[Federal Register Volume 62, Number 78 (Wednesday, April 23, 1997)]
[Notices]
[Pages 19770-19776]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-10435]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Rural Telemedicine Grant Program
AGENCY: Health Resources and Services Administration (HRSA), HHS.
ACTION: Notice of availability of funds.
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SUMMARY: The Office of Rural Health Policy, HRSA, announces that
applications are being accepted for Rural Telemedicine Grants to
facilitate development of rural health care networks through the use of
telemedicine and develop a baseline of information for the systematic
evaluation of telemedicine systems serving rural areas.
DATES: Applications for the program must be received by the close of
business on June 20, 1997. Applications shall be considered as meeting
the deadline if they are either (1) received on or before the deadline
date at the address noted below; or (2) postmarked on or before the
deadline date and received by the granting agency in time for the
independent review. 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 in lieu of a postmark. Private
metered postmarks shall not be acceptable as proof of timely mailing.
Applications are considered late if they do not meet the above
criteria; late applications will be returned to the sender.
ADDRESSES: Completed applications must be sent to HRSA GRANTS
APPLICATION CENTER, 40 West Gude Drive, Suite 100, Rockville, MD 20850.
FOR FURTHER INFORMATION CONTACT: Requests for technical or programmatic
information on this announcement should be directed to Cathy Wasem or
Amy Barkin, Office of Rural Health Policy, HRSA, 5600 Fishers Lane,
Room 9-05, Rockville, MD 20857, (301) 443-0835, cwasem@hrsa.dhhs.gov or
abarkin@hrsa.dhhs.gov. Requests for information regarding business or
fiscal issues should be directed to Martha Teague, Office of Grants
Management, Bureau of Primary Health Care, HRSA, West Tower, 11th
Floor, 4350 East West Highway, Bethesda, MD 20814, (301) 594-4258.
SUPPLEMENTARY INFORMATION:
Application Packet
The standard application form and general instructions for
completing applications (Form PHS-5161-1 [Revised 5/96], OMB #0937-
0189) have been approved by the Office of Management and Budget. To
receive an application kit call toll-free: HRSA GRANTS APPLICATION
CENTER at 1-888-300-HRSA. Individuals in rural areas where the 1-888
number cannot be dialed should call the operator and ask that the
operator connect them to 1-888-300-4772.
Authority
Grants for these projects are authorized under section 330A of the
Public Health Service (PHS) Act as amended by the Health Centers
Consolidation Act of 1996, Public Law 104-299. Awards will be made from
funds appropriated under Public Law 104-208 (HHS Appropriation Act for
FY 1997).
Legislative and Program Background
Section 330A of the PHS Act, as amended by Pub. L. 104-299,
authorizes the Rural Health Outreach, Network Development and
Telemedicine Grant Program. Grants supported under this program are to
``expand access to, coordinate, restrain the cost of, and improve the
quality of essential health care services, including preventive and
emergency services, through the development of integrated health care
delivery systems or networks in rural areas and regions.'' Two
approaches to achieve these goals are through projects funded under the
Rural Health Outreach and the Rural Network Development Program. A
third approach is through projects funded under the Rural Telemedicine
Grant Program. This program announcement pertains only to the Rural
Telemedicine Grant Program. (The Federal Register Notice for the Rural
Health Outreach and Rural Network Development Program was published
December 13, 1996. Applications were due March 31, 1997).
Rural residents in the United States often lack access to a range
of health services--from basic preventive services to highly
specialized services--that would enable them to prevent, recover from,
or cope with disease and disability. Consistent with the legislation,
the Office of Rural Health Policy (ORHP) views integrated health care
delivery systems or networks as a means to stabilize and integrate
fragile rural health care systems with more sustainable, comprehensive
delivery networks. ORHP believes that telemedicine has the potential to
facilitate the development of integrated health care networks, thereby
fostering improved access to quality health care services and reducing
the isolation of rural practitioners.
