Subject: NIH Guide 4/12/9 RFA CA-9l-l0
From: Dot Baker <[email-masked]>
To: [email-masked]
Date: Wed, 10 Apr 91 14:46 EST

Hi Paul,
  Please post this one to the listserver as:
    RFCA-91-14.910412
 ---------------------------- Text of forwarded message -----------------------
 
$$XID RFA CA9114 CA-91-14 P1O1 *****************************************
 
REQUEST FOR APPLICATIONS
 
RFA:  CA-91-14
 
P.T. 34; K.W. 0715035, 0745020, 0745027, 0745035
 
PUBLIC HEALTH APPROACHES TO BREAST AND CERVIX SCREENING
 
National Cancer Institute
 
Letter of Intent Receipt Date:  June 7, 1991
Application Receipt Date:   August 2, 1991
 
I.  INTRODUCTION
 
The Division of Cancer Prevention and Control (DCPC) of the
National Cancer Institute (NCI) invites grant applications from a
consortium of public health agencies or institutions to develop,
implement, and evaluate programs designed to increase breast and
cervical cancer screening of older, low income, low education,
and minority women.  Priority will be given to applications
specifically designed to include evaluation of breast and
cervical screening utilization of women over the age of 65 and
those targeting populations residing in rural areas.  Among
Hispanic women, priority will be given to applications targeting
Puerto Rican and Cuban populations to provide more comprehensive
information on Hispanic populations.  The NCI currently funds
projects targeting Hispanic women of Mexican descent.
 
The Request for Applications (RFA) method of grant application
solicitation is used to encourage projects of special importance to the
National Cancer Program, and awards are made in accordance with the
policies of the National Institutes of Health (NIH) grant-in-aid and
applicable Public Health Service (PHS) policies.  This RFA is limited to
applicants from within the U.S.
 
The PHS is committed to achieving the health promotion and
disease prevention objectives of Healthy People 2000, a PHS-led
national activity for setting priority areas.  This RFA is
related to the priority area of Cancer.
 
This project proposes to demonstrate how a consortium of
community agencies can develop and evaluate strategies to
increase the availability, accessibility, awareness, and
utilization of breast and cervical cancer screening regimens,
including mammography, clinical breast examination, breast self-
examination, and Pap smears by low income, low education,
and minority women over 40 years of age.  Health agencies are
expected to provide or arrange for funding for screening
procedures.
 
The intent of this RFA is to invite applications from official
health agencies or institutions, such as health departments,
community health centers, or public hospitals, in collaboration
with other community agencies or institutions capable of
addressing early detection of breast and cervical cancers in the
target population.  The lead agency must demonstrate experience
with disease control and must indicate how coordination of
agencies will be conducted.
 
II.  BACKGROUND INFORMATION
 
The Cancer Control Program, NCI, is
located within the Division of Cancer Prevention and Control.
This program is authorized under the National Cancer Act and
calls for cooperation with health agencies in the prevention,
control, and eradication of cancer.
 
Cancer control is defined as the reduction of cancer incidence,
morbidity, and mortality through an orderly sequence of
research on interventions and their impact in defined populations
to the broad, systematic application of the research results.
Activities supported under this RFA will involve the application
of valid interventions.
 
Research Rationale
 
Each year 41,000 women die of breast cancer and 4,500 die from
cancer of the cervix.  The women most likely to die are the least
likely to have been screened.  Among women 40 years of age and
older, those of lower income, less education, and members
of minority groups are less likely to have been screened for
cancer.   Socioeconomic factors appear to play an important role
in cancer survival as well.  Cancer mortality rates are higher
for patients of low socioeconomic status (SES) than for those
of higher brackets.  Data suggest that much of the difference in
survival rates is due to late diagnosis of cancer among lower
SES patients.  Clearly, there is a need to develop effective
screening programs for lower SES and minority segments of the
population.
 
NCI's Early Detection Guidelines indicate:
 
"That beginning at age 40, all women should be encouraged to have
a mammogram every one to two years until age 50 after which it
should become annual."
 
"That all women who are, or have been sexually active, or have
reached 18 years, have an annual Pap test and pelvic examination.
After a woman has had three or more consecutive satisfactory
normal examinations, the Pap test may be performed less
frequently at the discretion of her physician."
 
