Full Text PA-92-65 IMPLEMENTATION OF CARING FOR PEOPLE WITH SEVERE MENTAL DISORDERS NIH GUIDE, Volume 21, Number 13, April 3, 1992 PA NUMBER: PA-92-65 P.T. 34 Keywords: Mental Disorders Health Services Delivery Health Care Economics Rehabilitation/Therapy, Emotional Sociology National Institute of Mental Health PURPOSE The purpose of this announcement is to encourage research, research demonstration, and research career development applications for investigations of mental health care to persons with severe mental disorders. The ultimate goal of this initiative is to improve the care and quality of life of those who suffer from persistent and disabling mental illnesses. Applications are sought in the areas of clinical services, service systems, and mental health economics. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas. This program announcement, Implementation of Caring for People with Severe Mental Disorders, is related to the priority areas of mental health objectives 6.4, 6.6, and 6.7. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0) or "Healthy People 2000" (Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202/783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by any public or private, non-profit and for-profit organizations including universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal Government (for-profit corporations may not apply for research demonstration support). Foreign institutions may only apply for research project grants. Women and minority investigators are encouraged to apply. Special eligibility requirements for specific support mechanisms are described in the relevant announcements. Applications for CSP research demonstration grants may be made only by State mental health authorities. It is expected that the primary researcher will be the Principal Investigator and the State staff member with project oversight responsibility will be the Project Coordinator. MECHANISMS OF SUPPORT The Research Resources panel recommended that a broad array of grant mechanisms be used to encourage investigators at all stages of their careers to conduct research in the mental health services area. Research support may be requested through applications for an individual research grant (R01), a small grant (R03), the First Independent Research Support and Transition (FIRST) Award (R29), and the Multi-Institutional Collaborative Research Project (R10). Support for research projects that include funds for services may be requested through applications for research demonstration grants (R18), including Community Support Program (CSP) research demonstration grants. Research demonstration projects investigate particular approaches to providing, organizing, or funding services through experimental or quasi-experimental studies of interventions applied in actual service settings. Such projects involve implementing one or more interventions and comparing the effectiveness through the use of one or more control/comparison groups. A primary goal of a research demonstration project is to design and evaluate the outcomes of interventions that, if shown to be effective, can be generalized to other settings. Other mechanisms supported by this announcement include: National Research Service Awards (NRSA) Predoctoral Individual M.D./Ph.D. Fellowship (F30) Individual Predoctoral Fellowship (F31) Individual Postdoctoral Fellowship (F32) Institutional Training grant (T32) Research Career Development Awards Research Scientist Development Award (K02) Research Scientist Award (K05) Scientist Development Award for Clinicians (K20) Scientist Development Award (K21) Since the R03, R10, R29, NRSA, and Research Career Development mechanisms have special requirements regarding eligibility, application format, and review criteria, applicants are strongly encouraged to consult with NIMH program staff (see INQUIRIES). Copies of the specialized announcements for each are available from program staff. Terms and Conditions of Support Grant funds may be used for expenses clearly related and necessary to conduct the proposed research. Grant funds may not be used to operate a treatment, rehabilitation, or other service program, except in the case of a research demonstration grant (R18). Research demonstration grants are intended to assist in meeting the costs of planning, developing, and implementing research demonstration activities necessary to support attainment of project objectives. Grant funds are to be additive, not substitutive; they are not to be used to replace existing resources. Applications for CSP research demonstration grants must include the following assurance: "Not more than 10 percent of grant funds will be expended for administrative expenses." In addition, the Principal Investigator and project director of these grants will be asked to participate in one meeting each year of the grant to share information. The meetings will be held in the Washington, DC area or other designated central location. Questions about the terms and conditions of support for CSP research demonstration grants may be directed to the Community Support Program at NIMH. Grants must be administered in accordance with the "PHS Grants Policy Statement (Rev. October 1990)." Federal Regulations at 42 CFR Part 52, "Grants for Research Projects," and 45 CFR Parts 74 and 92 concerning administration of grants, are applicable to these awards. Period of Support Applicants may request support for up to five years for research and research demonstration projects. CSP demonstrations are limited to three years. Small grants are limited to two years and may not be renewed. FIRST awards are made for five years and are not renewable. Specific instructions regarding the period of