INTERDISCIPLINARY RESEARCH NETWORKS ON ADHD Release Date: July 24, 2001 RFA: RFA-MH-01-012 National Institute of Mental Health (http://www.nimh.nih.gov/) National Institute of Neurological Disorders and Stroke (http://www.ninds.nih.gov/) Letter of Intent Receipt Date: September 24, 2001 Application Receipt Date: October 24, 2001 THIS RFA USES "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS. USE THE MODULAR BUDGET INSTRUCTIONS THAT BEGIN ON PAGE 13 IN THE PHS 398 (REVISION 5/2001) AVAILABLE AT http://grants.nih.gov/grants/funding/phs398/phs398.html. THE INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS MUST BE USED WHEN RESPONDING TO THIS RFA/PA. PURPOSE The National Institute of Mental Health (NIMH) and National Institute of Neurological Disorders and Stroke (NINDS) invite grant applications for the formation of cross-disciplinary networks of scientists interested in studying the etiology of Attention-deficit/Hyperactivity Disorder (ADHD) and its implications for the disorder’s nosology, assessment and treatment. These research networks will allow the formation of novel collaborations among neuroscientists, behavioral scientists, and clinical scientists in order to develop integrative and cutting edge research project grant applications. These networks are intended to facilitate the connection between etiologic theory and ADHD assessment techniques and treatment procedures. Networks must include representation from multiple perspectives that, at a minimum, span expertise across levels of analysis (e.g., molecular to behavioral) and disciplines (e.g., behavioral science, neuroscience, genetics, psychiatry, pediatrics). HEALTHY PEOPLE 2010 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of Healthy People 2010, a PHS-led national activity for setting priority areas. This Request for Applications (RFA), Interdisciplinary Research Networks on ADHD, is related to one or more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople/. ELIGIBILITY REQUIREMENTS 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 and 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. MECHANISM OF SUPPORT This RFA will use the National Institutes of Health (NIH) Exploratory/ Developmental Grant (R21) award mechanism. Responsibility for the planning, direction, and execution of the proposed networks will be solely that of the applicant. The total project period for an application submitted in response to this RFA may not exceed three years. 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. Specific application instructions have been modified to reflect "MODULAR GRANT" and "JUST-IN-TIME" streamlining efforts that have been adopted by the NIH. Complete and detailed instructions and information on Modular Grant applications have been incorporated into the PHS 398 (rev. 5/2001). Additional information on Modular Grants can be found at: http://grants.nih.gov/grants/funding/modular/modular.htm FUNDS AVAILABLE The participating institutes intend to commit approximately $1,000,000 in fiscal year 2002 to fund approximately 4-6 new networks in response to this RFA. An applicant may request a project period of up to three years and a budget for direct costs of up to $150,000 per year (or up to $175,000 per year for network grants that include more than one institution to allow for facilities and administrative (F&A) costs on consortium arrangements), to support travel, meeting expenses, training and pilot research funding for network. Because the nature and scope of the research proposed may vary, it is anticipated that the size of each award will also vary. Although the financial plans of the institutes provide support for this program, awards pursuant to this RFA are contingent upon the availability of funds and the receipt of a sufficient number of applications of outstanding scientific and technical merit. Applicants are strongly encouraged to discuss their applications with program staff listed under INQUIRIES prior to the submission. RESEARCH OBJECTIVES Background During the 1998 NIH Consensus Development Conference on Attention- deficit/Hyperactivity Disorder (or ADHD) evidence was presented indicating wide variations in clinical and research approaches for identifying and diagnosing ADHD. This variation reflects the lack of an objective assessment tool in ADHD diagnosis and the paucity of normative information on the developmental progression of ADHD-relevant cognitive functions (e.g., attention regulation, impulse control). The lack of agreement also likely stems from the absence of a theoretical consensus of underlying causes, or pathways, specific to ADHD. Variations in theory and diagnostic strategy make theoretically driven assessment tools and etiology-targeted treatment procedures difficult. Wide variations in diagnostic strategy underscore the need for pragmatic assessment tools amenable for use in the major systems of service entry points for children with ADHD symptoms, such as primary care settings. It is likely that ADHD nosology, assessment and treatment could benefit from the application of findings from the basic sciences (particularly cognitive neuroscience, cognitive psychology, neurology, neuropsychology, molecular genetics, and biology); however, there seems to be a gap between this research and its integration into clinical phenomenology. On March 15 and 16, 2000, the NIMH convened a workshop of clinical and basic scientists to identify promising areas for collaborative research related to ADHD. Individual presentations and discussions focused on the translation and application of basic behavioral and neuroscientific research to the clinical phenomenology of ADHD (a summary of this meeting may be found at: http://www.nimh.nih.gov/research/interadhd.cfm). Several areas related to ADHD were identified in which translational or interdisciplinary research would be useful; however, participants identified multiple barriers to the development of comprehensive research proposals