National data indicate that subgroups of women (e.g., older
women, minority women, and women lower in socioeconomic status) at
risk for breast cancer or cervical cancer do not receive
preventive services to detect these conditions early.  The lack
of preventive care does not appear to be due to a lack of
physician contact, however.  Rather, these data suggest failure
to integrate routine preventive care with other services being
provided to unscreened segments of the population, and/or
behavioral barriers in unscreened populations that prevent them
from utilizing screening, even if it is available.
 
Public agencies or institutions, such as health departments,
community health centers, outpatient clinics, and public hospitals
frequently serve as providers of health care for lower SES
populations, or have the responsibility for ensuring that health
services are available to them through other channels in the
community.  However, many of these agencies have not been
actively developing and evaluating strategies to increase the
availability, accessibility, awareness, and utilization of
mammography and Pap smears by women over 40 years of age.
Although not identical, the overlap in risk status for breast and
cervical cancers based on age provides strong justification for
linking efforts in these two areas.  This research, therefore, is
intended to stimulate public health and community agencies to
demonstrate approaches to increasing the use of mammography and
cervical cytology among these unscreened women.
 
III.  RESEARCH GOALS AND SCOPE
 
Objectives
 
The goal of this project is to develop, implement, and evaluate
programs designed to increase breast and cervical cancer
screening of older, low income, low education, and minority
women.
 
The primary objectives of this research are to demonstrate how a
consortium of community agencies can:
 
1) Characterize utilization patterns for breast and cervical
screening in the target population through baseline surveys.
These data will establish frequency of screening, as well as
assess barriers to utilization.
 
2) Design and pilot test interventions to recruit women in need
of breast and cervical cancer screening regimens that can
 
o  be integrated with other health services used by these women
 
o  affect the behavior of non-health agency clients.
 
3) Evaluate the effectiveness of specific interventions to reach
the target population for breast and cervical cancer screening.
 
4) Ensure compliance with follow-up recommendations for women
with anything but completely normal mammograms (i.e.,
indeterminate or suspicious findings) and smears (i.e., further
action recommended).
 
5) Establish a mechanism to describe prospectively the screening
behavior of the targeted women in view of current NCI
recommendations, i.e., establish whether or not women are coming back at
recommended intervals for screening.
 
Project Description
 
This research will stimulate the development and evaluation of
strategies to increase and sustain the utilization of screening
mammograms and Pap smears in the least likely to be screened
women 40 years of age and older and in geographically defined
population areas.  This approach will permit extrapolation of
research results to other communities nationwide.  Exceptions to
the geographic focus may be proposed, if generalizations can be
made from the applicant's defined population to the larger
community.
 
Census and/or survey data should permit the characterization of
both the female population of a defined service area and its
sources of health care.  Moreover, the applicant's choice of
communities and consortium members should provide opportunities
to test a variety of promotional strategies.  Of particular
interest is the effectiveness of approaches that utilize contacts
with women who are already receiving care in public health
clinics, or other public facilities, for problems unrelated to
cancer screening ("inreach"), compared to strategies to
encourage women in the community who are at risk to come in for
screening examinations ("outreach").  Both approaches to the
problem must be proposed and tested.
 
Investigators must be able to enumerate unscreened women in the
population.  They must propose a feasible and technically sound
means for measuring the effect of their proposed inreach and
outreach interventions.  A variety of experimental and quasi-
experimental designs may be employed in testing interventions,
including the use of control communities, clinics, or health
centers.  An adequate design must be employed to reliably
demonstrate the effectiveness of interventions in reaching the
target population.  An assessment of current utilization patterns
must be conducted before any intervention is undertaken.
 
An evaluation of the effectiveness of the intervention must be
undertaken by the applicant per se or by one or more
subcontractors.  During the baseline period, before any
intervention is undertaken, survey or medical audit data should
permit an assessment of current usage patterns for mammography
and cervical cytology within the target population.  If self-
report of mammography and Pap smear utilization is to be an
outcome measure of the proposed interventions, investigators must
propose methods of assessing the validity of this measure for the
target population.  Investigators also should consider developing
methods that have the potential to improve the accuracy of self-
reported measures.
 