support for NRSA, career development, and minority supplement grant mechanisms are in the specialized announcements for these mechanisms. Annual continuation awards will be made, subject to continued availability of funds and progress achieved. RESEARCH OBJECTIVES Background Dramatic progress in clinical and basic research over the past two decades has led to major advances in diagnosis and treatment of mental disorders. As in the rest of medicine, however, this knowledge base may not be well used in the actual provision of mental health services. Particularly for persons with severe, persistent, disabling mental disorders, this situation may mean that diagnoses are in error, treatment plans are inadequate or ineffective, and essential services are poorly coordinated or nonexistent. With any illness, but especially with severe mental disorders that endure and disable, providing the right medication is essential, but not enough. Other services must be provided to assist rehabilitation, independent living, and quality of life. Finding ways to improve the quality, organization, and financing of care is a compelling public health need. In response to this need, the National Advisory Mental Health Council of the National Institute of Mental Health (NIMH) convened three panels of experts to evaluate the existing state of scientific knowledge on services for adults with severe mental disorders: the Clinical Services Research Panel, the Service Systems Research Panel, and the Research Resources Panel. The experts on the panels were asked to identify major research gaps and resource needs for the future. The findings of the three panels are summarized in "Caring for People with Severe Mental Disorders: A National Plan of Research to Improve Services." The research recommendations proposed by the first two panels and their consultants are the basis for the research issues identified in this announcement. This announcement is divided into two domains: clinical services research and service systems research. Each domain represents a separate content area that needs intensive study. However, applicants may propose research designs that crosscut these domains. There is a particular need for research that addresses issues related to members of special populations such as minorities, women, those living in rural areas, and homeless persons. Other NIMH program announcements address needs for research on mental health services provided for children and adolescents. Clinical Services Research Context Clinical services research extends the work done in clinical research and provides questions for further clinical trials. It focuses on how clinical knowledge, gained in a controlled research environment, is applied in the larger, relatively uncontrolled environment in which those with mental illness actually live. However, equally important, it is concerned with learning from community clinical practice what aspects of that care are most important in improving the outcome of mental health treatments. The primary goal of clinical services research is to improve the quality of care in everyday clinical practice. The true value of clinical research to the treatment of those with severe mental illness cannot be known until answers are provided to such questions as: How accurate are clinical assessments of severely mentally ill patients made in everyday practice--including assessments not only of psychological functioning, but of physical and social as well? Are the most appropriate treatments for a given disorder, as revealed through clinical studies, actually provided to those who need them and, if so, are the outcomes beneficial? Research Approaches and Issues Applicants may use a variety of approaches, singly or in combination, and may address any of a broad range of research issues related to clinical services for persons with severe mental disorders, including co-occurring substance abuse disorders. The following list of research issues is illustrative, not comprehensive, and other clinical services research issues may be proposed. Examples of research topics, by specific content subareas, include: Characteristics of the Population o Long-term, natural history studies of individuals with major mental disorders, including co-occurring substance abuse disorders, that focus on the course of illness and the resulting degree of disability, use of mental health and social services, and the effect of the illness on family members o Studies of treated and untreated populations to assess the types, patterns, duration, and mutability of mental illness-related disabilities and the role that socioeconomic and cultural influences play in the development and course of disabilities o Research on the prevalence of severe mental disorders, including co-occurring substance abuse disorders, and on the service needs of persons with these disorders who reside in prisons, nursing homes, and institutions other than mental hospitals Assessment Research o Studies to assess the generalizablity of diagnostic assessment techniques across major social and cultural groups o Studies of how the presence of a severe mental disorder affects the recognition and management of medical disorders o Research on the reliability, validity, and stability of quality-of-life, social status, and vocational status measures, particularly for severely mentally ill individuals from different socioeconomic, ethnic, or cultural groups Treatment Research o Studies of the effectiveness of various treatment modalities, including day treatment, partial hospitalization, home-based care, community treatment programs and long-term hospitalization, for different groups (diagnostic, socioeconomic, ethnic, cultural, gender, and age) of