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(b) the expansion of an existing system to cover geographical areas or population groups not previously served by such system.

§ 56a.403 Project requirements.

(a) An application under this subpart will not be approved by the Secretary unless

(1) The applicant demonstrates to the satisfaction of the Secretary that the emergency medical services system for which the application is submitted will meet each of the requirements specified in section 1206(b)(4)(C) of the Act and § 56a.103 of Subpart A of this part within the total period of eligibility for assistance under this subpart; except that if the applicant demonstrates to the satisfaction of the Secretary the inability of the applicant's emergency medical services system to meet one or more of such requirements within such period, the period (or periods) within which the system must meet such requirement (or requirements) is such period (or periods) as the Secretary may require. [43 FR 51533, Nov. 3, 1978, as amended at 46 FR 48597, Oct. 1, 1981]

§ 56a.404 Content of application-supporting information.

An approvable application for a grant under section 1204 of the Act shall contain the following information:

(a) A comprehensive description of the organizational structure which will manage the improved and expanded emergency medical services system; (b) A detailed description of current emergency medical services system and capability;

(c)-(e) [Reserved]

(f) A description of the projected emergency medical services capability that will exist after improvement and expansion of the system, including types of services, status of subsystems, and nature of community involvement; (g) A detailed description of the methodology which will be employed in order to achieve each of the objectives of the project; (h) [Reserved]

(i) A fiscal schedule containing estimated expenditures and justification therefor;

(j) [Reserved]

(k) Assurances of the participation in and support of the system by the public, private, and volunteer organizations and entities which are associated with and involved in activities essential to the effective provision of emergency medical services in the system's service area.

(1) For the purposes of this paragraph, an assurance shall consist of a document, signed by an official with full authority to act on behalf of the public, private, or volunteer organization and entity, committing resources to the operation of the emergency medical services system.

(2) For the purposes of this paragraph, "public, private, and volunteer organizations and entities essential to the effective provision of emergency medical services in the system's service area" include providers of emergency medical services, such as emergency departments, critical care units, ambulance services, and public safety agencies.

(1) First grants. Applications for a first grant under this section must be accompanied by—

(1) A specific plan for the step-bystep achievement of compliance with each of the requirements of section 1206(b)(4)(C) within the period specified in section 1206(b)(4)(B)(i); and

(2) Assurances, evidenced by copies of formal resolutions, proclamations or other acts of the executive or legislative governmental bodies of political subdivisions located in the system's service area which govern a substantial proportion of the population residing in such area, of their support and cooperation with the system and endorsement and support of a specific financial plan which provides for the maintenance of the financial support of the system, after the conclusion of the grant, at the level of expanded or improved activity to be achieved during the period of the grant.

[43 FR 51533, Nov. 3, 1978, as amended at 46 FR 48597, Oct. 1, 1981]

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award grants under this subpart to those applicants whose projects will, in his judgment, best promote the purposes of section 1204 of the Act and the regulations of this subpart, taking into account:

(1) The extent of the need for improved and expanded emergency medical services in the service area of the system;

(2) The capability of the applicant to carry out the proposed project;

(3) The reasonableness of the budget and the soundness of the fiscal plan for assuring effective utilization of grant funds;

(4) The extent of coordination with existing health planning agencies and emergency medical services providers, in the service area of the system;

(5) The potential of the project for accomplishing its objectives and fulfilling the purposes of the emergency medical services grant program;

(6) The potential of the project for becoming self-supporting; and

(7) The degree to which the proposed project addresses the needs of rural areas.

(b) [Reserved]

(c) All grant awards shall be in writing, shall set forth the amount of funds granted, and the period for which support is recommended.

[43 FR 51533, Nov. 3, 1978, as amended at 46 FR 48597, Oct. 1, 1981]

§ 56a.406 Use of project funds.

(a) Any funds granted pursuant to this subpart, as well as other funds to be used in performance of the approved project, shall be expended solely for carrying out the approved project in accordance with section 1204 of the Act, the regulations of this part, the terms and conditions of the award, and the applicable cost principles set forth in 45 CFR Part 74.

(b) Project funds may not be used for the following:

(1) Construction of new facilities. (2) Purchasing built-in hospital equipment which will be used more than 25 percent of the time for nonemergency department purposes.

[43 FR 51533, Nov. 3 1978, as amended at 46 FR 48597, Oct. 1, 1981]

§ 56a.407 Acquisition of facilities.