Applicants must provide a detailed description of how they
propose to monitor the effectiveness of the interventions over
time, including follow-up, in terms of the number of women
scheduled for repeat exams at recommended intervals.  It can be
assumed for the purposes of application that NCI funds for the
intervention activity will expire in three years.  However, the
evaluation effort should be budgeted for an additional year --
four years altogether.  However, investigators should briefly
outline mechanisms of how, through continuation of the project
beyond the four-year period, they will be able to prospectively
study maintenance of screening behavior.  NCI will encourage
investigators to study this important aspect of behavior through
a competitive renewal process.
 
Sample size calculations for the purpose of the evaluation must
take into account the need for data on the behavior and attitudes
of appropriate subgroups within the target population.  NCI
expects that the baseline and post-baseline evaluations of
utilization patterns will include assessments of barriers to the
use of mammography and cervical cytology as well as expediting
factors.  Thus, the applicant must address the measurement of
process variables that link the interventions to behavioral
change or nonchange among specific groups of women and their
health care providers.
 
To control for behavioral change that occurs independent of the
intervention strategies, applicants must address the issue of
control communities or subcommmunities.  Control groups may be
proposed as an integral part of the experimental design or simply
as a means of evaluating the impact of a particular intervention
strategy.
 
In developing the interventions, researchers must identify and
consider barriers to the utilization of mammograms and Pap smears
among the target population, as well as mechanisms needed to
overcome them.  It is anticipated that interventions will be
designed for the women as well as their health care providers or
the existing health care system.
 
Investigators will be required to document that they have access
to and can recruit a population of unscreened women 40 years of
age and older who are of low SES or minority status.  Priority
will be given to proposals specifically designed to include
evaluation of breast and cervical screening utilization among
women 65 years and over and proposals targeting women residing in
rural areas.  Among Hispanic women, proposals addressing Puerto
Rican and Cuban populations also will be given priority.
Additionally, applicants will have to provide or arrange for the
necessary screening and follow-up services.  A feasible plan to
integrate interventions into the usual practice of the health
care facility also will be required.
 
For cases with any but normal screening results, investigators
will be required to provide a specific plan for implementing
procedures that will ensure compliance with appropriate follow-up
recommendations.  This must include how and where women will be
referred for necessary treatment and follow-up, as well as
mechanisms to pay for the procedures.
 
With respect to quality and safety issues, all clinical,
laboratory, and radiologic procedures performed in relation to
the grant-supported interventions must meet state-of-science
levels.  Agencies already incorporating physical examination
and/or breast self-examination in their breast health programs
will be expected to continue to do so.  Where feasible, these
features must be incorporated into newly developed programs.
The discussion in the application must include a
series of quality assurance criteria and certify that
facilities involved in the project meet the current state and
Federal requirements for mammography and cervical cytology.  In
addition, applicants must include an implementation plan for
quality assurance.
 
This research will be accomplished by official health agencies or
institutions, such as health departments, community health
centers, or public hospitals, in collaboration with other
community agencies or institutions capable of addressing early
detection of breast and cervical cancers in the target
population.  The lead agency must demonstrate experience with
disease control and must indicate how coordination of agencies
will be conducted.  In many communities, the lead agency is
likely to be the health department or a community health center,
although other public agencies could fill this role.  Consortia
will be comprised of a variety of organizations that will vary
according to site.  If it is feasible, these agencies should
collaborate with research institutions or research efforts, such
as the Community Clinical Oncology Program (CCOP), cancer
centers, and SEER registries in the population proposed,
especially when addressing professional education as a means to
increase utilization of screening procedures.  The lead agency
does not necessarily have to be the direct provider of screening
services and may cooperate/contract with private practices or
hospitals for these services.  It is not the intention of this
research to offset the cost of screening procedures.  However, in
order for the results of this research to be of benefit to other
communities, applicants must document that they will be able to
provide these procedures in significant numbers at low cost.
Investigators must explain mechanisms to be used for payment of
screening and follow-up procedures, such as self-insurance,
Medicaid or Medicare, and describe approaches that will be
used to pay for women who do not have any coverage.
Investigators must maximize all sources of third-party payment,
including Medicare or Medicaid, private insurance payments, and
self-insurance.  Reimbursement must be used to offset appropriate
expenses.  Applicants must describe methods by which low-income
and uninsured women will be provided the full range of services.
 
