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which will minimize the need for pa- (c) In addition to other pertinent intient referral; and

formation that the Secretary may re(4) Coordinates dental treatment pro- quire, an application for a grant under vided by dental specialists and by den- this subpart must contain: tal auxiliary personnel, including den- (1) A full and adequate description of tal hygienists, dental assistants, and the proposed project and of the manner expanded function dental auxiliaries. in which the applicant intends to con

Project period means the total time duct the project and carry out the refor which support for a project has quirements of this subpart; and been approved, including any exten

(2) A budget justification for the sions thereof.

funds requested. If the applicant reSchool of dentistry means a public or quests funds for stipend support of parprivate nonprofit school which provides ticipants, the applicant must provide training leading to a degree of doctor evidence showing that income availof dentistry or an equivalent degree able from other sources, including inand which is accredited as provided in come derived from services of the parsection 799(1)(E) of the Act.

ticipants in the program, will be insufSecretary means the Secretary of ficient to pay their stipends and that Health and Human Services, and any

grant funds will not be used to supother officer or employee of the De- plant other available funds. partment of Health and Human Services to whom the authority involved

(Approved by the Office of Management and has been delegated.

Budget under control number 0915-0060) State means, in addition to the sev- [43 FR 54931, Nov. 24, 1978, as amended at 49 eral States, the District of Columbia, FR 38112, Sept. 27, 1984; 52 FR 19145, May 21, the Commonwealth of Puerto Rico, the

1987; 57 FR 45737, Oct. 5, 1992; 62 FR 51374, Commonwealth of the Northern Mar

Oct. 1, 1997) iana Islands, the Virgin Islands, Guam, American Samoa, the Republic of

$57.1105 What requirements must a

project meet? Palau, the Republic of the Marshall Islands, and the Federated States of Mi- A project supported under this subcronesia.

part must meet the following require

ments: [43 FR 54931, Nov. 24, 1978, as amended at 52 FR 19145, May 21, 1987; 57 FR 45737, Oct. 5,

(a) The general practice residency or 1992; 61 FR 6124, Feb. 16, 1996)

advanced education program in general

dentistry must be accredited by the $57.1103 What entities are eligible to American Dental Association Commisapply for a grant?

sion on Dental Accredation; Any public private nonprofit

(b) Each project must have at least school of dentistry or accredited post

two participants enrolled in the traingraduate dental training institution lo

ing program; and cated in a state is eligible to apply for (c) Each participant who receives stia grant.

pend support must sign a statement of

intent to work in the practive of gen(57 FR 45737, Oct. 5, 1992]

eral dentistry. 8 57.1104 How must an entity apply for (62 FR 51374, Oct. 1, 1997)

a grant? (a) To apply for a grant under this

$57.1106 How will applications be subpart, each entity shall submit an

evaluated? application in the form and at such (a) As required by section 798(a) of time as the Secretary may prescribe. the Act, each application for a grant

(b) The application must be signed by under this subpart shall be submitted an individual authorized to act for the to a peer review group, composed prinapplicant and to assume, on behalf of cipally of non-Federal experts, for an the applicant, the obligations imposed evaluation of the merits of the proby the terms and conditions of any posal as contained in the application. award including the regulations of this The Secretary may not approve such subpart.

an application unless a peer review


group has recommended the application for approval. The Secretary will award grants to applicants whose projects will best promote the purposes of section 749 of the Act. The Secretary will approve or disapprove applications filed in accordance with $7thnsp;57.1104, taking into consideration, among other factors, the degree to which:

(1) The proposal addresses the legislative intent of the program and has a well-documented rationale;

(2) The objectives of the proposed project are consistent with the program's rationale, and are measurable and achievable within the project period;

(3) The proposed project's methodology is consistent with the objectives and explained in appropriate detail;

(4) The evaluation is linked to the objectives and addresses the project outcomes;

(5) The applicant demonstrates the administrative and managerial capability to carry out the proposed project;

(6) The proposed budget is complete, appropriate, cost-effective, and clearly justified;

(7) The plan for institutionalizing the project outcomes is specific and realistic; and

(8) The proposal plans to attract, maintain, and graduate minority and disadvantaged students.