The goal of ORHP's Rural Telemedicine Grant Program is to improve
access to quality health services for rural residents and reduce the
isolation of rural practitioners through the use of telemedicine
technologies.
The two objectives of the Rural Telemedicine Grant Program are: (1)
To demonstrate how telemedicine can be used as a tool in developing
integrated systems of health care, thereby improving access to health
services for rural individuals across the lifespan and reducing the
isolation of rural health care practitioners; and (2) to evaluate the
feasibility, costs, appropriateness, and acceptability of rural
telemedicine services and technologies. Such evaluation is needed to
determine how best to organize and provide telemedicine services in a
sustainable manner.
Under its Rural Telemedicine Grant Program, ORHP funded eleven
telemedicine projects in fiscal year 1994 for a period of three years.
Building on the lessons learned from these first telemedicine grantees,
new grantees will be expected to further the development of integrated
health care networks by using telemedicine to increase access to a wide
range of clinical services based on community need.
Funds Available
Approximately $4 million is available for the Rural Telemedicine
Grant program in FY 1997. The Office of Rural
[[Page 19771]]
Health Policy expects to make approximately 10-14 new awards.
Applicants may propose project periods of up to three years. However,
applicants are advised that continued funding of grants beyond FY 1997
is subject to the availability of funds and grantee performance. No
project will be supported for more than three years. The budget period
for new projects will begin September 30, 1997.
Size of Awards
Individual grant awards under this notice will be limited to
$400,000 (including direct and indirect costs) per year. It is
anticipated that existing telemedicine networks would come in for
smaller grant awards, because the network would already have some
equipment and would be supporting some personnel. Overall, applications
for smaller amounts are strongly encouraged.
Definitions
For the purposes of this grant program the following definitions
apply:
Telemedicine: Telemedicine is the use of telecommunication and
information technologies for the clinical care of patients, including
patient counseling and clinical supervision/preceptorship of medical
residents and health professions students, when such supervising or
precepting involves direct patient care.
The definition does not include didactic distance education, such
as lectures that are designed solely to instruct health care students,
personnel or patients, and in which no clinical care is provided.
Telemedicine Clinical Consultation: A telemedicine clinical
consultation is a person-to-person interaction relating to the clinical
condition or treatment of a patient. It is the process by which a
clinical service is delivered. The consultation may be interactive
(i.e., in real-time) or asynchronous (i.e., using store-and-forward
technology).
Professionals from a variety of health care disciplines may be
involved in providing and/or receiving consultations including, but not
limited to: physicians, physician assistants, nurses, nurse
practitioners, nurse-midwives, clinical nurse specialists, dentists,
dental hygienists, physical therapists, occupational therapists, speech
therapists, clinical psychologists, clinical social workers, substance
abuse counselors, podiatrists, optometrists, dieticians/nutritionists,
pharmacists, optometrists, EMTs, etc.
Telemedicine Network: A telemedicine network is comprised of hubs
(i.e., entities whose health care professionals provide consultations
or whose faculty supervise or precept health professions students for
clinical care at rural facilities) and spokes (i.e., entities whose
professionals or patients receive consultations). Some entities may
function as both a hub and a spoke. The network may have additional
members who do not directly receive or provide consultations, but who
foster access to and coordination of services, such as area agencies on
aging and providers under the WIC program.
Rural spokes may be health care facilities or places in which
health care is provided such as schools and homes. Examples of spoke
sites include rural hospitals, clinics, nursing homes, mental health
centers, homes, public health clinics, school-based clinics, assisted
living facilities, senior citizen housing, and centers for the
developmentally disabled.