To ensure a sustained reduction in breast and cervical cancer
mortality, utilization of effective screening technologies must
be sustained within the population.  High priority will be given
to research designs that ensure continuation of the intervention
beyond the funded period.
 
IV.  MECHANISM OF SUPPORT
 
Support of this program will be through a National Institutes of
Health (NIH) grant-in-aid (RO1).  Applicants will be responsible for
the planning, direction, and execution of the proposed project.
Allowable direct costs for the intervention will not include
funds to pay for mammograms and Pap smears.  However, expenses
incurred in developing and promoting the utilization of these
services, such as baseline and follow-up surveys, design of
materials, and public and professional education are considered
allowable costs.  Except as otherwise stated in this
RFA, awards will be administered under PHS grants
policy as stated in the Public Health Service Grants Policy
Statement, DHHS Publication No. (OASH) 90-50,000, revised October
1, 1990.
 
This RFA is a one-time solicitation.  Future
competing renewal applications will compete with all
investigator-initiated applications and be reviewed by the
Division of Research Grants (DRG).  However, if the NCI
determines that there is a sufficient continuing program need, a
request for renewal applications will be announced.  Only
recipients of awards under this RFA will be eligible to apply.
 
Approximately $5,400,000 in total costs for four years
($1,200,000 for year one and for year four, $1,500,000 for year
two and for year three) will be committed to specifically fund
applications submitted in response to this RFA.  It is
anticipated that three to four awards will be made dependent on
the receipt of a sufficient number of applications of high
scientific merit.  The total project period for applications
submitted in response to the present RFA should not exceed four
years.  The earliest feasible start date for the initial awards
will be April 1992.  Although this program is provided for in the
financial plans of the NCI, the award
of grants pursuant to this RFA is also contingent upon the
availability of funds for this purpose.
 
V.  SPECIAL REQUIREMENTS
 
It is expected that awardees will
participate in a series of collaborative meetings at NCI and that
some components of the evaluation protocols will be common to all
areas.  Although independence and originality are encouraged in
the approaches of the various investigators, they are expected to
share ideas, experiences, and information in attempting to reach
their common goal.  Funds must be budgeted to permit travel of
senior staff to Bethesda, Maryland, twice a year over the course
of the grant.  Funds awarded for travel to these meetings will be
restricted for this purpose only.  Failure to participate in
these meetings may adversely affect NCI evaluation of the
project's progress when the non-competing continuation
application for the following year is reviewed.
 
SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF
NIH POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN
CLINICAL RESEARCH STUDY POPULATIONS
 
The following is the NIH and ADAMHA policy regarding the
inclusion of women and minorities in study populations.
Applications that are responsive to this RFA will, by definition,
meet the requirement for inclusion of women.  The inclusion of
minorities must be addressed in application submitted responding
to this RFA.
 
NIH and ADAMHA policy is that applicants for NIH/ADAMHA clinical
research grants and cooperative agreements will be required to
include minorities and women 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 is intended to apply
to males and females of all ages.  If women or minorities are
excluded or inadequately represented in clinical research,
particularly in proposed population-based studies, a clear
compelling rationale should be provided.
 
The composition of the proposed study population must be
described in terms of gender and racial/ethnic group.  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.  This information should be
included in the form PHS 398 in Section 2, A-D of the Research
Plan AND summarized in Section 2, E, Human Subjects.
Applicants/offerors are urged to assess carefully the feasibility
of including the broadest possible representation of minority
groups.  However, NIH recognizes 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., Native Americans (including American Indians
or Alaskan Natives), Asian/Pacific Islanders, Blacks, Hispanics).
 
The rationale for studies on single minority population groups
should be provided.
 
For the purpose of this policy, clinical research includes human
biomedical and behavioral studies of etiology, epidemiology,
prevention (and preventive strategies), diagnosis, or treatment
of diseases, disorders or conditions, including but not limited to
clinical trials.
 
The usual NIH policies concerning research on human subjects also
apply.  Basic research or clinical studies in which human tissues
cannot be identified or linked to individuals are excluded.
However, every effort should be made to include human tissues
from women and racial/ethnic minorities when it is important to
apply the results of the study broadly, and this should be
addressed by applicants.
 
For foreign awards, the policy on inclusion of women applies
fully; since the definition of minority differs in other
countries, the applicant must discuss the relevance of research
involving foreign population groups to the United States'
populations, including minorities.
 
