(c) Allotments, quarterly estimates, and payments. After the approval of a State plan the Chief of the Children's Bureau sends a notice of the approval to the Commissioner of Social Security who makes the allotment of funds and provides for payments to the States by signing the following 3 documents: (1) the annual allotment of funds for services for crippled children to the State in accordance with the approved apportionment of funds from CC Fund A and the quarterly allotment from CC Fund B in accordance with funds requested in the State plan as approved; (2) the estimate for the first quarter's payment based on the State quarterly estimate of expenditure submitted with the State plan; and (3) the voucher for the first payment certified by the Chief of the Children's Bureau.

(i) Allotments for CC Fund A are made on the basis of estimated needs of the States but the first allotment each year is in an amount not less than $30,000. Allotments for CC Fund B are made on the basis of estimates submitted quarterly by the State agency taking into consideration unexpended balances in the States.

(ii) Subsequent quarterly and special interim allotments, estimates, and vouchers are similarly submitted to the Commissioner for Social Security who signifies his approval by signing the documents submitted.

(iii) The vouchers for payments to the States as certified by the Chief of the Children's Bureau and the Commissioner of Social Security are listed on a schedule of disbursements which is sent with the vouchers to the Secretary of the Treasury as the basis for payments to the States.

(d) Review of operation and consultation service. For purposes of information on the operation of the State plan reports are submitted to the Children's Bureau by the State crippled children's agencies.

(1) Financial reports on State services for crippled children include reports on joint financial report forms as listed for financial reports under grants to States for maternal and child health services (§ 206.6(d)).

(2) Reports on services for crippled children are made on the following forms: (i) CC 51-Quarterly Statistical

Report of Services for Crippled Children; (ii) CC 52-Quarterly Report-Children on State Registers; and (iii) CC 55 (Special report) Crippled Children on State Register as of December 31-Age, Race, Sex; Diagnosis and Age.

(3) Annual Progress Reports for Services for Crippled Children under the Social Security Act, Title V, Part 2, not called for since the fiscal year 1941, will again be submitted annually.

(4) State crippled children's agencies are asked to report at the close of each year information regarding (i) the unduplicated count of crippled children who have received service during the year and (ii) the total amount expended for crippled children's services for the calendar year.

(5) The regional medical, nursing, medical-social, and nutrition consultants at intervals visit each State crippled children's agency and confer with the executive officer of the agency, the director of services for crippled children, and other members of the staff on the operation of the State plan, problems that have arisen and ways of extending and improving services for crippled children. Together with the State staff visits are made to local health departments, clinics, hospitals, and other facilities used in the program. Special consultation service from the headquarters staff of the Children's Bureau is given on request.

(6) Occasionally, the regional staff team, together with special consultants from the headquarters staff of the Division of Health Services, makes a joint administrative review of the operation of the State plan for services for crippled children.

Auditors

(e) Audit of expenditures. from the State Audits Unit visit each State crippled children's agency to make an audit on a test or detail basis, depending on auditor's findings, of expenditures for the previous year under the State plan for services for crippled children from Federal funds and State, local and private funds used for matching Federal funds under the crippled children's program (CC Fund A). Advice is given to State officials on the keeping of accounts and records relating to the budgets and financial reports under the State plan for services for crippled children.

(f) Withholding of Federal payments. Under section 515 of the Social Security Act as amended in the case of any State plan for services for crippled children which has been approved by the Chief of the Children's Bureau, if the Commissioner for Social Security, after reasonable notice and opportunity for hearing to the State agency administering or supervising the administration of such plan, finds that in the administration of the plan there is a failure to comply substantially with any provision required by section 513 to be included in the plan, he shall notify such State agency that further payments will not be made to the State until he is satisfied that there is no longer any such failure to comply. Until he is so satisfied he makes no further certification to the Secretary of the Treasury with respect to such State.

(g) Hearings. At hearings held as required under section 505 of the Social Security Act as amended, the Commissioner of Social Security presides and the hearings are conducted in accordance with sections 5 and 7 of the Administrative Procedure Act.

As used in this part:

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

(b) "Department" means the U.S. Department of Health, Education, and Welfare.

(c) "Bureau" means the Children's Bureau of the Social and Rehabilitation Service.

