[Federal Register Volume 61, Number 252 (Tuesday, December 31, 1996)]
[Notices]
[Pages 69102-69106]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-33097]



[[Page 69102]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration


Emergency Medical Services for Children Demonstration Grants

AGENCY: Health Resources and Services Administration (HRSA), DWHHS.

ACTION: Notice of availability of funds.

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SUMMARY: The HRSA in collaboration with the National Highway Traffic 
Safety Administration (NHTSA) announces that approximately $ 4.1 
million in fiscal year (FY) 1997 funds will be available for grants 
authorized under section 1910 of the PHS Act. These discretionary 
grants will be made to States or accredited schools of medicine to 
support projects for the expansion and improvement of emergency medical 
services for children (EMSC). Within the HRSA, EMSC grants are 
administered by the Maternal and Child Health Bureau (MCHB).
    The NHTSA participated with the MCHB in developing program 
priorities for the EMSC program for FY 1997. The NHTSA will share the 
Federal monitoring responsibilities for EMSC awards made during FY 1997 
and will continue to provide ongoing technical assistance and 
consultation in regard to the required collaboration/linkages between 
applicants and their Highway Safety Offices and Emergency Medical 
Services Agencies for the State(s). Grantees funded under this program 
are expected to work collaboratively with the State agency or agencies 
administering the Maternal and Child Health (MCH) and the Children with 
Special Health Needs (CSHN) programs under the MCH Services Block 
Grant, Title V of the Social Security Act (42 U.S.C. 701).
    The 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 EMSC grant program will 
directly address the Healthy People 2000 objectives related to 
emergency medical services and trauma systems linking prehospital, 
hospital, and rehabilitation services in order to prevent trauma deaths 
and long-term disability. 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, 
D.C. 20402-9325 (telephone 202-783-3238).
    The PHS strongly encourages all grant recipients to provide a 
smoke-free workplace and promote the non-use of all tobacco products. 
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 provided 
to children.

ADDRESSES: Federal Register notices and application guidance for MCHB 
programs are available on the World Wide Web via the Internet at 
address: http://www.os.dhhs.gov/hrsa/mchb. Click on the file name you 
want to download to your computer. It will be saved as a self-
extracting (Macintosh or) WordPerfect 5.1 file. To decompress the file 
once it is downloaded, type in the file name followed by a . 
The file will expand to a WordPerfect 5.1 file.
    For applicants for Emergency Medical Services for Children 
Demonstration Grants who are unable to access application materials 
electronically, a hard copy (Revised PHS form 5161-1, approved under 
OMB clearance number 0937-0189) must be obtained from the HRSA Grants 
Application Center. The Center may be contacted by: Telephone Number: 
1-888-300-HRSA, FAX Number: 301-309-0579, E-mail Address: 
[email protected]. Completed applications should be returned to: 
Grants Management Officer (CFDA #93.127), HRSA Grants Application 
Center, 40 West Gude Drive, Suite 100, Rockville, Maryland 20850.

DATES: The application deadline date is April 11, 1997. Competing 
applications will be considered to be on time if they are either: (1) 
Received on or before the deadline date, or (2) postmarked on or before 
the deadline date and received in time for orderly processing. 
Applicants should request a legibly dated receipt from a commercial 
carrier or the U.S. Postal Service, or obtain a legibly dated U.S. 
Postal Service postmark. Private metered postmarks will not be accepted 
as proof of timely mailing.
    Late competing applications or those sent to an address other than 
specified in the ADDRESS section will be returned to the applicant.

