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Questions & Answers For The Record -- Following Testimony by Dr. Henry Falk
Before the House Subcommittee on VA, HUD, and Independent Agencies
Provided on March 7, 2002

Questions Posed by James T. Walsh (Republican, District 25, New York), Chairman
House VA, HUD, and Independent Agencies Subcommittee


ATSDR's ROLE IN HOMELAND SECURITY

Mr. Walsh: Given your expertise in certain public health areas, are there in your opinion specific Homeland Security related activities you should be involved with that, for whatever reasons, you have not been involved with? If so, please be specific in your response.

Dr. Falk: As I mentioned in my testimony, in the aftermath of September 11th and the anthrax outbreak, ATSDR has been called upon to lend our expertise in a number of areas. These have included:

In addition, we are currently working with the Centers for Disease Control and Prevention (CDC), the New York City Department of Health (NYCDOH), EPA, and FEMA in the design and utility of a registry of residents and workers in the immediate vicinity of the World Trade Center. We also have participated in residential sampling of asbestos and other potentially hazardous materials. ATSDR will continue to assist EPA, the NYCDOH, and FEMA as they address these environmental public health issues.

This work by ATSDR has all been done in response to the World Trade Center and anthrax incidents -- i.e. a mass trauma and a biological terrorist event. I am even more concerned about the needed role that ATSDR should play in the event of a chemical or radiologic terrorist attack. We have been working with our colleagues at CDC to plan for a comprehensive and collaborative public health response to such an attack, capitalizing on our collective strengths and capabilities. Virtually all of ATSDR's expertise would be needed in such an event. This could range from providing immediate information on the toxicity of a chemical involved; to providing affected hospital emergency room physicians with emergency medical advice on diagnosis and treatment; to working with EPA and FEMA and others on environmental sampling strategies, when and how to decontaminate and reoccupy residences and businesses; or in the wake of the event, establishing followup epidemiologic studies to determine the long term health implications of people being exposed to the chemical involved. We would also be very actively engaged with both state and local health departments in support of their on-scene responses.

In addition to responses to a chemical terrorist emergency, where ATSDR would assist as part of the Federal Response in National Contingency Plans, there is a need for close coordination in preparedness planning with state and local health departments, EPA, FEMA, CDC, and others. ATSDR could have a very significant role linking state health departments with chemical terror preparedness planning underway at EPA and FEMA. ATSDR's existing Superfund program with state health departments could be readily adapted for chemical terror emergency planning.



Mr. Walsh: What specific plans does the Agency have to conduct or participate in Homeland Security related activities during fiscal 2003, and how much has been budgeted to conduct these activities?

Dr. Falk: As previously mentioned, ATSDR is well suited to consult or participate in Homeland Security-related activities. ATSDR's President's budget for FY 2003 does not detail homeland security activities nor budget for them.



Mr. Walsh: If there is more such work in this regard that you believe you should be involved in beyond what is included in the budget request, can you provide for the Record a specific list of all such work and the appropriations necessary to fund it?

Dr. Falk: There are a number of opportunities ATSDR is exploring. One focus is to build on ATSDR's already established network of cooperative agreement programs to enhance the capacity of state and local health departments to assess and respond to acts of chemical terrorism in a manner that minimizes the public health impact of such acts. This would supplement existing state cooperative agreement personnel as well as ATSDR staff who assess the public health implications of acute toxic releases. Increasing the number of technical experts at the state and regional levels will facilitate planning, preparedness, rapid response, assessment, and follow up. In this effort, ATSDR anticipates linking closely to FEMA and its community emergency preparedness planning activities, CDC and its support to states for biological terrorism, the Health Resources and Services Administration and its state support for hospital infrastructure, EPA and its program for environmental assessment and cleanup, and related programs at the National Institute for Environmental Health Sciences, NIH, and elsewhere. This activity would enable ATSDR to:

A core functions of ATSDR is surveillance. ATSDR Hazardous Substance and Emergency Events Surveillance System (HSEES) is a nationally recognized resource for tracking acute hazardous environmental exposures. HSEES was established to collect and analyze information about the public health impact of acute releases of hazardous substances. The goal of HSEES is to help reduce the morbidity and mortality experienced by first responders, employees, and the general public as a result of hazardous substances emergencies. We are investigating ways that this system can be enhanced to better identify emerging public health threats. Issues being considered include: expanding the number of states participating in the program (currently there are 16), adding the ability to analyze real-time data from the nation's poison control centers to augment information about chemical exposures, and standardizing and adding to data collection to enable better information delivery. Expected outcomes would include:

It is anticipated that $25 million in FY 2003 would cover the cost of these Homeland Security related activities.