severely mentally ill individuals at different times in their illnesses o Research on the relative effectiveness of psychotherapeutic drugs for severely mentally ill individuals in various community settings o Studies of the effects of peer support and self-help groups for those with severe mental illness o Research on ways to maximize the role of families in developing and delivering effective treatment Rehabilitation Research o Studies to determine what types and combinations of rehabilitation services are most beneficial for severely mentally ill individuals with different clinical, social, and economic circumstances o Studies of how well State vocational rehabilitation systems provide services, what diagnostic, socioeconomic, and ethnic groups of persons with severe mental illness are enrolled in State programs, and the outcomes for those enrolled o Research on the effect of housing policies on comprehensive rehabilitation programs o Research on ways to maximize effective use of family expertise and client preferences in planning rehabilitation services Outcomes Research o Studies of the reliability and validity of instruments in multiple outcome domains (clinical, rehabilitative, humanitarian, and public welfare), particularly for understudied populations, e.g., severely mentally ill persons who are homeless, migrants, minorities, rural residents o Studies of outcome utilities for individuals, families, and communities o Research on the appropriateness, in assessing health status among those with severe mental disorders, of general health status, physical, and psychosocial functioning measures, that were developed to assess a general or medically ill population o Research testing the performance over time of instruments measuring inherently unstable patient or client characteristics o Research to develop new analytic methods or adapt existing ones to handle the difficulties encountered in analyzing longitudinal data from multiple domains and perspectives Service Systems Research Context Service systems research focuses on the organizational, financial, and social issues related to the provision of services to persons with severe mental disorders. Its goal is to identify the optimal ways to organize and finance mental health and related services to meet the multiple and varying needs--psychological, social, and economic--of the individuals who suffer from severe mental disorders and of the individuals who provide care to them. This section of the announcement will focus on the organization, financing, and structure of service systems, as well as legal issues, human resource development, and issues related to stigma; the subsequent section will focus on the economics of providing mental health care and related services. A basic premise of service systems research is that multiple challenges confront those who seek to develop effective ways of providing state-of-the-art clinical services to all persons with severe mental illness. Therefore, it is essential that answers to questions such as the following be found: How can various types of care--from clinical management to rehabilitation, housing, and income support-- be better integrated? How can clinical personnel be recruited, trained, and retained, especially in geographical areas with a low concentration of providers? What methods of treatment coordination are most cost-effective or cost- beneficial? What are the linkages among supply and quality of board and care homes, the level of Social Security Income (SSI) payments, and housing market forces? What incentives are needed to reduce community admissions to State mental hospitals and ensure quality outpatient treatment and rehabilitation services? Can the law be used creatively to provide safe, affordable housing for clients? To what extent do courtroom uses of psychiatry reinforce perceptions of mentally ill people as violent and what is the ratio of violent crime to nonviolent crime among different subgroups of those with severe mental illness? Research Approaches and Issues Applicants may use a variety of approaches, singly or in combination, and may address any of a broad range of research issues related to service systems research. The following list of research issues is illustrative, not comprehensive, and other service system research issues may be proposed. Examples of research topics, by specific content subareas, include: Improving Service Systems o Research to develop brief screening methods for identifying individuals in the community who are afflicted with severe mental illness that can facilitate swift and appropriate referrals to specific services o Research on the acceptability of alternative mental health service models to severely mentally ill persons and their families o Studies of patterns of and reasons for differential use of mental health services by different ethnic groups Structure of Care o Studies of ways families can best be involved in working with and integrating the various elements of service systems o Research on ways to link mental health, general health, substance abuse, and social service systems components o Research on the provision of mental health services in locations other than mental health specialty settings, such as general hospitals, nursing homes, criminal justice facilities, and primary health care settings o Studies of the costs and effects on patients of changes in the organization of mental health services in a State or region The Allocation of Financial Resources: Financing of Care o Analysis of the interactions of mental health care financing among State Mental Health Agencies, Medicaid, Medicare, and private insurers o Studies of financial incentives that promote the development of programs for