Release Date:  January 16, 1998

RFA:  HL-98-006


National Heart, Lung, and Blood Institute

Letter of Intent Receipt Date:  March 17, 1998
Application Receipt Date:  April 28, 1998



This solicitation invites research grant applications focused on
regulation of local immunity in the lung in the context of human
immunodeficiency virus (HIV).  Studies might be directed at
cellular and molecular mechanisms of regulation of local immunity
in the airways and the lung tissue.  Ultimately, the goal of the
program is aimed at developing strategies for selectively
regulating mucosal or surface immunity (cellular and humoral), both
of which might be helpful in understanding acquired
immunodeficiency syndrome (AIDS) related pulmonary complications.
However, since lung immunity in AIDS is still poorly understood,
research could be directed at understanding normal local immune
responses of the lung as a framework for understanding abnormal
responses.  For example, projects aimed at assessing the integrity
of the immune apparatus in the naso-oropharynx, along the
conducting airways, and in the alveolar spaces might be included. 
Human studies, e.g., in subjects with varying stages of HIV
infection as compared to healthy persons, and studies in animal
models would be of interest.

Among the disciplines and expertise that may be appropriate for
this research program are immunology, molecular immunology, cell
biology, molecular biology, virology, mycology, bacteriology,
genetics, infectious diseases, pathology, pulmonary medicine, and


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 Request for Applications (RFA), Pulmonary Immune
Defenses and Their Regulation, is related to the priority areas of
HIV infection and immunization and infectious diseases.  Potential
applicants may obtain a copy of "Healthy People 2000" (Full Report: 
Stock No.017-001-00474-0 or Summary Report:  Stock No.
017-001-00473-1) through the Superintendent of Documents,
Government Printing Office, Washington, DC 20402-9325 (telephone


Applications may be submitted by domestic and foreign, for-profit
and non-profit organizations, public and private, such as
universities, colleges, hospitals, laboratories, units of State or
local governments, and eligible agencies of the Federal government. 
Racial/ethnic minority individuals, women, and persons with
disabilities are encouraged to apply as Principal Investigators.

All current policies and requirements that govern the research
grant programs of the National Institutes of Health (NIH) will
apply to grants awarded under this RFA.  Awards under this RFA to
foreign institutions will be made only for research of very unusual
merit, need, and promise, and in accordance with PHS policy
governing such awards.


This RFA will use the NIH individual research project grant (R01)
mechanism of support. Investigators without prior R29 or R01
support are encouraged to apply for this RFA and to identify their
status in a cover letter.  Specific R01 application instructions
have been modified to reflect "MODULAR GRANT" and "JUST-IN-TIME"
streamlining efforts being examined by the NIH.  The modular grant
concept establishes specific modules in which direct costs may be
requested as well as a maximum level for requested budgets.  Only
limited budgetary information is required under this approach.  The
just-in-time concept allows applicants to submit certain
information only when there is a possibility for an award. It is
anticipated that these changes will reduce the administrative
burden for the applicants, applicant institutions, reviewers, and
Institute staff.

Although multidisciplinary approaches are encouraged, it is not the
intent of this RFA to solicit applications for large studies
encompassing a variety of individual subprojects, i.e., program
projects.  If collaborative arrangements through subcontracts with
other institutions are planned, consult the program staff listed

For this RFA, funds must be requested in $25,000 direct cost
modules and a maximum of eight modules ($200,000 direct costs) per
year may be requested.  A feature of the modular grant concept is
that no escalation is provided for future years, and all
anticipated expenses for all years of the project must be included
within the number of modules being requested. Only limited
budgetary information will be required and any budget adjustments
made by the Initial Review Group will be in modules of $25,000. 
Instructions for completing the Biographical Sketch have also been
modified.  In addition, Other Support information and the
application Checklist page are not required as part of the initial
application.  If there is a possibility for an award, necessary
budget, Other Support and Checklist information will be requested
by NHLBI staff following the initial review.

