[Federal Register Volume 62, Number 99 (Thursday, May 22, 1997)]
[Notices]
[Pages 28032-28037]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-13429]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Announcement 745]
Cooperative Agreement for Population-Based Surveillance of Fetal
Alcohol Syndrome; Notice of Availability of Funds for Fiscal Year 1997
Introduction
The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 1997 funds for a cooperative agreement
program to establish or enhance statewide, population-based
surveillance of fetal alcohol syndrome (FAS). Population-based
surveillance of FAS is important to document the magnitude of the
problem and to monitor trends in the occurrence of this preventable
birth defect. Ongoing surveillance is also essential in documenting the
impact of prevention efforts.
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 areas of Alcohol and Other
Drugs, Environmental Health, Maternal and Infant Health, and
Surveillance and Data Systems. (To order a copy of ``Healthy People
2000,'' see section WHERE TO OBTAIN ADDITIONAL INFORMATION.)
Authority
This program is authorized under Sections 301 and 317(k)(2) of
Public Health Service Act (42 U.S.C. 241 and 247b(k)(2), as amended.
Smoke-Free Workplace
CDC strongly encourages all recipients to provide a smoke-free
workplace and to promote the non-use of all tobacco products, and
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in
certain facilities that receive Federal funds in which education,
library, day care, health care, and early childhood development
services are provided to children.
Eligible Applicants
Eligible applicants are the State health departments or other State
agencies or departments deemed most appropriate by the State to direct
and coordinate the State's surveillance activities and that: (1)
represent a population of not less than 25,000 live births per year
within
[[Page 28033]]
a State, group of States, or geographically-defined area; and/or (2)
demonstrate evidence of alcohol problems among women in the targeted
study population.
This eligibility includes bona fide agents or instrumentalities of
States which are acting as the official agent of the State(s) for
surveillance activities.
This eligibility also includes the District of Columbia, American
Samoa, the Commonwealth of Puerto Rico, the Virgin Islands, the
Federated States of Micronesia, Guam, the Northern Mariana Islands, the
Republic of Marshall Islands, the Republic of Palau, and federally
recognized Indian tribal governments.
State agencies applying under this announcement that are other than
the official State health department must provide written concurrence
for the application from the official State health agency.
Only one application from each single State or group of States may
enter the review process and be considered for an award under this
announcement.
Note: Effective January 1, 1996, Public Law 104-65 states that
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
(cooperative agreement), contract, loan, or any other form.
Availability of Funds
Approximately $300,000 will be available in FY 1997 to award up to
3 cooperative agreements. Projects are expected to begin on or about
September 30, 1997, and will be made for a 12-month budget period
within a project period of up to 5 years. Funding estimates may vary
and are subject to change.
Continuation awards within the approved project period will be made
on the basis of satisfactory progress and the availability of funds.
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, 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 1997 HHS Appropriations Act, which became
effective October 1, 1996, expressly prohibits the use of 1997
appropriated funds for indirect or ``grass roots'' lobbying efforts
that are designed to support or defeat legislation pending before State
legislatures. This new law, Section 503 of Pub. L. No. 104-208,
provides as follows:
Sec. 503(a) No part of any appropriation contained in this Act
shall be used, other than for normal and recognized executive-
legislative relationships, 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, * * *
except in presentation to the Congress or any State legislative body
itself.
(b) 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.
Department of Labor, Health and Human Services, and Education, and
Related Agencies Appropriations Act, 1997, as enacted by the Omnibus
Consolidated Appropriations Act, 1997, Division A, Title I, Section
101(e), Pub. L. No. 104-208 (September 30, 1996).
Background
Birth defects are the leading cause of infant mortality in the
United States, accounting for more than 20 percent of all infant
deaths. In addition, birth defects are the fifth leading cause of years
of potential life lost and contribute substantially to childhood
morbidity and long-term disability. Fetal Alcohol Syndrome is a leading
birth defect that causes significant lifetime disability. Unlike many
other birth defects, however, FAS has a known etiology and is
preventable. The success of any public health prevention or
intervention program must be measured by comparing the incidence or
prevalence of a condition before and after implementation of programs.
Incidence and prevalence data are also important for estimating the
societal impact of a disorder and planning for resource use.
The specific Healthy People 2000 health objective is to reduce the
rate of FAS in the general population to no more than .12 cases per
1,000 live births by the year 2000. The original baseline data for this
objective (.22 per 1,000 live births in 1987) were derived from a
national hospital-based epidemiologic surveillance program of birth
defects--the Birth Defects Monitoring Program (BDMP) of CDC. Although
more recent rates of .67 per 1,000 have been generated by this system,
this increase probably represents improvements in the recognition and
reporting of FAS at birth. Other studies using different methods and
data sources report prevalence rates ranging from .33 to 2.2 per 1000.