FOR FURTHER INFORMATION: Requests for technical or programmatic 
information from MCHB should be directed to Jean Athey, Ph.D., or Mark 
E. Nehring, D.M.D., M.P.H., Division of Maternal, Infant, Child and 
Adolescent Health, Maternal and Child Health Bureau, Health Resources 
and Services Administration, Room 18A-39, Parklawn Building, 5600 
Fishers Lane, Rockville, Maryland 20857, telephone 301-443-2250. 
Requests for technical or programmatic information from NHTSA should be 
directed to Garry Criddle, R.N., CDR, USCG/USPHS, Department of 
Transportation, NHTSA EMS Division, NTS-42, 400 Seventh Street SW, 
Washington, DC 20590, telephone 202-366-5440. Requests for information 
concerning fiscal, business or administrative management issues should 
be directed to: Maria Carter, Grants Management Specialist, Grants 
Management Branch, Maternal and Child Health Bureau, 5600 Fishers Lane, 
Room 18-12, Rockville, Maryland 20857, telephone 301-443-1440.
    The EMSC program funds three national EMSC resource centers that 
are available to provide technical assistance and support to 
applicants, particularly in the areas of: (1) Understanding EMSC 
terminology; (2) developing a manageable approach to EMSC 
implementation; (3) obtaining local support for the grant application 
process; (4) facilitating development of community linkages for a 
collaborative effort; (5) identifying products of previously-funded 
EMSC projects of interest to potential applicants; (6) offering advice 
on grant writing; and (7) data collection and analysis. Applicants may 
contact: James Seidel, M.D., Ph.D., or Deborah Henderson, R.N., M.A., 
National EMSC Resource Alliance, Research and Education Institute, 
Harbor/UCLA Medical Center, 1001 West Carson Street, Suite S, Torrance, 
CA 90502, telephone 310-328-0720; or Jane Ball, R.N., Dr. P.H., EMSC 
National Resource Center, Children's National Medical Center, Emergency 
Trauma Services, 111 Michigan Ave., N.W., Washington, DC 20010, 
telephone 202-745-5188; or J. Michael Dean, M.D., National EMSC Data 
Analysis Resource Center, University of Utah School of Medicine, 309 
Park Building, Salt Lake City, UT 84112, telephone 801-588-3280.

SUPPLEMENTARY INFORMATION:

Program Background and Objectives

    The Emergency Medical Services for Children statute (Section 1910 
of the PHS Act, as amended) establishes a program of two-year grants to 
States, through a State-designated agency, or to accredited medical 
schools within States, for projects for the expansion and improvement 
of emergency medical services for children who need treatment for 
trauma or critical illness. For purposes of this grant program, the 
term ``State'' includes the 50 States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Virgin Islands, the Northern Mariana

[[Page 69103]]

Islands, Guam, American Samoa, the Republic of Palau, the Republic of 
the Marshall Islands, and the Federated States of Micronesia. The term 
``school of medicine'' is defined as having the same meaning as set 
forth in Section 799(1)(A) of the PHS Act (42 U.S.C. 295p(1)(A)). 
``Accredited'' in this context has the same meaning as set forth in 
section 799(1)(E) of the PHS Act (42 U.S.C. 295p(1)(E)). It is the 
intent of this grant program to stimulate further development or 
expansion of ongoing efforts in the States to reduce the problems of 
life-threatening pediatric trauma and critical illness. The Department 
does not intend to award grants which would duplicate grants previously 
funded under the Emergency Medical Services Systems Act of 1972 or 
which would be used simply to increase the availability of emergency 
medical services funds allotted to the State under the Preventive 
Health Services Block Grant.

Eligible Applicants

    State governments and accredited schools of medicine are the only 
eligible applicants for funding under the EMSC program. It is 
anticipated that the application for planning and implementation funds 
will come, in most States, from the organization responsible for EMS 
for children, which will most likely be the Emergency Medical Services 
agency in the State. Because the purpose of the partnership grants is 
to solidify the integration of a pediatric perspective within the basic 
EMS system, the only eligible applicant for that category is the State 
EMS agency, unless the State specifically requests and designates 
another State entity or a school of medicine and provides a convincing 
justification for doing so. Because of the importance of linking EMS 
activities with the system of care for children, the involvement of the 
State MCH program in all grant categories is strongly encouraged. Such 
involvement could be demonstrated either by a co-signed application or 
by a letter of support.
    If the applicant is a school of medicine, the application must be 
endorsed by the State EMS office. The State's endorsement constitutes 
an acknowledgement that the applicant has consulted with the State and 
that the State has been assured that the applicant will work with the 
State on the proposed project. No application from a school of medicine 
will be considered for funding without the endorsement. Further 
information on application endorsements can be found in the program 
guidance. Any State (or medical school within that State) may apply for 
any category of grant, subject to the following considerations:
     For Category (1) Planning Grants, States (or medical 
schools within those States) that have received prior EMSC State 
systems grants may not apply for a planning grant.
     For Category (2) Implementation Grants, applications from 
States (and medical schools within those States) that have not 
previously received EMSC program funds, or that have received only 
partial support under this program as part of a regional alliance, will 
receive preference for funding in this category. This means that 
approved applications from States (and medical schools within those 
States) with no or very limited prior EMSC program support will be 
funded ahead of approved applications from outside this group.
     For Category (3) State Partnership Grants, States that 
have previously received EMSC funds may apply for a State partnership 
grant, as long as they will not also be receiving implementation or 
``enhancement'' funds during the project period of the partnership 
grant. States that have not previously received EMSC funds are advised 
to apply first for planning category funds.
     For Category (4) Targeted Issues Grants, eligibility is 
not affected by previous receipt of other EMSC funding.
    Funding of an application for a planning grant or for an 
implementation grant bars a State from future competitions for that 
category.

