[Federal Register Volume 63, Number 89 (Friday, May 8, 1998)]
[Notices]
[Pages 25483-25488]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-12236]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Announcement Number 98039]
Programs To Prevent the Emergence and Spread of Antimicrobial
Resistance; Notice of Availability of Fiscal Year 1998 Funds
Introduction
The Centers for Disease Control and Prevention (CDC) is
implementing a multifaceted effort to address the problem of
antimicrobial resistance. As part of this, CDC announces the
availability of fiscal year (FY) 1998 funds for a cooperative agreement
program to provide assistance for the development and evaluation of
demonstration projects to prevent and control the emergence and spread
of antimicrobial resistance.
The 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 improve the quality of life. This
announcement is related to the priority area of Immunization and
Infectious Diseases. (For ordering a copy of Healthy People 2000, see
the section WHERE TO OBTAIN ADDITIONAL INFORMATION.)
Authority
This program is authorized under sections 301(a), 317(k)(1), and
317(k)(2) of the Public Health Service Act, as amended (42 U.S.C.
241(a), 247b(k)(1), and 247b(k)(2)).
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's 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
organizations and governments and their agencies in the United States
(U.S.). Thus, universities, colleges, research institutions, hospitals,
other public and private nonprofit organizations, including State and
local governments or their bona fide agents, federally recognized
Indian tribal governments, Indian tribes or Indian tribal
organizations, and small, minority- and/or women-owned businesses are
eligible to apply.
Note: An organization described in Section 501(c)(4) of the
Internal Revenue Code of 1986 which engages in lobbying activities
shall not be eligible to receive Federal funds constituting an
award, grant, contract, loan, or any other form.
Also, only one application will be accepted from any single applicant.
Availability of Funds
Approximately $1.2 million is available in FY 1998 to fund
approximately 2 to 3 awards. It is expected that awards will begin on
or about August 15, 1998, and will be made for a 12-month budget period
within a project period of up to 5 years. It is expected that the
average annual award for the first 3 years of the project period will
be $450,000 (direct costs and indirect costs), ranging from $300,000 to
$600,000. The last 2 years will involve data collection and analysis
only for purposes of evaluating the program; therefore, it is
anticipated that lesser amounts of funding will be needed in these
years.
Continuation awards within the project period will be made on the
basis of satisfactory progress and availability of funds.
Note: Approximately 50 percent of the available funds are
allocated for projects focusing on community-based projects.
Approximately 50 percent of the available funds are allocated for
projects focusing on integrated health care delivery systems.
Applicants should indicate clearly whether they consider their
application to be primarily directed at community-based
interventions or interventions in integrated health care delivery
systems. (Applications addressing both are encouraged. However, for
purposes of the evaluation process, the application must clearly
state whether it is primarily addressing community-based
interventions or interventions in integrated health care delivery
systems.)
Use of Funds
Restrictions on Lobbying
Applicants should be aware of restrictions on the use of HHS funds
for lobbying of Federal or State legislative bodies. Under the
provisions of 31 U.S.C. section 1352 (which has been in effect since
December 23, 1989), recipients (and their subtier contractors) are
prohibited from using appropriated Federal funds (other than profits
from a Federal contract) for lobbying Congress or any Federal agency in
connection with the award of a particular contract, grant, cooperative
agreement, or loan. This includes grants/cooperative agreements that,
in whole or in part,
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involve conferences for which Federal funds cannot be used directly or
indirectly to encourage participants to lobby or to instruct
participants on how to lobby.
In addition, the FY 1998 Department of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act (Pub.
L. 105-78) states in section 503(a) and (b) that no part of any
appropriation contained in this Act shall be used, other than for
normal and recognized executive-legislative relations, for publicity or
propaganda purposes, for the preparation, distribution, or use of any
kit, pamphlet, booklet, publication, radio, television, or video
presentation designed to support or defeat legislation pending before
the Congress or any State legislature, except in presentation to the
Congress or any State legislature itself. No part of any appropriation
contained in this Act shall be used to pay the salary or expenses of
any grant or contract recipient, or agent acting for such recipient,
related to any activity designed to influence legislation or
appropriations pending before the Congress or any State legislature.
