[Federal Register Volume 60, Number 77 (Friday, April 21, 1995)]
[Notices]
[Pages 19943-19948]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-9879]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement 523]


Innovations in Syphilis Prevention in the United States: 
Reconsidering the Epidemiology and Involving Communities

Introduction

    The Centers for Disease Control and Prevention (CDC) announces the 
availability of fiscal year (FY) 1995 funds for cooperative agreements 
to conduct research toward substantially reducing syphilis in the 
United States, especially in the southeastern United States, the region 
with the highest syphilis rates. Syphilis is linked to substantial 
mortality and morbidity through congenital syphilis, and through its 
ecologic relationship with and cofactor role in HIV transmission. 
Therefore, effective, innovative, community-based approaches to 
syphilis prevention may have an important multiplier effect on HIV 
prevention and adult and infant health in the communities where 
syphilis is most prevalent.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2000, a PHS-led national activity to reduce morbidity and mortality and 
improve the quality of life. This announcement is related to the 
priority area of Sexually Transmitted Diseases. (To order a copy of 
``Healthy People 2000,'' see the section ``Where to Obtain Additional 
Information.'')

Authority

    These cooperative agreements are authorized under Section 318(b) of 
the Public Health Service Act (42 U.S.C. 247c(b)) as amended. 
Applicable program regulations are found in part 51 (b), subparts A and 
F of title 42, Code of Federal Regulations.

Smoke-Free Workplace

    The PHS strongly encourages all grant recipients to provide a 
smoke-free workplace and to promote the non-use of all tobacco 
products, and Public Law 103-227, the Pro-Children Act of 1994, 
prohibits smoking in certain facilities that receive Federal funds in 
which education, library, day care, health care, and early childhood 
development services are provided to children.

Eligible Applicants

    Applications may be submitted by public and private, nonprofit and 
for-profit organizations and governments and their agencies. 
Universities, colleges, research institutions, hospitals, other public 
and private organizations, State and local governments or their bona 
fide agents, federally recognized Indian tribal governments, Indian 
tribes or Indian tribal organizations, and small, minority- or women-
owned businesses are eligible to apply. Applicants must, however, 
document collaboration with each of the following entities:
    1. At least one non-profit, public or private research institution 
(e.g., university, college, hospital, laboratory);
    2. A public health agency in State or local government; and
    3. At least one community-based organization (CBO) or other 
institution or agency with a track record for working with communities 
affected by syphilis in the project area. The CBO does not need to have 
a record of working on the problem of sexually transmitted diseases, 
only to have [[Page 19944]] worked with the communities that are 
affected.
    To be eligible, the project area as defined under ``Program 
Requirements'' must have an incidence of primary and secondary (P&S) 
syphilis in calendar year (CY) 1993 above the PHS year 2000 objective 
of 10/100,000 and a total of more than 150 cases of P&S syphilis in CY 
1993.

Availability of Funds

    Approximately $1 million is available in FY 1995 for a 12-month 
budget period; the project period for Phase I (Preparation) is expected 
to be for two years. Four to five awards will be funded for Phase I. 
The awards are expected to range from $200,000 to $250,000, beginning 
in September 1995. Shortly before the completion of Phase I, recipients 
will compete for continuation of award in years 3 through 5 (Phase II--
Implementation). Two to three awards are anticipated for expansion into 
Phase II research activities for the remaining three years of the 
project period. (Further details on Phases I and II is presented below 
under the heading ``Purpose and Outline of Program Plan.'') Funding 
estimates may vary and are subject to change. Continuation awards 
within an approved project period will be based on satisfactory 
progress and the availability of funds.

Program Goals

    By the end of Phase I (24 months), it is expected that:
    1. Strong partnerships among research institutions, health 
departments, and at least one community-based organization will have 
been established or strengthened.
    2. The epidemiology of the transmission of syphilis will have been 
analyzed to identify characteristics and target interventions to the 
most important mechanisms that sustain syphilis spread and persistence 
in the community (Component 1).
    3. A programmatic intervention will have been pilot tested and 
assessed for its potential for measurably lowering syphilis 
transmission in a defined area while being acceptable to members of the 
affected communities and to participating organizations or agencies 
(Component 2).
    4. A sensitive surveillance system for following trends in syphilis 
transmission in a population will have been implemented and at least 
one full year of baseline data collected.
    5. A management information system will have been implemented to 
track activities and costs in syphilis prevention activities (Component 
3).
    At approximately month 18 of the project, applications for a 
competitive continuation award for the implementation and evaluation of 
a population-level intervention (Phase II) will be due. Fewer, larger, 
Phase II awards are foreseen for interventions that show the greatest 
potential impact and that are based on well-conducted research from 
Phase I. Supplementary guidance for Phase II awards will be provided to 
the recipients of Phase I awards.

