RESEARCH TO IMPROVE CARE FOR DYING CHILDREN AND THEIR FAMILIES
 
RELEASE DATE:  July 29, 2002
 
RFA: NR03-003
 
National Institute of Nursing Research 
 (http://www.ninr.nih.gov)
National Institute of Mental Health 
 (http://www.nimh.nih.gov)
 
LETTER OF INTENT RECEIPT DATE: October 28, 2002

APPLICATION RECEIPT DATE: November 22, 2002
 
THIS RFA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this RFA
o Research Objectives
o Mechanisms of Support 
o Funds Available
o Eligible Institutions
o Individuals Eligible to become Principal Investigators
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS RFA

The National Institute of Nursing Research (NINR) and the National 
Institute of Mental Health (NIMH) invites applications for research 
grants to encourage research that will improve the quality of life for 
children who are approaching the end of life and the quality of the 
dying process and bereavement following the death for the children"s 
families, friends and other care providers.  For this RFA, family is 
defined broadly in terms of traditional families and non-traditional 
families including children being cared for in foster situations, by 
distant relatives, or friends.

RESEARCH OBJECTIVES

Background

A recent Institute of Medicine (IOM) report, "When Children Die: 
Improving Palliative and End of Life Care for Children and Their 
Families," highlights the importance of facing the challenges of caring 
for dying children and their families (IOM, 2002). (Hyperlink: 
http://www.iom.edu).  In 1997, the five leading causes of death in 
children under the age of 15 were accidents, congenital anomalies, 
cancer, homicide and diseases of the heart (National Vital Statistics 
Report, 1999).  While these deaths are relatively uncommon in the 
United States (55,000 in 1999), the international burden of childhood 
death is staggering.  For example, the Joint United Nations Program on 
HIV/AIDS (UNAIDS) estimates that 580,000 children under the age of 15 
succumbed to HIV/AIDS during 2001. Regardless of the number of deaths, 
the death of a child can be a devastating event for the family, friends 
and care providers.  Despite the importance of this issue, there is 
very little science to guide the care of dying children and their 
families.  What is known is primarily anecdotal.  For example, many, if 
not most, care providers avoid discussing the possible death of a child 
with the families and the children themselves.  This reluctance leads 
to care that focuses so single-mindedly on cure or life-prolongation 
that the possibility (or even likelihood) of death is ignored and the 
potential burdens of treatment are not adequately weighed against 
potential benefits.  Consequently, opportunities to combine curative 
therapies, such as anticancer regimens, with palliative therapies that 
will prevent or relieve a child"s suffering are neglected.  

The cause of the child"s death is important to consider.  When a child 
dies of a sudden and unexpected event, the parents, siblings, extended 
family and friends become the focus.  Interactions between the family 
and the health care providers in the emergency room or between the 
family and other emergency response personnel can leave a lasting, and 
often unpleasant memory with the survivors.  When a child dies of a 
chronic condition, such as cancer, it is likely that the family and the 
health care providers have established relationships that are truncated 
when the child dies. Loss of this ongoing support system can impair the 
family"s ability to cope with the loss of their child, particularly if 
health care providers have served as the primary support, as can be the 
case with stigmatized illnesses such as HIV/AIDS.  The death of a child 
due to a genetic illness or to HIV/AIDS adds further complexity because 
parents sometimes feel guilty for passing the life-threatening illness 
to their child.  Genetic illnesses or HIV/AIDS may be one of the few 
scenarios where there can be foreknowledge of impending death in a 
child who is currently in good health or where a fatal congenital 
condition can be diagnosed prenatally.  Children dying from stigmatized 
diseases such as AIDS may face significant barriers to high-quality 
end-of-life care.