Developing a surveillance system for FAS presents unique challenges
that cannot be met by current birth defects monitoring systems that
focus only on the first year of life. There is no simple, objective
laboratory test for the diagnosis of FAS. The diagnosis is based
primarily on clinical examination and the application of diagnostic
criteria in each of three categories: (1) prenatal or postnatal growth
retardation; (2) central nervous system abnormalities which may
manifest as developmental delays in childhood; and (3) characteristic
abnormal facial features (including short palpebral fissures, a long
smooth philtrum, thin upper lip, and flattened midfacial area). Since
no single characteristic (beyond the facial dysmorphia) is specific to
the diagnosis of FAS, the application of these criteria requires
expertise in recognizing dysmorphic features and differentiating this
condition from other syndromes and malformations.
Furthermore, some of the cardinal facial features and central
nervous system abnormalities are not apparent during the first year of
life. FAS, like other syndromes, becomes easier to diagnose with
increasing age, at least until about puberty.
Clearly, surveillance of FAS cannot depend on any single source for
case ascertainment. A multiple source method which may include, but is
not limited to, birth defects monitoring programs, developmental
disabilities or special needs registries, hospital discharge data,
special education and other school records, Medicaid data, vital
statistics, private provider and special diagnostic units, screening
and case-finding activities in special settings, and other population-
based systems appear promising. The theoretical basis for this
multiple-source approach is that children with FAS, because of the
nature of the health and developmental problems associated with the
condition, are likely to encounter one or more of these resources for
services at some point in early childhood or school age. Often-times,
however, the correct diagnosis is not made. Thus, an integral component
of a multiple-source methodology is provider education and training.
[[Page 28034]]
Purpose
The purpose of this cooperative agreement is to:
A. Enhance an existing system or to develop and implement a new
system which uses a multiple source surveillance methodology to enable
researchers to determine the prevalence of FAS within a geographically-
defined area (statewide, multiple States, or regions of a State);
B. Improve the capacity to ascertain true cases of FAS and generate
population-based surveillance data;
C. Establish relationships with facilities or programs where
children with FAS are likely to be diagnosed or receive services, such
as high-risk newborn registries, special diagnostic units, special
education programs, special needs registries, and other programs or
settings for children with developmental disabilities;
D. Evaluate the completeness of the surveillance system
methodology, the system's ability to generate a prevalence rate for
FAS, and the potential for monitoring trends;
E. Implement provider training and education on FAS to improve case
ascertainment, referral and case management practices, and prevention
activities.
Program Requirements
In conducting activities to achieve the purpose of this cooperative
agreement, the recipient will be responsible for the activities under
A. (Recipient Activities) below, and CDC will be responsible for
activities under B. (CDC Activities) below:
A. Recipient Activities
1. Meet at CDC to:
a. Develop and agree on a surveillance case definition.
b. Develop and agree on a plan to implement the data collection
instruments and methods for abstracting medical and school records as
appropriate.
c. Develop an evaluation plan for the surveillance system. This
will include a plan for estimating false positive and false negative
error rates, such as a comparison of cases identified using the
surveillance criteria with more comprehensive clinical criteria or
follow-up of cases to confirm the diagnosis.
d. Develop a plan for publishing prevalence rates and rates among
various risk groups and authorship on other publications emanating from
the surveillance activities.
2. Develop and implement a multiple source methodology to ascertain
cases of FAS and generate population-based estimates of the prevalence
of FAS.
3. Develop a plan for provider education and training on FAS case
ascertainment.
4. Establish collaborative relationships (for the purpose of
diagnosis and case ascertainment) with appropriate diagnostic units
serving the surveillance population, such as special genetics,
dysmorphology, neurobehavioral, and developmental pediatrics clinics.
5. Establish collaborative relationships with agencies providing
services to children with FAS including special education, foster care
programs, high-risk newborn nurseries, and other high-risk service
environments.
6. Implement quality assurance procedures to ensure that study
protocols are being followed, and that the surveillance procedures are
being uniformly implemented in the study sites.
7. Collaborate with other participating sites on a manuscript which
describes the surveillance system, case definitions, methodology,
collaborative relationships, data collection, findings (including the
prevalence rate of FAS), and recommendations across sites.
B. CDC Activities
1. Convene two meetings of awardees in the first nine months, then
annually thereafter, to develop and review the surveillance case
definition, design surveillance data collection instruments, and
develop study protocols and procedures.