Program Requirements
Telemedicine Network
In order to compete for the program, applicants must participate in
a telemedicine network that includes at least three members: (1) a
multispecialty entity (i.e., hub) located in an urban or rural area
that can provide 24-hour-a-day access to a range of specialty health
care; and (2) at least two rural health facilities (i.e., spokes),
which may include small rural hospitals (fewer than 100 staffed beds),
rural physician offices, rural health clinics, rural community health
centers and rural nursing homes. For the purposes of this grant
program, a multispecialty entity may be a tertiary care hospital, a
multispecialty clinic, or a collection of facilities that, combined,
could provide 24-hour-a-day specialty consultations.
A telemedicine network is characterized by a partnership among its
members that is evidenced by each member's: (1) resource contribution;
(2) specific network role; (3) active planning and programmatic
participation; (4) long-term commitment to the project; and (5)
signature on a signed, dated memorandum of agreement.
Applicants are encouraged to include other types of members in
their network such as mental health clinics, public health clinics and
departments, school-based clinics, emergency service providers, health
professions schools, home health providers, and social service programs
such as area agencies on aging and providers under the WIC program.
Preference will be given to applicants whose networks meet the
statutory preference noted in the ``Statutory Preference Section.''
Clinical Services
An applicant must meet the following programmatic requirements for
clinical services:
(1) It must provide a minimum of seven (7) clinical telemedicine
services over the network, one of which must be the stabilization of
patients in emergency situations. Not all services need be provided to
all sites.
(2) The applicant and its network members should select the other
six (6) services to be provided. These services must be based on
documented needs of the communities to be served.
(3) In addition to emergency stabilization services, at least two
of the grant-funded services provided by the telemedicine network must
be consultant services provided by physician specialists.
(4) All services provided with funding from this grant program must
be available from the multispecialty entity on a 24-hour-a-day basis
unless there is a strong justification for services being available
less than 24 hours-a-day. An entity is considered capable of providing
specialty consultations 24-hours-a-day if they have specialists on-
call.
System Design
All members of a telemedicine network will be required to be
electronically linked, for at least e-mail services, by the ninth month
of the first budget period.
Whenever possible, telemedicine systems should be designed with an
open architecture, fostering interoperability with other telemedicine
systems.
Telemedicine systems should be designed using the least costly,
most efficient technology to meet the identified need(s).
ORHP grant recipients will be expected, during the first nine
months of the first budget period, to develop a set of protocols for
each of the clinical services to be provided using telemedicine.
Evaluation and Data Collection
An applicant must submit a plan for evaluating the telemedicine
services it provides and monitoring its own performance, as well as
participate in an ORHP-sponsored evaluation of telemedicine services.
The ORHP-sponsored activities may include maintaining a data-log
provided by ORHP and collecting data, completing surveys, and
participating in on-site observations by independent evaluators. The
ORHP-sponsored data activities will be subject to OMB approval under
the Paperwork Reduction Act of 1995.
[[Page 19772]]
Funding Requirements
Use of Grant Funds
Grant funds may be used to support the operating costs of the
telemedicine system, including compensation for consulting and
referring practitioners.
Grant funding must be used for services provided to or in rural
communities. Fifty percent (50%) or more of the grant award must be
spent for: transmission costs and clinician compensation payments;
costs incurred in rural communities, including rural staff salaries and
equipment maintenance; and equipment placed in rural communities,
irrespective of where the equipment is purchased.
Grant dollars may not be used to support didactic distance
education activities. However, equipment purchased to provide clinical
services may be used for a variety of non-clinical purposes, including
didactic education, administrative meetings, etc.
No more than forty percent (40%) of the total grant award each year
may be used to purchase, lease or install equipment (i.e., equipment
used inside the health care facility for providing telemedicine
services such as codecs, cameras, monitors, computers, multiplexers,
etc.).
Grant funds may not be used to purchase or install transmission
equipment, such as microwave towers, satellite dishes, amplifiers,
digital switching equipment or laying cable or telephone lines.
Grant funds may not be used to build or acquire real property, or
for construction or renovation, except for minor renovations related to
the installation of equipment.