severely mentally ill persons who have special needs o Research on the use and cost of mental health services by severely mentally ill individuals receiving Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits Impact of Cost-Containment Policies o Studies that examine impacts of cost-containment policies on the provision of mental health care to severely mentally ill persons within and across different managed care systems, e.g., health maintenance organizations, preferred provider organizations, and utilization review management o Studies of capitated payment systems for severely mentally ill individuals and the effectiveness of capitation in financing comprehensive, coordinated, continuing care o Research that addresses the financial impact of various forms of managed mental health care on patients, providers, and payers Cost-Benefit/Cost-Effectiveness Studies o Cost-benefit and cost-effectiveness analyses of alternative treatment, rehabilitation, and case management modalities, including studies of family care o Cost-effectiveness analyses of innovative financing mechanisms for providing services to persons with severe mental disorders and mental disorders that co-occur with substance abuse disorders o Analyses of costs and benefits of providing a comprehensive range of health and human services for severely mentally ill persons, including housing, social services, income security, and employment assistance Legal Issues o Research on ways to screen, refer, and/or treat severely mentally ill individuals who enter the criminal justice system o Studies that track and contrast the careers of minority and nonminority severely mentally ill individuals through the criminal justice, mental health, and substance abuse treatment systems o Research on the effects of outpatient commitment programs o Studies of the ability of professionals to predict violence by severely mentally ill persons Human Resources Issues o Studies to assess the outcome of programs designed to recruit, train, and retain minority and nonminority mental health professionals, particularly in underserved areas, in nontraditional settings, and for underserved populations o Research on how changes in professional and other regulations, such as licensure and reimbursement, affect programs available to severely mentally ill persons o Studies of the effectiveness of professional and paraprofessional workers in various types of service settings; the impact of specific configurations of staff treatment teams; the effects of matching clients and providers based on gender, culture, ethnicity, and age; and the effects of consumer and family members as providers of services Overcoming Stigma o Research to determine the prevalence of different types of illegal acts--from loitering to child molesting and assault--committed by severely mentally ill persons and those without evidence of severe mental illness o Longitudinal research on public attitudes toward people with severe mental illness, focusing particularly on cultural, ethnic, and class differences o Research to determine the effectiveness of efforts to improve public attitudes toward persons suffering from severe mental illness SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF ADAMHA POLICIES CONCERNING INCLUSION OF FEMALES AND MINORITIES IN RESEARCH STUDY POPULATIONS Applications for grants and cooperative agreements and proposals for contracts that involve human subjects are required to include minorities and both genders in study populations so that research findings can be of benefit to all persons at risk of the disease, disorder or condition under study; special emphasis should be placed on the need for inclusion of minorities and women in studies of diseases, disorders and conditions which disproportionately affect them. This policy applies to all research involving human subjects and human materials, and applies to males and females of all ages. If one gender and/or minorities are excluded or are inadequately represented in this research, particularly in proposed population-based studies, clear compelling rationale for exclusion or inadequate representation should be provided. The composition of the proposed study population must be described in terms of gender and racial/ethnic group, together with a rationale for its choice. In addition, gender and racial/ethnic issues should be addressed in developing a research design and sample size appropriate for the scientific objectives of the study. Applicants/offerors are urged to assess carefully the feasibility of including the broadest possible representation of minority groups. However, NIH and ADAMHA recognize that it may not be feasible or appropriate in all research projects to include representation of the full array of United States racial/ethnic minority populations (i.e., American Indians or Alaskan Natives, Asians or Pacific Islanders, African Americans, Hispanics). Investigators must provide the rationale for studies on single minority population groups. Applications/proposals for support of research involving human subjects must employ a study design with minority and/or gender representation (by age distribution, risk factors, incidence/prevalence, etc.) appropriate to the scientific objectives of the research. It is not an automatic requirement for the study design to provide statistical power to answer the questions posed for men and women and racial/ethnic groups separately; however, whenever there are scientific reasons to anticipate differences between men and women, and racial/ethnic groups, with regard to the hypothesis under investigation, applicants should include an evaluation of these gender and minority group differences in the proposed study. If adequate