The APPLICATION PROCEDURES section of this RFA provides specific
details of modifications to standard PHS 398 application kit
instructions. Applicants are expected to furnish their own
estimates of time required to achieve the objectives of the
proposed research project. Since a variety of approaches would
represent valid responses to this RFA, it is anticipated that there
will be a range of costs among individual grants awarded. Up to 5
years of support may be requested on R01 applications.

This RFA is a one-time solicitation.  Future unsolicited competing
continuation applications will compete with all investigator-
initiated applications and be reviewed according to the customary
peer review procedures. It is anticipated that support for this
program will begin in September, 1998.   Administrative adjustments
in project period and/or amount may be required at the time of the

Applicants from institutions that have a General Clinical Research
Center (GCRC) funded by the NIH National Center for Research
Resources may wish to identify the GCRC as a resource for
conducting the proposed research.  If so, a letter of agreement
from either the GCRC program director or principal investigator
should be included with the application.

The National Institute of Allergy and Infectious Diseases (NIAID)
has interest in regulation of immunity in health and disease. 
Therefore, applications that are of mutual interest are likely to
be given a secondary assignment to NIAID in accordance with the NIH
referral guidelines.

A program announcement "Mucosal Immunity in Pathogenesis/Prevention
of Human Disease" (PA-97--073), NIH Guide Vol 26, 23, 7/18/97,
sponsored by many institutes at NIH covers areas of research
complementary to this RFA.  PA-97-073 may be of interest to some


It is anticipated that for fiscal year 1998, approximately
$2,000,000 total costs will be available for the first year of
support for this initiative.  Award of grants pursuant to this RFA
is contingent upon receipt of such funds for this purpose.  It is
anticipated that approximately  8 new grants will be awarded under
this program.  The specific number to be funded will, however,
depend on the merit and scope of the applications received and on
the availability of funds.  Direct costs will be awarded in modules
of $25,000, less any overlap or other necessary administrative
adjustments. Indirect costs will be awarded based on the negotiated
rates.  Applicants may request up to 5 years of support.



Patients with AIDS continue to die predominantly as a result of
respiratory infections.  It is well recognized that the tubercle
bacillus is deposited in the lower respiratory tract via aerosol
and there is increasing evidence that other pathogens such as
Pneumocystis carinii can also be transferred by the aerosol route
from one infected subject to another.  In addition, common bacteria
such as S. pneumoniae are increasingly the cause of death in
patients with AIDS.  Systemic vaccination as a way to control
respiratory infections has been attempted since the turn of the
century. However, up to our recent attempts to protect high risk
patients from pneumococcal pneumonia, using Pneumovax, systemic
vaccination has not been very effective in controlling respiratory

Most AIDS lung research is based on bronchoalveolar lavage fluid
analysis of cells retrieved from the lower respiratory tract and on
in vitro cultured cells.  Important information is known about
macrophage-lymphocyte interactions, release of cytokines,
activation status of macrophages, etc.  However, less is known
about functions of cells along the conducting airways in HIV
disease.  This is in contrast to asthma studies in which
endobronchial biopsy methods in conjunction with bronchoscopy (in
asthma and healthy controls) have elucidated lymphocyte
subpopulations, cytokine production and interactions with the
ciliated epithelium.

A specific aspect of lung immunity that is poorly understood is the
role of pulmonary lymphoid tissue in HIV infection.  Much has been
learned recently of the relationship between blood virus and
lymphoid tissue, but little is currently known about the pulmonary
lymphoid tissues, and whether virus/infected cells circulate
between the alveolar space, interstitium, and lung lymphoid tissue. 
It is not known whether virus residing locally within the lung
contributes to pulmonary immune dysfunction or simply reflects
systemic immune damage.

Another question is whether the lung, which is recognized as an
important antigen-immune cell interface, is also an important site
of lymphocyte killing.  To what extent might the HIV-lymphocyte
interactions in the lung lymphoid tissue contribute to local immune
depletion, or even to systemic immune depletion?