Grant funds may be used to pay for transmission costs such as the
cost of satellite time or the use of phone lines. However, those
applicants who anticipate very high transmission rates for all or some
of their sites should consider activities to achieve more sustainable
rates.
If ORHP funds are used for clinician compensation payments,
payments can be up to a maximum of $60 per practitioner per consult. If
a third-party payer, including Medicaid or Medicare, can be billed for
a consult, the grantee may not provide the practitioner with an ORHP-
funded compensation payment. This requirement applies even if the
grantee has not yet established its own internal procedure to bill
Medicaid or Medicare.
Indirect Costs
In accordance with the law, no more than 20 percent of the amount
provided under a grant in this grant program can be used to pay for the
indirect costs associated with carrying out the purposes of such grant.
Cost Participation
The amount of cost participation will serve as an indicator of
community and institutional support for the project and of the
likelihood that the project will continue after federal grant support
has ended. Cost participation may be in cash or in-kind (e.g.,
equipment, personnel, building space, indirect costs).
If an award is made, all funds identified as dedicated to this
project (including funds used for cost participation) will be subject
to the applicable cost principles, audit and reporting requirements.
Eligible Applicants
A grant award will be made either (1) to an entity that is a health
care provider and is a member of an existing or proposed telemedicine
network, or (2) to an entity that is a consortium of health care
providers that are members of an existing or proposed telemedicine
network. The applicant must be a legal entity capable of receiving
federal grant funds. The grant recipient must be a public (non-federal)
or private nonprofit entity, located in either a rural or urban area.
Other telemedicine network members may be public or private, nonprofit
or for-profit. Health facilities operated by a Federal agency may be
members of the network but not the applicant.
All spoke facilities supported by this grant must meet one of the
two criteria stated below:
(1) The facility is located outside of a Metropolitan Statistical
Area (MSA) as defined by the Office of Management and Budget. (A list
of the cities and counties that are designated as Metropolitan
Statistical Areas is included in the application kit); or
(2) The facility is located in one of the specified rural census
tracts of the MSA counties listed in Appendix I. Although each of these
counties is an MSA, or part of one, large parts of each county are
rural. Facilities located in these rural areas are eligible for the
program. Rural portions of these counties have been identified by
census tract because this is the only way we have found to clearly
differentiate them from urban areas in the large counties. Appendix I
provides a list of these eligible census tracts by county. Appendix II
includes the telephone numbers for regional offices of the Census
Bureau. Applicants may call these offices to determine the census tract
in which they are located.
Statutory Funding Preference
As provided in section 330A of the PHS Act, as amended by the
Health Centers Consolidation Act of 1996 (Pub. L. 104-299), an
applicant will be given preference in the review process if its network
includes any of the following:
(a) a majority of the health care providers serving in the rural
areas or region to be served by the network;
(b) any federally qualified health centers, rural health clinics,
and local public health departments serving in the rural area or
region;
(c) outpatient mental health providers serving in the rural area or
region; or
(d) appropriate social service providers (e.g., agencies on aging,
school systems, and providers under the Women, Infants, and Children
[WIC] program) to improve access to and coordination of health care
services.
For preference purposes, the following definitions apply:
``Health care providers'' in `element (a)' are defined as
institutions and/or facilities that provide health care. ``Federally
Qualified Health Centers (FQHCs)'' are defined as those federally
and nonfederally-funded health centers that have status as federally
qualified health centers under section 1861(aa)(4) or section
1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(4) and
1396d(l)(2)(B), respectively).
``Rural health clinics (RHCs)'' are defined as clinics certified
by HCFA and approved to participate in the Medicare and Medicaid
programs and receive payments as a Rural Health Clinic as defined
under section 1861(aa) or 1905(l) of the Social Security Act (42
U.S.C. 1395x(aa) and 1395d(l), respectively).
Approved applications that qualify for the statutory funding preference
will be funded ahead of other approved applications.