Purpose and Outline of Program Plan

    The purpose of this announcement is to generate new knowledge, 
tools, and strategies toward sharply reducing syphilis incidence, 
particularly in the southeastern States where incidence is 
disproportionately high. Congenital syphilis is closely linked to newly 
acquired syphilis infections in women, so an intensified focus on 
syphilis transmissions is expected to contribute directly to a 
principal, short-term PHS goal of eliminating congenital syphilis.
    Phase I and Phase II of the research program. This research program 
is separated into two phases of activity and funding (Table 1). The 
fundamental goal is best understood in the context of Phase II (years 3 
to 5 of the anticipated 5-year project), in which the grantees will 
implement and evaluate an innovative, science-based, cost-effective 
approach to reducing the transmission of syphilis in a project area.

                                 Table 1                                
------------------------------------------------------------------------
                        Grantees                                        
 Phase  Project years    (No.)              Focus of activities         
------------------------------------------------------------------------
I.....  1 and 2......        4-5  Preparation for innovative approaches 
                                   to syphilis control and prevention.  
II....  3 to 5.......        2-3  Implementation of interventions and   
                                   evaluation of impact on population.  
------------------------------------------------------------------------

    However, CDC is not seeking final proposals for such Phase II 
intervention trials at this time because science-based, innovative 
approaches to syphilis prevention will require multifaceted preparation 
and planning. In particular, communities affected by syphilis should be 
represented more substantively than in the past in developing new 
approaches to syphilis prevention. This announcement, therefore, 
focuses on Phase I subject areas and solicits research proposals that 
will yield scientific findings and stimulate the building of multi-
disciplinary research teams needed to guide and implement the Phase II 
intervention trial.
    Areas of preparatory research in Phase I. During Phase I of this 
program, three key research components will be addressed:
    1. Innovative uses of epidemiologic and behavioral science methods 
and findings about syphilis transmission in communities to direct 
prevention strategies.
    2. Development of a programmatic intervention and pilot test of 
that proposed intervention before large-scale implementation; 
development of partnerships with communities affected by syphilis.
    3. Development of a sensitive syphilis surveillance activity to be 
used in evaluating the efficacy and cost-effectiveness of efforts to 
prevent syphilis.
    Further explanation of these Phase I activities can be found in the 
section ``Program Requirements.''

Program Requirements

    This cooperative agreement is foreseen as an important element in a 
national reassessment of our approaches to syphilis control and 
prevention. To achieve the purpose of this program, the recipient will 
be responsible for activities under A. and CDC for activities under B., 
below:

A. Recipient Activities

    1. Develop an overall framework to design an effective, innovative 
approach to syphilis prevention and to evaluate its impact on a 
population.
    2. Define a project area. The geographic area defined as the 
project area for this program announcement must have reported at least 
150 cases of P&S syphilis in 1993. An entire State could be defined as 
the project area for this cooperative agreement, or several counties 
could be combined to establish the minimum number of syphilis cases. 
Applications are especially encouraged from rural areas that meet this 
minimum morbidity requirement (150 cases of P&S syphilis). 
[[Page 19945]] 
    3. Undertake the following three research components during Phase I 
of this cooperative agreement:
    A. Analyze the epidemiology of syphilis transmission within the 
project area with the goal of identifying more efficacious and cost-
effective ways to prevent syphilis.
    B. Develop an intervention and conduct a pre-implementation of that 
evaluation. In collaboration with representatives from affected 
communities, consider hypotheses about barriers to or opportunities for 
more efficacious and cost-effective innovations in syphilis prevention.
    C. Establish surveillance and information systems adequate for 
monitoring and evaluating innovative syphilis prevention activities.

    Note: Traditional disease surveillance for syphilis demonstrates 
substantial year-to-year variability as well as incompletely 
understood cyclic oscillations over periods of 5 to 10 years.