Background
The introduction of antibacterial drug therapy in the 1940s led to
a dramatic reduction in illness and death from infectious diseases over
the past 50 years. Worldwide, antimicrobial drugs have spared the lives
of millions of people for whom premature death or crippling
complications would have been unavoidable. However, this situation is
changing rapidly. Emergence of drug resistance in bacteria, fungi,
parasites, and viruses is swiftly reversing the miracles of the past 50
years and threatens to create an era where antimicrobial agents are no
longer useful for many common diseases. The identification this year of
Staphylococcus aureus with reduced susceptibility to vancomycin in both
Japan and the United States (U.S.) is particular cause for concern. At
least 70 percent of the bacteria-causing, hospital-acquired infections
are resistant to at least one antimicrobial agent commonly used for
treatment. Among community-acquired pathogens, drug resistance among
respiratory tract pathogens, particularly pneumococci, represents a
growing problem. Pneumococcal strains have been identified that are not
susceptible to any of the oral agents commonly used as therapy, and
combination therapy with vancomycin now is recommended for life
threatening pneumococcal infections due to increasing resistance among
extended spectrum cephalosporins. The spread of resistance means that
more toxic, more difficult to administer, more costly, or experimental
antimicrobial agents must be used for therapy.
Factors that promote the spread of resistance differ between
pathogens. In the community, transmission within families and in other
settings where close contact may occur (e.g., child care facilities);
rates of antibiotic therapy, the agents used and their dose; and the
impact of resistance on the fitness of a pathogen, all may affect the
spread of resistance. For pathogens that cause nosocomial infections,
health-care-associated transmission involving acute-care hospitals,
long-term-care institutions, such as nursing homes, and non-
institutionalized persons in the community receiving health care in
their homes and/or ambulatory clinical settings also may be important.
Few programs to reduce the development and spread of antimicrobial
resistance have been implemented in whole communities. Strategies to
prevent the spread of resistance among nosocomial pathogens which have
proven successful within a single institution or a limited population
of patients include the implementation of infection control guidelines
and controls on antibiotics to limit inappropriate use. Antibiotic use
has been controlled with formulary restrictions, intervention by
infectious disease consultants and/or clinical pharmacologists,
clinical practice guidelines for physicians, computer-assisted
prescribing, and physician and patient educational programs.
Infection control guidelines include the use of barrier
precautions, pre-admission and discharge screening, environmental
controls, and cohorting. In the community, successful interventions
have included education of physicians and patients, the development of
clinical practice guidelines and their promotion by peer educators and
opinion leaders, feedback to clinicians comparing their practices with
those of their peers, decreasing availability of antibiotics, and
changing the agents used, their dose, and the duration of therapy.
Purpose
This program is intended to evaluate the effectiveness and impact
of strategies to control the spread of antimicrobial resistance within
a larger population, such as a geographically defined community, the
catchment area of large health-care delivery organization, or the
population of one or more integrated health-care delivery systems.
Another purpose of this program is to conduct research which
develop, implement, and evaluate programs designed to reduce the
emergence and spread of antimicrobial resistance. It is anticipated
that these programs will be effective and that they could subsequently
be replicated widely in order to reduce antimicrobial resistance
throughout the U.S. Applicants may submit applications that focus
primarily on either (1) communities or (2) integrated networks of
health facilities. This program is not intended to support an infection
control program at an individual health-care facility or evaluation of
a single intervention in a community or health-care setting.
Programs will address the problem of antimicrobial resistance
through interventions potentially including, but not limited to:
1. Promoting more judicious antimicrobial use (e.g., using
antimicrobials only when needed, using appropriate doses of
antimicrobial agents, etc.).
2. Reducing transmission of antimicrobial resistant microorganisms.
3. Preventing colonization and infection through the use of
vaccines.
4. Improving the ability to provide effective narrow spectrum
therapy by rapidly and accurately diagnosing resistant microorgansims
through the use of improved laboratory testing procedures and improved
quality and flow of laboratory data.