Funding Categories

    There will be four categories of competition for funding this year: 
State planning grants, State implementation grants, State partnership 
grants, and targeted issue grants.
Category (1): State Planning Grants
    Planning grants are intended for States that have never received an 
EMSC grant and that are not at a stage of readiness to initiate a full-
scale implementation project. States (or medical schools within those 
States) that have not received prior EMSC implementation grants are the 
only applicants eligible for this category. Planning grants are 
designed to enable a State to assess needs and develop a strategy to 
begin to address those needs. Funds may be used to hire staff to assist 
in the assessment of EMSC needs of the State; obtain technical 
assistance from national, State, regional or local resources; help 
formulate a State plan for the integration of EMSC services into the 
existing State EMS plan; and conduct a needs assessment. A 
comprehensive approach, addressing physical, psychological, and social 
aspects of EMSC along the continuum of care, should be reflected. An 
ongoing working relationship with Federal EMSC program staff and 
resource center staff, beginning with the initiation of a planning 
grant application, is desirable. The project period is one year.
Category (2): State Implementation Grants
    Implementation grants will improve the capacity of a State's EMS 
program to address the particular needs of children. Implementation 
grants are used to assist States in integrating research-based 
knowledge and state-of-the-art systems development approaches into the 
existing State EMS, MCH and CSHN systems, using the experience and 
products of previous EMSC grantees. The program components of these 
grants should reflect the goals of the MCHB/NHTSA Five Year Plan for 
EMSC. This plan outlines the direction of the EMSC program and 
identifies specific objectives for the program. It builds on the 1993 
report for EMSC conducted by a blue ribbon Institute of Medicine panel. 
The plan will be included with the application kit. Depending upon the 
appropriation of funds, project periods are up to two years.
    Proposals are sought which include strategies and/or models to 
ensure that pediatric emergency care is family centered. ``Family 
centered'' includes the following key elements: maximum possible 
involvement of families in all phases of the EMSC continuum of care; 
clear and continuous communication between family members and the 
emergency care team; attention to the psychological needs of all family 
members; cultural competence of providers; consumer (parental) 
involvement in planning and needs assessment; organizational support 
for the formation of parent involvement groups; and ongoing 
partnerships with such groups. For this competition, we intend to fund 
applications from States (and medical schools within those States) that 
have not as yet received support, or that have received only partial 
support under this program as part of a regional alliance. This means 
that approved applications from States (and medical schools within 
those States) with no or very limited prior EMSC program support will 
be funded before approved applications from outside this group.
    Applications will not be accepted for both planning grants and 
state implementation grants simultaneously from the same State.

[[Page 69104]]

Category (3): State Partnership Grants
    State partnership grants will fund activities that represent the 
next logical step or steps to take to institutionalize EMSC within EMS 
and to continue to improve and refine EMSC. The program components of 
these grants should reflect the goals and objectives of the MCHB/NHTSA 
Five Year Plan for EMSC. For example, funding might be used to improve 
linkages between local and regional or State agencies, to develop 
pediatric standards for a region, or to assure effective field triage 
of the child in physical or emotional crisis to appropriate facilities 
and/or other resources. States that have previously received EMSC funds 
may apply for a State partnership grant, as long as they will not also 
be receiving continuation funding for a State implementation grant or a 
previously awarded ``System Enhancement Grant'' during the project 
period of the State partnership grant. The project period is up to two 
years, depending upon the availability of funds.
Category (4): Targeted Issue Grants
    The fourth funding category is that of targeted issue grants on 
topics of importance to EMSC. Targeted issue grants are intended to 
address specific, focused issues related to the development of EMSC 
capacity. Proposals under this category must have a well-conceived 
methodology for evaluation of the impact of the activity. The EMSC Five 
Year Plan identifies several activities judged to be appropriate for 
support through targeted issue grants for FY 1997. They include the 
following:

1. Cost-Benefit Analyses Related to EMSC

    Very little information is available on the costs related to 
different aspects of EMSC, and yet such information is critical to 
decision making. Projects in this category may include topics such as 
the following:
     Evaluation of the cost effectiveness of different EMSC 
program configurations (such as different approaches to medical 
control, categorization, and regionalization).
     Assessment of the marginal incremental cost of different 
approaches to improving EMSC.
     Evaluation of the benefits vs. costs of different 
treatment modalities.