    During Phase I, you will be expected to implement: (1) A sensitive, 
population-level surveillance system for syphilis incidence; and (2) a 
management information system (MIS) for estimating the cost of syphilis 
prevention, including the costs of collecting and analyzing program 
data. Although components 1 and 2 are distinct foci of activity that 
involve different types of expertise, they are related in that 
interventions that do not focus prevention resources on settings, 
social contexts, or individuals who help maintain syphilis transmission 
in the community are unlikely to be effective. Likewise, components 1 
and 3 are related in that a sensitive surveillance system that truly 
reflects incident syphilis cases should have some direct relationship 
to syphilis transmission events characterized by the ``epidemiologic 
model'' of syphilis for that community.
    4. Include affected communities as partners in the research. 
Syphilis generally is concentrated in communities with limited 
resources. In many communities, syphilis is also a stigmatizing 
condition and one for which the most important consequences (congenital 
syphilis and facilitation of HIV transmission) often occur 
unrecognized. Furthermore, some past control efforts and research 
activities may have damaged community rapport with the health 
departments and with CDC rather than building trust in a common 
purpose. Partnerships with communities affected by syphilis, including 
many African American communities where racism may have a continuing 
effect, is essential to building trust and to finding solutions.
    5. Linkage to other public health programs. Research on syphilis 
prevention in the 1990s should occur in the context of other major 
public health program areas. These include:
    A. Prenatal care (required). The first priority in syphilis 
prevention is the elimination of congenital syphilis, which can be 
accomplished through prenatal care for women at risk for syphilis and 
the appropriate screening for and management of syphilis during 
pregnancy. However, it is possible that many pregnant women with 
syphilis have a low risk for transmitting syphilis to other adults, and 
therefore, are not central to the persistence of syphilis among adults 
in the community.
    B. HIV Prevention (required). Communities, sub-populations, and 
individuals with syphilis are probably at high risk for HIV infection 
because of common modes of transmission, the usually higher prevalence 
of syphilis and HIV in the same communities, infection, and the role of 
genital ulcer diseases as cofactors for sexual transmission of HIV. 
Syphilis prevention should be coordinated with and should reinforce 
community intervention strategies and other efforts to change sexual 
behavior as are associated with HIV prevention. Because syphilis is a 
curable communicable disease, screening, health care seeking, and 
treatment will likely play prominent roles in syphilis prevention. 
Nonetheless, some effort to change behavior must be a component of a 
responsible syphilis prevention activity, both to prevent HIV infection 
and other STDs in the community from which one is trying to eliminate 
syphilis, and to lower the risk of spread if syphilis is reintroduced.
    C. Substance abuse (optional). A number of studies have shown that 
crack cocaine was closely linked to local epidemics of syphilis in the 
late 1980s. People who inject drugs are at high risk for STDs. 
Effective, innovative, epidemiologically focused syphilis prevention 
activities may be augmented if they are closely linked to substance 
abuse treatment. Explain how the proposed syphilis prevention 
activities interact with, and possibly reinforce, efforts to prevent 
drug abuse.
    D. Correctional systems (optional). Because of the association of 
syphilis with substance abuse and prostitution, collaboration with the 
criminal justice system (e.g., correctional health programs, probation 
officers, court referral, juvenile justice) could result in highly 
effective approaches to syphilis and HIV prevention. Explain any 
interaction between the proposed syphilis prevention activities and 
criminal justice programs.
    6. Manage, analyze, and interpret data. Data from the three core 
activities in part 3 should be secure and confidential. In 
collaboration with CDC, analyze, interpret, and publish data promptly 
in scientific, programmatic, and policy-making forums. Data should 
regularly be communicated to community partners in language that they 
can understand.
    7. Build a multidisciplinary research team and program 
implementation capability. Assemble a multidisciplinary team with the 
appropriate expertise (such as in microbiology, medicine, epidemiology, 
behavioral sciences, health care services research) to undertake each 
of the enumerated steps or activities.
    8. Implement a unified core protocol common to all grant recipients 
that will be established for component 3 of the required activities 
(population-based surveillance for new syphilis transmissions) and 
implemented by each recipient. The final core multicenter protocol for 
component 3 will likely differ somewhat from the protocol specified by 
any individual recipient. Core protocols or common approaches will be 
encouraged but will not be required for other components, especially 
component 1.
    9. Each grantee will participate with other recipients and CDC 
representatives in as many as four meetings during the first 24 months, 
during which the core protocol for component 3 will be established, and 
strategies for and progress toward achieving the goals of the program 
announcement will be assessed.
    10. The recipient will share reports on progress toward goals with 
representatives of communities affected by syphilis and other involved 
organizations, agencies, and persons.
    11. The recipients will take the lead in data analysis and 
publication of data from their own research centers, with participation 
and support from CDC.