MANAGEMENT REFORMS

Mr. Walsh: Was the proposal to institute these management reforms generated from within ATSDR before pass back of the 2003 budget by OMB?

Dr. Falk: ATSDR in conjunction with the Centers for Disease Control and Prevention (CDC ) submitted a "Restructuring and Delayering Plan" that articulated several initiatives and goals to promote greater economies of scale, eliminate duplication, and provide better delivery of service. This plan supports the restructuring goals set forth in OMB Bulletin No. 01-07, which emphasizes reducing the number of managers, reducing organizational layers, reducing the time it takes to make decisions, increasing the span of control, and redirecting employees to positions for directly delivering customer services. It also augments and builds upon the President's Governmentwide Management Reforms. ATSDR in conjunction with CDC is developing plans to coordinate and monitor the progress for each delayering goal.



Mr. Walsh: Will you start the reforms in fiscal 2002 or wait until after the 2003 bill is signed into law?

Dr. Falk: The implementation of these reforms will not occur until FY 2003.



Mr. Walsh: Do you anticipate that these reforms or the slight reduction in R & D contracting will cause you any disruption in the operation or delivery of any of your programs or activities?

Dr. Falk: The reforms will necessitate some accommodations, however we will seek to ensure that these have limited impact on programs.



FY 2003 ATSDR CHILDREN's HEALTH PLANS

Mr. Walsh: Three of the more visible, active projects currently being pursued by the Agency are the Children's Health Program and the Fallon, Nevada and Libby, Montana health assessment projects. Can you please give the Subcommittee a brief explanation of the work you are currently doing and plan to do in fiscal 2003 on the Children's Health Program?

Dr. Falk: ATSDR's Child Health Initiative targets funding at projects that specifically address child-health issues in all agency programs and public health actions. This initiative has achieved important benefits for children who dwell near hazardous waste sites and forged collaborative partnerships with academic medical centers and other governmental and nongovernmental organizations. ATSDR modified many of its public health programs and added new actions to improve its focus on children's special vulnerabilities. ATSDR's Child Health Initiative has been cited by professional groups as a model federal program. Agency activities planned in 2003 include:



FY 2003 DETAILS ON CHILDREN HEALTH, LIBBY, AND FALLON

Mr. Walsh: Then, for the Record, please provide a more detailed review of what you propose to do in these three areas during fiscal 2003, including expected costs, FTE requirements and other such appropriate information.

Dr. Falk: Children's Health Program: ATSDR has established a firm commitment to incorporating children's issues in our products and programs. Specific agency activities related to children's health planned in 2003 include the following.

In FY 2003, we have identified over $3 million in support of Child Health programs. There are 2 FTE assigned to coordinate children's health activities.

Libby, Montana: ATSDR is working in collaboration with EPA, the Montana Department of Public Health and Human Services and the Lincoln County Environmental and Health Department to identify asbestos-related health effects, and also to:

We project that 7 FTE and at least $2 to 3 million will be required for FY 2003.

Fallon, Nevada: ATSDR has a number of activities underway in response to concerns about high rates of childhood leukemia in the Fallon area. Information about these activities follows.

We currently have several staff FTE devoted to this effort. Subsequent funding and staffing depend on the findings of the investigations that are currently underway; if possible they will be conducted with existing resources.



STATUS OF FY 2002 NATIONAL ENVIRONMENTAL SURVEILLANCE

Mr. Walsh: As I noted in last year's hearing, ATSDR proposed and has now implemented a new program -- NESP -- to which you expect to devote $2.5 million and five [CORRECTION - SHOULD BE 2] full time equivalent positions during the current fiscal year. According to last year's justification document, "the NESP at Superfund sites would assist in focusing on interpretations of causality between human exposure to toxic substances and health effects." Dr. Falk, can you please give the Committee an idea of how this effort is proceeding as we come to the halfway point of the fiscal year.

