form other than cash by a public or private agency.

(v) (a) Any incentive allowance from the Department of Labor to individual members of the family participating in manpower training (up to $30 per month per individual).

(b) Any incentive allowance (not to exceed $30 per month per individual) from the Department of Labor or the Department of Health, Education, and Welfare to individual members of the family who are unemployed and unable to work solely because of an illness or incapacity and who are receiving vocational rehabilitation services from the appropriate State agency administering or supervising the administration of the approved State plan for vocational rehabilitation services approved under the Vocational Rehabilitation Act;

(c) Allowances paid by a State or political subdivision to a member of a family participating in a Federal income maintenance program (not to exceed $30 per month);

(vi) Any portion of any grant, scholarship, or fellowship received for use in paying the cost of tuition and fees at any educational (including technical or vocational education) institution;

(vii) Home produce raised by a member of the family for consumption by the household;

(viii) One-third of any payments received for the support of children who are family members, or alimony paid to family members; and

(ix) Any amounts received for the foster care of a child who is not a member of the family but who is living in the same home as the family and was placed in such home by a public or nonprofit private childplacement or child-care agency.

Notwithstanding any other provision, the total amount which may be excluded under the preceding items (1), (ii), and (iii), in determining the income of any family for any year shall not exceed the lesser of

1. $2,000 plus $200 for each member of the family in excess of four, or

2. $3,000 or a proportionately smaller amount for a shorter period.

APPENDIX D-DETERMINATION OF PREMIUMS AND "PER VISIT" CHARGES

The amount of premiums and "per visit" charges for Group III eligible enrollees will be determined for each income class in accordance with the following table:

The income class of a family is the class in column I of the table, on the line on which appear (within the column for the number of members in the family) its income. The size of a family and income are determined in accordance with Appendix C.

1. Cost Sharing-a. Premiums-The amount of premiums for family coverage and enrollment in a family health center project shall be paid periodically and for a twelve month period shall total:

1. None in the case of a family income class 1;

2. $25 in the case of a family in income class 2;

3. $35 in the case of a family in income class 3;

4. $60 in the case of a family in income class 4;

5. $120 in the case of a family in income class 5.

In the case of a family in income class 1, no premiums shall be charged for enrollment in the family health center project.

0-3,000 3,001-3, 500 3, 501-4.000 4,001-4, 500 4, 501-5, 000

0-3,800 3. 801-4, 300 4,301-4, 800 4,801-5, 300 5, 301-5, 800

0-4,400 4,401-4, 900 4, 901-5, 400 5, 401-5, 900 5, 901-6, 400

0-5,000 5,001-5, 500 5, 501-6,000 6,001-6, 500 6,501-7,000

b. Per Visit Charge-A charge of $1 per visit shall be made for persons in families in income classes 3 or 4 and $2 in class 5 (except with respect to visits for immunizations, well baby, and other preventive care, family planning or maternity care). There is to be no charge in the case of persons in income classes 1 and 2.

2. Alternative Cost Sharing: An applicant may provide, as an alternative to the premium and per visit charges set forth in paragraph 1 above, other premiums and per visit charges provided that the amount of money generated by such alternative must be commensurate with that which it is estimated would have been generated under paragraph 1 provided, however, that such alternative may not require a premium or per visit charge to a family in income class 1. A schedule setting forth the alternative charges, as well as justifying their use, must be submitted and approved as part of the application.

As used in this subpart:

(a) "Act" means section 508 of the Social Security Act as amended (42 U.S.C. 708).

(b) "State" means any of the several States, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam.

(c) "Secretary" means the Secretary of Health, Education, and Welfare and any other officer or employee of the Department of Health, Education, and Welfare to whom the authority involved has been delegated.

§ 51a.203 Eligibility for grants.

In order to be eligible for a grant under this part, an applicant must be (a) the State health agency of any State; (b) with the consent of such State health agency, the health agency of a political subdivision of the State; or (c) any public or nonprofit private agency, institution, or organization.

(a) An application for a grant under this subpart shall be submitted to the Secretary in such form and manner and at such time as the Secretary may prescribe.1 The application shall contain a budget and a narrative plan of the manner in which the applicant intends to conduct the project and carry out the requirements of this subpart.

(b) The application shall be executed by an individual authorized to act for the applicant and to assume on behalf of the applicant the obligations imposed by the terms and conditions of the grant award, including the regulations of this subpart and the policies and procedures

1 Applications and instructions may be obtained from the Regional Health Director of the Health Services and Mental Health Administration at the Regional Office of the Department of Health, Education, and Welfare for the region in which the project is to be conducted.

prescribed by the Secretary for grants under this subpart.