The following provisions are applicable to the acquisition of existing facilities:

(a) Estimated costs of acquisition and remodeling: Suitability of facility. Each application for a project involving the acquisition of existing facilities shall include in the detailed estimates of the cost of the project the cost of acquiring such facilities to serve the purposes for which they are acquired. Such application shall demonstrate to the satisfaction of the Secretary that the architectural, structural, and other pertinent features of the facility, as modified by any proposed expansion, remodeling, renovation, or alteration, will be clearly suitable for the purposes of the program, and, to the extent of the costs in which Federal participation is requested, are not in excess of what is necessary for the services proposed to be provided in such facilities.

(b) Determination of necessary cost. The necessary cost of aquisition of existing facilities shall be determined on the basis of such documentation submitted by the applicant as the Secretary may prescribe (including the reports of such real estate appraisers as the Secretary may approve) and other relevant factors.

(c) Bona fide sale. Federal participation in the acquisition of existing facilities is on condition that such acquisition constitutes a bona fide sale involving an actual cost to the applicant and will result in additional or improved facilities for purposes of the program.

(d) Facility which has previously received Federal grant. No grant for the acquisition of a facility which has previously received a Federal grant for construction, acquisition, or equipment shall serve either to reduce or restrict the liability of the applicant or any other transferor or transferee from any obligation of accountability imposed by the Federal Government by reason of such prior grant.

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Committee on Emergency Medical Services such progress and other reports as the Secretary may require, including the following: (a) [Reserved]

(b)

report.

Annual performance Within 60 days following the end of the budget period, an annual performance report, which shall contain:

(1) A summary of the major activities supported under the grant and the major accomplishments resulting from activities to improve emergency medical services in the region.

(2) A narrative description of the system's status at the conclusion of the grant, including organizational management and operational aspects of the prehospital and in-hospital activities.

(3) A description of the specific objectives included in the grant application and the accomplishments and failures resulting from the activities during the grant period.

(4) A review of the system's resources for basic and advanced life support services including levels of training, transportation vehicles, communications capability, emergency departments, and critical care units.

(5) A review of the basic process measures and changes in these measures associated with the operation of emergency medical service system.

(6) A narrative statement describing compliance of the grantee's operation with the plans set forth in the application.

(7) A review and evaluation of the changes in patient care categories in terms of impact and outcome activities as appropriate to the grant support of activities.

(8) A review of how grant funds were used.

(9) A review of the status of implementation of the financial plan described in § 56a.404(1)(2).

(c) Final report. No later than 1 year after the completion of the final grant under section 1204 of the Act, the grantee shall submit a final report, which shall contain a more substantive examination of the material required in paragraph (b)(1) through (9) of this section.

[43 FR 51533, Nov. 3, 1978, as amended at 46 FR 48597, Oct. 1, 1981]

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57.1103 What entities are eligible to apply for a grant?

57.1104 How must an entity apply for a grant?

57.1105 What requirements must a project meet?

57.1106 What are the criteria for deciding which applications are to be funded? 57.1107 How will grant awards be made? 57.1108 How will grant payments be made? 57.1109 Purposes for which grant funds may be spent.

57.1110 What nondiscrimination requirements apply to grantees?

57.1111 How must grantees account for grant funds received?

57.1112 Applicability of 45 CFR Part 74. 57.1113 What recordkeeping, audit, and inspection requirements apply to grantees?

57.1114 What additional conditions apply to grantees?

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57.1303 What entities are eligible to apply for a grant?

57.1304 How must an entity apply for a grant?

57.1305 What requirements must a project meet?

57.1306 What are the criteria for deciding which applications are to be funded? 57.1307 How will grant awards be made? 57.1308 How will grant payments be made? 57.1309 What are the purposes for which grant funds may be spent?

57.1310 What nondiscrimination requirements apply to grantees?

57.1311 How must grantees account for grant funds received?

57.1312 Applicability of 45 CFR Part 74. 57.1313 What recordkeeping, audit, and inspection requirements apply to grantees?

57.1314 What additional conditions apply to grantees?

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Subpart M-Financial Distress Grants to Health Professions Schools

57.1409

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57.1201 To what programs do these regulations apply?

57.1202 Definitions.

57.1203 Who is eligible to apply for a grant?

57.1204 What assurances are required of an applicant?

57.1205 What requirements may the Secretary impose?

57.1206 How will applications be evaluated?

57.1207 How is the amount of the award determined?

57.1208 How long does grant support last? 57.1209 For what purposes may grant

funds be spent?

57.1210 What other audit and inspection requirements apply to grantees?

57.1211 What additional Department regulations apply to grantees?

57.1212 Additional conditions.

Publications and copyright.

Grantee accountability.

57.1413 Records, reports, inspection, and audit.

57.1414 Additional conditions.

57.1415 Early termination and withholding of payments.

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