RAPID ASSESSMENT POST-IMPACT OF DISASTER

RELEASE DATE:  July 24, 2002 (see NOT-DA-05-013 and NOT-MH-04-001) 

PA NUMBER:  PAR-02-133

March 2, 2006 (NOT-OD-06-046) – Effective with the June 1, 2006 submission date, 
all R03, R21, R33 and R34 applications must be submitted through Grants.gov using 
the electronic SF424 (R&R) application. Replacement R03 (PAR-06-252) and 
R21 (PAR-06-253) funding opportunity announcements have been issued for the 
submission date of June 1, 2006 and submission dates thereafter.

EXPIRATION DATE:  December 2, 2005 (Program extended, see NOT-MH-05-018)

National Institute of Mental Health (NIMH)
 (http://www.nimh.nih.gov/)

THIS PA CONTAINS THE FOLLOWING INFORMATION

o  Purpose of the PA
o  Research Objectives
o  Mechanism(s) of Support
o  Eligible Institutions
o  Individuals Eligible to Become Principal Investigators
o  Special Requirements
o  Where to Send Inquiries
o  Submitting an Application
o  Peer Review Process
o  Review Criteria
o  Award Criteria
o  Required Federal Citations

PURPOSE OF THIS PA

This Program Announcement (PA) replaces PA-91-04, which was published in the NIH 
Guide for Grants and Contracts, Vol. 19, No. 40, November 1990, revised in 
October 1995 (http://www.nimh.nih.gov/grants/research/910004.cfm), and amended 
by a NIH Guide notice in October 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-MH-01-012.html).

The purpose of this PA is to provide a rapid funding mechanism for research on 
the post-impact of disasters, in order to permit access to a disaster area in 
the immediate aftermath of the event.  The regular grant submission, review, and 
funding process is lengthy, such that it requires investigators who would 
conduct such studies to wait a minimum of 9 months after the submission of the 
application to obtain the research funds, during which time important data may 
be lost.  An emergency event of potential significance for mental health may 
occur with little or no warning (e.g., Hurricane Andrew, Los Angeles earthquake, 
the Oklahoma bombing, or the terrorist attacks of September 2001, including 
bioterrorism) and therefore modified procedures are required to expedite the 
funding of research applications on such events.

The Traumatic Stress Research Program of the NIMH recognizes that prompt 
assessment may be crucial to many kinds of mental health disaster studies, 
including those that focus on service seeking, on efficacy of outreach or 
prevention efforts, and on identifying high-risk victims on the basis of early 
response.  Advances regarding post-traumatic psychopathology, which build on 
findings from basic research on cognitive processing, arousal, and memory, 
highlight the need for rapid data collection in the days and weeks following 
natural and human caused events.  Rapidly supported pilot-type studies on the 
symptoms and course of traumatic stress reactions, the organization and delivery 
of mental health services, and approaches to intervention, can lay the 
foundation for larger studies on the neurobiological nature, cause, 
pathogenesis, treatment and prevention of these conditions.

This kind of research most often has a serious urgency with regard to 
availability of, or access to, data or facilities.  The Rapid Assessment 
Post-Impact of Disaster (RAPID) grants described in this program announcement 
are designed to provide a limited sum of money for early assessment to 
investigators who intend to follow up with a full research application, using 
the preliminary data from this initial effort as a basis for their larger 
application.

RESEARCH OBJECTIVES

Although disasters are disconcertingly prevalent in modern culture, prospective 
systematic studies of them have been relatively few, in part because of the 
difficulties inherent in field research that are compounded by circumstances 
associated with disaster scenes.  Additionally, the ability to generalize about 
psychological effects of disasters has been limited by vast differences in 
methodologies used including critical items such as time frames, identification 
of populations, sampling, and instruments.