2. Provide leadership and current scientific information on
relevant health information and surveillance approaches, and provide
oversight of the surveillance and research design to ensure adherence
to appropriate standards.
3. Provide guidance and technical assistance in the development of
an evaluation plan for the surveillance system.
4. Conduct periodic site visits to observe and discuss development
and implementation of activities and analysis of surveillance data.
5. Provide guidance and coordinate the aggregation and analysis of
data across surveillance sites.
6. Maintain multi-state data base to develop FAS prevalence rates
and other information for reports and other publications, when
appropriate.
7. Cooperate in preparation and publication of study results.
Technical Reporting Requirements
An original and two copies of semiannual progress reports are
required of all awardees. Time lines for the semiannual reports will be
established at the time of award. An original and 2 copies of the
Financial Status Report (FSR) are required no later than 90 days after
the end of the budget period. A final program 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, Procurement and Grants
Office, CDC.
Application Content
Applications must be developed in accordance with PHS Form 5161-1
(Revised 7/92, OMB Number 0937-0189). All material must be typewritten,
double-spaced pages, with type no smaller than 10 CPI (12 point), on
8.5'' x 11'' paper, with at least 1'' margins, headings, and footers,
unbound and printed on one side only. Number each page clearly, and
provide a complete index to the application and appendices. Do not
include any spiral or bound materials or pamphlets. All graphics, maps,
overlays, etc., should be in black and white and meet the above
criteria.
The applicant should provide a detailed description of first-year
activities and briefly describe future-year objectives and activities.
Do not include a detailed budget or detailed budget justification as
part of the Program Narrative.
A. Abstract
A one-page, single-spaced, typed abstract must be submitted with
the application. The heading should include the title of the grant
program, project title, organization, name and address, project
director and telephone number. The abstract should briefly summarize
the program for which funds are requested, the activities to be
undertaken, and the applicant's organization and composition. The
abstract should precede the Program Narrative. The abstract should
include the required cohort statistics and eligibility status.
B. Program Narrative (not to exceed 25 pages)
The Program Narrative should specifically address all items in the
``PROGRAM REQUIREMENTS.'' All items of the Program Narrative should
begin on a new page. If the proposed program is a multiple-year
project, the applicant should provide detailed description of the
first-year activities, and briefly describe future-year objectives and
activities. The ``EVALUATION CRITERIA'' will serve as the basis for
evaluating the
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application; therefore, the narrative of the application should address
the following:
1. Applicant's Understanding of the Problem
The applicant should demonstrate an understanding of FAS, the
challenges to conducting surveillance of FAS and other conditions
associated with prenatal alcohol use, and an understanding of the
applicant's abilities and resources to conduct FAS surveillance.
2. Applicant's Description of the Surveillance Methodology
The applicant's description should include at least the following:
a. A proposed surveillance case definition and how the definition
will be operationalized given the described methodology;
b. Clearly described methods for case ascertainment using multiple
sources. Methods should include a plan for estimating the completeness
of the surveillance system including a plan for estimating sensitivity
and specificity;
c. Demonstration of a minimum annual birth population of not less
than 25,000 in the State or region to be included in the study and/or
evidence of unusually high rates of alcohol use among women in the
population (e.g., analysis of BRFSS, PRAMS, or other local surveys)
from which the surveillance data will be generated;
d. Methods for collaboration with and written assurances from
special diagnostic units such as genetics clinics, developmental
disabilities registries, special education programs, and other agencies
serving children who may have FAS;
e. Collaboration with existing state-based birth defects,
developmental disabilities, or FAS surveillance activities;
f. A description of the proposed plan for the inclusion of both
sexes and racial and ethnic minority populations for appropriate
representation.
3. Project Management and Staffing
The applicant must demonstrate the ability and expertise to carry
out population-based surveillance for FAS. The applicant must
demonstrate the following:
a. Expertise in abstracting medical and school records;
b. Expertise in the diagnosis of FAS;
c. Expertise in epidemiology and public health surveillance;
d. Plan for personnel resources to be allocated to the project to
achieve the goals and objectives of the application (dedication of at
least one full-time professional, scientific employee or equivalent to
the project is strongly advised).
4. Relationship to Other Funding Sources
The applicant must describe the availability of State resources and
other sources of funds to support the surveillance activities in this
cooperative agreement. The applicant must describe how its program will
build on existing surveillance, screening, diagnosis, or service-
related activities for FAS.