B. CDC Activities

    1. Provide scientific and technical assistance in the general 
operation of this syphilis prevention project and in the three key 
research components in Phase I.
    2. Within 45 days of the notice of grant award, host a meeting of 
the successful applicants to develop the core protocol for component 3 
and to plan other aspects of the research program. CDC will host as 
many as three other meetings of investigators during the first 24 
months of the project to [[Page 19946]] promote progress toward core 
and national objectives.
    3. Assist in monitoring and evaluating scientific and operational 
accomplishments of this syphilis elimination project through periodic 
site visits for research program reviews, frequent telephone calls, and 
review of technical reports and interim data analyses.
    4. CDC will assist in data analysis and in the presentation and 
publication of data from Phase I and Phase II activities in scientific, 
programmatic, and policy-making forums. CDC will actively participate 
in evaluating the multicenter core protocol data for component 3 
(surveillance and evaluation).

Review Conditions and Evaluation Criteria

    To be referred to the independent review group for consideration, 
applications must:
    1. Document effective partnerships among research institutions, 
State or local health departments, and CBOs; and
    2. Address the specific requirements in all three research 
components.
    Applications not meeting these two requirements will be returned to 
the applicant without being reviewed. Applications that meet the 
preceding requirements will be evaluated according to the following 
criteria:

1. Understanding of Goals, Purpose, and Context

    Understanding of the objectives of this research and evaluation 
program as reflected in statement of research background, program 
objectives, and linkage of the specific activities of Phase I to a 
well-articulated vision of what is needed to substantially reduce the 
prevalence of syphilis in the United States (5 points). Extent the 
choice of a project area in which to conduct this research is 
appropriate to the research objectives and is explained and justified 
in those terms, and extent in the proposed project area the 
epidemiology of syphilis, barriers to its reduction or elimination, and 
resources available to STD/HIV prevention are well-described (5 
points). (Total, 10 points.) (APPLICATION CONTENT items 1 and 2.)

2. Quality and Focus of Proposed Phase I Research

    The extent to which excellent research designs address the three 
major components of the program announcement while avoiding extraneous 
efforts. (APPLICATION CONTENT item 9.)
    Component 1: Innovative uses of epidemiologic methods and findings 
about syphilis transmission in communities to direct prevention 
strategies. The extent to which the proposal is theoretically sound and 
reflects detailed knowledge of the meaning of the underlying data, such 
as reported syphilis cases of different durations (primary, secondary, 
early latent, late latent), reports of sexual contacts among patients, 
syphilis seroprevalence from screening data, and other data sources. 
The extent to which the planned approaches to analyzing, interpreting, 
and using data are innovative and likely to yield new insights into the 
transmission of syphilis and the opportunities for prevention and 
elimination within the study community (10 points). The extent to which 
the findings might be directly translated into public health practice 
(e.g., changes in screening criteria or the location for syphilis 
serologic testing; changes in PN practices or priorities; relocation or 
reorganization of clinical services; development of community-based 
interventions), and the clarity with which that potential for 
translation is explained in the application (5 points). (Total, 15 
points.)
    Component 2: Development of a programmatic intervention and pilot 
test of that proposed intervention before large-scale implementation; 
developing partnerships with communities affected by syphilis. Choice 
of an appropriate potential intervention, based on syphilis 
epidemiology in the study region plus analysis of community, program, 
or other factors that compose an important barrier or opportunity for 
more effective, epidemiologic programs (10 points). Scientifically 
sound plan for evaluating, during this pre-implementation phase, the 
potential impact of the proposed intervention on syphilis transmission 
(5 points) and on community perceptions and support for those 
prevention activities (5 points). The extent to which the planned 
research findings from this component could be directly translated into 
public health practice, and the clarity with which that translation is 
explained in the application (5 points). (Total, 25 points.)
    Component 3: Development of a sensitive syphilis surveillance 
activity to serve as a basis for evaluating the efficacy and cost-
effectiveness of syphilis prevention efforts. The extent to which the 
proposal is theoretically sound for evaluating the sensitivity and 
cost-effectiveness of estimating and following population and sub-
population trends in the transmission of syphilis (5 points). The 
extent to which the proposal demonstrates detailed familiarity with 
public health disease surveillance and the complexity of trying to 
change practices in disease surveillance settings proposed (e.g., 
jails, maternity wards delivery suites) (5 points). Implementation of a 
management information system adequate for a cost-effectiveness 
analysis of new approaches to prevention programs 5 points). (Total, 15 
points.)