Dr. Falk: ATSDR is focusing particularly on diseases of concern at Superfund sites (e.g. neurological) while coordinating with CDC and others on the use of existing databases (e.g. cancer and birth defects). Workshops of experts and state health department personnel will be held in the summer of 2002 to assess what disease(s) should be considered for new pilot tracking projects, develop tracking guidelines, and case definitions. Diseases for which workshops are initially planned are autoimmune diseases (rheumatoid arthritis, lupus, scleroderma, Hashimoto's thyroiditis) neurodegenerative diseases (Amyotrophic Lateral Sclerosis - ALS, Multiple Sclerosis - MS, Parkinson's, Alzheimer's), and neurodevelopmental diseases.

Additionally, grants for linking environmental databases with health outcome databases will be awarded this year to at least two, and hopefully three, state health departments to develop hypotheses for future epidemiologic studies. These pilot projects will also be used by ATSDR in developing guidelines for state health departments who would like to conduct similar projects. We are in the process of preparing the grant announcement at this time.

In addition to our work on Superfund-related issues, ATSDR is coordinating with CDC on disease tracking. Staff from ATSDR are currently working with CDC and a significant number of State and outside experts to develop detailed guidelines for a CDC-funded Environmental Health Tracking Network grant program. ATSDR believes that this program would benefit Superfund communities concerned about high rates of chronic disease.



FUTURE PLANS - NATIONAL ENVIRONMENTAL SURVEILLANCE PROGRAM

Mr. Walsh: Can you also please enlighten us on what you expect to accomplish with this program for the remainder of fiscal year 2002 and during fiscal 2003?

Dr. Falk: We will enhance our work already established in the areas of childhood asthma and multiple sclerosis, expanding to new states. We will increase the focus on studying certain diseases based on information from our state and local partners.

Workshops of experts and state health department personnel will be held in the summer of 2002 to assess what disease(s) should be considered for new pilot tracking projects, develop tracking guidelines, and case definitions. From those diseases for which workshops are planned, we will determine which will afford the best possibility for collecting data that can be used to develop true prevalence rates. In 2003, we plan to fund projects to develop the systems to collect data on those identified diseases.

We will expand our relationships with other federal, state, and local agencies to collect information using the tracking system once it is established.




STATUS OF STATE ROLE IN NATIONAL ENVIRONMENTAL SURVEILLANCE

Mr. Walsh: According to past budget materials, major elements of your plans for NESP include support for state health departments in establishing pilot surveillance systems and support for states and state-based universities in conducting research associated with Superfund sites. Once again, how are your plans proceeding in this regard?

Dr. Falk: As previously stated, in fiscal year 2002 we will be supporting at least two, and hopefully three, states in establishing pilot surveillance systems in our "linking" projects. We will also continue to support states and state-based universities in our focused research in asthma and multiple sclerosis.



ANTICIPATED ROLE OF STATES AND UNIVERSITIES IN NESP

Mr. Walsh: Is it still your expectation that states and universities are to be given an opportunity to compete to participate in this program?

Dr. Falk: Yes, we are developing a grant program for states and state-based universities.



PROGRESS OF NESP

Mr. Walsh: Last year, you testified that you expected the NESP to be fully operational by the end of fiscal 2002. Has anything happened which could possibly result in a change in that goal?

Dr. Falk: We have had slight delays while responding to chemical and biological terrorist attacks and threats in the wake of September 11th. However, we should be able to get back on target by funding all initial awards by the end of fiscal year 2002.



FY 2003 PLAN FOR GREAT LAKES PROGRAM

Mr. Walsh: Each year we ask about the ongoing Great Lakes Fish Consumption Study, and I would note that your budget justification includes some detail on what you are doing in this regard as well as your response to certain related Committee directives. Can you please briefly provide us a summary of what you expect to accomplish in this regard during fiscal 2003?

Dr. Falk: The expected accomplishments of the ATSDR Great Lakes Human Health Effects Research Program for FY 2003 are:



FUNDING SOURCE AND PROJECTIONS FOR GREAT LAKES PROGRAM

Mr. Walsh: Can you give us an idea of the funding, federal and otherwise, that has to date been provided to this project, and your estimate of what it will take in terms of finances and time to finish the project? What remains to be studied to complete this project?

Dr. Falk: ATSDR has provided approximately $25 million in support of Great Lakes Human Health Effects Research Program (GLHHERP) since FY 1992. ATSDR is the only funding source for this research-based program. At the current funding levels, it is expected that this project will require approximately $5 million over a four-year period to complete.