No matter the cause of death, health care providers need to focus on 
promoting the quality of life of the child and family. Managing 
symptoms, such as cancer related pain or chemotherapy induced nausea 
and vomiting, can be particularly difficult in children because of 
dosing uncertainties, side effects and the reluctance of care providers 
to give opiate medications to children. Communication with the child 
and family that focuses on cure, rather than the potential for death, 
can also affect the quality of life at the end of life because the 
child may be unaware that he/she is dying.  Age appropriate 
communication that includes the child and family can prevent unwanted 
interventions and facilitate a peaceful death.  The siblings of 
chronically ill children are often isolated and grieve in silence or 
harbor feelings of anger and guilt as family attention and resources 
are focused on the ill child.  Ways to appropriately include and 
support siblings throughout the dying process need to be elucidated.  

Where the child dies can have a profound impact on his/her quality of 
life at the end of life and the family"s experience of the dying 
process.  When the possibility of death has not been discussed until 
very late in the dying process, dying children are often admitted to 
intensive care units and die a "high tech" death.  Such deaths can 
isolate the family from the dying child and prevent a peaceful death.  
Research is needed to identify and test approaches that care providers 
can implement to improve the care of dying children in all settings, 
including children dying from a stigmatized illness such as HIV/AIDS in 
areas with limited resources.

Research Scope

The chapter on research directions in the IOM report (2002) offers 
suggestions for future research directions regarding care for dying 
children and their families.  Examples of potential research topics 
include, but are not limited to the following:

o  Identify age specific end-of-life issues from preterm babies through 
adolescents and determine how the age of the parents influences the 
dying process.

o  Test ways of integrating palliative care with life prolonging 
therapies in children with life threatening illnesses.

o  Identify the dying trajectories of children (e.g., sudden death vs. 
life threatening condition) and determine if interventions can and 
should be structured according to the trajectories.

o  Test interventions to facilitate communication among health 
professionals and the extended family in different situations such as 
prenatal diagnosis of a fatal condition, premature birth, and death of 
a child from traumatic injury or chronic illness such as cancer.

o  Evaluate the role of health care providers in the lives of 
chronically ill children and their families, especially when the 
emphasis changes from cure to end-of-life care, or when families have 
few supports outside of the health care system.

o  Study school-based interventions to assist teachers and classmates 
who are continuing to interact with the child through a life 
threatening illness. Interventions may include ways to reduce stigma 
and improve palliative care in this environment.

o  Determine ways to help a child cope with the visible signs (e.g., 
hair loss, fatigue, frequent absences, medication regimes) of their 
illness or treatments.

o  Evaluate effective bereavement interventions for siblings, parents, 
and other family members or caregivers and determine the effect the 
type of death (e.g., violence, suicide, cancer, stigmatized illness) 
has on the bereavement process. 

o  Study hope versus uncertainty in the rapidly evolving field of 
genetics where advances such as transplants and gene therapy are 
prolonging life well beyond expectations.

o  Identify specific issues in vulnerable children (e.g., those who are  
from resource poor settings, handicapped,  stigmatized or who have 
experienced multiple losses, ) who are diagnosed with life threatening 
conditions. Develop and test culturally relevant interventions to 
support the child and family through death and bereavement in domestic 
and international settings.

o  Determine approaches appropriate to the cognitive and emotional 
maturity of the child, to assess and manage physical and psychological 
symptoms associated with conditions that are likely to be fatal.

o  Test culturally sensitive communication models, appropriate to the 
cognitive and emotional maturity of the child, that involve him/her in 
decision making throughout a life threatening illness and death.

o  Evaluate the effect of a child"s death on the family unit, 
especially siblings, including the financial impact and long-term 
consequences.

o  Develop and test culturally sensitive individual, peer, family, 
community and structural interventions that promote a peaceful death 
for the child within the cultural context of the family.