5. Using improved means of communication with health-care providers
to improve their use of antimicrobials, such as through the use of
information management systems and Internet-based technology.
It is envisioned that funded projects will use a combination of
approaches to achieve judicious antimicrobial use and other changes
that will result in decreased appearance and spread of resistance.
Funded projects will also be expected to conduct a multifaceted
evaluation of many aspects of the program. An essential part of such an
evaluation will be assessing the costs and cost savings associated with
any proposed intervention.
Program Requirements
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. Select Community or Health Facility Focus and Define Pathogens of
Interest
Identify whether the primary focus of activities will be on
decreasing spread
[[Page 25485]]
of resistance among community-or health-care-associated pathogens and
define the pathogen/resistance patterns that will be evaluated in the
project.
2. Select Study Population
Identify a population of adequate size for study purposes.
a. If the primary focus of the application is to address
antimicrobial resistance in community settings, the population should
be defined by a geographic area and should include a variety of health-
care providers and health-care provider organizations. (One example of
an appropriate approach would be to define the population to be
addressed as metropolitan area or part of a State in which case the
project might involve, at a minimum, public health entities and
providers of outpatient health care in this area.)
b. If the primary focus of the application is on integrated health
care delivery systems or networks, the population should be defined
such that interventions could be conducted in multiple settings in
which antimicrobial resistance among the target pathogens can develop
or be spread (for example, inpatient hospital settings, emergency
rooms, ambulatory care facilities, home health settings, long term care
facilities, etc.). One example of an appropriate approach would be to
define the population as those receiving hospital, long-term care
services, and ambulatory care services through a network of related
organizations, in which case the project might involve the targeted
health facilities, as well as public health authorities in the area.
3. Define, Collect, and Analyze Baseline Data
Collect baseline data so that evaluation of the interventions can
be done. This includes, at a minimum, collecting incidence and/or
prevalence data on antimicrobial resistance among the target pathogens
and measuring indicators of prescribing practices of providers serving
the population under study.
4. Design and Implement an Intervention Promoting Judicious
Antimicrobial Use and Other Approaches to Reducing Antimicrobial
Resistance
It is anticipated that this will involve developing coalitions
among public health agencies, health-care providers, professional
societies, and others, as well as implementing specific strategies.
These strategies may include peer education of physicians, public
education campaigns, clinical practice guidelines, formulary
guidelines, prescribing restrictions, pre-admission and pre-discharge
screening and the implementation of admission and discharge guidelines,
cohorting, barrier precautions, isolation precautions, and other
strategies which are likely to be efficacious. The choice of strategies
should be justified based on the nature of the study population and the
structure of the health care delivery system(s) within which the study
population receives health care.
5. Measure Effect of the Intervention
a. Measure the change in rates of antimicrobial resistance of the
organisms over time. Changes in rates of resistance among organisms
that are carried (e.g., in the nasopharynx) may be evaluated in
addition to changes in rates of resistant infections. Measurement of
antimicrobial resistance should be by a laboratory with proven ability
to do these measurements well.
b. As decreases in resistance as a result of the program may take
several months to years to manifest themselves, measure outcomes
related to how well the interventions have been implemented and whether
they have resulted in behavior change.
c. Measure cost implications of the intervention. This should
include impact of the intervention on direct costs (e.g., costs of
antibiotics, medical care visits, duration of hospitalization, etc.)
and indirect costs (e.g., time lost from work or child care). Costs
should be differentiated from charges, and the perspective of the costs
should be defined (e.g., societal, payer, patient, provider). Costs of
the intervention program must be differentiated from those of the
evaluation.
d. Other possible outcomes that could be measured include changes
in parent or provider knowledge and attitudes regarding antimicrobial
use.
6. Disseminate Research Findings
Disseminate research results by appropriate methods such as
publication in journals, presentation at meetings, conferences, etc.
B. CDC Activities
CDC will provide technical assistance in the design and conduct of
the research. This may include:
1. Provide technical assistance in the design and conduct of the
project, including intervention methods and analytic approach.
2. Upon recipient's request, perform selected laboratory tests as
appropriate.