§ 208.3 Eligibility for grants.

The Bureau is authorized to make grants under this part:

(a) To the State health agency of any State;

(b) With the consent of such agency, to the health agency of any political subdivision of the State; and

(c) To any other public or nonprofit private agency, institution, or organization.

§ 208.4 Application.

(a) Any applicant for a grant under this part may file application therefor with the Regional Commissioner of the Social and Rehabilitation Service, for the region of the Department in which the project is to be conducted, on such forms and containing such information as the Bureau may prescribe. The application shall contain a budget and a narrative plan of the way the applicant intends to conduct the project and carry out the requirements of this part. A revision of the budget and project plan is required whenever there is to be a significant change in the scope of project activities.

(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, including this part and the policies and procedures for these grants.

(c) The applicant will be notified of action taken on his application. If a grant is made, the initial award 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.

§ 208.5 Matching requirements.

Federal funds will be granted on the basis of project applications and will not exceed 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 on-going activities of the grantee agency which are made a part of the project. 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.

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 be those which; (a) are found, upon investigation by the grantee, to be best adapted for the attainment of the specific purpose, (b) will assume a reasonably high standard of care, and (c) are in substantial accordance with national standards as accepted by the Social and Rehabilitation Service or standards prescribed by the Social and Rehabilitation Service. However, if a project is planned for an area in which it is not possible to meet such standards, the best available resources must be used, and steps must be taken to improve the care. The application must include a description of such steps.

§ 208.7 Availability of services.

Services in the project must be available:

(a) Without any requirement for legal residence except that the person

or family is currently living in the area served by the project;

(b) Upon referral from any source including the patient's own application; (c) With respect for the dignity of the individual;

(d) With efficient administrative procedures for registration, avoiding prolonged waiting and multiple visits for registration;

(e) Without regard to race, religion, national origin, or maternity or marital status; and

(f) Only to persons who are of low income or who for other reasons beyond their control could not 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 someone on the project staff designated by him, and shall be made in accordance with this section, policies and procedures governing the project, and the project plan and budget as approved.

(a) Acceptance of services 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 the 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 counselling, and interpretation to individuals of the services provided.

(e) Family planning medical services should 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.

(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 § 208.6. Grantees will maintain a schedule of rates for such services.

(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 for inpatient hospital care and physicians' services rendered in hospitals, and then only to the extent that payment will be made by a third party (including a government agency) which is authorized or is under legal liability to pay such charges.

§ 208.10 Confidentiality of information.

All information as to personal facts and circumstances obtained by the project staff shall constitute 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 individuals.

§ 208.11 Project expenditures.

particular

(a) Project funds (Federal and matching) are available for the direct costs of operating and maintaining the

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

§ 208.12 Interest and other income.

(a) Pursuant to section 203 of the Intergovernmental Cooperation Act of 1968 (Public Law 90-577), 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 other grantees must return to the Social and Rehabilitation Service all interest earned on grant funds.

(b) All grantees must return to the Social and Rehabilitation Service a part of any other project income proportionate to the grant contribution to the support of the project.

Items of equipment purchased with project funds are to be used for the purposes of the project, and the grantee shall maintain complete equipment inventory and adequate property controls. § 208.14 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.

A grant may be terminated in whole or in part at any time at the discretion of the Administrator of Social and Rehabilitation Service. 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.

§ 208.17 Records and reports.

(a) The grantee shall maintain such records, including medical, fiscal, and other health records, and make such reports, as the Bureau may prescribe.

(b) All fiscal transactions by a grantee relating to grants under this part are subject to audit by the Department to determine whether expenditures have been made in accordance with this part, policies and procedures governing the project, and the project plan and budget as approved.

§ 208.18 Copyright.

The Government of the United States reserves a royalty free, nonexclusive license to use and authorize others to use all copyrightable or copyrighted material resulting from a project.

§ 208.19 Effect of payment.

Neither the approval of a project plan nor any certification of funds or payment to a grantee pursuant thereto shall be deemed to waive the obligation of the grantee to observe before or after such action any Federal requirements, or to waive the right or duty of the Administrator of Social and Rehabilitation Service to withhold funds for noncompliance with Federal requirements.