If the required information is not contained within the
application, the application will be returned.
 
Peer reviewers will address specifically whether the research
plan in the application conforms to these policies.  If the
representation of women or minorities in a study design is
inadequate to answer the scientific question(s) addressed AND the
justification for the selected study population is inadequate, it
will be considered a scientific weakness or deficiency in the
study design and will be reflected in assigning the priority
score to the application.
 
All applications for clinical research submitted to NIH are
required to address these policies.  NIH funding components will
not award grants or cooperative agreements that do not comply
with these policies.
 
VI.  ELIGIBILITY REQUIREMENTS
 
Grants-in-aid may be awarded to profit and nonprofit
organizations and institutions, and governments and their
agencies within the United States.  However, it should be noted
that this RFA is primarily targeted at a consortium
approach, involving public agencies or institutions, such as
health departments, community and migrant health centers or
public hospitals with established linkages to the target
population (e.g., the health department or community health
center may have experience with providing or contracting for the
health services, a regional agency on aging may have established
networks with elderly women, and a voluntary organization may
have experience with providing public education campaigns).  This
approach seeks to address the problem in a coordinated fashion
while taking advantage of the public agency's role as
noncompetitive collaborator, stimulator, convenor, and
facilitator of existing resources to increase mammography and Pap
smear utilization in women least likely to be screened.  The lead
agency must demonstrate experience with disease control, but does
not necessarily have to be the direct provider of the screening
services.  In many communities, the lead agency is likely to be a
health department, although other public agencies could fill this
role.  Among the team of applicants or consortium, one
institution must be proposed as the lead institution to serve as
the applicant and assume responsibility for the conduct of the
award.
 
VII. REVIEW PROCEDURES AND CRITERIA
 
REVIEW PROCEDURE
 
Upon receipt, applications will be examined by the DRG for completeness.
Incomplete applications will be returned to the applicant without
further consideration.  Evaluation for responsiveness to the program
requirements and criteria stated in the RFA is an NCI program staff
function.  Applications that are judged non-responsive will be returned
to the applicant but may be submitted as investigator-initiated research
grants at the next receipt date.  Questions concerning the
responsiveness of proposed research to the RFA should be directed to
program staff (see Section X).
 
If the number of applications is large compared to
the number of awards to be made, the NCI may conduct a
preliminary scientific peer review to eliminate those
applications that are clearly not competitive.  The NCI will
remove from competition those applications judged to be
noncompetitive and notify the applicant and institutional
business official.
 
Those applications judged to be both competitive and responsive
will be further evaluated according to the review criteria stated
below for scientific and technical merit by an appropriate peer
review group convened by the Division of Extramural Activities,
NCI.  The second level of review by the National Cancer Advisory
Board considers the special needs of the Institute and the
priorities of the National Cancer Program.
 
REVIEW CRITERIA
 
The applications will be evaluated on the basis of the following
criteria:
 
1. Extent to which proposed research will meet the project goal of
developing, implementing, and evaluating the effectiveness of
interventions designed to increase breast and cervical cancer
screening of older, low income, low education, or minority women.
 
2. Scientific merit of the research approach, design, and
methodology, including appropriateness of the proposed plans and
methods to characterize utilization of screening and evaluate the
effectiveness of both inreach and outreach strategies to screen
the target population at recommended intervals over time.
 
3. Appropriateness of quality assurance procedures for
mammography and cervical cytology.
 
4. Appropriateness and feasibility of ensuring adequate follow-up
procedures for positive screenees.
 
5. Documented access and ability to recruit participation of the
target population.
 
6. Evidence that the applicant will be able to provide screening
procedures in significant numbers at low cost, as well as
evidence that the applicant will maximize all sources of third-
party payment, including Medicare or Medicaid, private insurance
payments, self-insurance, and other grants.  Applicants must also
describe methods by which low-income and uninsured women will be
provided the full range of services.
 
7. Availability of resources to conduct proposed interventions.
 
8. Research experience and competence of the Principal
Investigator and staff and adequacy of time (effort) that they
will devote to proposed project.
 
9. Relevant experience within the consortium in conducting
chronic disease control programs.
 
10. Documented support for the project from participating community
agencies, including previous relationship and relevant experience
in conducting other collaborative efforts with the lead agency,
as well as a clear delineation of each agency's responsibilities
with regard to the project.
 