Disasters and acts of mass violence are a terrible reality, with the potential 
to cause great public health and economic burdens.  Unlike individual traumatic 
events, disasters tend to strike without preference to personal characteristics 
that increase the risk of exposure to other kinds of traumatic events.  
Individual characteristics predisposing to traumatic events are also associated 
with vulnerability to post-traumatic psychopathology, thus confounding the 
effects of the event with predisposing characteristics.  Disasters and acts of 
mass violence provide for a unique scientific aperture, the need to learn more 
about the biological and behavioral consequences of traumatic stress can be 
uniquely addressed with careful and sensitive research involving disaster 
exposed populations.

The Traumatic Stress Research Program is the focal point in the NIMH for support 
of research projects on the mental health sequelae of emergencies resulting from 
events in the external environment, which include natural and human-made 
situations.  Such events range from individual to community and to larger- 
than-community catastrophes, and they encompass natural disasters (e.g., flood, 
tornado, drought), human-made emergencies (e.g., toxic waste spill, fire, bridge 
collapse), and violence (e.g., riot, combat, school-based shootings, suicides, 
workplace violence, terrorism).  The Program supports research on psychological, 
physiological, biological, and behavioral reactions to emergencies, risk factors 
for developing prolonged mental health sequelae (including post-traumatic stress 
disorder) resulting from exposure to such emergencies, service delivery and 
treatment of victims, and effectiveness of programs designed to prevent mental 
health problems.

In order to respond appropriately and in a timely manner to the psychological 
distress likely to occur in the context of any disaster, it is necessary to 
better understand the nature of problems people experience, the types of help 
they seek, and the readiness of the health and human service delivery system to 
provide needed care and treatment.  Collecting information following a disaster 
presents special challenges, foremost among them is the need for investigators 
to attach the highest priority to standards of privacy, dignity, and courtesy in 
their interactions with participants who were affected in any way by an event 
under study.  Any information gathering activities in this context must 
acknowledge and adhere to the imperatives of doing no harm, placing the care and 
safety of victims and survivors above all else, and coordinating with assistance 
efforts.  This may involve coordination with state and local response efforts as 
well as federally supported counseling and outreach activities such as those 
funded by the Federal Emergency Management Agency (FEMA) and administered by the 
Center for Mental Health Services (CMHS) in the Substance Abuse and Mental 
Health Services Administration (SAMHSA) 
http://www.mentalhealth.org//cmhs/EmergencyServices/default.asp

The Traumatic Stress Research Program is concerned with research topics 
including but not limited to:  psychological, physiological, biological, and 
behavioral reactions to trauma, risk factors for mental health sequelae 
(including post-traumatic stress disorder, depression and substance abuse), 
optimal provision of mental health services, prevention and treatment.  
Applications for research support may include a substantive emphasis in any one 
or more of the following areas:

o  Epidemiological research on exposures and reactions - the mental and physical 
health impact on victims/survivors, families, emergency workers, and community 
members.  In the case of events involving biological or otherwise unseen agents, 
research on the implication of perceived and actual exposure may be relevant.

o  Differential risk of negative effects among different population subgroups 
(age, race/ethnicity, sex, those with prior mental health/substance abuse 
disorders).

o  Rapid assessment of early psychological, biological, and behavioral reactions 
to loss of life, contaminated facilities, loss of social and economic resources 
and other stressors (to guide the allocation of resources and targeted 
intervention).

o  The effects of possible toxic exposure on the central nervous system, the 
mechanisms underlying impaired functioning, clinical phenomena of toxin-related 
neuropsychological and neuropsychiatric disorders.

o  Research on developing and communicating strategies to facilitate realistic 
individual risk assessment and protective strategies, to prevent negative 
consequences (e.g., panic, stigma, blaming, requests for unnecessary/ 
inappropriate services) and promote adaptive and responsible behavior to 
minimize risk and injury.

o  Research on the settings in which direct and indirect victims/survivors 
present for care, including studies of the impact of co-locating mental health 
services into non-traditional mental health settings (e.g., places of worship, 
community centers, work settings, health clinics, schools, etc) on access, 
referral, and acceptability of services.

o  Research on methods for assessing risk, and for triaging based on severity of 
risk.

o  Observational and descriptive studies to identify factors that promote or 
impede effective health provider training in screening, assessment, referral and 
treatment.