Delayed type hypersensitivity (Th1-like responses) are clearly
important in granulomatous diseases such as mycobacterial and
fungal infection. Responses of T cells to specific antigens are the
first to deteriorate in HIV-infected people.  Lack of knowledge
concerning interstitial macrophages and dendritic cells has been
identified as a major gap in understanding lung defenses.  The
alveolar macrophages serve as accessory cells for T lymphocyte
responses to stimuli.  This function is up-regulated by HIV
infection.  Almost nothing is known about the role of lung
interstitial macrophages and dendritic cells in HIV infection.

Strategies to reconstitute the immune apparatus or manipulate
selective features to produce antibodies against microbes or to
prevent microbial adhesion should be explored.  Considerations for
mucosal immunization include: appropriate antigen, local
application of antigen, primary immunization versus repeated
application, antigen processing, manipulation of cytokine networks
to maximize antibody output, type of antibody needed and
persistence of memory cells.  Studies might focus on stimulating a
specific IgA.

Objectives and Scope

The objective of this program is to understand regulation of local
immunity in the lung at molecular and cellular levels in the
context of HIV infection and HIV-associated opportunistic
infections.  Research applicable to this initiative could include
studies of regulation of local immunity in the normal lung and
airways in human subjects, animals, in vitro models or mathematical
models to provide a frame of reference for what occurs in the
immunodeficient state.  However, the emphasis is on how HIV affects
lung immunity.  Investigations might address how HIV infection and
other immunosupressed states perturb local immunity in the lung. 
If sufficient data are available to justify them, projects might
include studies aimed at manipulating local lung immunity to
restore function, to prevent or treat opportunistic infections or
lung complications associated with HIV infection.

In responding to this initiative expertise might be needed in the
following areas:  pathogenesis of infections; lung and respiratory
tract immunology; and principles of vaccination.  Expertise in
aerosol delivery might also be necessary to develop or adapt
delivery techniques to insure accuracy in deposition.  If
successful, new approaches to augmenting lung defenses might be
developed which could reduce the incidence or severity of pulmonary
infections in immunocompromised subjects such as patients with

Examples of areas of research (in HIV-infected, other
immunodeficient or "normal" human subjects, suitable animal models,
in vitro models, or non-linear mathematical models) that might be
included under this RFA are as follows:

o  determine effect of HIV infection (or appropriate model of HIV
infection) on respiratory tract lymphocyte subpopulations, local
cytokine regulation and interactions with ciliated epithelium;

o  investigate the HIV-lymphocyte interactions in pulmonary
lymphoid tissue and the regulation of local lymphocyte killing in
the pathogenesis of lung complications of HIV and overall
progression of HIV disease;  o elucidate the role of lung
interstitial macrophages dendritic cells in determining T
lymphocyte responses to antigenic stimuli in HIV disease;

o  investigate regulation of specific immunoglobulins (e.g., IgA)
including the function of cytokines in Ig switching and elucidate
role(s) in the pathogenesis of specific HIV-related opportunistic

o  investigate strategies for reconstituting local pulmonary immune
function and preventing lung disease in HIV infection and other
immunodeficient conditions relevant to pulmonary immunity in HIV

These are examples only.  Investigators should not feel limited to
the subjects mentioned above and are encouraged to submit other
topics pertinent to the objectives of the RFA.

Of great concern, is that any attempt to augment immune function
might potentially upregulate HIV replication.  Progress in
understanding the issues outlined in this initiative will help in
determining the role of concomitant antiretroviral therapy with
immunomodulatory therapy.

It is anticipated that human, animal, in vitro studies and studies
that include non-linear mathematical models would be appropriate.
Investigators are encouraged to apply findings from theoretical and
in vitro work to in vivo studies when this is feasible.  The
initiative is relevant to black and Hispanic minority populations
who are disproportionately affected by HIV in comparison to the
total population.