MECHANISMS OF SUPPORT 

This RFA will use the NIH R01 and R21 award mechanisms.  As an 
applicant, you will be solely responsible for planning, directing, and 
executing the proposed project.  The objective of the 
exploratory/developmental mechanism (R21) is to encourage applications 
from individuals who are interested in testing innovative or 
conceptually creative ideas that are scientifically sound and may 
advance our understanding of the end of life for children and their 
families.  Investigators are encouraged to explore the feasibility of 
an innovative research question or approach that will provide a basis 
for future research project applications.  Exploratory/developmental 
grants (R21) are limited to 3 years of support and up to $125,000 per 
year in direct costs.  For further guidance on the R21 mechanism, 
please see: http://grants1.nih.gov/grants/guide/pa-files/PA-99-134.html.

This RFA is a one-time solicitation.  Future unsolicited, competing 
continuation applications based on this project will compete with all 
investigator-initiated applications and will be reviewed according to 
the customary peer review procedures. The anticipated award date is 
July 1, 2003.
 
This RFA uses just-in-time concepts.  It also uses modular and non-
modular grant formats. (see 
http://grants.nih.gov/grants/funding/modular/modular.htm).   If you are 
submitting an application with direct costs in each year of $250,000 or 
less, use the modular format.  Otherwise, follow the standard PHS 398 
application instructions for detailed budgets.  

FUNDS AVAILABLE
 
NINR intends to commit approximately $2 million in FY 2003 to fund 5-7 
applications in response to this RFA. NIMH intends to commit 
approximately $500,000 in FY 2003 to fund 1-3 new and/or competitive 
continuation grants.  For the R01 mechanism, an applicant may request 
up to 5 years of support and up to $340,000 per year in direct costs.  
For the R21, applicants may request up to 3 years of support and up to 
$125,000 per year in direct costs.  Because the nature and scope of the 
proposed research will vary from application to application, it is 
anticipated that the size and duration of each application will also 
vary. Although the financial plans of the NINR provide support for this 
program, awards pursuant to this RFA are contingent upon the 
availability of funds and the receipt of a sufficient number of 
meritorious applications.
 
ELIGIBLE INSTITUTIONS
 
You may submit (an) application(s) if your institution/organization has 
any of the following characteristics:

o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, 
hospitals, and laboratories 
o Units of State and local governments
o Eligible agencies of the Federal government  
o Domestic or foreign
o Faith-based organizations
 
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS   

Any individual with the skills, knowledge, and resources necessary to 
carry out the proposed research is invited to work with their 
institution to develop an application for support.  Individuals from 
underrepresented racial and ethnic groups as well as individuals with 
disabilities are always encouraged to apply for NIH programs.   

WHERE TO SEND INQUIRIES

We encourage inquiries concerning this RFA and welcome the opportunity 
to answer questions from potential applicants.  Inquiries may fall into 
three areas:  scientific/research, peer review, and financial or grants 
management issues:

o Direct your questions about scientific/research issues to:

Dr. Ann Knebel
Office of Extramural Programs
National Institute of Nursing Research
6701 Democracy Blvd, Room 710, MSC 4870
Bethesda, MD  20892-4870
Telephone:  (301) 594-5966
FAX:  (301) 480-8260
Email:  ann_knebel@nih.gov

Dr. Nicolette Borek
Center For Mental Health Research on AIDS
National Institute of Mental Health
6001 Executive Blvd., Room 6206, MSC 9619
Bethesda, MD  20892-9619
Telephone:  (301) 443-4526
FAX:  (301) 443-9719
Email:  nborek@mail.nih.gov 

o Direct your questions about peer review issues to:

Dr. John Richters
Office of Review
National Institute of Nursing Research
6701 Democracy Blvd, Room 707, MSC 4870
Bethesda, MD  20892-4870
Telephone:  (301) 594-5971
FAX:  (301) 451-5645
Email: john_richters@nih.gov 

o Direct your questions about financial or grants management matters 
to:

Ms. Cindy McDermott
Office of Grants and Contracts Management
Division of Extramural Activities
National Institute of Nursing Research
6701 Democracy Blvd, Room 710, MSC 4870
Bethesda, MD  20892-4870
Telephone:  (301) 594-6869
FAX:  (301) 451-5648
Email:  cindy_mcdermott@nih.gov 