5. Budget Justification and Adequacy of Facilities
This section must include a detailed first-year budget narrative
justification with future annual projections. Budgets should include
costs for travel for two project staff to attend at least two two-day
meetings in Atlanta with CDC staff. The applicant should describe the
program purpose of each budget item. Proposed contracts should identify
the name of the contractor, if known; describe the services to be
performed; provide an itemized budget and justification for the
estimated costs of the contract; specify the period of performance; and
describe the method of selection.
6. Human Subject Review
This section must describe how the project will be subject to
initial and continuing review by the appropriate human subjects
institutional review committees.
Evaluation Criteria
Applications will be reviewed and evaluated according to the
following criteria:
A. Understanding of the Problem (20%)
The extent to which the applicant has a clear, concise
understanding of the requirements, objectives, and purpose of the
cooperative agreement, including the applicant's willingness to
collaborate and coordinate activities with CDC and other funded sites.
The extent to which the application reflects an understanding of the
complexities of FAS surveillance and an understanding of the necessary
resources to conduct this surveillance.
B. Description of the Surveillance Methodology (50%)
The extent to which the applicant describes an approach to
surveillance of FAS that demonstrates collaboration with multiple
sources (letters of support encouraged) and addresses all issues
outlined in the ``Program Requirements'' recipient activities section.
In addition to these program requirements, the extent to which the
applicant addresses the six issues outlined under section 2 of the
``Program Narrative'' regarding the surveillance methodology.
The degree to which the applicant has met the CDC Policy
requirements regarding the inclusion of women, ethnic, and racial
groups in the proposed project. This includes:
(a) The proposed plan for the inclusion of both sexes and racial
and ethnic minority populations for appropriate representation; (b) The
proposed justification when representation is limited or absent; (c) A
statement as to whether the design of the study is adequate to measure
differences when warranted; and (d) A statement as to whether the plans
for recruitment and outreach for study participants include the process
of establishing partnerships with community(ies) and recognition of
mutual benefits.
C. Project Management and Staffing (30%)
The extent to which the applicant has the skills, experience, and
access to data that demonstrate the ability to conduct FAS
surveillance. The extent to which the applicant addresses the issues
described in the ``Program Narrative'' section 3. The adequacy of the
description of the present staff and capability to assemble competent
and trained staff to conduct FAS surveillance. The applicant shall
identify all current and potential personnel who will be utilized to
work on this cooperative agreement, including qualifications and
specific experience as it relates to the requirements set forth in this
request.
D. Budget Justification and Adequacy of Facilities (not scored)
The budget will be evaluated for the extent to which it is
reasonable, clearly justified, and consistent with the intended use of
the cooperative agreement funds. The applicant shall describe and
indicate the availability of facilities and equipment and other sources
of funds necessary to carry out this project.
E. Human Subject Review (not scored)
The extent to which the applicant complies with the Department of
Health and Human Services Regulations (45 CFR Part 46) regarding the
protection of human subjects.
Funding Preferences
In making awards, priority consideration may be given to: (1)
[[Page 28036]]
ensuring a racial/ethnic balance; and (2) ensuring rural, urban, and
national geographic distribution among the grantees.
Executive Order 12372
Applications are subject to the Intergovernmental Review of Federal
Programs as governed by Executive Order (E.O.) 12372. E. O. 12372 sets
up a system for State and local government review of proposed Federal
assistance applications. Applicants (other than federally recognized
Indian tribal governments) should contact their State Single Point of
Contact (SPOC) as early as possible to alert them to the prospective
applications and receive any necessary instructions on the State
process. For proposed projects serving more than one State, the
applicant is advised to contact the SPOC of each affected State or
tribe. A current list of SPOCs is included in the application kit. If
SPOCs have any State process recommendations on applications submitted
to CDC, they should forward them to Ron Van Duyne, Grants Management
Officer, Grants Management Branch, Procurement and Grants Office,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road, NE., Room 321, Mailstop E-13, Atlanta, Georgia 30305, no later
than 60 days after the application deadline date. The granting agency
does not guarantee to ``accommodate or explain'' State process
recommendations it receives after that date.
Indian tribes are strongly encouraged to request tribal government
review of the proposed application. If tribal governments have any
tribal process recommendations on applications submitted to CDC, they
should forward them to Ron Van Duyne, Grants Management Officer, Grants
Management Branch, Procurement and Grants Office, Centers for Disease
Control and Prevention (CDC), 255 East Paces Ferry Road, NE., Room 321,
Mailstop E-13, Atlanta, Georgia 30305, no later than 60 days after the
application deadline date. The granting agency does not guarantee to
``accommodate or explain'' tribal process recommendations it receives
after that date.