Additional key activities necessary to complete this research project are:



HAZARDOUS SUBSTANCES EMERGENCY EVENT SURVEILLANCE

Mr. Walsh: With regard to the Hazardous Substances Emergency Events Surveillance (HSEES) program, you have reported that the use of the system data promotes the prevention of environmental injuries, including changes to municipal emergency plans, and has resulted in a reduction of the number of deaths experienced by HAZMAT first responders. In light of the events of last fall can you give us an updated report as to what ATSDR is now doing with this program, including any changes you have instituted since last year's hearing?

Dr. Falk: The goals of the Hazardous Substances Emergency Events Surveillance System (HSEES) are to describe the spacial and temporal distribution of hazardous-substances emergencies; to describe the morbidity and mortality experienced by employees, responders, and the general public; to identify the risk factors associated with the morbidity and mortality; and to develop strategies to reduce subsequent morbidity and mortality. ATSDR currently funds 16 states to participate in HSEES

Events reported to and captured in HSEES are usually from spills in factories or during the transportation of chemicals. We have been working with these states to input the data into the system in a more timely manner. We are developing computer programs that will analyze data on an ongoing basis to more quickly identify chemical events, unusual clusters of events, and emerging health impacts so that these "unusual" events can be identified and referred to the appropriate authorities for further investigation. These "unusual" events could include acts of chemical terrorism. In this respect, HSEES could serve as an "early warning system" for terrorist events.

We hope to have a mapping capability within the system this year which will allow a visual representation of the spills and help identify vulnerable populations, such as hospitals, schools, and nursing homes, that could be impacted by the spills. We are working with FEMA to use this information to assist communities in preparing for chemical disasters.

ATSDR also is considering ways to add a rapid-response element to the HSEES data. One way to do this is working more closely with the nation's poison control centers. Most of the 60 regional poison control centers in the US collect data and computerize them in real time. By collaborating with this network, the federal government could learn, literally within minutes, of any unusual number of chemical casualties reported to the regional poison centers anywhere in the US.

Ideally, the reporting system should be extended to additional, possibly all, states and be linked with state activities in chemical terrorism preparedness and response.



RELATIONSHIP WITH FEMA AND OTHERS IN EMERGENCY PLANNING

Mr. Walsh: You reported last year that ATSDR coordinated its work on this program with FEMA and other federal agencies, particularly with regard to changing municipal emergency response plans. Again, since September of last year, has your relationship with FEMA or any other federal agencies changed in any way?

Dr. Falk: Last spring ATSDR began meeting regularly with FEMA's Division of Technological Services, now part of its Office of National Preparedness. FEMA initiated these discussions with ATSDR, because it was concerned that, when municipal emergency response plans were tested, medical preparedness/response and involvement of state and local health departments clearly are high priorities.

Our discussions clearly intensified as a result of the 9/11 impact, and we have more explicitly considered how ATSDR could be of benefit to FEMA, particularly in relation to planning and responding to chemical and other technological forms of terrorism. Consequently, last fall ATSDR and FEMA's Division of Technological Services began three working groups. The objective of these working groups was to identify precise ways ATSDR and FEMA could work together to improve local emergency medical preparedness; to integrate ATSDR and FEMA geographic information systems databases (e.g., HSEES), and to identify mechanisms for future collaboration. We are coordinating closely with the DHHS Office of Public Health Preparedness in our discussions with FEMA.

The first step in piloting working-group recommendations is ATSDR providing technical assistance to FEMA's Comprehensive HAZMAT Emergency Response -- Community Assessment Program (CHER-CAP) at 3 Local Emergency Preparedness Committees (LEPCs). The 3 LEPC pilots are located in Ithaca, New York, Tri-Town (New London, Waterford, East Lyme) Connecticut and Carlisle, Pennsylvania. Partnership activities are presently underway with the Tri-Town, Connecticut LEPC, with activities at Ithaca, New York and Carlisle, Pennsylvania to follow.