11. Feasibility of approach to work, including how tasks are to
be carried out by different community agencies, project
management, and anticipated problems and proposed solutions.
 
12. Extent to which study design will ensure continuation of the
intervention beyond the funded period.
 
13. Extent to which relationships have been, or will be, developed
with existing cancer centers, CCOPs, and SEER registries in the
proposed study area.
 
14. Originality of approach to the research, i.e., does not
duplicate past or current breast and cervical cancer intervention
research funded by the NCI or any other institution.
 
15. Provision for the protection of human subjects.
 
The review group will critically examine the submitted budget and
will recommend an appropriate budget and period of support for
each approved application.
 
VIII.  METHOD OF APPLYING
 
The research grant application form PHS 398 (revised
10/88) must be used in applying for these grants.  These forms
are available at most institutional business offices; from the
Office of Grants Inquiries, Division of Research Grants, National
Institutes of Health, Room 449, Westwood Building, 5333 Westbard
Avenue, Bethesda, Maryland 20892 (301) 496-7441; and from the NCI
Program Director named below.
 
State Health Departments may submit applications on either Form
PHS 398 (revised 10/88) or PHS 5161-1.  If the PHS 5161-1 is
used, it is requested that the budget pages from PHS 398 (pages 4
and 5) be used.  In addition, separate detailed budgets must be
provided for contracts/coalitions as described in PHS 398
(revised 10/88).
 
The RFA label available in the 10/88 revision of application form
PHS 398 must be affixed to the bottom of the face page.  Failure to
use this label could result in delayed processing of your
application such that it may not reach the review committee in
time for review.   In addition, the RFA number and title must
be typed on line 2 of the face page of the application form.
 
Submit a signed, typewritten original of the application,
including the Checklist, and four (4) signed, exact photocopies,
in one package to the DRG at the address below.  The photocopies
must be clear and single sided.
 
DIVISION OF RESEARCH GRANTS
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**
 
At time of submission, send two (2) additional copies of the
application to:
 
REFERRAL OFFICER
Division of Extramural Activities
National Cancer Institute
Room 848, Westwood Building
5333 Westbard Avenue
Bethesda, MD  20892
 
Applications must be received by August 2, 1991.  If an
application is received after that date, it will be returned.
If the application submitted in response to this RFA is
substantially similar to a research grant application already
submitted to the NIH for review, but has not yet been reviewed,
the applicant will be asked to withdraw either the pending
application or the new one.  Simultaneous submission of identical
applications will not be allowed, nor will essentially identical
applications be reviewed by different review committees.
Therefore, an application cannot be submitted in response to this
RFA that is essentially identical to one that has already been
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.
 
IX.  LETTER OF INTENT
 
Prospective applicants are asked to submit, by June 7, 1991, a
letter of intent that includes a descriptive title of the
proposed research, the name and address of the Principal
Investigator, the names of other key personnel, the participating
institutions, and the number and title of the RFA in response to
which the application is being submitted.
 
Although a letter of intent is not required, is not binding, and
does not enter into the review of subsequent applications, it is
requested in order to provide an indication of the number and
scope of applications to be reviewed.
 
The letter of intent must be sent to:
 
Helen I. Meissner, Sc.M., C.H.E.S.
Program Director
Public Health Applications Research Branch
National Cancer Institute
EPN, Room 239G
Bethesda, MD  20892
Telephone:  (301) 496-0273
 
X.  INQUIRIES
 
Written and telephone inquiries concerning the objectives and
scope of this RFA or inquiries about whether or not specific
proposed research would be responsive are encouraged and should
be directed to the program director at the above address.  The
program director welcomes the opportunity to clarify any issues
or questions from potential applicants.  Grants management
inquiries should be directed to:
 
Marian F. Focke
Grants Management Specialist
Grants Administration Branch
EPS, Room 242
Grants Administration Branch
National Cancer Institute
9000 Rockville Pike
Bethesda, MD  20892
Telephone:  (301) 496-7800, ext. 46
 
This program is described in the Catalog of Federal Domestic
Assistance No. 93.399.  Awards are under authorization of the
Public Health Services Act, Title IV, Part A and administered
under PHS grant 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
Health Systems Agency review.