HRSA will consider geographic coverage when deciding which approved
applications to fund. In addition, HRSA is concerned with assuring that
grants to new networks, as well as to existing networks, be funded.
Therefore when making awards, HRSA will consider the balance between
awards to new telemedicine networks and to existing telemedicine
networks.
Review Criteria
Grant applications will be evaluated on the basis of the following
criteria:
(1) Extent to which the applicant has documented the need for the
project, developed measurable project objectives for meeting the need,
and developed a methodology or plan of activities that will lead to
attaining the project objectives, including a plan to monitor the
performance of the project. (20 points)
[[Page 19773]]
(2) Extent to which the project objectives and related activities
are consistent with the goal and objectives of the grant program noted
in the `Legislative and Program Background' section. (35 points)
(a) Extent to which the proposed project will, using telemedicine
as a tool, facilitate the development of an integrated rural health
network, thereby increasing access to health services and decreasing
practitioner isolation. (20 points)
(b) Extent to which the proposed project will provide a baseline of
information and data for the systematic evaluation of telemedicine. (15
points)
(3) Demonstrated capability, experience and knowledge (i.e.
managerial, technical, and clinical) of the applicant and other network
members to implement the project and to disseminate information about
the project. (20 points)
(4) Level of local involvement in defining needs and planning and
implementing the project. Level of commitment to the project as
evidenced by cost participation by the applicant, other network members
and/or other organizations, and realistic plans to sustain the
telemedicine network after federal grant support ends. (15 points)
(5) Relevance of the budget to the proposed activities and
reasonableness of the budget to anticipated outcomes/results. (10
points)
Other Information
Applicants must develop projects that address specific, documented
needs of the rural communities. Applicants should consider (1) the
health care needs of the rural communities served by the project, (2)
the information and support needs of rural health care practitioners,
and (3) the extent to which the project can build upon existing
telecommunications capacity in the communities. Needs can be
established through a formal needs assessment, by population specific
demographic and health data, and by health services data.
Applicants are advised that the narrative description of their
program plus the narrative budget justification may not exceed 35 pages
in length. All applications must be typewritten or printed and legible.
Pages must have margins no less than one inch on top and one-half inch
on the sides and bottom. The print font on each page, with the
exception of the narrative budget pages, must be no smaller than 12
characters per inch (cpi) or a 12 point scalable font. The narrative
budget pages must be no smaller than a 12 cpi or a 10 point scalable
font.
Any application that is judged nonresponsive because it is
inadequately developed, in an improper format, exceeds the specified
page length, or otherwise is unsuitable for peer review and funding
consideration, will be returned to the applicant. All responsive
applications will be reviewed by an objective review panel.
National Health Objectives for the Year 2000
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 for setting priority areas. The Rural
Telemedicine Grant program is related to the priority areas for health
promotion, health protection, and preventive services. 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) through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325 (Telephone (202) 783-3238).
Smoke-Free Workplaces
The PHS strongly encourages all grant recipients to provide a
smoke-free workplace and promote the non-use of all tobacco products.
This is consistent with the PHS mission to protect and advance the
physical and mental health of the American people. In addition, Public
Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain
facilities (or in some cases, any portion of a facility) in which
regular or routine education, library, day care, health care or early
childhood development services are offered to children.
Public Health System Impact Statement
This program is subject to the Public Health System Reporting
Requirements as approved by the OMB--0937-0195. Under these
requirements, the community-based nongovernmental applicant must
prepare and submit a Public Health System Impact Statement (PHSIS). The
PHSIS is intended to provide information to State and local health
officials to keep them apprised of proposed health services grant
applications submitted by community-based nongovernmental organizations
within their jurisdictions.
Community-based nongovernmental applicants are required to submit
the following information to the head of the appropriate State and
local health agencies in the area(s) to be impacted: a. A copy of the
face page of the application (SF 424) b. A summary of the project, not
to exceed one page, which provides:
(1) A description of the population to be served.
(2) A summary of the services to be provided.