2. Implications of Managed Care for EMSC

    The changes in reimbursement mechanisms due to managed care are 
having profound effects on the provision of medical care. It is unclear 
how these changes may affect pediatric emergency care. Projects in this 
category may include topics such as:
     Analyses of the impact of managed care and other financing 
mechanisms on pediatric emergency medical services.
     Analyses of the impact of differing reimbursement policies 
in contiguous jurisdictions on pediatric patients.
     Demonstrations and analyses of collaborative activities 
with managed care plans designed to improve access and/or quality of 
pediatric emergency care.

3. Evaluations of EMSC Components

    If EMSC is to improve and provide quality services, evaluation is 
critical. Projects in this category may include topics such as:
     Development of quality standards for the care of children 
within the EMS system and analyses of how well the system performs.
     Pilot testing and evaluation of model quality improvement 
programs in EMS/EMSC.
     Models to determine if the right patients are getting to 
the right levels of care.
     Analyses of outcomes for children using EMS systems.
     National study to identify and document the extent to 
which EMSC components have been implemented in each State.

4. Risk-Taking Behaviors of Children and Adolescents

    EMS and emergency department health professionals are uniquely 
positioned to provide interventions to reduce the incidence of injuries 
or medical conditions (e.g., noncompliant child or adolescent with a 
chronic condition, such as diabetes) resulting from risk-taking 
behavior. Projects in this category can be directed to development and 
evaluation of materials and strategies in one of the following areas:
     Unintentional injury prevention
     Violence or suicide prevention
     Illegal drug usage
     Integration of mental health services with preventive 
interventions (injury or medical)
    Projects are especially sought to develop, implement, and evaluate 
model guidelines for emergency departments to use following injury to 
reduce risk-taking behaviors. Projects are also sought that link 
prevention with managed care quality indicators.

5. Models for Improving the Care of Culturally Distinct Populations

    Health care providers are often required to meet the needs of 
culturally and ethnically distinct children and families, but little 
training is provided in this area. Projects in this category can be 
directed to one or more of the following:
     Development, implementation and evaluation of education 
and training programs in cultural sensitivity for prehospital 
providers, nurses, and physicians.
     Development (or translation), implementation, and 
evaluation of discharge, injury prevention and health care materials 
for low literacy populations and for culturally and/or ethnically 
distinct populations.

6. Children's Emergencies in Disasters

    Local, regional, and State disaster plans typically do not address 
the training and equipment necessary to meet the special needs of 
children in disasters. Projects in this category should seek to 
overcome these deficiencies and assess the outcome. Curricula are not 
being solicited in this category. Examples of projects appropriate for 
this category include the following:
     Development and evaluation of a strategy to integrate 
pediatrics into existing disaster plans, in particular focusing on the 
following components: Training, equipment, psychosocial support, system 
access and cost reimbursement, shelter services, and mitigation.
     Identification of key data to be collected and analysis of 
data on children's health and mental health needs in disasters.

7. Coordination Between Primary Care Providers and EMSC

    Primary care providers are important partners on the EMSC team; 
however, their role is often overlooked, particularly with respect to 
injury prevention, emergency care, and discharge planning. Projects in 
this category may include topics that promote collaboration between 
primary care providers and EMS, including topics such as the following:
     Implementation and evaluation of model programs designed 
to improve a primary care provider's office-preparedness to handle 
increased patient acuity and emergencies.
     Development and evaluation of an information system to 
provide access to patient information and to enhance communication and 
coordination between emergency care providers and primary care 
providers.
    Proposals may be submitted on emerging issues that are not included 
in the above list. However, any such proposal must demonstrate 
relevance to

[[Page 69105]]

the EMSC Five Year Plan and must make a persuasive argument that the 
issue is particularly critical. The justification provided should 
clearly link the activities in the application with the Plan's 
objectives. The project period is up to two years, depending upon the 
availability of funds.