Brian Albertini
Grants Management Branch
Division of Extramural Activities
National Institute of Mental Health
6001 Executive Blvd, Room 6134, MSC 9605
Bethesda, MD  20892-9605
Telephone:  (301) 443-0004
FAX:  (301) 443-6885
Email:  balberti@nih.gov 

LETTER OF INTENT
 
Prospective applicants are asked to submit a letter of intent that 
includes the following information:

o Descriptive title of the proposed research
o Name, address, and telephone number of the Principal Investigator
o Names of other key personnel 
o Participating institutions
o Number and title of this RFA 

Although a letter of intent is not required, is not binding, and does 
not enter into the review of a subsequent application, the information 
that it contains allows IC staff to estimate the potential review 
workload and plan the review.
 
The letter of intent is to be sent by the date listed at the beginning 
of this document.  The letter of intent should be sent to:

Dr. John Richters
Office of Review
National Institute of Nursing Research
6701 Democracy Blvd, Room 707, MSC 4870
Bethesda, MD  20892-4870
Telephone:  (301) 594-5971
FAX:  (301) 451-5645
Email: john_richters@nih.gov 

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant 
application instructions and forms (rev. 5/2001).  The PHS 398 is 
available at http://grants.nih.gov/grants/funding/phs398/phs398.html in 
an interactive format.  For further assistance contact GrantsInfo, 
Telephone (301) 710-0267, Email: GrantsInfo@nih.gov.

Please note, when completing an application for the R21 mechanism, 
Items a-d in the Research Plan must not exceed a total of 15 pages. 
Tables and figures are included in the page limitations. Applications 
that exceed the page limitation or NIH requirements for type size and 
margins (refer to PHS 398 application for details) will be returned to 
the applicant without further consideration. The 15-page limitation 
does not include Items e-i (Human Subjects, Vertebrate Animals, 
Literature Cited, Consortia and Consultants/Collaborators).

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications 
requesting up to $250,000 per year in direct costs must be submitted in 
a modular grant format.  The modular grant format simplifies the 
preparation of the budget by limiting the level of budgetary detail.  
Applicants request direct costs in $25,000 modules.  Section C of the 
research grant application instructions for the PHS 398 (rev. 5/2001) 
at http://grants.nih.gov/grants/funding/phs398/phs398.html includes 
step-by-step guidance for preparing modular applications.  Additional 
information on modular applications is available at 
http://grants.nih.gov/grants/funding/modular/modular.htm.

USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 
5/2001) application form must be affixed to the bottom of the face page 
of the application.  Type the RFA number on the label.  Failure to use 
this label could result in delayed processing of the application such 
that it may not reach the review committee in time for review.  In 
addition, the RFA title and number must be typed on line 2 of the face 
page of the application form and the YES box must be marked. The RFA 
label is also available at: 
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.
 
SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten 
original of the application, including the Checklist, and three signed, 
photocopies, in one package to:
 
Center For Scientific Review
National Institutes Of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for express/courier service)
 
At the time of submission, two additional copies of the application 
must be sent to:

Dr. John Richters
Office of Review
National Institute of Nursing Research
6701 Democracy Blvd, Room 707, MSC 4870
Bethesda, MD  20892-4870
 
APPLICATION PROCESSING: Applications must be received by the 
application receipt date listed in the heading of this RFA.  If an 
application is received after that date, it will be returned to the 
applicant without review.
 
The Center for Scientific Review (CSR) will not accept any application 
in response to this RFA that is essentially the same as one currently 
pending initial review. The CSR will not accept any application that is 
essentially the same as one already reviewed. This does not preclude 
the submission of substantial revisions of applications already 
reviewed, but such applications must include an Introduction addressing 
the previous critique.

PEER REVIEW PROCESS  
 
Upon receipt, applications will be reviewed for completeness by the CSR 
and responsiveness by the (IC).  