(b) In determining the funding of applications approved under paragraph 9a) of this section, the Secretary will consider any special factors relating to national needs as the Secretary may from time to time announce in the FEDERAL REGISTER. [62 FR 51374, Oct. 1, 1997]

funds. This period, called the project period, will not exceed 3 years.

(3) Generally, the grant will initially be funded for 1 year, and subsequen: continuation awards will also be for 1 year at a time. Decisions regarding continuation awards and the funding levels of these awards will be made after consideration of such factors as the grantee's progress and management practices, existence of legislative authority, and the availability of funds. In all cases, continuation awards require a determination by the Secretary that continued funding is in the best interest of the Federal Government.

(4) Neither the approval of any project nor the award of any grant 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 any portion of an approved project. For continuation support, grantees must make separate application at such times and in such a form as the Secretary may prescribe.

(b) Determination of grant amount. The Secretary will determine the amount of any award under this subpart on the basis of his or her estimate of the sum necessary for the cost (including both direct and indirect costs) of the project. In addition, in determining the amount of stipend support to be made available for the general practice residency program, the amount of any stipend must be limited to that portion of the annual amount normally paid to other residents by the applicant which the Secretary determines, on the basis of the documentation required in the application, cannot reasonably be paid from other available funds, including the incomes derived from the residents services. For the advanced educational program in general dentistry, stipends for participants (who are postdoctoral students) must be paid in accordance with established Public Health Service postdoctoral stipend rates. (43 FR 54931, Nov. 24, 1978, as amended at 57 FR 45737, Oct. 5, 1992; 61 FR 6125, Feb. 16. 1996)

$57.1107 How will grant awards be

made? (a) General. (1) Within the limit of funds available, the Secretary will award grants to those applicants whose approved projects will, in his or her judgment, best promote the purposes of section 749 of the Act, as determined in accordance with $ 57.1106.

(2) The notice of grant award specifies the length of time the Secretary intends to support the project without requiring the project to recompete for

$57.1108 How will grant payments be

made? The Secretary will, from time to time, make payments to a grantee of all or a portion of any grant award, either in advance or by way of reimbursement.

43 FR 54931, Nov. 24, 1978]

$57.1109 Purposes for which grant

funds may be spent. (a) A grantee shall only spend funds it receives under this subpart according to the approved application and budget, the authorizing legislation, terms and conditions of the grant award, applicable cost principles specified in subpart Q of 45 CFR part 74, and these regulations.

(b) Any balance of federally obligated grant funds remaining unobligated by the grantee at the end of a budget period may be carried forward provided specific approval is granted by the Secretary. If at any time during a budget period it becomes apparent to the Secretary that the amount of Federal funds awarded and available to the grantee for that period, including any unobligated balance carried forward from prior periods, exceeds the grantee's needs for the period, the Secretary may adjust the amounts awarded by withdrawing the excess. A budget period is an interval of time (usually 12 months) into which the project period is divided for funding and reporting purposes.

(c) Grants funds may not be used for sectarian instruction or for any religious purpose. (43 FR 54931, Nov. 24, 1978, as amended at 52 FR 19146, May 21, 1987; 57 FR 45738, Oct. 5,