grounded in a truly interdisciplinary approach. Given the wealth of research available, diverse domains of symptom and functional impairment, multiple service sector contact with diagnosed individuals, and remaining unanswered etiologic questions, ADHD seems to be an ideal candidate for multidisciplinary investigation. The participating institutes are encouraging opportunities for such collaboration among scientists to develop the truly interdisciplinary research questions, measures, and methodological designs necessary to adequately address the gaps between ADHD etiology, diagnosis and treatment. This strategy is consistent with the need for innovative approaches to support translational research noted in the 2000 NIMH Behavioral Science Workgroup report (http://www.nimh.nih.gov/council/bswsummary.cfm) and the new National Plan for Research on Child and Adolescent Mental Health, soon to be available on the NIMH website (http://www.nimh.nih.gov). This RFA is intended to begin a process where scientists can overcome barriers to cross-disciplinary research agendas to address the gaps related to ADHD etiology, assessment, and treatment. Research Themes The following sections describe examples of ADHD-related research areas ripe for interdisciplinary questions, methods, and designs. These areas are intended to be used only as guides for organizing networks and in formulating questions that could be used in developing network agendas. Nosology and the Integration of Basic Research on Attention, Working Memory, and Impulse Control The fourth edition of the Diagnostic and Statistical Manual (DSM-IV) describes three different subtypes of ADHD: primarily hyperactive/impulsive, primarily inattentive, and a combined subtype. These subtypes are in part based on evidence suggesting different patterns of gender-based prevalence, developmental change, comorbid symptom clusters, associated functional impairments, and long-term outcomes associated with inattentive versus impulsive/hyperactive ADHD symptoms. Various theories of ADHD etiology are currently being investigated; however, few theories include implications for ADHD subtypes or make connections to associated functional impairments. Genetics research supports the familial aggregation and heritability of ADHD and associated symptomatology. Cognitive neuroscience research indicates a central nervous system basis for ADHD including potential roots in the prefrontal cortex and monoamine systems. Many connections between etiology, symptoms and functional impairment remain to be made. For instance, there is a need to better connect identified genotypes to cognitive deficits and/or behavioral phenotypes, as well as to substantiate proposed connections between behavioral ADHD symptoms and cognitive deficits. Similarly, the connections between these deficits and subsequent pathways to functional impairment need to be more fully understood. A better understanding of the links between ADHD etiology, symptoms, and functional impairment are needed to more clearly specify ADHD nosology. Monoamine Systems and Pharmacological Interventions ADHD is a complex disorder often characterized by heterogeneity and comorbid conditions (e.g., learning disabilities, conduct disorders, mood disorders). In addition, samples of children with ADHD frequently demonstrate high rates of temporal, contextual, and neurochemical variability. This variability may be critical in understanding the disorder’s etiology. Given the importance of the monoamine system in treatment, the neurochemical variability noted within this system is likely to be important to ADHD etiology. More research is needed on the interaction of various neurochemical systems known to be important in the expression of ADHD symptoms and its pharmacological treatment (e.g., interaction of norepinephrine, dopamine and serotonin systems). Furthermore, in-depth studies of the monoamine system and specifically dopamine transporters, in terms of their abilities to function dynamically and respond to the environment, are needed in both animal and human models. Psychostimulant medication is the most common treatment for ADHD and has been proven to be particularly effective in reducing ADHD symptoms; however, many questions remain regarding the long-term safety and effectiveness of these medications, particularly when used in very young children. Interdisciplinary research looking at the role of the monoamine system in the expression of ADHD symptoms, associated impairments, and pharmacological treatment would likely shed light on ADHD etiology, treatment mechanisms of action, effectiveness and safety. The Development and Validation of Diagnostic Tools Grounded in the Basic Sciences The hyperactive, inattentive and impulsive symptoms of ADHD can be reliably assessed through a variety of behavioral rating scales. However, the conceptualization and assessment of essential constructs (e.g., attention ) and ADHD symptoms differ across disciplines. Cross-disciplinary definitional problems are compounded by the widely varying and dimensional nature of ADHD symptoms (i.e., most children display some amount of inattention and hyperactivity/impulsivity) and their co-occurrence with a variety of other problem behaviors (e.g., aggression, learning disabilities). Consequently, there is a continued need to develop more objective assessment tools, rating scales and/or diagnostic interviews that map onto basic underlying processes as well as a need to supplement behavioral assessment tools with improved cognitive and/or neuropsychological measures. The Development of Strategies for Assessing, Monitoring and Administering Treatment in Primary Care Settings Information on service use and patterns of care indicate that the primary care setting is a particularly critical gateway for the identification of children with ADHD symptoms. Survey research further indicates that approximately one quarter of pediatricians have never referred their