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                                                                                             .1. DATE ISSUED (7VIO., day, Yr.)        2. CATALOG OF FED. DOM.
                                    DEPARTMENT OF                                                                                        ASSIST. NO.
                      HEALTH, EDUCATION, AND WELFARE                                           August 27, 1973                              13.249
                               PUBLIC      HEALTH      SERVICE
                                                                                                                                           June 30, 1973
          -iIEALTH RESOURCES ADMINISTRATION, BUREAU                                          3. SUPERSEDES AWARD NOTICE dated
                                                                                             except that any conditions or restrictions previously imposed remain in
          OF HEALTH SERVICES RESEARCH AND EVALUATION                                         effect unless specifically rescinded.
                           NOTICE OF GRANT AWARD                                             4. PROJECT IDENTIFICATION No.            B. ADMINISTRATIVE CODES
                                                                                             5 G03 RM 00059-04A3                               N/A
          Under Authority of Federal Statutes and Regulations, cind HSMHA                    f,. PROJECT PERIOD
          Policy Standards Applicable to the Following Grant Program:                        FROM       4/l/69                          Thr-ough 12/31/73
                                                                                             7. BUDGET PERIOD
                       REGIONAL MEDICAL PROGRAMS                                             FROM        9/l/72                           T@-ugh 12/31/73
          a. TITLE OF PROJECT JOR PROGRAM) (Limit to 53 spaces)
                                         SUSQUEHANNA   VALLEY   REGIONAL   MEDICAL   PROGRAM
          9. GRANTEE (Name and Address)                                                      10.   DIRECTOR   OF   PROJECT   (PROGRAM    OR    CENTER    DIRECTOR.
                                                                                             COORDINATOR OR PRINCIPAL INVESTIGATOR@ (Name & Address)
          Pennsylvania    Medical    Society                                                 Mr. Chad Combs
          Taylor  Bypass  and  Erford   Road                                                 Susquehanna Valley Regional Medical Program
          Lemoyne, Pennsylvania                      17043                                   1104  Fernwood  Avenue,  Box   541
                                                                                             Camp Hill, Pennsylvania                     17011

          it.    APPROVED     BUDGET     FOR     HRA     FUNDS                               12. SOURCE OF  HRA   FINANCIAL ASSISTANCE

          BUDGET CATEGORIES                        FINANCIAL            DIRECT
          For items identifiedby                  ASSISTANCE         ASSISTANCE                                                                        845,151
          Asterisk*, see re,3iarke                 A                       B                 0. APPROVED BUDGET (11 g. Col. A)                 $
          a. PERSONAL SERVICES         s         565,381                                     b. INDIRECT Irl TS                                $       1535404
                                                                   $                         (RATE _                 %
          b. PATIENT CARE                                                                    Bose:         S&W-TADCof$                                 998,555
          ,6. EQUIPMENT                            16,230                                    C. TOTAL                                          $
          d. CONSTRUR- TION                                                                  d. LESS UNOBLIGATE:D BALANCE FROM                 s       133,075      2/
          e. OTHER:                                                                          i?RIOR BUDGET PERIOD(S)
          (Specify)                                                                          a. LESS CUMULATIVE PRIOR AWARD(S)                 $       844,959
          Consultant Serv.                         20,933                                    THIS    BUDGET     PERIOD
          Supplies                                 10,923
          Travel                                   18,312                                                                                               20,521
          Publications                               3,647                                   f. A'MOUNT OF THIS ACTION              $
          ALL     OTHER                         209'@725                                     13. REQUIRED        GRANTEE         PARTICIPATION
          TRAINEE COSTS                                                                           INSTITUTIONAL C09T SHARING AGREEMENT
                                                                                                  EFFECTIVE       DATE

          g. TOTAL APPROVED                                                                       INDIVIDUAL GRANT AGREEMENT                          %
          BUDGET                        s        845,151                                     F-] MATCHING AGREEMENT                        %
          14.REMARKS                                                                         n OTHER S                     EX NONE REQUIRED
          1/  Indirect costs are awarded based on                                            15. RECOMMENDED FUTURE SUPPORT (Subject to availability of funds)
          current negotiated indirect cost rates.
          2/  Actual unexpended balance from the 03                                          BUDGET       FISCAL       BUDGET       PERIOD  TOTAL DIRECT COSTS
          budget period ($86,378) and grant related                                          'YEAR           'YEAR
          income ($46,697).
          Amended Award issued June  30, 1973,
          provided $213,960 additional funds in items
          lla, 12a and 12f.  These funds remain un-
          available for expenditure until advised                                            16. ACCOUNTABILITY FOR EQUIPMENT
          by- RMPS.                                                                               CONDITIONALLYWAIVED   ff] NOT WAIVED               Ej NOT AP-
                                                                                                                                                          PLICABLE
          17. FINANCIAL MANAGEMENT OFFICIAL (Title & Address)                                is.  HRA  OFFICIAL  (Signature,  Name  and   Title)
          Assistant Treasurer
          Pennsylvania    Medical    Society
                                                                                             (    kL @ @ )-@"I   @@   r , @ ? (, ,),-  i.@)
          Taylor Bypass and Erford Road                                                      Robert van Hoek, M.D., Acting Director
          Lemoyne, Pennsylvania                     17043                                    Bureau of Health Services Research and Evaluat

          q.            0. PHS LIST NO,           b. PAYMENT SYSTEM              C. DIRECT      ASSISTANCE       FUNDS          d. GRANTEE LOCATION         CODES
          FOR
          RRA           RM-6-74                      F- HSMHA nR.O.                     FY          s                           City 440           State         37
          INFORM-                                                  [:RN I H         F        Y      S                               County         Cong. Dist.   9@
          ATION         a. ACCOUNTING DATA
          ONLY                                                                               -
                                   7540321 04-190109              4-3990402         41.91  NIH        796789 HSM 400756

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