11202 Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices

1Copies of the Complaint, the Decision and

Order, and statements by Commissioners Pitofsky,

Steiger, Varney, Azcuenaga and Starek are available

from the Commission’s Public Reference Branch,

H–130, 6th Street & Pennsylvania Avenue, NW.,

Washington, DC. 20580.

comment. Interested parties were given

sixty (60) days in which to submit

comments, suggestions or objections

regarding the proposed form of the

order.

No comments having been received,

the Commission has ordered the

issuance of the complaint in the form

contemplated by the agreement, made

its jurisdictional findings and entered

an order to cease and desist, as set forth

in the proposed consent agreement, in

disposition of this proceeding.

(Sec. 6, 38 Stat. 721; 15 U.S.C. 46. Interprets

or applies sec. 5, 38 Stat. 719, as amended;

15 U.S.C. 45)

Donald S. Clark,

Secretary.

[FR Doc. 97–6053 Filed 3–10–97; 8:45 am]

BILLING CODE 6750–01–M

[Dkt C–3709]

Time Warner Inc., et al.; Prohibited

Trade Practices, and Affirmative

Corrective Actions

AGENCY: Federal Trade Commission.

ACTION: Consent order.

SUMMARY: In settlement of alleged

violations of federal law prohibiting

unfair or deceptive acts or practices and

unfair methods of competition, this

consent order requires the restructuring

of the acquisition by Time Warner of

Turner Broadcasting Systems, Inc. by,

among other things, requiring TeleCommunications, Inc. (TCI) to divest its

interest in Time Warner to a separate

company, requiring TCI, Turner and

Time Warner to cancel long-term

carriage agreements, barring Time

Warner’s programming interests from

discriminating in carriage decisions

against rival programmers, and

requiring Time Warner’s cable interests

to carry a rival to CNN.

DATES: Complaint and Order issued

February 3, 1997.1

FOR FURTHER INFORMATION CONTACT:

William Baer, FTC/H–374, Washington,

D.C. 20580. (202) 326–2932.

SUPPLEMENTARY INFORMATION: On

Wednesday, September 25, 1996, there

was published in the Federal Register,

61 FR 50301, a proposed consent

agreement with analysis In the Matter of

Time Warner Inc., et al., for the purpose

of soliciting public comment. Interested

parties were given sixty (60) days in

which to submit comments, suggestions

or objections regarding the proposed

form of the order.

Comments were filed and considered

by the Commission. The Commission

has ordered the issuance of the

complaint in the form contemplated by

the agreement, made its jurisdictional

findings and entered an order to divest,

as set forth in the proposed consent

agreement, in disposition of this

proceeding.

(Sec. 6, 38 Stat. 721; 15 U.S.C. 46. Interpret

or apply sec. 5, 38 Stat. 719, as amended; sec.

7, 38 Stat. 731, as amended; 15 U.S.C. 45, 18)

Donald S. Clark,

Secretary.

[FR Doc. 97–6054 Filed 3–10–97; 8:45 am]

BILLING CODE 6750–01–M

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.
Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices 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 nonFederal 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, nonFederal 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)—NonFederal 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 underinsured women. Many women do not

have access to a well-coordinated and

integrated health care system that

provides screening, follow-up, and
11204 Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices

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
Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices 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 underinsured. (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 lowincome.

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
11206 Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices

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.
Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices 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 broadbased 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.
11208 Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices

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 problemsolving 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 selfstudy 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 ageadjusted 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 followup 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
Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices 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 broadbased 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;
11210 Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices

(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, rescreening, 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 capacityfunded 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, noncompeting 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
Federal Register / Vol. 62, No. 47 / Tuesday, March 11, 1997 / Notices 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

Current Status of the Vessel Sanitation

Program and Experience to Date With

Program Operations—Public Meeting

The National Center for

Environmental Health (NCEH) of the

Centers for Disease Control and

Prevention (CDC) announces the

following meeting.

Name: Current Status of the Vessel

Sanitation Program (VSP) and

Experience to Date with Program

Operations—Public meeting between

CDC and the cruise ship industry,

private sanitation consultants, and other

interested parties.

Time and Date: 9 a.m.–12 noon,

Thursday, April 3, 1997.

Place: Port of Miami, Terminal #10,

Miami, Florida 33132. For directions

call 305/536–4307, or fax 305/536–4528.

Status: Open to the public for

participation, comment, and

observation, limited only by the space

available. The meeting room

accommodates approximately 400

people.

Purpose: To discuss current status of

the VSP and experience to date with

program operations.

Matters to be Discussed: During the

past 10 years, as part of the revised VSP,

CDC has conducted a series of public

meetings with members of the cruise

ship industry, private sanitation

consultants, and other interested

parties. This meeting is a continuation

of that series of public meetings. Some

of the topics to be discussed at this

meeting include the finalization of

CDC’s ‘‘Final Recommended

Shipbuilding Construction Guidelines

for Cruise Vessels Destined to Call on

U.S. Ports,’’ the finalization of ‘‘Interim

Recommendations to Minimize

Transmission of Legionnaires’ Disease

from Whirlpool Spas on Cruise Ships,’’

revising the current VSP Operations

Manual, status of development of a VSP

Hazard Analysis Critical Control Point

training seminar and future plans for

program direction.

For a period of 15 days following the

meeting, through April 18, 1997, the

official record of the meeting will

remain open so that additional material

or comments may be submitted to be

made part of the record of the meeting.

Agenda items are subject to change as

priorities dictate.

Contact Person for More Information:

Dan Harper, Program Manager, VSP,

Special Programs Group (F29), NCEH,

CDC, 4770 Buford Highway, NE,

Atlanta, Georgia 30341–3724, telephone

770/488–3524.

Dated: March 5, 1997.

Carolyn J. Russell

Director, Management Analysis and Services

Office, Centers for Disease Control and

Prevention (CDC)

[FR Doc. 97–5960 Filed 3–10–97; 8:45 am]

BILLING CODE 4163–18–P

Administration for Children and

Families

Submission for OMB Review;

Comment Request

Title: Application Requirements or

the Low Income Home Energy

Assistance Program (LIHEAP) and

Detailed Model Plan (submitted every 3

years. Abbreviated applications to be

submitted in intervening years.)

OMB No.: 0970–0075.

Description: This information

requirement is an annual activity which

is required by law for the receipt of

federal block grant funds under the

LIHEAP statute. By law, we must make

this model plan available to grantees. It

provides grantees an optional

management tool that may alleviate the

burden of preparing additional

information to complete plans. The

detailed mode plan is to be filed only

once every three years or sooner if major

changes are made to grantee’s program.

We are also seeking approval for a

streamlined application to be used in

alternate years.

Respondents: State, Territories and

Tribal Govts.

ANNUAL BURDEN ESTIMATES

Instrument Number of respondents

Number of responses per respondentAverage burden

hours per response

Total burden

hours

Detailed model plan .......................................................................... 65 1 1 65

Abb. model plan ............................................................................... 115 1 .33 38

Estimated Total Annual Burden Hours: 103.