Availability of Funds

    Approximately $4.1 million will be available for competitive 
grants. It is anticipated that a total of 47 grants will be awarded for 
the project periods shown in the four identified funding categories:

------------------------------------------------------------------------
                                                                Project 
                Category                  Grants     Amount      Period 
                                                               (year(s))
------------------------------------------------------------------------
State Planning Grants..................        2     $ 50,000         1 
State Implementation Grants............        4      250,000         2 
State Partnership Grants...............       32       60,000         2 
Targeted Issue Grants..................        7   50-150,000         2 
------------------------------------------------------------------------

Special Concerns

    HRSA's Maternal and Child Health Bureau places special emphasis on 
improving service delivery to women, children and youth from 
communities with limited access to comprehensive care. In order to 
assure access and cultural competence, it is expected that projects 
will involve individuals from the populations to be served in the 
planning and implementation of the project. The Bureau's intent is to 
ensure that project interventions are responsive to the cultural and 
linguistic needs of special populations, that services are accessible 
to consumers, and that the broadest possible representation of 
culturally distinct and historically underrepresented groups is 
supported through programs and projects sponsored by the MCHB. This 
same special emphasis applies to improving service delivery to children 
with special health care needs.
    In keeping with the goals of advancing the development of human 
potential, strengthening the Nation's capacity to provide high quality 
education by broadening participation in MCHB programs of institutions 
that may have perspectives uniquely reflecting the Nation's cultural 
and linguistic diversity, and increasing opportunities for all 
Americans to participate in and benefit from Federal public health 
programs, HRSA will place a funding priority on projects from 
Historically Black Colleges and Universities (HBCU) or Hispanic Serving 
Institutions (HSI) in all categories in this notice for which 
applications from academic institutions are encouraged. This is in 
conformity with the Federal Government's policies in support of White 
House Initiatives on Historically Black Colleges and Universities 
(Executive Order 12876) and Educational Excellence for Hispanic 
Americans (Executive Order 12900). An approved proposal from a HBCU or 
HSI will receive a 0.5 point favorable adjustment of the priority score 
in a 4 point range before funding decisions are made.

Evaluation Protocol

    A maternal and child health discretionary grant project, including 
any project awarded as part of the Emergency Medical Services for 
Children Demonstration Grants program, is expected to incorporate a 
carefully designed and well planned evaluation protocol capable of 
demonstrating and documenting measurable progress toward achieving the 
project's stated goals. The protocol should be based on a clear 
rationale relating the grant activities, the project goals, and the 
evaluation measures. Wherever possible, the measurements of progress 
toward goals should focus on health outcome indicators, rather than on 
intermediate measures such as process or outputs. A project lacking a 
complete and well-conceived evaluation protocol as part of the planned 
activities will not be funded.

Project Review and Funding

    The Department will review applications in the preceding funding 
categories as competing applications and will fund those which, in the 
Department's view, are consistent with the statutory purpose of the 
program, with particular attention to children from culturally distinct 
populations and children with special health care needs; and that best 
meet the purposes of the EMSC program and address achievement of 
applicable Healthy People 2000 objectives related to emergency medical 
services and trauma systems.

Review Criteria

    The review of applications will take into consideration the 
following criteria:
     For Category (1) State Planning Grants:
    --Evidence of the State's commitment to improve pediatric emergency 
care services and to continue with EMSC program implementation.
    --The adequacy of the applicant's proposed method to identify 
problems and conduct a needs assessment.
    --Evidence of the applicant's understanding of obstacles to EMSC 
activity in the past, and the completeness of proposed strategies to 
overcome these obstacles.
    --The adequacy of the applicant's proposed planning process for 
improving EMSC.
    --The soundness of the methods the applicant will use to: (1) 
recruit, select and assemble appropriate participants, including 
members of culturally distinct populations, with demonstrated expertise 
and experience in EMS; trauma systems; child health issues; and 
emergency care for children; and (2) obtain input from potential 
consumers (i.e., families) of a State EMSC plan.
    --Reasonableness of the proposed budget, soundness of the 
arrangements for fiscal management, effectiveness of use of personnel, 
and likelihood of project completion within the proposed grant period.
     For Category (2) State Implementation Grants:
    --The adequacy of the applicant's understanding of the problem of 
pediatric trauma and critical illness in the State and/or project area, 
including the special problems of (a) children with special health care 
needs and their families; and (b) minority children and families 
(including American Indian/Alaska Natives, and Native Hawaiians).
    --The appropriateness of project objectives and outcomes in 
relation to the specific nature of the problems identified by the 
applicant.
    --The adequacy of the proposed methodology for achieving project 
goals and objectives.
    --The soundness of the plan for evaluating progress in achieving 
project objectives and outcomes.
    --The adequacy of the plan for organizing and carrying out the 
project.
    --The reasonableness of the proposed budget and soundness of the 
applicant's plans for fiscal management.