patients with ADHD to specialized medical centers or mental health clinics. Thus, many children diagnosed with ADHD are being assessed and treated only by their primary care physician. Many of the currently utilized assessment measures and treatments for ADHD are incompatible with the primary care setting. There is also a dearth of practical decision-making tools for medication monitoring, differential diagnosis, and the distinction of referral service needs based upon impairment severity. Consequently, there is a great need for the development of practical, reliable and valid procedures to be used in primary care settings to identify and manage ADHD symptoms, as well as to distinguish appropriate referral needs. Interdisciplinary strategy development rooted in basic research on the etiology of ADHD and associated impairments, theories of decision-making and information processing, measurement and test development, as well as expertise in primary care practice would enhance the availability of quality tools for improving the care of ADHD in primary care practice. Symptom Etiology, Functional Impairments, and the Development of Targeted Treatments Several effective treatments for ADHD have been identified. Randomized clinical trials have established the efficacy of stimulants for ameliorating some symptoms of ADHD and associated aggressiveness. These studies have further indicated that stimulants are generally more effective than psychosocial therapies in treating these symptoms; however, results indicate inconsistent post-treatment improvements in functional impairments (e.g., academic achievement, peer relationships). Initial findings of the NIMH sponsored multi-site treatment study of children diagnosed with ADHD (MTA; see Archives of General Psychiatry, December 1999) suggest that the combination of medication management and behavioral intervention may have a slightly greater impact on positive functional outcomes (e.g., reading achievement, parent/child relations) than medication alone. Furthermore, the MTA provides preliminary evidence that ADHD children with various comorbid conditions may respond differentially to treatment modalities. These findings suggest the importance of matching children and families to treatments to which they will be most responsive; however, there is still relatively little information to guide treatment. Various etiologic theories of ADHD have implications for which interventions might be most successful for different individuals. Consequently, there is a great need for scientists to translate basic science findings to applications for ADHD etiology, ADHD-associated functional impairments, and the development of targeted interventions. Scope The etiology, symptom manifestation, and functional impairments associated with ADHD are complex and have been studied independently by investigators in a number of different disciplines; however, a comprehensive conceptualization of ADHD will likely include the interaction of genetic, neurochemical, cognitive and behavioral factors. To better understand the interrelationship of these multiple factors it may be helpful to form integrated research programs that span multiple levels of analysis. This RFA is intended to begin a process where scientists can overcome barriers to cross-disciplinary research agendas. Scientists interested in investigating the connection between ADHD etiology and its assessment or intervention may propose the formation of networks of individuals across disciplinary fields to form collaborative research agendas. The establishment of these networks would support the meeting of interdisciplinary scientists around a priority ADHD research area. Networks are expected to generate creative and well-designed research plans that address questions that benefit from integrative perspectives and form the basis of competitive grant applications. Investigators are encouraged to participate in only one network, although exceptions can be made with appropriate scientific justification. Networks must include representation from multiple disciplines. For example, investigators with expertise in neuroscience, behavioral science, and psychiatry would be highly appropriate. Also, networks must span multiple levels of analysis (e.g., molecular to behavioral) and are encouraged to include expertise in animals and humans when appropriate. SPECIAL REQUIREMENTS Principal investigators of grants resulting from this RFA will be asked to participate in yearly meetings to report progress, discuss problems, and share information related to the conduct of their networks. Requests for funds to support attendance at these meetings, to be held in the Washington, D.C. area, should be included as a part of the budget proposal. Funds may also be requested to support administrative costs for the Network Director, communication costs, travel expenses in order to attend and participate in scheduled activities and meetings of the network, as well as evaluation and analysis of pilot data by network members. Further, funded network activities might include opportunities for training and hosting among network scientists at alternative laboratories or research settings to stimulate collaborative grant writing and/or pilot funding for collaborative feasibility studies. The purpose of these activities and meetings will be to refine conceptual frameworks for organizing cross-disciplinary research and identifying which specific questions and possible experiments show the greatest promise for advancement. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their sub-populations must be included in all NIH-supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification are provided indicating that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing research involving human subjects should read the UPDATED "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research," published in the NIH Guide for Grants and Contracts on August 2, 2000 (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-048.html); a complete copy of the updated Guidelines are available at http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm. The revisions relate to NIH defined Phase III clinical trials and require: a) all applications or proposals and/or protocols to provide a description of plans to conduct analyses, as appropriate, to address differences by sex/gender and/or racial/ethnic groups, including subgroups if applicable; and b) all investigators to report accrual, and to conduct and report analyses, as appropriate, by sex/gender and/or racial/ethnic group differences. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of NIH that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines on the Inclusion of Children as Participants in Research Involving Human Subjects" that was published in the NIH Guide for Grants and Contracts, March 6, 1998, and is available at the following URL address: http://grants.nih.gov/grants/guide/notice-files/not98-024.html 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. URLS IN NIH GRANT APPLICATIONS OR APPENDICES All applications and proposals for NIH funding must be self-contained within specified page limitations. Unless otherwise specified in an NIH solicitation, internet addresses (URLs) should not be used to provide information necessary to the review because reviewers are under no obligation to view the Internet sites. Reviewers are cautioned that their anonymity may be compromised when they directly access an Internet site. REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS NIH policy requires education on the protection of human subject participants for all investigators submitting NIH proposals for research involving human subjects. This policy announcement is found in the NIH Guide for Grants and Contracts Announcement dated June 5, 2000, at the following website: http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html. PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT The Office of Management and Budget (OMB) Circular A-110 has been revised to provide public access to research data through the Freedom of Information Act (FOIA) under some circumstances. Data that are (1) first produced in a project that is supported in whole or in part with Federal funds and (2) cited publicly and officially by a Federal agency in support of an action that has the force and effect of law (i.e., a regulation) may be accessed through FOIA. It is important for applicants to understand the basic scope of this amendment. NIH has provided guidance at: http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm Applicants may wish to place data collected under this RFA in a public archive, which can provide protections for the data and manage the distribution for an indefinite period of time. If so, the application should include a description of the archiving plan in the study design and include information about this in the budget justification section of the application. In addition, applicants should think about how to structure informed consent statements and other human subjects procedures given the potential for wider use of data collected under this award. NIH GRANTS POLICY STATEMENT The NIH Grants Policy Statement (NIHGPS) has been revised and reissued. The provisions of the revised NIHGPS are effective for all funded NIH grants and cooperative agreements with budget periods beginning on or after March 1, 2001. The revised NIHGPS is available at: http://grants.nih.gov/grants/policy/nihgps_2001. LETTER OF INTENT Prospective applicants are asked to submit a letter of intent that includes a descriptive title of the proposed network, the name, address, and telephone number of the principal investigators participating in the proposed network, 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 a subsequent application, the information that it contains allows NIMH and NINDS staff to estimate the potential review workload and plan the review. The letter of intent must be received by the letter of intent receipt date listed in the heading of this RFA. The letter of intent is to be sent to: Farris Tuma, Sc.D. Division of Mental Disorders, Behavioral Research and AIDS National Institute of Mental Health 6001 Executive Boulevard, Room 6200, MSC 9617 Bethesda, MD 20892-9617 Telephone: (301) 443-5944 FAX: (301) 480-4415 Email: ftuma@mail.nih.gov APPLICATION PROCEDURES The PHS 398 research grant application instructions and forms (rev. 5/2001) at http://grants.nih.gov/grants/funding/phs398/phs398.html are to be used in applying for these grants. This version of the PHS 398 is available in an interactive, searchable PDF format. Although applicants are strongly encouraged to begin using the 5/2001 revision of the PHS 398 as soon as possible, the NIH will continue to accept applications prepared using the 4/1998 revision until January 9, 2002. Beginning January 10, 2002, however, the NIH will return applications that are not submitted on the 5/2001 version. For further assistance contact GrantsInfo, Telephone 301/710-0267, Email: GrantsInfo@nih.gov. 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, reviewers and NIH staff. The research grant application form PHS 398 (rev. 5/2001) at http://grants.nih.gov/grants/funding/phs398/phs398.html is to be used in applying for these grants, with modular budget instructions beginning on page 13 of the application instructions. Applicants are permitted, however, to use the 4/1998 revision of the PHS 398 for scheduled application receipt dates until January 9, 2002. If you are preparing an application using the 4/1998 version, please refer to the step-by-step instructions for Modular Grants available at http://grants.nih.gov/grants/funding/modular/modular.htm. The RFA label available in the PHS 398 (rev. 4/98) application form must be affixed to the bottom of the face page of the application. Type the RFA number on the label. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed on line 2 of the face page of the application form and the YES box must be marked. The sample RFA label available at: http://grants.nih.gov/grants/funding/phs398/label-bk.pdf has been modified to allow for this change. Please note this is in pdf format. Submit a signed, typewritten original of the application, including the Checklist, and three signed photocopies, in one package to: CENTER FOR SCIENTIFIC REVIEW NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application must be sent to: Jean G. Noronha, Ph.D. Division of Extramural Activities National Institute of Mental Health 6001 Executive Boulevard, Room 6154, MSC 9609 Bethesda, MD 20892-9609 Applications must be received by the application receipt date listed in the heading of this RFA. If an application is received after that date, it will be returned to the applicant without review. The Center for Scientific Review (CSR) will not accept any application in response to this RFA that is essentially the same as one currently pending initial review, 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. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed for completeness by the CSR and responsiveness by NIMH staff. Incomplete and/or non-responsive applications will be returned to the applicant without further consideration. 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 NIMH in accordance with the review criteria stated below. As part of the initial merit review, all applications will receive a written critique and undergo a process in which only those applications deemed to have the highest scientific merit, generally the top half of the applications under review, will be discussed, assigned a priority score, and receive a second level review by the NIMH and/or NINDS National Advisory Council. Review Criteria The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. In the written comments reviewers will be asked to discuss the following aspects of the application 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 assigning the overall score, weighting them as appropriate for each application. Note that the application does not need to be strong in all categories to be judged likely to have major scientific impact and thus deserve a high priority score. For example, an investigator may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. o Scientific, technical, or medical significance of the goals that the network is designed to achieve. o Appropriateness and adequacy of the proposed network design and membership for achieving these goals through cross-disciplinary interaction. o Qualifications and research experience of the principal investigators and network members. o Evidence that the scientific environment(s) in which the work will be done will contribute to the probability of success. Does the proposed work take advantage of unique features of the scientific environment(s)? Is there evidence of institutional support? o Adequacy of the conceptual framework, design, and methods of any proposed pilot projects. o Feasibility of network participants successfully completing scheduled meetings and activities. In addition to the above criteria, in accordance with NIH policy, the initial review group will also examine: o Adequacy of plans to include both genders, minorities and their subgroups, and children as appropriate for the scientific goals of the network. Plans for the recruitment and retention of subjects will also be evaluated. o Adequacy of the proposed protection for humans, animals or the research environment, to the extent they may be adversely affected by the project proposed in the application. o Appropriateness of proposed project budget and duration. o Adequacy of the proposed plan to share data, if appropriate. SCHEDULE Letter of Intent Receipt Date: September 24, 2001 Application Receipt Date: October 24, 2001 Peer Review Date: Jan/Feb 2002 Council Review: May 2002 Earliest Anticipated Start Date: July 2002 AWARD CRITERIA Scientific merit as determined by peer review and programmatic priorities will be the primary criteria for award determination. Only applications judged to have met the highest scientific standards of excellence will be considered for award. Networks must demonstrate feasibility for integrated discussions among investigators in pursuit of cross-disciplinary research agendas. Networks proposing themes that address high-risk experimental questions, but with high potential benefits, will be given careful consideration. INQUIRIES Inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Farris Tuma, Sc.D. Division of Mental Disorders, Behavioral Research and AIDS National Institute of Mental Health Bethesda, MD 20892-9617 Telephone: (301) 443-5944 FAX: (301) 480-4415 Email: ftuma@mail.nih.gov Robert Finkelstein, Ph.D. National Institute of Neurological Disorders and Stroke 6001 Executive Boulevard, Room 2143 Bethesda, MD 20892-9527 Telephone: (301) 496-5745 FAX: (301) 402-1501 Email: finkelsr@ninds.nih.gov Direct inquiries regarding fiscal matters to: Diana S. Trunnell Grants Management Branch National Institute of Mental Health 6001 Executive Boulevard, Room 6115, MSC 9605 Bethesda, MD 20892-9605 Telephone: (301) 443-2805 FAX: (301) 443-6885 Email: Diana_Trunnell@nih.gov Tina M. Carlisle Grants Management Branch National Institute of Neurological Disorders and Stroke 6001 Executive Boulevard, Room 3290 Bethesda, MD 20892 Telephone: (301) 496-3938 FAX: (301) 402-0219 Email: carlislt@ninds.nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance Nos. 93.242 (NIMH) and 93.853 (NINDS). Awards are made under authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and administered under NIH grants policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74 and 92. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. The PHS strongly encourages all grant 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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