uN

 
DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE
PUBLIC HEALTH SERVICE

_ HEALTH RESOURCES ADMINISTRATION, BUREAU

OF HEALTH SERVICES RESEARCH AND EVALUATION

 

4. DATE ISSUED (Mo., day, yrs) 2. CATALOG OF FED. Dom.

 

 

August 27, 1973 ASSIST NO

June 30, 1973
3. SUPERSEDES AWARD NOTICE dated
except that any conditions or restrictions previously imposed remain in
effect unless specifically rescinded,

 

 

 

 

 

— NOTICE OF GRANT AWARD 4. PROJECT IDENTIFICATION NO, 5. ADMINISTRATIVE CODES
5 G03 RM 00059-04A3 N/A
Under Authority of Federal Statutes and Regulations, and HSMHAI-<~ enosee? PERIOD
Policy Standards Applicable to the Following Grant Program: From 4/1/69 “| Through 19 731/73
. 7, BUDGET Sesion
REGIONAL MEDICAL PROGRAMS From 9/4/72 Through 12/31/73

 

8. TITLE OF PROJECT (OR PROGRAM) (Limit to 53 spaces)

SUSQUEHANNA VALLEY REGIONAL MEDICAL PROGRAM

9. GRANTEE (Name and Address)
Pennsylvania Medical Society
Taylor Bypass and Erford Road
Lemoyne, Pennsylvania 17043

10. DIRECTOR OF PROJECT (PROGRAM OR CENTER DIRECTOR,
COORDINATOR OR PRINCIPAL INVESTIGATOR) (Name & Address)

Mr. Chad Combs

Susquehanna Valley Regional Medical Program
1104 Fernwood Avenue, Box 541

Camp Hill, Pennsylvania 17011

 

11, APPROVEO BUDGET FOR HRA FUNDS

12, SOURCE OF HRA FINANCIAL ASSISTANCE

 

BUDGET CATEGORIES FINANCIAL DIRECT
For items identified by ASSISTANCE ASSISTANCE
A

ASterisk”, see remarks

 

a. PERSONAL SERVICES $©§6©655 65,381 $
b. PATIENT CARE,
€. EQUIPMENT > “ F - 16,230
d, CONSTRUCTION ~ ,
e. OTHER:
(Specify)
Consultant Serv. 20,933
—~ Supplies 10,923
Travel 18,312
Publications 3,647
ALL OTHER. 209,725

f. TRAINEE COSTS

 

 

 

 

g. TOTAL APPROVED

BUDGET $ 845,151

 

 

 

i4. REMARKS :

l/ Indirect costs are awarded based on
current negotiated indirect cost rates,

2/ Actual unexpended balance from the 03

budget period ($86,378) and grant related

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
by RMPS.

17. FINANCIAL MANAGEMENT OFFICIAL (Title & Address)
Assistant Treasurer

Pennsylvania Medical Society
Taylor Bypass and Erford Road
Lemoyne, Pennsylvania 17043

 

Qa. APPROVED BUOGET (11 @ Col A) $ 845, 151
b. INDIRECT ¢° TS
153,404
(RATE i7/ % $ 2
Bose: S&W-~TADC of $__
998,555
©. TOTAL $F
d. LESS UNOBLIGATED BALANCE FROM $___ 133,075 2/
PRIOR BUDGET PERIOD(S)
@. LESS CUMULATIVE PRIOR AWARD(S) $ 844,959
THIS BUDGET PERIOD
20,521
f. AMOUNT OF THIS ACTION $
13. REQUIRED GRANTEE PARTICIPATION
LL INSTITUTIONAL COST SHARING AGREEMENT
EFFECTIVE DATE
LJ inolviDUAL GRANT AGREEMENT %
[_] MATCHING AGREEMENT __ ss %
(JotHers __ ss —CsdDEXJ NOONEE REQUIRED

 

15. RECOMMENDED FUTURE SUPPORT (Subject to availability of funds)

BUDGET FISCAL BUDGET PERIOD TOTAL DIRECT COSTS
-YEAR -YEAR

 

 

16, ACCOUNTABILITY FOR EQUIPMENT

[_] CONDITIONALLY walvED ([X] NoT Walveo [_] ee BLeE

te. HRA oF FICIAL (Signature, Name and Title)
Kade. ). Ute lee i WD
Robert van Hoek, M.D., Acting Director
Bureau of Health Services Research and Evaluat:

 

 

 

 

 

 

 

pie @. PHS LIST NO, b. PAYMENT SYSTEM c. DIRECT ASSISTANCE FUNDS d, GRANTEE LOCATION CODES
GRA RM-6-74 [ HsmHa []r.0. FY s_ city 440 state __ 37
INFORM- C3tnin FY s County O41 Cong. Dist. 19
SuLY. e. ACCOUNTING DATA
7540321 04-190109 4-3990402 41.91 NIH 796789 HSM 400756

 

 

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