inclusion of one gender and/or minorities is impossible or inappropriate with respect to the purpose of the research, because of the health of the subjects, or other reasons, or if in the only study population available, there is a disproportionate representation of one gender or minority/majority group, the rationale for the study population must be well explained and justified. The NIH/ADAMHA funding components will not make awards of grants, cooperative agreements, or contracts that do not comply with this policy. For research awards that are covered by this policy, awardees will report annually on enrollment of women and men, and on the race and ethnicity of subjects. PROTECTION OF HUMAN SUBJECTS The Department of Health and Human Services has regulations for the protection of human subjects and has developed additional regulations for the protection of children. A copy of the human subject regulations (45 CFR 46, Protection of Human Subjects) and those pertaining specifically to children are available from the Office of Protection from Research Risks, National Institutes of Health, Bethesda, MD 20892, telephone 301/496-7041. Specific questions concerning protection of human subjects in research may be directed to NIMH staff members listed under INQUIRIES. APPLICATION PROCEDURES Applicants are to use the Public Health Service research grant application form PHS 398 (rev. 9/91). The number (PA-92-65) and the abbreviated title of this announcement, "Caring for People with Severe Mental Disorders," must be typed in item number 2a on the face page of the PHS 398 application form. Applicants must also specify the appropriate code for the support mechanism they are applying under, e.g., FIRST (R29), small grant (R03), research demonstration (R18). Applications for the Individual NRSA (F32) must use the application form PHS 416-1 (rev. 7/88). Application kits containing the necessary forms may be obtained from business offices or offices of sponsored research at most universities, colleges, medical schools, and other major research facilities. If such a source is not available, the following office may be contacted for the necessary application material: Grants Management Branch National Institute of Mental Health 5600 Fishers Lane, Room 7C-05 Rockville, MD 20857 Telephone: (301) 443-4414 The signed original and five legible copies (two copies of fellowship forms) of the completed application must be sent to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892** Applications for CSP demonstration grants must comply with the intergovernmental review requirements of Executive Order 12372. Through this process, States, in consultation with local governments, are provided the opportunity to review and comment on applications for Federal financial assistance. Applicants must contact their State's single point of contact (SPOC) as early as possible to determine the applicable procedure. A current listing of SPOCs are available from the Community Support Program. SPOC comments must be forwarded 60 days after the application receipt date to: Stephen J. Hudak, Chief, Grants Management Section, 5600 Fishers Lane, Room 7C-23, Rockville, MD 20857. The NIMH does not guarantee to accommodate or explain comments from the SPOC after that date. REVIEW PROCEDURES Applications will be assigned on the basis of established PHS referral guidelines. Applications will be reviewed for scientific and technical merit by an initial review group (IRG) composed primarily of non-Federal scientific experts. Final review is by the appropriate National Advisory Council. With the exception of small grants and NRSA individual fellowship applications, which are not reviewed by Council, only applications recommended by the Council may be supported. Summaries of IRG outcomes are sent to applicants as soon as possible following IRG review. Review Criteria General review criteria for scientific/technical merit review of R01, R03, R29, R18, and R10 applications include: o Significance of the research objectives to the public health goals of this announcement o Adequacy of the theoretical and conceptual framework of the proposed research and appropriateness of research methods o Evidence of familiarity with and understanding of relevant research literature and mental health services issues o Potential contribution of the project to improving services for persons disabled by severe mental disorders o Quality of project design and methodology, including appropriateness of control or comparison groups, reliability and validity of instruments to assess key variables, methods to identify and minimize biases and threats to validity, and specification of statistical power and sample sizes (i.e., numbers of cases needed for statistical significance) o Adequacy of representation of the multiple disciplines important for mental health services for persons with severe mental disorders and adequacy of arrangements to produce collaboration and cooperation among investigators from various disciplines o Demonstrated scientific and technical capability, experience, and level of commitment of the proposed research staff o Extent of institutional support and commitment to the proposed research program o Relevance of proposed research to minorities and females o Adequacy of facilities, general environment, core resources, collaborative relationships, and support from service providers and civic leaders for the development and implementation of the proposed research o Evidence of cooperation and commitment from persons and organizations whose support is essential for the conduct of the research; appropriateness of the collaborative arrangements o Adequacy of plans to protect research participants Additional criteria used