(c) The applicant will be notified of action taken on his application.

(1) If a grant is made, the initial award will set forth the amount of funds granted and will specify the project period for which support is contemplated if the activity is satisfactorily carried out and Federal funds are available. For continuation support, grantees must make separate application annually.

(2) Neither the approval of any project nor a grant award shall commit or obligate the United States in any way to make any additional, supplemental, continuation or other award with respect to any approved project or portion thereof, but this provision shall not preclude the Secretary from making upward adjustments to actual costs as to amounts awarded on a provisional basis as provided in subparagraph (1) of this paragraph.

§ 51a.205 Matching requirements.

Federal funds will be granted on the basis of project applications and may be used to meet not more than 75 percent of the cost of the project. The non-Federal participation may be derived from a variety of sources, including (a) new State or local appropriations or other new grantee funds, and (b) existing funds and time of personnel used for the ongoing activities of the grantee agency which are made a part of the project. Voluntary services or space donated to the project may not be included as a grantee contribution. Grantee funds or services derived from other Federal funds or used for matching any other Federal grant may not be used to match the Federal funds in this program except as otherwise specifically allowed by Federal statute.

§ 51a.206 Personnel and facilities standards.

The application shall describe the standards required for personnel and facilities utilized in the provision of services under the program. These standards for personnel and facilities must (a) be those which are found upon investigation by the grantee to be best adapted for the attainment of the specific purposes of the project, (b) assure a reasonably high standard of care, and (c) be in substantial accordance with national standards as accepted by the Secretary or standards prescribed by the Secretary. However, if

a project is planned for an area in which it is not possible to meet standards accepted or prescribed by the Secretary, the best available resources must be used, and steps must be taken to improve the standard of care. In such case, the application must include a description of such proposed remedial action.

§ 51a.207 Availability of services.

Project services must be made available:

(a) Without any requirement for legal residence other than a requirement that the person or family to be served is currently residing in the project area;

(b) Upon referral from any source or upon the patient's own application;

(c) With respect for the dignity of the individual;

(d) With efficient administrative procedures for registration and delivery of services;

(e) Without regard to religion, family size, or marital status (see also section 51a.20); and

(f) Only to persons who because of low income or for other reasons beyond their control could not otherwise obtain services comparable to those provided under the project. However, if specific income standards are used, they must be applied flexibly, with due regard for total family needs in the particular case. Determinations of eligibility for services under the project shall be made by the project director or a member of the project staff designated by him, and shall be made in accordance with this section, the policies and procedures governing the project, and the project plan and budget as approved. § 51a.208

Provision of services.

(a) Acceptance of services provided under the project must be voluntary, and individuals must not be subjected to any coercion to receive services or to employ or not to employ any particular method of family planning. Acceptance of family planning services shall not be a prerequisite to eligibility for or receipt of any other services.

(b) Measures must be taken to promote community understanding of the objectives of the program, to make the availability of services known to the community, and to encourage and facilitate attendance in the program.

(c) The project must be coordinated with related services of local health and welfare departments, hospitals and

related voluntary agencies, and health projects supported by the Office of Economic Opportunity. Where appropriate, there should be referral arrangements with local welfare departments for services to persons under the Aid to Families With Dependent Children Program.

(d) The program must include counseling, and interpretation to individuals of the service provided.

(e) Family planning medical services shall be under the direction and responsibility of a physician with special training or experience in family planning.

(f) Projects are to be designed to assure comprehensiveness and continuity in the health management and supervision of project patients with respect to family planning services.

(g) A variety of medically approved methods of family planning, including the rhythm method, must be available to persons to whom family planning services are offered and provided.

(h) Diagnostic and treatment services for infertility must be provided for in the family planning project. § 51a.209 Payment for services.

(a) Project plans shall set forth the methods utilized by the grantee in establishing the rates of payment for medical care, and in substantiating that the rates are reasonable and necessary to maintain standards relating to the provision of services established pursuant to § 51a.206. Grantees will maintain schedule of rates for such services.

a

(b) All services purchased for project patients must be authorized by the project director or his designee on the project staff.

(c) No charge shall be made to any person or family for services under the project, except to the extent that payment will be made by a third party (including a government agency) which is authorized or is under legal obligation to pay such charges. Where the cost of care and services furnished by or through the project is to be reimbursed under Title XIX of the Social Security Act, a written agreement with this Title XIX agency is required. Reimbursement may be either to the project or directly to the provider.