(3) A description of the coordination planned with the appropriate
State of local health agencies.
This information must be submitted no later than the federal
application receipt due date.
Executive Order 12372
The Rural Telemedicine Grant program has been determined to be a
program that is subject to the provisions of Executive Order 12372
concerning intergovernmental review of federal programs by appropriate
health planning agencies as implemented by 45 CFR part 100. Executive
Order 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 (SPOCs) as early as possible to alert the
SPOC to the prospective applications and receive any necessary
instructions on the State process. For proposed projects serving more
then one State, the applicant is advised to contact the SPOC of each
affected State. A list of SPOCs is included in the application kit. All
SPOC recommendations should be submitted to Pam Hilton, Office of
Grants Management, Bureau of Primary Health Care, 4350 East West
Highway, 11th floor, Bethesda, Maryland, 20814, (301) 594-4260. The due
date for State process recommendations is 60 days after the application
deadline of June 20, 1997 for competing applications. The granting
agency does not guarantee to ``accommodate or explain'' for State
process recommendations it receives after that date. (See Part 148 of
the PHS Grants Administration Manual, ``Intergovernmental Review of PHS
Programs under Executive Order 12372 and 45 CFR Part 100,'' for a
description of the review process and requirements.
Applicants should notify their State Office of Rural Health (or
other appropriate State entity) of their intent to apply for this grant
program and to consult with such agency regarding the content of the
application. The State Office can provide information and technical
assistance. A list of State Offices of Rural Health is included with
the application kit.
[[Page 19774]]
OMB Catalog of Federal Domestic Assistance number is 93.211.
Claude Earl Fox,
Acting Administrator.
Appendix I
Census tract numbers are shown below each county name.
For a spoke health care facility to be eligible as `rural' under
criterion #2, the facility must be located in one of the census tracts
(CTs) or block numbered areas (BNAs) that is listed below the following
counties. If a facility is classified as rural under this criterion,
the CT number or BNA number must be included next to the county name
when identifying the facility in the `Telemedicine Network
Identification' portion of the application.
State, County and Tract Number
Alabama
Baldwin
101-102
106
110
114-116
Mobile
59
62
66
72.02
Tuscaloosa
107
Arizona
Coconino
16-25
Maricopa
101
405.02
507
611
822.02
5228
7233
Mohave* *
* *See Below
Pima
44.05
48-49
Pinal
01-02
04-12
Yuma
105-107
110
112-113
115-116
California
Butte
24-36
El Dorado
301.01-301.02
302-303
304.01-304.02
305.01-305.03
306
310-315
Fresno
40
63
64.01
64.03
65-68
71-74
78-83
84.01-84.02
Kern
33.01-33.02
34-37
40-50
51.01
52-54
55.01-55.02
56-61
63
Los Angeles
5990
5991
9001-9002
9004
9012.02
9100-9101
9108.02
9109-9110
9200.01
9201
9202
9203.03
9301
Madera
01.02-01.05
02-04
10
11.98
12.98
Merced
01-02
03.01
04
05.01-05.02
06-08
19.98
20
21.98
22
23.01
24
24.75-24.98
Monterey
109
112-0113
114.01-0114.02
115
Placer
201.01-201.02