3. Capacity, Interdisciplinary Involvement, and Partnerships

    Overall ability of a multidisciplinary research team (including 
persons in various academic disciplines, public health practitioners, 
and community collaborators) to perform the technical aspects of the 
project(s) (i.e., qualified and experienced personnel with a record of 
excellent scientific achievement) (15 points); appropriate facilities 
and plans for the administration of the project(s), and a detailed and 
realistic schedule for the specified activities (5 points). (Total, 20 
points: APPLICATION CONTENT items 3, 4, 5, and 6.)

4. Inclusion of Affected Communities

    The extent to which communities affected by syphilis are involved 
in all parts of these research and demonstration activities (5 points). 
The extent to which the effective work of one or more CBOs is 
documented in attachments to the application and the collaboration and 
support of a CBO is thoroughly incorporated into the work of the 
multidisciplinary team (5 points). (Total, 10 points: APPLICATION 
CONTENT items 3 and 6.)

5. Linkage to Related Prevention Activities

    The extent to which the proposed research agenda and the 
intervention reflect awareness of other critical prevention services in 
the community (pre-natal care, HIV, drug abuse, correctional health) 
and are synergistic or at least well-coordinated with those other 
preventive health services. (Total, 5 points: APPLICATION CONTENT item 
7.)
    In addition, consideration will be given to the extent to which the 
budget is reasonable, clearly justified, and consistent with the 
intended use of the funds. (APPLICATION CONTENT item 8

Funding Priorities

    CDC intends to achieve some geographic diversity of project sites 
while retaining a principal focus on syphilis in the southeastern 
United [[Page 19947]] States. It is the intention to fund at least two 
Phase I projects that address syphilis in rural areas in the 
southeastern United States, if those applications are fully 
competitive.
    Interested persons are invited to comment on the proposed funding 
priority. All comments received on or before May 19, 1995, will be 
considered before the funding priority is established. If the funding 
priority should change as a result of any comments received, a revised 
Announcement will be published in the Federal Register and revised 
applications accepted.
    Written comments should be addressed to: Henry S. Cassell III, 
Grants Management Officer, Grants Management Branch, Procurement and 
Grants Office, Centers for Disease Control and Prevention (CDC), 255 
East Paces Ferry Road, NE., Room 300, Mailstop E-16, Atlanta, GA 30305.

Executive Order 12372 Review

    Applications are subject to Intergovernmental Review of Federal 
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets 
up a system for State and local government review of proposed Federal 
assistance applications. Applicants (other than federally recognized 
Indian tribal governments) should contact their State Single Point of 
Contact (SPOC) as early as possible to alert them to the prospective 
applications 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 for each affected State. A 
current list of SPOCs is included in the application kit. If SPOCs have 
any State process recommendations on applications submitted to CDC, 
they should send them to Henry S. Cassell III, Grants Management 
Officer, Grants Management Branch, Procurement and Grants Office, 
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry 
Road, NE., Room 300, Mailstop E-16, Atlanta, GA 30305, not later than 
60 days after due date for receipt of applications. The Program 
Announcement Number and Program Title should be referenced on the 
document. CDC does not guarantee to ``accommodate or explain'' State 
process recommendations it receives after that date. Indian tribes are 
strongly encouraged to request tribal government review of the proposed 
application. If tribal governments have any tribal process 
recommendations on applications submitted to CDC, they should forward 
them to Henry S. Cassell III, Grants Management Officer, Grants 
Management Branch, Centers for Disease Control and Prevention (CDC), 
255 East Paces Ferry Road, NE., Room 300, Mailstop E-16, Atlanta, GA 
30305. This should be done no later than 60 days after the application 
deadline date. The granting agency does not guarantee to ``accommodate 
or explain'' for tribal process recommendations it receives after that 
date.

Public Health System Reporting Requirements

    This program is subject to the Public Health System Reporting 
Requirements. Under these requirements, all community-based 
nongovernmental applicants must prepare and submit the items identified 
below to the head of the appropriate State and/or health agency(s) in 
the program area(s) that may be impacted by the proposed project no 
later than the receipt date of the Federal application. The appropriate 
State and/or local health agency is determined by the applicant. The 
following information must be provided:
    A. A copy of the face page of the application (SF 424).
    B. A summary of the project that should be titled ``Public Health 
System Impact Statement'' (PHSIS), not exceeding one page, and 
including the following:
    1. A description of the population to be served;
    2. A summary of the services to be provided; and
    3. A description of the coordination plans with the appropriate 
State and/or local health agencies.