Coordination and collaboration has also improved with other federal agencies which have shown particular interest in ATSDR's expertise in health care provider education, toxicology, and environmental assessment. For example, in response to the collapse of the World Trade Center towers, ATSDR was named lead from the Department of Health and Human Services on the federal Environmental Assessment Working Group, which is co-chaired by EPA and the Occupational Safety and Health Administration (OSHA). The working group has coordinated public health and occupational sampling and data review among the federal agencies in support of the NYCDOH and the New York State Department of Health.



TERRORIST RESPONSE/PREPAREDNESS ACTIVITIES RELATIONSHIPS

Mr. Walsh: Have your relationships in fact been enhanced or improved since last fall?

Dr. Falk: The events of last fall made it clear that strong collaboration is not characterized by a series of bilateral relationships -- a variety of agencies must work in concert toward common goals. ATSDR strives to improves these efforts by serving an active liaison and coordinating role. Since last fall there has been both increased and improved collaboration between ATSDR, EPA and FEMA, as well as within the Department of Health and Human Services (HHS) itself. For example, HHS is already devoting resources to plan how all HHS agencies and FEMA's Office of National Preparedness will work together to ensure a strong homeland security. A potential role for ATSDR with FEMA's Office of National Preparedness will be defined through that agreement.

The events of last fall suggest that local first-responders may respond to a counter-terrorism incident of multiple and simultaneous terrorist attacks. Examples of potential coordination might be:



WORK FOR OTHER GOVERNMENTAL AGENCIES

Mr. Walsh: In addition to its appropriated dollars, the ATSDR expects to receive approximately $25 million in reimbursements for work performed on behalf of other governmental agencies. Please provide for the Record a list of the entities from whom you expect to receive such reimbursements, the dollar amount you expect to receive, and a brief description of the work you will perform for these entities.

Dr. Falk: ATSDR's FY 2003 Congressional Justification (CJ) reflects projected reimbursements of $25 million. Our projection of FY 2003 reimbursable effort was done in October 2001. Since that time, budget projections have been revised. For example, based upon information from the Department of Energy the anticipated FY 2003 funding level for ATSDR has changed from $10.5 million to $5.4 million. The anticipated level of reimbursement from all of these other government agencies in FY 03 is approximately $13.5 million. Following is a current breakout of our estimated reimbursable funding by agency with a brief description of the activities being performed.

Agency Projected Amount Description
Department of Energy $5,400,000 Assessing the presence and nature of health hazards at specific DOE hazardous waste sites.
Department of Defense $5,600,000 Assessing the presence and nature of health hazards at specific DoD hazardous waste sites.
Department of Interior
Bureau of Indian Affairs
$250,000 Assessing the presence and nature of health hazards at specific DOI/BIA hazardous waste sites.
U.S. Agency for
International Development
$890,000 Assisting in the evaluation of toxic chemical exposures and potential health effects and providing expert consultation and assistance.
USDA $275,000 Assessing the presence and nature of health hazards at specific USDA hazardous waste sites.
NIEHS $100,000 Support for Neurodevelopmental Test Methods Program. A research project to determine and validate a battery of test methods for assessing neurodevelopmental effects from pre/and postnatal exposure to hazardous substances.
FDA $10,000 Support for Neurodevelopmental Test Methods Program
EPA $1,025,000 Support Pediatric Environmental Health Specialty Units; Neurodevelopmental Test Methods Program; Lead and Cadmium Exposure Project; Lead Exposure Health Study - Jasper County; Blood Lead in Pre-school children - Oklahoma
Total $13,525,000



STATUS OF GREAT LAKES HUMAN EFFECTS PROGRAM

Mr. Walsh: Can you update us on the progress of the Great Lakes Human Health Effects Research Program?

Dr. Falk: The ATSDR Great Lakes Human Health Effects Research Program (GLHHERP) supports ten cohort studies of vulnerable communities. These cohorts include about 14,000 individuals such as young children first studied at birth, subsistence anglers, American Indians, reproductive aged men and women, and the elderly. The ATSDR's GLHHERP has made significant progress in reporting and evaluating findings that address public health issues from exposure to contaminants in the basin. One primary reason for this progress is that the program has focused its research efforts on assessing health outcomes in communities of concern by virtue of their intrinsic physiologic sensitivity and/or elevated exposure to toxic chemicals in Great Lakes sport fish. These susceptible populations have been identified above. The key research findings from this program to date include:



Questions Posed by Joseph Knollenberg (Republican, District 11, Michigan)


RISK COMMUNICATION IN GREAT LAKES REGION

Mr. Knollenberg: I understand that women and minorities are susceptible populations in the Great Lakes basin because they are generally less knowledgeable about fish advisories than other segments of the population. Can you tell me about your efforts to inform them of these risk?