in the review of research demonstration (R18) projects include: o Extent to which the applicant demonstrates a clear understanding of the scope and range of service needs among persons with severe mental illness and the adequacy and appropriateness of proposed services for identifying and meeting the needs of the population o Adequacy of the proposed strategy and mechanisms for management and coordination of the research and service aspects of the demonstration project and feasibility of the proposed management plan and timetables detailing each task o Extent to which the applicant has anticipated the barriers to implementing the demonstration project and has proposed adequate solutions Additional specific review criteria for small grants (R03), FIRST awards (R29), and other support mechanisms (e.g., R10s) are included in the specialized announcements for these mechanisms. Applicants are advised to refer to the appropriate announcement before preparing an application. Receipt and Review Schedule All applications, except those requesting support for NRSA training and fellowships, will be reviewed in accordance with the following review schedule: Receipt Dates Initial Advisory Council Earliest New/Renewal Review Review Start Date Jun 1/Jul 1** Oct/Nov Jan/Feb Apr 1 Oct 1/Nov 1** Feb/Mar May/Jun Jul 1 Feb 1/Mar 1** May/Jun Sep/Oct Dec 1 **Competing continuation, supplemental, and revised applications are to be submitted on these dates. NRSA institutional training applications have a single receipt date of May 10; NRSA Predoctoral Individual M.D./Ph.D. fellowship applications have a single receipt date of September 10. All other NRSA individual fellowship applications are accepted on the following schedule: Earliest Receipt Dates Initial Review Start Date Jan 10 May/Jun Aug May 10 Oct/Nov Jan Sep 10 Feb/Mar May Applications received after a given receipt date will be held for the next scheduled receipt date or returned to the applicant without review if so requested by the applicant. AWARD CRITERIA For applications that are assigned to the NIMH, special encouragement is given to those that involve active collaborations between academic researchers and public sector agencies in planning, undertaking, analyzing, and publishing research pertaining to persons with severe mental illness. The Public Academic Liaison (PAL) initiative is based on the premise that important new advances in understanding and treatment of severe mental illness can result from improved linkages between the Nation's scientific resources and the public sector agencies and programs in which many persons with severe mental illness receive care. The scope of the PAL initiative encompasses public sector agencies of all types that deal with children, adolescents, adults, and elderly persons with severe mental disorders. In addition, the NIMH will give preference in funding to projects involving underserved populations (e.g., minorities, those who live in rural areas) and projects that include females and minorities in study populations. Factors considered in determining which applications will be funded include IRG and Council recommendations, program needs and priorities, and availability of funds. INQUIRIES NIMH staff are available for consultation concerning application procedures before or during the process of preparing an application. Potential applicants may contact the NIMH as early as possible for information and assistance in initiating the application process and developing an application. Inquiries related to clinical services research may be directed to: Ann A. Hohmann, Ph.D., M.P.H. Telephone: (301) 443-3364 Cille Kennedy, Ph.D. Telephone: (301) 443-1330 Kathy Magruder, Ph.D., M.P.H. Telephone: (301) 443-3364 Junius Gonzales, M.D. Telephone: (301) 443-1330 Inquiries related to service systems research may be directed to: Chuck Windle, Ph.D. Telephone: (301) 443-4233 Ecford Voit, Ph.D. (mental health law) Telephone: (301) 443-3728 Agnes Rupp, Ph.D. (mental health economics) Telephone: (301) 443-4233 Paul Widem (mental health economics) Telephone: (301) 443-4233 To address correspondence to any of the above named persons, use the following address: Services Research Branch Division of Applied and Services Research National Institute of Mental Health 5600 Fishers Lane, Room 18C-14 Rockville, MD 20857 Inquiries related to Community Support Project research demonstrations may be directed to: Neal B. Brown, M.P.A. or Fran L. Randolph, Dr.P.H. Community Support Section, SDCSB Division of Applied and Services Research National Institute of Mental Health 5600 Fishers Lane, Room 11C-22 Rockville, MD 20857 Telephone: (301) 443-3653 For further information on grants management issues, applicants may contact: Stephen J. Hudak Chief, Grants Management Section National Institute of Mental Health 5600 Fishers Lane, Room 7C-23 Rockville, MD 20857 Telephone: (301) 443-4456 AUTHORITY AND REGULATIONS The activities of this program are described in the Catalog of Federal Domestic Assistance Nos. 93.125, 93.242, 93.282, and 93.281. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) and administered under PHS grants policies and Federal Regulations 42 CFR 52 and 45 CFR part 74. Applications for Community Support Program demonstration grants (described in the Catalog of Federal Domestic Assistance No. 93.125), must comply with the intergovernmental review requirements of Executive Order 12372. .
Return to NIH Guide Main Index
Office of Extramural Research (OER) |
National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892 |
Department of Health and Human Services (HHS) |
||||||||
Note: For help accessing PDF, RTF, MS Word, Excel, PowerPoint, Audio or Video files, see Help Downloading Files. |