45 CFR part 75-Informal grant appeals pro

cedures 45 CFR part 76—Governmentwide debarment

and suspension (nonprocurement) and governmentwide requirements for drug-free

workplace (grants) 45 CFR part 80—Nondiscrimination under

programs receiving Federal assistance through the Department of Health and Human Services effectuation of title VI of

the Civil Rights Act of 1964 45 CFR part 81-Practice and procedure for

hearings under part 80 of this title 45 CFR part 83—Regulation for the adminis

tration and enforcement of section 794 and

855 of the Public Health Service Act 45 CFR part 84—Nondiscrimination on the

basis of handicap in programs and activities receiving or benefiting from Federal

financial assistance 45 CFR part 86—Nondiscrimination on the

basis of sex in education programs and activities receiving or benefiting from Fed

eral financial assistance 45 CFR part 91-Nondiscrimination on the

basis of age in HHS programs or activities

receiving Federal financial assistance 45 CFR part 93—New restrictions on lob

bying. (52 FR 19146, May 21, 1987, as amended at 57 FR 45738, Oct. 5, 1992; 61 FR 6125, Feb. 16, 1996]

$57.1111 What other audit and inspec

tion requirements apply to grant

ees? Each entity which receives a grant under this subpart must meet the requirements of 45 CFR part 74 concerning audit and inspection. [61 FR 6125, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]


$57.1110 What additional Department

regulations apply to grantees? Several other regulations apply to grants under this subpart. These include, but are not limited to: 42 CFR part 50, subpart D-Public Health Service grant appeals procedure 45 CFR part 16-Procedures of the Depart

mental Grant Appeals Board 45 CFR part 46 Protection of human sub

jects 45 CFR part 74—Administration of grants

$57.1112 What additional conditions

apply to grantees? The Secretary may with respect to any grant award impose additional conditions prior to or at the time of any award when in his or her judgment these conditions are necessary to assure or protect the advancement of the approved activity, the interest of the public health, or the conservation of grant funds. [43 FR 54931, Nov. 24, 1978. Redesignated at 52 FR 19146, May 21, 1987; 57 FR 45738, Oct. 5, 1992)

Subparts M-O [Reserved]

Subpart P-Loan Guarantees and

Interest Subsidies to Assist in
Construction of Teaching Fa-
cilities for Health Profession

AUTHORITY: Sec. 727, Public Health Service Act. 77 Stat. 170, as amended (42 U.S.C. 293g).

SOURCE: 38 FR 31836, Nov. 19, 1973, unless otherwise noted.

agreement with a school of medicine, osteopathy, or dentistry eligible for assistance under subpart B of this part, providing for effective control by the school of the health professions teaching program in the hospital or outpatient facility.

(f) Nonprofit as applied to any school, hospital, outpatient facility, or other entity means one which is owned and operated by one or more corporations or associations no part of the net earnings of which inures, or may lawfully inure to the benefit of any private shareholder or individual.

(g) Council means the National Advisory Council on Health Professions Education (established pursuant to section 725 of the Act).

857.1501 Applicability.

The regulations of this subpart are applicable to loan guarantees and interest subsidy payments made pursuant to section 729 of the Public Health Service Act (42 U.S.C. 293i) to assist nonprofit private entities which are eligible for grants under subpart B of this part in carrying out projects for construction of teaching facilities for health professions personnel.

$57.1502 Definitions.

As used in this subpart:

(a) All terms not defined herein shall have the same meanings as given them in section 724 of the Act.

(b) Act means the Public Health Service Act, as amended.

(c) Secretary means the Secretary of Health and Human Services and any other officer or employee of the Department of Health and Human Services to whom the authority involved may be delegated.

(d) School means a school of medicine, dentistry, osteopathy, pharmacy, optometry, podiatry, veterinary medicine, or public health which provides a course of study or a portion thereof which leads respectively to a degree of doctor of medicine, doctor of dental surgery or an equivalent degree, doctor of osteopathy, doctor of optometry or an equivalent degree, doctor of podiatry or an equivalent degree, bachelor of science in pharmacy or an equivalent degree, doctor of veterinary medicine or an equivalent degree, or a graduate degree in public health, and which is accredited as provided in section 721(b)(1) of the Act.

(e) Affiliated hospital or affiliated outpatient facility means a hospital or outpatient facility (as defined in section 645 of the Act) which, although not owned by such school, has a written

$57.1503 Eligibility.