3. Participate in data management, the analysis of research data,
and the interpretation and dissemination of research findings as
appropriate.
4. Assist in the design of the evaluation, in particular, in the
identification of outcome measures that will allow for later analysis
of economic benefits.
5. Provide educational materials, including working with grantees
to develop new materials that might be needed at multiple sites.
6. Facilitate exchange of information between recipients.
Technical Reporting Requirements
Narrative progress reports are required semiannually. The first
semiannual report is required with each year's noncompeting
continuation application and should cover program activities from date
of the previous report (or date of award for reporting in the first
year of the project). The second semiannual report is due 90 days after
the end of each budget period and should cover activities from the date
of previous report. Progress reports should address the status of
progress toward specific project objectives and should include copies
of any publications resulting from the project.
An original and two copies of a Financial Status Report (FSR) are
required no later than 90 days after the end of each budget period. A
final performance report and FSR are due no later than 90 days after
the end of the project period. All reports are submitted to the Grants
Management Branch, CDC.
Application
1. Pre-application Letter of Intent
In order to assist CDC in planning and executing the evaluation of
applications submitted under this program announcement, all parties
intending to submit application(s) are requested to submit a non-
binding letter of intent. Notification should be provided as soon as
possible but not later than 30 business days prior to the application
due date. Notification should include: (1) Name and address of
institution, (2) name, address, and telephone number of contact person,
and (3) whether the application will primarily address community-based
interventions or interventions in integrated health care delivery
systems. Notification can be provided by facsimile, postal mail, or
electronic mail (E-mail) to Suzanne Binder, M.D., National Center for
Infectious Diseases, Mailstop F-22, 1600 Clifton Road, NE., Atlanta,
Georgia 30333, Facsimile (770) 488-7794, Internet scb1@cdc.gov.
2. Application Content
Applicants are required to submit an original and two copies of the
[[Page 25486]]
application and must develop their application in accordance with the
PHS Form 5161-1 (Revised 7/92, OMB Control number 0937-0189),
information contained in this program announcement, and the
instructions outlined below. In order to ensure an objective,
impartial, and prompt review, applications which do not conform to
these instructions may be disqualified.
All pages must be clearly numbered, and a complete index to the
application and its appendixes must be included. The application must
be submitted unstapled and unbound. Bound materials (e.g., pamphlets,
booklets, etc.) will not be accepted in the narrative or appendices. To
submit such materials, copy them onto 8\1/2\'' x 11'' white paper, one-
side only. All materials must be typewritten, single spaced, and in
unreduced type (no smaller than font size 12) with at least 1''
margins, headers, and footers.
The application narrative must not exceed 20 pages (excluding
budget and appendixes). Unless indicated otherwise, all information
requested below must appear in the narrative. Materials or information
that should be part of the narrative will not be accepted if placed in
the appendices. The application narrative must contain the following
sections in the order presented below.
a. Abstract
Provide a brief (two pages maximum) abstract of the project. State
the length of the project period for which assistance is being
requested (see AVAILABILITY OF FUNDS Section for additional information
regarding project period). Indicate clearly whether this project
primarily addresses antimicrobial resistance in communities or in
integrated health-care networks.
b. Background and Need
Discuss the background and need for the proposed project.
Illustrate and justify the need for the proposed project that is
consistent with the purpose and objectives of this cooperative
agreement program.
c. Capacity and Personnel
Describe applicant's past experience in conducting projects/studies
similar to that being proposed. Describe applicant's resources,
laboratory and other facilities, and professional personnel that will
be involved in conducting the project. Include in an appendix
curriculum vitae for all professional personnel involved with the
project. Describe plans for administration of the project and identify
administrative resources that will be assigned to the project. Provide
in an appendix letters of support from all key participating non-
applicant organizations, individuals, etc., which clearly indicate
their commitment to participate as described in the operational plan.
