a chart showing the expected funding 
levels and the number of women to be screened by mammography and Pap 
tests by contract, county, or locality in the State/territory/tribe.

Evaluation Criteria (Total 100 Points)

    Applications will be reviewed and evaluated according to the 
following criteria:
    1. Background and Need (5 points)
    The extent of the disease burden and the need among the priority 
populations as measured by:
    (a) The State/territorial/tribal breast and cervical cancer age-
adjusted mortality rates averaged more than five years and ranking 
nationally;
    (b) The disease burden, including the incidence rates of breast and 
cervical cancer by age, race and ethnicity (where available);
    (c) The number of uninsured women by race/ethnicity who are 18-49 
years, 50-64 years, and the number of women eligible for Medicare;
    (d) The unmet screening needs of uninsured and under-insured women;

[[Page 11210]]

    (e) Existing access and barriers to early detection services, 
(e.g., social, financial, geographic).
    2. Implementation Plan (60 points)
    The degree of comprehensiveness and quality of the Operational Plan 
in relation to:
    a. The number of women projected for screening, quality of 
screening, re-screening, and surveillance programs, and compliance with 
Federal requirements (i.e., screening guidelines, FDA mammography 
certification requirements, BI-RAD reporting, and CLIA regulations). 
(20 Points).
    b. The extent to which proposed public education activities appear 
likely to increase the number of women screened, especially women 
identified in priority populations (see ``Purpose'). (15 Points)
    c. The extent to which proposed professional education activities 
provide training options and educational opportunities to improve the 
quality of care of women. (15 Points)
    d. The extent to which proposed surveillance and evaluation appears 
to use reliable data and program results to measure program 
effectiveness and to facilitate program planning, development, and 
implementation, and to enhance program goals and objectives. (10 
Points)
    3. Collaborative Partnerships and Community Involvement (15 points)
    The feasibility and extent of the applicant's proposal to develop 
collaborative partnerships with other Federal, State and local 
programs, territories, tribes and voluntary, professional, and private-
sector agencies, and to establish and maintain a broad-based council of 
partners at State, territory, tribe and local levels.
    4. Management and Organizational Structure (10 points)
    The feasibility and appropriateness of the applicant's management 
plan that describes the development of qualified and diverse technical, 
program, and administrative staff, organizational relationships 
including lines of authority, internal and external communication 
systems, and a system for sound fiscal management.
    5. Capability for Program Implementation (10 points)
    The extent to which the applicant appears likely to be successful 
in implementing the proposed activities as measured by:
    a. Accomplishments by comprehensive-funded States in implementing a 
breast and cervical cancer early detection program as required through 
previous funding agreements.
    b. Accomplishments by capacity-funded States in establishing a 
comprehensive public health infrastructure to support a breast and 
cervical cancer early detection program.
    c. Relevant past experiences of unfunded applicants in conducting 
breast and cervical cancer early detection programs.
    6. Budget and Justification (Not Weighted)
    The extent to which the proposed budget is adequately justified, 
reasonable, and consistent with this program announcement.

Non-competing Continuation Application Content

    In compliance with 45 CFR 74.51(d) and 92.10(b)(4), as applicable, 
non-competing continuation applications submitted within the project 
period need only include:
    A. A brief progress report describing the accomplishments of the 
previous budget period.
    B. Any new or significantly revised items or information 
(objectives, scope of activities, operational methods, evaluation, 
etc.) not included in the 01 Year application.
    C. An annual budget and justification. Existing budget items that 
are unchanged from the previous budget period do not need 
rejustification. Simply list the items in the budget and indicate that 
they are continuation items. Supporting justification should be 
provided where appropriate.

Executive Order 12372 Review

    Applications are subject to Intergovernmental Review of Federal 
Programs as governed by Executive Order 12372. This order sets up a 
system for State/territory/tribe and local review of proposed Federal 
assistance applications. Applicants (other than federally recognized 
Indian tribal governments) should contact their State Single Point of 
Contact (SPOC) as early as possible to alert them to expected 
announcements of cooperative agreement funds and receive any necessary 
instructions on the State process. For proposed projects serving more 
than one State, the applicant is advised to contact the SPOC of each 
State. A current list of SPOCs is included in the application kit. 
Indian territories are strongly encouraged to request tribal government 
review of the proposed application. If tribal governments have any 
tribal process recommendations or if SPOCs have any State process 
recommendations on applications submitted to CDC, they should reference 
this Announcement Number 718 and forward recommendations 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, GA 
30305, no later than 60 days after the application deadline date. The 
Program Announcement Number and Program Title should be referenced on 
the document. The granting agency does not guarantee to ``accommodate 
or explain'' the State or tribal process recommendations it receives 
after that date.

Public Health System Reporting Requirements

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

Catalog of Federal Domestic Assistance Number

    The Catalog of Federal Domestic Assistance Number is 93.919.

Other Requirements

Paperwork Reduction Act

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

Application Submission and Deadline

    The original and two copies of the completed 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, GA 30305 
on or before May 9, 1997.
    1. Deadline: Applications will be considered as meeting the 
deadline if they are either:
    a. Received on or before the stated 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 the U.S. Postal Service. Private 
metered postmarks will not be accepted as proof of timely mailing.)
    2. Late Applications: Applications which do not meet the criteria 
in 1.a. or 1.b., above, are considered late applications. Late 
applications will not be considered in the current

[[Page 11211]]

competition and will be returned to the applicant.

Where To Obtain Additional Information

    To receive additional written information, call (404) 332-4561. You 
will be asked to leave your name, address, and telephone number. Please 
refer to Announcement #718. You will receive a complete program 
description, information on application procedures and application 
forms. If you have questions after reviewing the contents of all the 
documents, business management technical assistance may be obtained 
from Gladys T. Gissentanna, Grants Management Specialist, Grants 
Management Branch, Procurement and Grants Office, Centers for Disease 
Control and Prevention (CDC), 255 East Paces Ferry Road, NE., Room 314, 
Mailstop E-18, Atlanta, GA 30305, telephone (404) 842-6801, fax (404) 
842-6513. Programmatic technical assistance may be obtained from Kevin 
Brady, MPH, Assistant Branch Chief, Program Services Branch, Division 
of Cancer Prevention and Control, National Center for Chronic Disease 
Prevention and Health Promotion, Centers for Disease Control and 
Prevention (CDC), 4770 Buford Highway, NE., Mailstop K-57, Atlanta, GA 
30341-3724, telephone (404) 488-4343, fax (404) 488-4727. You may also 
obtain this announcement, and other CDC announcements, from one of two 
Internet sites on the actual publication date: 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).
    Please refer to Announcement Number 718 when requesting information 
and submitting an application.
    Potential applicants may obtain a copy of ``Healthy People 2000'' 
(Full Report, Stock No. 017-001-00474-0) or ``Healthy People 2000'' 
(Summary Report, Stock No. 017-001-00473-1) referenced in the 
``Introduction'' section through the Superintendent of Documents, 
Government Printing Office, Washington, DC 20402-9325, telephone (202) 
512-1800.

    Dated: March 5, 1997.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for 
Disease Control and Prevention (CDC).
[FR Doc. 97-5956 Filed 3-10-97; 8:45 am]
BILLING CODE 4163-18-P