Incomplete applications will be returned to the applicant without 
further consideration.  If the application is not responsive to the 
RFA, CSR staff may contact the applicant to determine whether to return 
the application to the applicant or submit it for review in competition 
with unsolicited applications at the next appropriate NIH review cycle.

Applications that are complete and responsive to the RFA will be 
evaluated for scientific and technical merit by an appropriate peer 
review group convened by the NINR in accordance with the review 
criteria stated below.  As part of the initial merit review, all 
applications will:

o Receive a written critique
o Undergo a process in which only those applications deemed to have the 
highest scientific merit, generally the top half of the applications 
under review, will be discussed and assigned a priority score
o Receive a second level review by the National Advisory Council for 
Nursing Research
 
REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  
In the written comments, reviewers will be asked to discuss the 
following aspects of your application in order to judge the likelihood 
that the proposed research will have a substantial impact on the 
pursuit of these goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment
  
The scientific review group will address and consider each of these 
criteria in assigning your application"s overall score, weighting them 
as appropriate for each application.  Your application does not need to 
be strong in all categories to be judged likely to have major 
scientific impact and thus deserve a high priority score.  For example, 
you may propose to carry out important work that by its nature is not 
innovative but is essential to move a field forward.

(1) SIGNIFICANCE:  Does your study address an important problem? If the 
aims of your application are achieved, how do they advance scientific 
knowledge?  What will be the effect of these studies on the concepts or 
methods that drive this field?

(2) APPROACH:  Are the conceptual framework, design, methods, and 
analyses adequately developed, well integrated, and appropriate to the 
aims of the project?  Do you acknowledge potential problem areas and 
consider alternative tactics?

(3) INNOVATION:  Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project 
challenge existing paradigms or develop new methodologies or 
technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to 
carry out this work?  Is the work proposed appropriate to your 
experience level as the principal investigator and to that of other 
researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your work 
will be done contribute to the probability of success?  Do the proposed 
experiments take advantage of unique features of the scientific 
environment or employ useful collaborative arrangements?  Is there 
evidence of institutional support?

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your 
application will also be reviewed with respect to the following:

o PROTECTIONS:  The adequacy of the proposed protection for humans, 
animals, or the environment, to the extent they may be adversely 
affected by the project proposed in the application.

o INCLUSION:  The adequacy of plans to include subjects from both 
genders, all racial and ethnic groups (and subgroups), and children as 
appropriate for the scientific goals of the research.  Plans for the 
recruitment and retention of subjects will also be evaluated. (See 
Inclusion Criteria included in the section on Federal Citations, below)

o DATA SHARING:  The adequacy of the proposed plan to share data. 

o BUDGET:  The reasonableness of the proposed budget and the requested 
period of support in relation to the proposed research.

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date: October 28, 2002
Application Receipt Date: November 22, 2002
Peer Review Date: February/March 2003
Council Review: May 2003
Earliest Anticipated Start Date: July 2003

AWARD CRITERIA

Award criteria that will be used to make award decisions include:

o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities.
 
REQUIRED FEDERAL CITATIONS 

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research 
components involving Phase I and II clinical trials must include 
provisions for assessment of patient eligibility and status, rigorous 
data management, quality assurance, and auditing procedures.  In 
addition, it is NIH policy that all clinical trials require data and 
safety monitoring, with the method and degree of monitoring being 
commensurate with the risks (NIH Policy for Data Safety and Monitoring, 
NIH Guide for Grants and Contracts, June 12, 1998: 
http://grants.nih.gov/grants/guide/notice-files/not98-084.html).  

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy 
of the NIH that women and members of minority groups and their sub-
populations must be included in all NIH-supported clinical research 
projects unless a clear and compelling justification is provided 
indicating that inclusion is inappropriate with respect to the health of 
the subjects or the purpose of the research. This policy results from 
the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43).