(Do not include letters of support from CDC personnel--they will not be
accepted in the application.)
d. Objectives and Technical Approach
Describe specific objectives for the proposed project which are
measurable and time-phased and are consistent with the purpose and
goals of this cooperative agreement program. Include a detailed
timeline for completion of key activities. Provide a detailed
operational plan for initiating and conducting the project which
clearly and appropriately addresses all recipient activities. Include a
clear description of applicant's technical approach/methods which are
directly relevant to the study objectives. Clearly identify specific
assigned responsibilities/tasks for all key professional personnel.
Describe the nature and extent of collaboration with CDC and/or others
during various phases of the project. If the applicant is not a health
department, describe plans for involving local and State health
departments. Clearly describe the population to be studied. Describe in
detail a plan for evaluating study results (including how data on
prescribing practices, costs, and charges will be obtained) and for
evaluating progress toward achieving project objectives. Justify the
choice of organisms and antimicrobial susceptibility that will be used
for evaluation, and include a description about how quality of
laboratory measurements will be assured. Clearly state the proposed
length of the project period.
e. Budget
Provide in an appendix a budget and accompanying detailed
justification for the first year of the project that is consistent with
the purpose and objectives of this program. Provide estimated total
budgets for subsequent years. If requesting funds for any contracts,
provide the following information for each proposed contract: (1) Name
of proposed contractor, (2) breakdown and justification for estimated
costs, (3) description and scope of activities to be performed by
contractor, (4) period of performance, and (5) method of contractor
selection (e.g., sole-source or competitive solicitation). (See sample
budget included in application package.)
Note: If indirect costs are requested, a copy of the applicant
organization's current negotiated Federal indirect cost rate
agreement or cost allocation plan must be provided.
f. Human Subjects
Whether or not exempt from DHHS regulations, if the proposed
project involves human subjects, describe in an appendix adequate
procedures for the protection of human subjects. Also, ensure that
women, racial and ethnic minority populations are appropriately
represented in applications for research involving human subjects (see
OTHER REQUIREMENTS Section for additional information).
Evaluation Criteria
The applications will be reviewed and evaluated according to the
following criteria:
1. Background and Need (10 points): Extent to which applicant's
discussion of the background for the proposed project demonstrates a
clear understanding of the purpose and objectives of this cooperative
agreement program. Extent to which applicant illustrates and justifies
the need for the proposed project that is consistent with the purpose
and objectives of this program.
2. Capacity (30 points total):
a. Extent to which applicant describes adequate resources and
facilities (both technical and administrative) for conducting the
project. This includes the capacity to conduct quality laboratory
measurements. (10 points)
b. Extent to which applicant documents that professional personnel
involved in the project are qualified and have past experience and
achievements in research and programs related to that proposed as
evidenced by curriculum vitae, publications, etc. (15 points)
c. Extent to which applicant includes letters of support from non-
applicant organizations, individuals, etc. Extent to which the letters
clearly indicate the author's commitment to participate as described in
the operational plan. (5 points)
3. Objectives and Technical Approach (60 points total):
a. Extent to which applicant describes specific objectives of the
proposed project which are consistent with the purpose and goals of
this program and which are measurable and time-phased. (10 points)
b. Extent to which the applicant identifies an appropriate
population for study, including whether the results of a study in this
population will be generalizable to other populations in the U.S.
Extent to which adequate procedures are described for the protection of
human subjects. Extent to
[[Page 25487]]
which the applicant identifies microbes/resistance patterns for study
that are of public health importance. (10 points)
c. Extent to which applicant presents a detailed operational plan
for initiating and conducting the project, which clearly and
appropriately addresses all recipient activities. Extent to which
applicant clearly identifies specific assigned responsibilities for all
key professional personnel. Extent to which the plan clearly describes
applicant's technical approach/methods for developing and conducting
the proposed program and evaluation and extent to which the plan is
adequate to accomplish the study objectives. The degree to which the
applicant has met the CDC Policy requirements regarding the inclusion
of women, ethnic, and racial groups in the proposed research. The
extent to which applicant describes the existence of or plans to
establish partnerships. (20 points)
d. Extent to which applicant describes adequate and appropriate
collaboration with CDC and/or others during various phases of the
project. (10 points)
e. Extent to which applicant provides a detailed and adequate plan
for evaluating study results (including laboratory data and data on
prescribing practices), as well as plans for evaluating progress toward
achieving project objectives. (10 points)
4. Budget (not scored): Extent to which the proposed budget is
reasonable, clearly justifiable, and consistent with the intended use
of cooperative agreement funds.