[[Page 69106]]

    --The qualifications and experience of the Project Director and 
proposed staff.
    --The extent to which the applicant will employ products and 
expertise of EMSC programs in other States, especially of current and 
former grantees of the Federal EMSC program. Such resources include, 
but are not limited to, technical assistance and consultation.
    --The extent to which the applicant demonstrates the involvement 
and participation of consumers (i.e., families) and parent involvement 
groups in planning, needs assessment, and project implementation.
    --The extent to which the project gives special emphasis to the 
concerns identified in the Special Concerns section (see page 19-20).
    --The evidence that the applicant will collaborate and coordinate 
with other participants in the EMSC continuum including, but not 
limited to, the State EMS agency (if not the applicant) the State MCH/
CSHN agency, the State Highway Safety Office, other relevant State 
agencies, tribal nations, State and local professional organizations, 
private sector voluntary organizations, business organizations, parent 
advocacy groups, consumer or community representatives, hospital 
organizations, and any other ongoing Federally-funded projects in EMS, 
injury prevention, and rural health.
    --The extent to which the applicant demonstrates a multi-
disciplinary approach to EMSC system development, including providers 
at all levels (e.g., physicians, nurses, EMTs, social workers, and 
others appropriate to project activities).
    --The adequacy of the applicant's plan to integrate pediatric 
emergency care into the primary care delivery system.
    --The adequacy with which the applicant addresses 
institutionalization of the proposed project.
     For Category (3) State Partnership Grants:
    --The adequacy of the applicant's plan to institutionalize EMSC 
into EMS.
    --The evidence that the applicant will collaborate and coordinate 
with other participants in the EMSC continuum including, but not 
limited to, the State MCH/CHSN agency, the State Highway Office, tribal 
nations, State and local professional organizations, private sector 
voluntary organizations, parent advocacy groups, consumer or community 
representatives, hospital organizations, and any other ongoing 
Federally-funded projects in EMS, injury prevention, and rural health.
    --The reasonableness of the proposed budget and soundness of the 
applicant's plans for fiscal management.
     For Category (4),Targeted Issue Grants:
    --The appropriateness of project objectives and outcomes in 
relation to the specific nature of the problems identified by the 
applicant.
    --The adequacy of the proposed methodology for achieving project 
goals and outcome objectives.
    --The soundness of the plan for evaluating progress in achieving 
project objectives and outcomes.
    --The reasonableness of the proposed budget and soundness of the 
arrangements for fiscal management.
    --The adequacy of the plan for organizing and carrying out the 
project.
    --The qualifications and experiences of the Project Director and 
proposed staff.
    --The extent to which the project addresses the issues raised in 
the section on Special Concerns.
    --The relevance of the proposed project to the MCHB/NHTSA Five Year 
Plan for EMSC.

Allowable Costs

    The HRSA may support reasonable and necessary costs of EMSC 
Demonstration Grant projects within the scope of approved projects. 
Allowable costs may include salaries, equipment and supplies, travel, 
contracts, consultants, and others, as well as indirect costs as 
negotiated. The HRSA adheres to administrative standards reflected in 
the Code of Federal Regulations, 45 CFR Part 92 and 45 CFR Part 74.

Public Health System Reporting Requirements

    This program is subject to the Public Health System Reporting 
Requirements (approved under OMB No. 0937-0195). Under these 
requirements, community-based nongovernmental applicants 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 non-governmental 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 no later 
than the Federal application receipt due date:
    (a) A copy of the face page of the application (SF 424).
    (b) A summary of the project (PHSIS), 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 or local health agencies.
    The project abstract may be used in lieu of the one-page PHSIS, if 
the applicant is required to submit a PHSIS.

Executive Order 12372

    This program has been determined to be a program which 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 allows States the 
option of setting up a system for reviewing applications from within 
their States for assistance under certain Federal programs. The 
application packages to be made available under this notice will 
contain a listing of States which have chosen to set up such a review 
system and will provide a single point of contact (SPOC) in the States 
for review. Applicants (other than federally-recognized Indian tribal 
governments) should contact their State SPOCs 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 of each 
affected State. The due date for State process recommendations is 60 
days after the application deadline for new and competing awards. The 
granting agency does not guarantee to ``accommodate or explain'' for 
State process recommendations it receives after that date. (See Part 
148, Intergovernmental Review of PHS Programs under Executive Order 
12372 and 45 CFR Part 100 for a description of the review process and 
requirements).

    The OMB Catalog of Federal Domestic Assistance number is 93.127.

    Dated: December 23, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-33097 Filed 12-30-96; 8:45 am]
BILLING CODE 4160-15-P