Public Health System Reporting Requirement
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
A. Paperwork Reduction Act
Projects that involve the collection of information from 10 or more
individuals and funded by this cooperative agreement program will be
subject to review by the Office of Management and Budget (OMB) under
the Paperwork Reduction Act.
B. Human Subjects
If the proposed project involves 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 assurance with the
appropriate guidelines and form provided in the application kit.
In addition to other applicable committees, Indian Health Service
(IHS) institutional review committees also must review the project if
any component of IHS will be involved or will support the research. If
any American Indian community is involved, its tribal government must
also approve that portion of the project applicable to it.
C. Confidentiality
All personal identifying information obtained in connection with
the delivery of services provided to any person in any program carried
out under this cooperative agreement cannot be disclosed unless
required by a law of a State or political subdivision or unless such a
person provides written, voluntary informed consent.
1. Nonpersonal identifying, unlinked information, which preserves
the individual's anonymity, derived from any such program may be
disclosed without consent:
a. In summary, statistical, or other similar form, or
b. For clinical or research purposes.
2. Personal identifying information: Recipients of CDC funds who
must obtain and retain personally identifying information as part of
their CDC-approved work plan must:
a. Maintain the physical security of such records and information
at all times;
b. Have procedures in place and staff trained to prevent
unauthorized disclosure of client-identifying information;
1c. Obtain informed client consent by explaining the risks of
disclosure and the recipient's policies and procedures for preventing
unauthorized disclosure;
d. Provide written assurance to this effect including copies of
relevant policies; and
e. Obtain assurances of confidentiality by agencies to which
referrals are made.
Assurance of compliance with these and other processes to protect the
confidentiality of information will be required of all recipients. A
DHHS certificate of confidentiality may be required for some projects.
D. Women, Racial and Ethnic Minorities
It is the policy of the Centers for Disease Control and Prevention
(CDC) to ensure that individuals of the various racial and ethnic
groups will be included in CDC-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, Alaskan Native, Asian, Pacific Islander, Black and Hispanic.
Applicants shall ensure that women, racial and ethnic minority
populations are appropriately represented in applications for research
involving human subjects. Where a clear and compelling rationale exists
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 47949-47951,
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 Number 0937-0189) must be submitted to Joanne
Wojcik, Grants Management Specialist, Grants Management Branch,
Procurement and Grants Office, Centers for Disease Control and
Prevention (CDC), 255 East Paces Ferry Road, NE., Room 321, Mailstop E-
13, Atlanta, Georgia 30305, on or before July 22, 1997.
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 special emphasis panel review committee. For proof of
timely mailing, applicants must request a legibly dated
[[Page 28037]]
U.S. Postal Service postmark or obtain a legibly dated receipt from a
commercial carrier or the U.S. Postal Service. Private metered
postmarks will not be acceptable as proof of timely mailing.
2. Late Applications:
Applications that do not meet the criteria in 1.a. or 1.b. above
are considered late. Late applications will not be considered and will
be returned to the applicant.
Where To Obtain Additional Information
To receive additional written information call (404) 332-4561. You
will be asked your name, address, and phone number and will need to
refer to Announcement 745. A complete program description and
information on application procedures are contained in the application
package. Business management technical assistance, and an application
package may be obtained from Joanne Wojcik, Grants Management
Specialist, Grants Management Branch, Procurement and Grants Office,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road, NE., Room 321, Mailstop E-13, Atlanta, Georgia 30305, telephone
(404) 842-6535; Internet: [email protected].
FAS surveillance technical assistance may be obtained from Karen
Hymbaugh at telephone (770) 488-7370, Internet: [email protected], or
programmatic assistance from Gregg Leeman, at telephone (770) 488-7370,
Internet: [email protected], Division of Birth Defects and Developmental
Disabilities, National Center for Environmental Health, Centers for
Disease Control and Prevention (CDC), 4770 Buford Highway, NE.,
Mailstop F-15, Atlanta, Georgia 30341-3724.
This and other CDC announcements are available through the CDC
homepage on the Internet. The address for the CDC homepage is [http://
www.cdc.gov].
CDC will not send application kits by facsimile or express mail.
Please refer to Announcement Number 745 when requesting information and
submitting an application.
Potential applicants may obtain a copy of ``Healthy People 2000''
(Full report; Stock No. 017-001-00474-0) or ``Healthy People 2000''
(Summary Report; Stock No. 017-001-00473-1) referenced in the
``INTRODUCTION'' through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325, telephone (202) 512-1800.
Dated: May 16, 1997.
Joseph R. Carter
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
[FR Doc. 97-13429 Filed 5-21-97; 8:45 am]
BILLING CODE 4163-18-P