§ 51a.210 Confidentiality of information.

All information as to personal facts and circumstances obtained by the project staff shall be treated as privileged

communications, shall be held confidential, and shall not be divulged without the individual's consent except as may be necessary to provide services to the individual. Information may be disclosed in summary, statistical, or other form which does not identify particular individuals.

§ 51a.211 Project expenditures.

(a) Project funds (Federal and matching) are available for the direct costs of operating and maintaining the project approved in the plan and budget.

(b) Funds may not be used for the following:

(1) Construction of buildings;

(2) Depreciation of existing building or equipment;

(3) Dues to societies, organizations, or federations;

(4) Entertainment costs;

(5) General agency overhead;

(6) Fundraising material and activities;

(7) Consultants or other personnel paid from other Federal grant funds; (8) Any other costs not approved in the plan and budget.

(c) Prior approval of revision of the budget and project plan is required whenever there is to be a significant change in the scope or nature of project activities. § 51a.212 Interest and other income.

(a) Pursuant to section 203 of the Intergovernmental Cooperation Act of 1968, 42 U.S.C. 4213, a State, as defined in section 102 of that Act, will not be held accountable for interest earned on grant funds, pending their disbursement for program purposes. A State, as defined in the Intergovernmental Cooperation Act, section 102, means any one of the several States, the District of Columbia, Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State, but does not include the governments of the political subdivisions of the State. All grantees other than a State, as so defined, must return to the Health Services and Mental Health Administration all interest earned on grant funds.

(b) All grantees must either return to the Health Services and Mental Health Administration that part of any other project income proportionate to the grant contribution to the support of the project, or use such income for the activities of the project.

§ 51a.213 Equipment.

Items of equipment purchased with project funds are to be used for the purposes of the project, and the grantee shall maintain a complete equipment inventory and property controls adequate for prompt identification and accountability. § 51a.214 Control of project funds or services.

Funds or services made available to the project for project purposes, whether or not utilized to meet the grantee's share of the costs, shall be under the control of the grantee and expended and utilized in accordance with this part, policies and procedures governing the project, and the project plan and budget as approved. § 51a.215 Effect of State or local law.

Except as otherwise authorized, where the grantee is a public agency, administrative provisions of State or local law applicable to the moneys appropriated to the public agency shall apply to the project funds.

§ 51a.216 Termination of grants or withholding of payments.

Whenever the Secretary finds that a grantee has failed in a material respect to comply with the Act or with the terms of the grant, including the regulations of this subpart, he may, on reasonable notice to the grantee, withhold further payments, and take such other action, including the termination of the grant, as he finds appropriate to carry out the purposes of the Act and regulations. Noncancellable obligations of the grantee properly incurred prior to the receipt of the notice of termination will be honored. The grantee shall be promptly notified of such termination in writing and given the reasons therefor.

§ 51a.217

Records, reports, inspection.

(a) Records and reports. Each grant awarded pursuant to this subpart shall be subject to the condition that the grantee shall maintain such progress and fiscal records, and file with the Secretary such progress and fiscal reports relating to the use of grant funds, as the Secretary may find necessary to carry out the purposes of the Act and the regulations. All records shall be retained for 3 years after the close of the budget period; or, if a Federal audit has not occurred within 3 years, (1) for 5 years after the

close of the budget period or (2) until the grantee is notified of the completion of the Federal audit, whichever is earlier, except that where audit questions have arisen before the end of 5 years, records shall be retained until resolution of such questions.

(b) Inspection and audit. Any application for a grant under this part shall constitute the consent of the applicant to inspections at reasonable times by persons designated by the Secretary of the facilities, equipment and other resources of the applicant and to interviews with principal staff members to the extent that such resources and personnel are, or will be, involved in the project. In addition, the acceptance of any grant under this subpart shall constitute the consent of the grantee to inspections and fiscal audits by such persons of the supported activity and of progress and fiscal records relating to the use of grant funds. § 51a.218 Copyright.

The United States reserves a royaltyfree, nonexclusive license to use and authorize others to use all copyrightable or copyrighted material resulting from a project.

Attention is called to the requirements of Title VI of the Civil Rights Act of 1964 (78 Stat. 252, 42 U.S.C. 2000d et seq.) and in particular section 601 of such act which provides that no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. A regulation implementing such Title VI, which applies to grants made under this subpart, has been issued by the Secretary of Health, Education, and Welfare with the approval of the President (45 CFR Part 80).