All investigators proposing clinical research should read the AMENDMENT 
"NIH Guidelines for Inclusion of Women and Minorities as Subjects in 
Clinical Research - Amended, October, 2001," published in the NIH Guide 
for Grants and Contracts on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html), a 
complete copy of the updated Guidelines are available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.   
The amended policy incorporates: the use of an NIH definition 
of clinical research, updated racial and ethnic categories in 
compliance with the new OMB standards, clarification of language 
governing NIH-defined Phase III clinical trials consistent with the new 
PHS Form 398, and updated roles and responsibilities of NIH staff and 
the extramural community.  The policy continues to require for all NIH-
defined Phase III clinical trials that: a) all applications or 
proposals and/or protocols must provide a description of plans to 
conduct analyses, as appropriate, to address differences by sex/gender 
and/or racial/ethnic groups, including subgroups if applicable, and b) 
investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN 
SUBJECTS: The NIH maintains a policy that children (i.e., individuals 
under the age of 21) must be included in all human subjects research, 
conducted or supported by the NIH, unless there are scientific and 
ethical reasons not to include them. This policy applies to all initial 
(Type 1) applications submitted for receipt dates after October 1, 
1998.

All investigators proposing research involving human subjects should 
read the "NIH Policy and Guidelines" on the inclusion of children as 
participants in research involving human subjects that is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH 
policy requires education on the protection of human subject 
participants for all investigators submitting NIH proposals for research 
involving human subjects.  You will find this policy announcement in the 
NIH Guide for Grants and Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

HUMAN EMBRYONIC STEM CELLS (hESC): Criteria for federal funding of 
research on hESCs can be found at 
http://grants.nih.gov/grants/stem_cells.htm and at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-005.html.  
Only research using hESC lines that are registered in the NIH Human 
Embryonic Stem Cell Registry will be eligible for Federal funding (see 
http://escr.nih.gov).   It is the responsibility of the applicant to 
provide the official NIH identifier(s)for the hESC line(s)to be used in 
the proposed research.  Applications that do not provide this 
information will be returned without review. 

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: 
The Office of Management and Budget (OMB) Circular A-110 has been 
revised to provide public access to research data through the Freedom of 
Information Act (FOIA) under some circumstances.  Data that are (1) 
first produced in a project that is supported in whole or in part with 
Federal funds and (2) cited publicly and officially by a Federal agency 
in support of an action that has the force and effect of law (i.e., a 
regulation) may be accessed through FOIA.  It is important for 
applicants to understand the basic scope of this amendment.  NIH has 
provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application 
should include a description of the archiving plan in the study design 
and include information about this in the budget justification section 
of the application. In addition, applicants should think about how to 
structure informed consent statements and other human subjects 
procedures given the potential for wider use of data collected under 
this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and 
proposals for NIH funding must be self-contained within specified page 
limitations. Unless otherwise specified in an NIH solicitation. Internet 
addresses (URLs) should not be used to provide information necessary to 
the review because reviewers are under no obligation to view the 
Internet sites.   Furthermore, we caution reviewers that their anonymity 
may be compromised when they directly access an Internet site.

HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to 
achieving the health promotion and disease prevention objectives of 
"Healthy People 2010," a PHS-led national activity for setting priority 
areas. This RFA is related to one or more of the priority areas. 
Potential applicants may obtain a copy of "Healthy People 2010" at 
http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS: This program is described in the Catalog of 
Federal Domestic Assistance Nos. 93.361 (NINR) and 93.242 (NIMH) and is 
not subject to the intergovernmental review requirements of Executive 
Order 12372 or Health Systems Agency review.  Awards are made under 
authorization of Sections 301 and 405 of the Public Health Service Act 
as amended (42 USC 241 and 284 and administered under NIH grants 
policies described at http://grants.nih.gov/grants/policy/policy.htm 
and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. 

The PHS strongly encourages all grant recipients to provide a smoke-
free workplace and discourages the 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.  This is consistent with the PHS mission to protect and 
advance the physical and mental health of the American people.

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