Upon initiation of the program, the NHLBI will sponsor periodic
meetings to encourage exchange of information among investigators
who participate in this program.  In the budget of the grant
application, travel funds for a one day meeting each year, most
likely to be held in Bethesda, Maryland, should be included in the
modules.  Applicants should also include a statement in their
applications indicating their willingness to participate in these

Applications that focus exclusively on normal pulmonary immunity
are not acceptable.  However, studies of normal pulmonary immune
responses may be included, for comparison purposes, along with
studies of local pulmonary immunity in HIV infection, HIV-
associated pulmonary opportunistic infections and complications and
models pertaining to these. Applications that propose descriptive
studies and do not contain hypothesis driven studies directed at
understanding the mechanisms that influence pulmonary immune
defenses and their regulation will not be acceptable.  Applications
that focus on  mechanisms of local immunity in the lung at the
molecular level are of particular interest.  Although studies in
human subjects are strongly encouraged, large clinical studies are
not within the scope of this RFA.  Applicants who propose to test
hypotheses in animal, in vitro models or theoretical models must
provide a strong rationale for relevance to the human host.  This
program will not support studies directed at development of animal
models alone.  Therefore, models must be applied to the study of
pulmonary immunity regulation in "normals," in HIV-infection and in
other immunodeficient states relevant to elucidating dysfunction of
pulmonary immunity in HIV-infection.


It is the policy of the NIH that women and members of minority
groups and their subpopulations must be included in all NIH
supported biomedical and behavioral research projects involving
human subjects, unless a clear and compelling rationale and
justification is provided 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 research involving human subjects
should follow the "NIH Guidelines for Inclusion of Women and
Minorities as Subjects in Clinical Research", which have been
published in the Federal Register of March 28, 1994 (FR 59
14508-14513), and in the NIH GUIDE FOR GRANTS AND CONTRACTS of
March 18, 1994, Volume 23, Number 11.

Investigators also may obtain copies of the policy from the program
staff listed under INQUIRIES.  Program staff may also provide
additional relevant information concerning the policy.


Prospective applicants are asked to submit, by March 17, 1998, a
letter of intent that includes a descriptive title of the proposed
research, the name, address, and telephone number of the Principal
Investigator, the identities of other key personnel and
participating institutions, and the number and title of the RFA in
response to which the application may be submitted.  Although a
letter of intent is not required, is not binding, and does not
enter into the review of subsequent applications, the information
that it contains allows NIH staff to estimate the potential review
workload and to avoid conflict of interest in the review.

The letter of intent is to be faxed or sent to Dr. C. James
Scheirer, at the address listed under INQUIRIES.


The research grant application form PHS 398 (rev 5/95) is to be
used in applying for these grants.  Application kits are available
at most institutional offices of sponsored research and may be
obtained from the Division of Extramural Outreach and Information
Resources, National Institutes of Health, 6701 Rockledge Drive, MSC
7910, Bethesda, MD 20898-7910, telephone 301-710-0267, Email:

The RFA label found in the PHS 398 application form must be affixed
to the bottom of the face page of the application.  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

This RFA is restricted to R01 grants.  All will be awarded as
modular grants.  The modular grant concept establishes specific
modules (increments) in which direct costs may be requested and a
maximum level for requested direct cost.  Only limited budgetary
information is required in the application; a detailed budget need
not be provided.


Sample budgets and justification page will be provided upon request
from Mr. Raymond Zimmerman at the address listed under INQUIRIES.

The total direct costs must be requested in accordance with the
program guidelines and the modifications made to the standard PHS
398 application instructions described below:

As a reminder, Item 7 should be completed to indicate Modular
Direct Costs requested and Item 8 should reflect Total Costs
(Modular Direct plus F&A costs).

Do not complete Form Page 4 of the PHS 398 (rev 5/95).  It is not
required nor will it be accepted at the time of application.