202-204
216-217
219-220
Riverside
421
427.02-427.03
429-432
444
452.02
453-455
456.01-456.02
457.01-457.02
458-462
San Bernardino
89.01-89.02
90.01-90.02
91.01-91.02
93-95
96.01-96.03
97.01
97.03-97.04
98-99
100.01-100.02
102.01-102.02
103
104.01-104.03
105-107
San Diego
189.01-189.02
190
191.01
208
209.01-209.02
210
212.01-212.02
213
San Joaquin
40
44-45
52.01-52.02
53.02-53.04
54-55
San Luis Obispo
100-106
107.01-107.02
108
114
118-122
124-126
127.01-127.02
Santa Barbara
18
19.03
Santa Clara
5117.04
5118
5125.01
5127
Shasta
126-127
1504
Sonoma
1506.04
1537.01
1541-1543
Stanislaus
01
02.01
32-35
36.05
37-38
39.01-39.02
Tulare
02-07
[[Page 19775]]
26
28
40
43-44
Ventura
01-02
46
75.01
Colorado
Adams
84
85.13
87.01
El Paso
38
39.01
46
Larimer
14
17.02
19.02
20.01
22
Mesa
12
15
18
19
Pueblo
28.04
32
34
Weld
19.02
20
24
25.01-25.02
Florida
Collier
111-114
Dade
115
Marion
02
04-05
27
Osceola
401.01-401.02
402.01-402.02
403.01-403.02
404
405.01-405.02
405.03
405.05
406
Palm Beach
79.01-79.02
80.01-80.02
81.01-81.02
82.01-82.02
82.03-83.01
83.02
Polk
125-127
142-144
152
154-161
Kansas
Butler
201-205
209
Louisiana
Rapides
106
135-136
Terrebonne
122-123
MINNESOTA
Polk*
204-210
*9701-9704
St. Louis
105
112-114
121-135
137.01-137.02
138-139
141
151-155
Stearns
103
105-111
Montana
Cascade
105
Yellowstone
15-16
19
Nevada
Clark
57-59
Washoe
31.04
32
33.01-33.04
34
New Mexico
Dona Ana
14
19
Nye**
**See Below
Sandoval
101-104
105.01
Santa Fe
101-102
103.01
Valencia*
*9701
*9703-9706
*9708
*9711-9712
New York
Herkimer
101
105.02
107-109
110.01-110.02
111-112
113.01
North Dakota
Burleigh
114-115
Grand Forks
114-116
118
Morton
205
Oklahoma
Osage
103-108
Oregon
Clackamas
235-236
239-241
243
Jackson
24
27
Lane
01
05
07.01-07.02
08
13-16
Pennsylvania
Lycoming
101-102
South Dakota
Pennington
116-117
Texas
Bexar
1720
1821
1916
Brazoria
606
609-619
620.01-620.02
621-624
625.01-625.03
626.01-626.02
627-632
Harris
354
544
546
Hidalgo
223-228
230-231
243
[[Page 19776]]
Washington
Benton
116-120
Franklin
208
King
327-328
330-331
Snohomish
532
536-538
Spokane
101-102
103.01-103.02
133
138
143
Whatcom
110
Yakima
18-26
Wisconsin
Douglas
303
Marathon
17-18
20-23
Wyoming
Laramie
16-18
*This county is divided into Block Numbered Areas (BNAs), not
Census Tracts (CTs).
**This entire county, although part of a large city MSA, is
eligible as rural.
Appendix II
Bureau of The Census Regional Information Service
Atlanta, GA 404-730-3957
Alabama, Florida, Georgia
Boston, MA 617-424-0501
Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island,
Vermont, Upstate New York
Charlotte, NC 704-344-6144
Kentucky, North Carolina, South Carolina, Tennessee, Virginia
Chicago, IL 708-562-1740
Illinois, Indiana, Wisconsin
Dallas, TX 214-767-7105
Louisiana, Mississippi, Texas
Denver, CO 303-969-7750
Arizona, Colorado, Nebraska, New Mexico, North Dakota, South
Dakota, Utah, Wyoming
Detroit, MI 313-259-0056
Michigan, Ohio, West Virginia
Kansas City, KS 913-551-6711
Arkansas, Iowa, Kansas, Missouri, New Mexico, Oklahoma
Los Angeles, CA 818-904-6339
California
Philadelphia , PA 215-597-8313
Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania
Seattle, WA 206-728-5314
Idaho, Montana, Nevada, Oregon, Washington
[FR Doc. 97-10435 Filed 4-22-97; 8:45 am]
BILLING CODE 4160-15-P