Executive Order 12372 Review
This program is not subject to Executive Order 12372 Review,
Intergovernmental Review of Federal Programs.
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 93.283.
Other Requirements
Paperwork Reduction Act
Projects that involve the collection of information from ten or
more individuals and funded by the cooperative agreement will be
subject to review and approval by the Office of Management and Budget
(OMB) under the Paperwork Reduction Act.
Human Subjects
If the proposed project involves research on human subjects, the
applicant must comply with the Department of Health and Human Services
Regulations (45 CFR part 46) regarding the protection of human
subjects. Assurance must be provided to demonstrate that the project
will be subject to initial and continuing review by an appropriate
institutional review committee. The applicant will be responsible for
providing evidence of this assurance in accordance with the appropriate
guidelines and form provided in the application kit.
Women, Racial and Ethnic Minorities
It is the policy of the Centers for Disease Control and Prevention
(CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR)
to ensure that individuals of both sexes and the various racial and
ethnic groups will be included in CDC/ATSDR-supported research projects
involving human subjects, whenever feasible and appropriate. Racial and
ethnic groups are those defined in OMB Directive No. 15 and include
American Indian or Alaska Native, Asian, Black or African American,
Hispanic or Latino, Native Hawaiian or Other Pacific Islander.
Applicants shall ensure that women, racial and ethnic minority
populations are appropriately represented in applications for research
involving human subjects. Where clear and compelling rationale exist
that inclusion is inappropriate or not feasible, this situation must be
explained as part of the application. This policy does not apply to
research studies when the investigator cannot control the race,
ethnicity, and/or sex of subjects. Further guidance to this policy is
contained in the Federal Register, Vol. 60, No. 179, pages 47947-47951,
and dated Friday, September 15, 1995.
Application Submission and Deadline
The original and two copies of the application PHS Form 5161-1
(Revised 7/92, OMB Control 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), Room 300, Mailstop E-18, 255 East Paces Ferry Road,
NE., Atlanta, Georgia 30305, on or before June 29, 1998.
1. Deadline: Applications shall be considered as meeting the
deadline if they are either:
a. Received on or before the 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 U.S. Postal Service. Private
metered postmarks shall not be acceptable 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 and will be returned to the
applicant.
Where To Obtain Additional Information
To receive additional written information and to request an
application kit, call 1-888-GRANTS (1-888-472-6874). You will be asked
to leave your name and address and will be instructed to identify the
Announcement number of interest. (Please refer to Announcement Number
98039.) 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 Oppie M. Byrd, Grants
Management Specialist, Grants Management Branch, Procurement and Grants
Office, Centers for Disease Control and Prevention (CDC), Room 314,
Mailstop E-18, 255 East Paces Ferry Road, NE., Atlanta, Georgia 30305,
telephone (404) 842-6546, Facsimile (404) 842-6513, Internet
oxb3@cdc.gov.
Programmatic technical assistance may be obtained from David Bell,
telephone (404) 639-2603 or Suzanne Binder, M.D., National Center for
Infectious Diseases, Centers for Disease Control and Prevention (CDC),
Mailstop F-22, 1600 Clifton Road, NE., Atlanta, Georgia 30333,
telephone (770) 488-7793, Facsimile (770) 488-7794, Internet
scb1@cdc.gov.
Please refer to Announcement Number 98039 when requesting
information regarding this program.
You may obtain this announcement from one of two Internet sites on
the actual publication date: CDC's homepage at http://www.cdc.gov or at
the Government Printing Office homepage (including free on-line access
to the Federal Register at http://www.access.gpo.gov).
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,
[[Page 25488]]
Washington, DC 20402-9325, telephone: (202) 512-1800.
Dated: May 4, 1998.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
[FR Doc. 98-12236 Filed 5-7-98; 8:45 am]
BILLING CODE 4163-18-P