Do not complete the categorical budget tables on Form page 5 of the
PHS 398 (rev. 5/95). Only the requested total direct costs line for
each year must be completed based on the number of $25,000 modules
being requested.  Applicants may not request a change in the amount
of each module.  A maximum of EIGHT modules ($200,000 direct costs)
per year may be requested and each applicant may request up to FIVE
years of support for this RFA.  Direct cost budgets will remain
constant throughout the life of the project (i.e. the same number
of modules requested for all budget periods).  Any necessary
escalation should be considered when determining the number of
modules to be requested.  However, in the event that the number of
modules requested must change in any future year due to the nature
of the research proposed, appropriate justification must be
provided.  Total Direct Costs for the Entire Proposed Project
Period should be shown in the box provided.


-  Budget justifications should be provided under "Justifications"
on Form Page 5 of the PHS 398.

-  List the names, role on the project and proposed percent effort
for all project personnel (salaried or unsalaried)and provide a
narrative justification for each person based on his/her role on
the project.  Under the justification for the principal
investigator, indicate if you are a new investigator (i.e. an
investigator without prior R29 or R01 support).

-  Identify all consultants by name and organizational affiliation
and describe the services to be performed.

-  Provide a general narrative justification for individual
categories (equipment, supplies, etc.) required to complete the
work proposed.  More detailed justifications should be provided for
high cost items.  Any large one-time purchases, such as large
equipment requests, must be accommodated within these limits.

o  CONSORTIUM/CONTRACTUAL COSTS - If collaborations or subcontracts
are involved that require transfer of funds from the grantee to
other institutions, it is necessary to establish formal subcontract
agreements with each collaborating institution.  A letter of intent
from each collaborating institution should be submitted with the
application.  Only the percentage of the consortium/contractual
TOTAL COSTS (direct and indirect) relative to the total DIRECT
COSTS of the overall project needs to be stated at this time. The
following example should be used to indicate the percentage cost of
the consortium, "The consortium agreement represents 27% of overall
$175,000 direct costs requested in the first year."  A budget
justification for the consortium should be provided as described in
the "Budget Justification" section above (no Form Page 5 required
for the consortium).  Please indicate whether the consortium will
be in place for the entire project period and identify any future
year changes in the percentage relative to the parent grant.

If there is a possibility for an award, the applicant will be
requested to identify actual direct and indirect costs for all
years of the consortium. Please note that total subcontract costs
need not be calculated in $25,000 modules.  However, when
subcontract funds are added to the parent grant budget, the total
direct cost amount must be included in the number of $25,000
modules requested.

o  BIOGRAPHICAL SKETCH - A biographical sketch is required for all
key personnel, following the modified instructions below.  Do not
exceed the two-page limit for each person.

-  Complete the educational block at the top of the form page;

-  List current position(s) and those previous positions directly
relevant to the application;

-  List selected peer-reviewed publications directly relevant to
the proposed project, with full citation;

-  The applicant has the option to provide information on research
projects completed and/or research grants participated in during
the last five years that are relevant to the proposed project.

o  OTHER SUPPORT - Do not complete the "Other Support" pages (Form
Page 7).  Selected other support information relevant to the
proposed research may be included in the Biographical Sketch as
indicated above. Complete Other Support information will be
requested by NHLBI staff if there is a possibility for an award.

o  CHECKLIST - No "Checklist" page is required as part of the
initial application.  A completed Checklist will be requested by
NHLBI staff if there is a possibility for an award.

o  The applicant should provide the name and phone number of the
individual to contact concerning fiscal and administrative issues
if additional information is necessary following the initial

Applications not conforming to these guidelines will be considered
unresponsive to this RFA and will be returned without further

Submit a signed, typewritten original of the application and three
signed, photocopies, in one package to:

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. C. James Scheirer at the listed under

Applications must be received by April 28, 1998.  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, unless the
applicant withdraws the pending application.  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.

o  If an application is determined to be unresponsive to the RFA,
the principal investigator will be notified and may request that
the application be returned or sent to CSR where it will be
processed in the next available cycle as a regular grant


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 NHLBI, in accordance with NIH peer
review procedures.  As part of the initial merit review, all
applications will receive a written critique and undergo a review
in which only those applications deemed to have the highest
scientific merit of the applications under review (usually two to
three times the number of applications that the NHLBI anticipates
being able to fund under the program) will be discussed, assigned
a priority score, and receive a second level review by the National
Heart, Lung, and Blood Advisory Council.