Dr. Falk: ATSDR works with local and state health departments, other federal agencies (e.g., EPA), and the affected communities to develop culturally-appropriate risk communication messages about consuming contaminated fish. These risk communication messages and public health intervention methods are in various forms, including:



STATUS OF MICHIGAN FISH CONSUMPTION PILOT PROGRAM PROPOSAL

Mr. Knollenberg: I can see in your budget justification that the Agency has submitted a feasibility report to OMB concerning a pilot program for increasing the reach and effectiveness of fish consumption advisories in Michigan. What is the status of this pilot program?

Dr.Falk: The report entitled, "Feasibility of Pilot Program to Educate At-Risk Populations about Fish Consumption Advisories in the state of Michigan" was delivered to Congress on January 17, 2002; we are awaiting further guidance.



CLARIFICATION OF MICHIGAN FISH REPORT VS. GREAT LAKES PROGRAM

Mr. Knollenberg: How does the pilot program differ from your current activities in the Great Lakes Human Health Effect Research program?

Dr.Falk: In response to a Congressional directive, ATSDR developed a proposal to pilot a risk communication and public health intervention program to susceptible populations, particularly those in the Upper Peninsula of Michigan.

By way of background, the state of Michigan has approximately 132 fish consumption health advisories for its numerous waterways. Their outreach efforts to educate the public about health advisories have been aimed at reproductive age women and anglers. Although these programs have the intent of serving the entire state, some less populated areas, such as Michigan's Upper Peninsula area, have not received the benefit of these programs because of their remote location and low population density.

Fifteen counties are located in Michigan's Upper Peninsula. Despite this low population density, the area has a specific need for health education about fish advisories. Many residents fall in the at risk groups of reproductive age women and minorities, including American Indians. In addition, many of the residents depend heavily on sport fish as a subsistence food. Because the population is spread out over a large and often remote area, the process of educating groups of residents in this 15 county area is made more difficult. For this reason, ATSDR proposed a pilot project that would provide these residents with outreach education helping them to make decisions that would minimize their exposure to contaminants in Great Lakes sport caught fish.

ATSDR's Great Lakes Human Health Effects Research Program has focused on research. The research findings have provided a foundation for public information and education efforts such as those targeting Michigan.



Questions Posed by Carrie Meek (Democrat, District 17, Florida)


SUPPORT FOR SUBSTANCE-SPECIFIC APPLIED RESEARCH PROGRAM

Ms. Meek: What do we need to do this year to ensure that the Cooperative Agreement on Environmental Health and Toxicology Research is both fiscally and programmatically sound?

Dr. Falk: ATSDR, in collaboration with the Minority Health Professions Foundation (MHPF), is working to develop a new 5-year cooperative agreement program to be initiated in the first quarter of FY 2003. The new program will maintain a focus on substance-specific applied research while being expanded to include other areas of environmental health. These activities will focus on environmental public health issues that particularly impact low-income and minority communities adjacent to Superfund sites.

Past language in the VA/HUD Appropriations conference reports has consistently reflected Congressional support for the program. Unfortunately, in recent years due to new and competing priorities, ATSDR was not able to maintain funding at the original level. Nevertheless, the Agency remains committed to continue substance-specific applied research program to include expansion into other areas of environmental public health.

We are encouraged with the responsiveness of the new leadership of the MHPF organization in the planning of our new cooperative agreement. I was particularly impressed with the program at Florida A & M University during my recent visit to that institution with Drs. Henry Lewis and Cynthia Harris. It is very clear that our cooperative agreement has been of real benefit to both FAMU, other participating historically black colleges and universities, and ATSDR. We hope to gain comparable value from our new cooperative agreement program to start next year.

ATSDR and the MHPF are working together to determine the highest program priorities and procedures to ensure fiscal and programmatic effectiveness. For example, ways to ensure evaluation planning and practice are being considered as the plans for the next cooperative agreement program are being made.

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Oral & Written Testimony - March 7, 2002

This page last updated on April 1, 2002

Contact Name: Joanne Cox/ ATSDR-OpeaMail@cdc.gov


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