Catalog of Federal Domestic Assistance Number

    The Catalog of Federal Domestic Assistance Number is 93.978, 
Preventive Health Services--Sexually Transmitted Diseases Research, 
Demonstration, and Public Information and Education Grants.

Other Requirements

Paperwork Reduction Act

    Projects that involve the collection of information from 10 or more 
individuals and funded by the cooperative agreement will be subject to 
review by the Office of Management and Budget (OMB) under the Paperwork 
Reduction Act.

Confidentiality

    Applicants must have in place systems to ensure the confidentiality 
of patient records.

HIV/AIDS Requirements

    Recipients must comply with the document entitled Content of AIDS-
Related Written Materials, Pictorials, Audiovisuals, Questionnaires, 
Survey Instruments, and Educational Sessions (June 1992) (a copy is in 
the application kit). To meet the requirements for a program review 
panel, recipients are encouraged to use an existing program review 
panel, such as the one created by the State health department's HIV/
AIDS Prevention Program. If the recipient forms its own program review 
panel, at least one member must also be an employee (or a designated 
representative) of a State or local health department. The names of the 
review panel members must be listed on the Assurance of Compliance form 
CDC 0.1113, which is also included in the application kit. The 
recipient must submit the program review panel's report that indicates 
all materials have been reviewed and approved.
    Before funds can be used to develop HIV/AIDS-related materials, 
determine whether suitable materials are already available at the CDC 
National AIDS Clearinghouse.

Human Subjects

    If your project involves research on human subjects, you must 
comply with the Department of Health and Human Services Regulations, 45 
CFR Part 46, regarding the protection of human subjects. Provide 
assurance that the project will be subject to initial and continuing 
review by an appropriate institutional review committee. You must 
provide assurance in accordance with the guidelines and form provided 
in the application kit.
    In addition to other applicable committees, Indian Health Service 
(IHS) institutional review committees also must review the project if 
any component of IHS will be involved or will support the research. If 
any American Indian community is involved, its tribal government must 
also approve that portion of the project applicable to it.

Letters of Intent

    Letters of intent are required. On or before May 15, 1995, submit 
the original and two copies of a letter of intent to submit an 
application to: Henry S. Cassell III, Grants Management Officer, Grants 
Management Branch, Procurement and Grants Office, Centers for Disease 
Control and Prevention (CDC), 255 East Paces Ferry Road, NE., Room 300, 
Mailstop E-16, Atlanta, GA 30305. [[Page 19948]] 

Application Submission and Deadline

    On or before July 3, 1995, submit the original and two copies of 
the application (Form PHS 5161-1--OMB Number 0937-0189) and one 
electronic copy on disk to: Henry S. Cassell III, Grants Management 
Officer, Procurement and Grants Office, Grants Management Branch, 
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry 
Road, NE., Room 300, Mailstop E-16, Atlanta, GA 30305.
    1. Deadline: Applications shall be considered as meeting the 
deadline if they are:
    A. Received on or before the deadline or
    B. Sent on or before the deadline date and received in time for 
submission to the independent review committee. (Applicants must 
request a legibly dated U.S. Postal Service postmark or obtain a 
legibly dated receipt from a commercial carrier or U.S. Postal Service. 
Private metered postmarks will not be acceptable proof of timely 
mailing.)
    2. Late Applications: Applications that do not meet the criteria in 
1.A. or 1.B. are considered late applications and will not be 
considered in the current competition and will be returned to the 
applicant.

Where to Obtain Additional Information

    A complete program description, information on application 
procedures, an application package, and business management technical 
assistance may be obtained from: Manuel Lambrinos, Grants Management 
Specialist, Grants Management Branch, Procurement and Grants Office, 
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry 
Road, NE., Room 300, Mailstop E-16, Atlanta, GA 30305, telephone (404) 
842-6777. Programmatic technical assistance may be obtained from: Sevgi 
Aral, Ph.D., Division of STD/HIV Prevention, National Center for 
Prevention Services, Centers for Disease Control and Prevention (CDC), 
1600 Clifton Road, NE., Mailstop E-02, Atlanta, GA 30333, telephone 
(404) 639-8259.
    Please refer to Announcement 523 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'' through the Superintendent of Documents, Government 
Printing Office, Washington, DC 20402-9325, telephone (202) 512-1800.

    Dated: April 14, 1995.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for 
Disease Control and Prevention (CDC).
[FR Doc. 95-9879 Filed 4-20-95; 8:45 am]
BILLING CODE 4163-18-P