(a) Eligible applicants. In order to be eligible for a loan guarantee or interest subsidy under this subpart, the applicant shall:

(1) Be a nonprofit private school of medicine, dentistry, osteopathy, pharmacy, optometry, podiatry, veterinary medicine, or public health, or any combination of such schools, or a nonprofit private affiliated hospital or affiliated outpatient facility: Provided, however, That in the case of an affiliated hospital or affiliated outpatient facility, an application which is approved by the school of medicine, osteopathy or dentistry with which the hospital or outpatient facility is affiliated and which otherwise complies with the requirements of subpart B of this part may be filed by any nonprofit private entity qualified to file an application under section 605 of the Act; and

(2) Otherwise meet the applicable requirements set forth in section 721(b) of the Act and $57.103 with respect to eligiblity for grants for construction of teaching facilities for health professions personnel.

(b) Eligible loans. Subject to the provisions of this subpart, the Secretary may guarantee payment, when due, of principal and interest on, or may pay interest subsidies with respect to, or may both guarantee and pay interest subsidies with respect to any loan or portion thereof made to an eligible applicant by a non-Federal lender: Provided, That no such guarantee or interest subsidy shall apply to any loan the interest on which is exempt from Federal income taxation.

$57.1504 Application.

Each applicant desiring to have a loan guaranteed or to have interest subsidies paid on its behalf, or any combination of such loan guarantee or interest subsidies, shall submit an application for such assistance in such form and manner and at such time as the Secretary may require.'

(a) The application shall contain or be supported by such information as the Secretary may require to enable him to make the determinations required of him under the Act and 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 any loan guarantee or agreement to pay interest subsidies, including the applicable regulations of this subpart. (38 FR 31836, Nov. 19, 1973, as amended at 49 FR 38113, Sept. 27, 1984)

cilities, the term of the guaranteed loan, and

(2) Any such application may be approved by the Secretary only if he determines:

(i) That the applicant will have sufficient financial resources to enable him to comply with the terms and conditions of the loan;

(ii) That the applicant has the necessary legal authority to finance, construct, and maintain the proposed project, to apply for and receive the loan, and to pledge or mortgage any assets or revenues to be given as security for such loan;

(iii) That the loan will be made only with respect to the initial permanent financing of the project;

(iv) That the loan will be secured by a lien against the facilities to be constructed or against other security satisfactory to the Secretary specified in $ 57.2210;

(v) That the rate of interest on the loan does not exceed such percent per annum as the Secretary determines to be reasonable, taking into account the range of interest rates prevailing in the private market for similar loans and the risks assumed by the United States; and

(vi) Such additional determinations as the Secretary finds necessary with respect to particular applications in order to protect the financial interests of the United States.

(b) Loan guarantees. In addition to the requirements of paragraph (a) of this section, any application for a loan guarantee may be approved by the Secretary only if he determines that the loan with respect to which such guarantee is sought would not be available to the applicant on reasonable terms and conditions without such guarantee. To assist the Secretary in making such determination, each applicant for a loan guarantee shall submit statements from at least three non-Federal institutions normally engaged in making long-term loans for construction, describing whether, and the terms and conditions under which, each institution would make a loan to the applicant for the project described in the application.

(c) Interest subsidies. In addition to the requirements of paragraph (a) of

$57.1505 Approval of applications.

(a) General. Any application for loan guarantee or interest subsidies, or for a combination of both, may be approved by the Secretary, after consultation with the Council, only if he makes each of the applicable determinations set forth in section 721(c) of the Act. In addition:

(1) Any such approval shall be subject to compliance by the applicant with the applicable provisions set forth in $857.106, 57.107, 57.108, and 57.110: Provided however, That for purposes of the title assurance in $57.107(a) the period shall be not less than 20 years or the term of the guaranteed loan, whichever is longer or in the case of interim fa

'Applications and instructions are available from the Division of Facilities Conversion and Utilization, Bureau of Health Maintenance Organizations and Resources Development, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857.

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