The personnel category will be reviewed for appropriate staffing
based on the requested percent effort.  The direct costs budget
request will be reviewed for consistency with the proposed methods
and specific aims. Any budgetary adjustments recommended by the
reviewers will be in $25,000 modules.  The duration of support will
be reviewed to determine if it is appropriate to ensure successful
completion of the requested scope of the project.

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 review, comments on
the following aspects of the application will be made in order to
judge the likelihood that the proposed research will have a
substantial impact on the pursuit of these goals.  Each of these
criteria will be addressed and considered in the assignment of the
overall score.

(1) Significance

Does this study address an important problem?  If the aims of the
application are achieved, how will scientific knowledge be
advanced? 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?  Does the applicant acknowledge potential problem
areas and consider alternative tactics?

(3) Innovation

Does the project employ novel concepts, approaches or method?  Are
the aims original and innovative?  Does the project challenge
existing paradigms or develop new methodologies or technologies?

(4) Investigator

Is the investigator appropriately trained and well suited to carry
out this work?  Is the work proposed appropriate to the experience
level of the principal investigator and other researchers (if any)?

(5) Environment

Does the scientific environment in which the 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?

In addition, the adequacy of plans to include both genders and
minorities and their subgroups as appropriate for the scientific
goals of the research will be reviewed.  Plans for the recruitment
and retention of subjects will also be evaluated.

The initial review group will also examine the provisions for the
protection of human and animal subjects, the safety of the research
environment, and conformance with the NIH Guidelines for the
Inclusion of Women and Minorities as Subjects in Clinical Research.

The roster of the initial review group will be available, via the
NHLBI homepage, at the following address:


The following will be considered in making funding decisions:
quality of the proposed project as determined by peer review,
availability of funds, and program priority.  Applications from new
investigators will be strongly considered.

The anticipated date of award is September 29, 1998.


Inquiries concerning this RFA are encouraged.  Potential applicants
may request a copy of sample budget and justification pages, as
previously stated.  The opportunity to clarify any issues or
questions from potential applicants is welcome.

Direct requests for sample budget pages to:

Melonie Shine
Division of Lung Diseases
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Suite 10018, MSC 7952
Bethesda, MD  20892-7952
Telephone:  (301) 435-0222
FAX:  (301) 480-3557
Email:  melonie_shine@nih.gov

Direct inquiries regarding programmatic issues to:

Hannah H. Peavy, M.D.
Division of Lung Diseases
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Suite 10018, MSC 7952
Bethesda, MD  20892-7952
Telephone:  (301) 435-0222
FAX:  (301) 480-3557
Email:  hannah_peavy@nih.gov

Direct inquiries regarding fiscal matters to:

Raymond L. Zimmerman
Grants Operations Branch Division of Extramural Affairs
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Suite 7154, MSC 7926
Bethesda, MD  20892-7926
Telephone:  (301) 435-0171
FAX:  (301) 480-3310
Email:  zimmermr@gwgate.nhlbi.nih.gov


This program is described in the Catalog of Federal Domestic
Assistance, No. 93.838.  Awards are made under authorization of the
Public Health Service Act, Title IV, Part A (Public Law 78-410,
amended by Public Law 99-158, 42 U.S.C. 241 and 285) and
administered under PHS grants policies and Federal Regulations 42
CFR 52 and 45 CFR Part 74.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or
a Health Systems Agency Review.

The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the non-use of all
tobacco products. In addition, Public Law 103-227, the Pro-Children
Act of 1994, prohibits smoking in certain facilities (or in some
cases, any portion of a facility) in which regular or routine
education, library, day care, health care or early childhood
development services are provided to children.  This is consistent
with the PHS mission to protect and advance the physical and mental
health of the American people.

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