which is required by a school to meet an increase in student enrollment; or (d) any other project where the Secretary determines that unusual circumstances require a larger percent of participation in order to carry out the intent of Part B of title VII of the Act the amount of such grant may not exceed 80 percent of the necessary cost of construction.

(2) For purposes of paragraph (a)(1) of this section:

(i) A major expansion of training capacity at an existing school shall be construed to mean that the full-time first-year enrollment at such school, upon completion of construction, will exceed the highest fulltime first-year enrollment at such school for any of the 5 full school years preceding the year in which the application for a construction grant is made by not less than 40 students or 40 percent, whichever is greater: Provided, however, That where the Secretary determines whith respect to a particular school that such increased enrollment cannot be achieved until the second or third full school year after completion of construction, he may determine that the requirements for a major expansion of training capacity are met for each of the first or second full school years after completion of construction, if during such first or second full school year the increase in first-year enrollment will equal such amount in excess of 5 percent or five students, whichever is greater, as the Secretary may specify;

(ii) a major remodeling or renovation of a facility shall include only that portion of remodeling or renovation which is necessary to meet an increase in student enrollment, which increase shall be construed to mean that, during the first full school year after completion of construction and for each of the 9 school years thereafter the first-year enrollment will exceed the highest first-year enrollment at such school for any of the 5 full school years preceding the year in which the application is made by not less than the mandatory increase as provided for under section 770(f)(1)(A) of the Act;

(iii) unusual circumstances may be determined by the Secretary to exist: (a) Where a school is located in a geographical area of the United States

with a critical shortage of health profession manpower (as determined by the Secretary with the advice of Council);

(b) where the project is found to be necessary to prevent the curtailment of enrollment at a school;

(c) where the project is essential to the securing or maintenance of a school's accreditation; or

(d) where there are other relevant factors consistent with this subpart and the purposes of Part B of title VII of the Act.

(b) Amount of construction grantless than maximum. In determining the amount of a construction grant within the percentage limitations as set forth in paragraph (a) of this section, the Secretary shall take into consideration the most effective use of available Federal funds to further the purposes of Part B of title VII of the Act, and the needs of the applicant.

§ 57.106 Nondiscrimination.

(a) Executive Order 11246. Each construction contract under this subpart is subject to the condition that the applicant shall comply with the requirements of Executive Order 11246, 30 FR 12319 (September 24, 1965), as amended, relating to nondiscrimination in construction contract employment, and the applicable rules, regulations, and procedures prescribed pursuant thereto.

(b) Civil Rights Act of 1964. 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.), which provides that no person in the United States shall, on the grounds 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 is applicable to grants made under this part, has been issued by the Secretary with the approval of the President (45 CFR Part 80).

(c) Discrimination on the basis of sex prohibited. Attention is called to the requirements of section 799A of the Act, and to 45 CFR Part 83 which together provide that the Secretary may not make a grant, loan guarantee,

costs, costs borne by Federal funds, or costs used to match other Federal grants may not be included except as otherwise provided by law.

(2) In determining the amount of any grant under this subpart, the Secretary will evaluate the availability of funds under Federal programs authorized by laws other than the Act to support any particular component of an emergency medical services system. Such Federal programs shall include programs under legislative authorities administered by other Federal agencies, such as the Highway Safety Act and the Omnibus Crime Control and Safe Streets Act. On the basis of such evaluation, the secretary will provide assistance under this subpart only to the extent that assistance under such other legislative authorities is insufficient to enable the applicant to meet the qualitative and quantitative requirements for an emergency medical services system as described in section 1206(b)(4)(C) of the Act and § 56a.103 of Subpart A of this part.

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

(d) Neither the approval of any project nor any grant award shall commit or obligate the United States in any way to make additional, supplemental, continuation, or other award with respect to any approved project or portion thereof.

§ 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.

(3) Establishment, operation, or improvement of services or facilities in

volved in the care of patients in the normal hospital environs or in any other care facility, except for those which are customarily associated with the emergency department.

(4) Financial assistance to trainees for stipends, tuition and fees, per diem, or other reimbursement for food, lodging, etc. Domestic travel of trainees may be supported at the lesser of 10 cents per mile or the grantee's formal travel policy when justified as a necessary and integral part of an approved training program.

(5) Hospitalization costs normally borne by the patient.

(6) Acquisition of receiving and sending devices for particular individuals with auditory handicaps.

§ 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.

§ 56a.408 Reports.

Each grant awarded under section 1204 of the Act is subject to the condition that the grantee shall file with the Secretary and the Interagency Committee on Emergency Medical Services such progress and other reports as the Secretary may require, including the following:

(a) Quarterly performance reports. Within 30 days following the end of each calendar quarter (except when an annual performance report is required pursuant to paragraph (b) of this section), a quarterly performance report, which shall contain:

(1) A concise summary of the most significant achievements and problems during the grant report period.

(2) A comparison of progress with goals established for the quarter, using the grantee's implementation schedule; and where such goals were not met, a statement of why they were not met.

(3) Other pertinent information, such as changes in management organization, progress made in implementing the requirements of § 56.103 of subpart A, regionalization of emergency medical services, relevant legislation, and appropriation of State and local funds for emergency medical services activities.

report.

(b) 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.

57.201 Applicability. 57.202 Definitions.

57.203 Application by school.

57.204 Payment of federal capital contributions.

57.205 Health professions student loan funds.

57.206 Eligibility and selection of health professions student loan applicants. 57.207 Maximum amount of health professions student loans.

57.208 Health professions student loan promissory note.

57.209 Payment of health professions student loans.

57.210 Repayment and collection of health professions student loans.

57.211 Cancellation of health professions student loans for disability or death. 57.212 Repayment or cancellation of loans for practice in a health manpower shortage area.

57.213 Continuation of provisions for cancellation of loans made prior to November 18, 1971.

57.214 Repayment of loans made after November 17, 1971, for failure to complete a program of study.

57.215 Records, reports, inspection, and

Subpart E-Grants for Construction of Nurse Training Facilities

57.409 Good cause for other use of completed facility.

Subpart F-Grants to Schools of Medicine, Dentistry, Osteopathy, Optometry, Podiatry, Pharmacy, and Veterinary Medicine for Support of Their Educational Programs

57.501 Purpose and scope. 57.502 Definitions.

57.503 Enrollment increase requirement. 57.504 Waiver provisions.

Subpart G-Scholarship Grants to Schools of Medicine, Osteopathy, Dentistry, Optometry, Podiatry, Pharmacy, and Veterinary Medi

cine

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?

57.1203 What entities are eligible to apply for a grant?

57.1204 How must a school apply for a grant?

57.1205 What assurances are required of an applicant?

57.1206 What requirements may the Secretary impose?

57.1207 What are the criteria for deciding which applications will be funded? 57.1208 How will the Secretary make grant awards?

57.1209 Purposes for which grant funds may be spent.

57.1210 What nondiscrimination requirements apply to grantees?

57.1211 How must grantees account for grant funds received?

57.1212 What recordkeeping, audit, and inspection requirements apply to grantees?

57.1213 What additional regulations apply to grantees?

57.1214 What additional conditions apply to grantees?

Subpart N Grants for Dental Team Practice Training Program

57.1301 To what projects do these regulations apply?

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