o  Research on the organization, delivery and outcome (intended and unintended) 
of individual and public-health level interventions by mental health and non-
mental health providers and Federal, state and local agencies.

o  Research on the mental and behavioral health implications of communications 
about and actual efforts involving evacuation, vaccination, and quarantine.

o  Research on social support systems, including families, spiritual 
affiliations, and coping mechanisms as mediators of psychological response to 
emergency events.

o  Research on intervention and treatment to reduce the risk of psychopathology, 
symptom severity, and disability.

o  The mental health consequences of the subjective appraisal of traumatic 
events, including such aspects as extreme fear, perceived responsibility, 
perception of lasting consequences, and expectation of the reoccurrence of such 
an event.

MECHANISM(S) OF SUPPORT 

This PA will use the NIH Small Grant (R03) and Exploratory/Developmental Grant 
(R21) award mechanisms.  The applicant is solely responsible for planning, 
directing, and executing the proposed project.  The Small Grant (R03) award may 
not exceed $50,000 in direct costs per year.  Exploratory/Developmental Grants 
(R21) submitted under this PA may request up to two years of funding and may not 
exceed $125,000 in direct costs per year.  Potential applicants should note the 
Peer Review Process section of this Program Announcement as there are some 
additional review criteria for these applications.

RAPID awards are non-renewable and may not exceed two years, although one year 
is appropriate in most cases.  Continued support may be requested only through 
submission of a complete regular research application that will be reviewed 
through the regular peer review system.

This PA uses just-in-time concepts.  It also uses the modular budgeting format 
(see http://grants.nih.gov/grants/funding/modular/modular.htm).  Specifically, 
applications with direct costs in each year of $250,000 or less should use the 
modular format, thus all applications in response to this PA should use the 
modular format.

ELIGIBLE INSTITUTIONS

See SUBMITTING AN APPLICATION before preparing a formal application for 
submission.

You may submit (an) application(s) if your institution has any of the following 
characteristics:

o  For-profit or non-profit organizations
o  Public or private institutions, such as universities, colleges, hospitals, 
and laboratories
o  Units of State and local governments
o  Eligible agencies of the Federal government
o  Domestic or foreign
o  Faith-based organizations

INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS

Any individual with the skills, knowledge, experience, and resources necessary 
to carry out the proposed research is invited to work with their institution to 
develop an application for support.  Individuals from underrepresented racial 
and ethnic groups as well as individuals with disabilities are always encouraged 
to apply for NIH programs.

WHERE TO SEND INQUIRIES

We encourage your inquiries concerning this PA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into three 
areas:  scientific/research, peer review, and financial or grants management 
issues:

o  Direct your questions about scientific/research issues to:

Child Trauma Studies
Farris Tuma, Sc.D.
Division of Mental Disorders, Behavioral Research and AIDS
National Institute of Mental Health
6001 Executive Boulevard, Room 6197, MSC 9617
Bethesda, MD  20892-9617
Rockville, MD 20852 (for express/courier service)
Telephone:  (301) 443-5944
FAX:  (301) 480-5514
Email:  ftuma@nih.gov

Adult Trauma Studies
Regina T. Dolan-Sewell, Ph.D.
Division of Mental Disorders, Behavioral Research and AIDS
National Institute of Mental Health
6001 Executive Boulevard, Room 6183, MSC 9625
Bethesda, MD  20892-9625
Telephone:  (301) 443-6802
FAX:  (301) 480-4611
Email:  rdolan@nih.gov

o  Direct your questions about peer review issues to:

Michael Kozak, Ph.D.
Division of Extramural Activities
National Institute of Mental Health
6001 Executive Boulevard, Room 6139, MSC 9608
Bethesda, MD  20892-9608
Telephone:  (301) 443-1340
FAX:  (301) 443-4720
Email:  mkozak@nih.gov

o  Direct your questions about financial or grants management matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
6001 Executive Boulevard, Room 6115, MSC 9605
Bethesda, MD  20892-9605
Telephone:  (301) 443-2805
FAX:  (301) 443-6885
Email:  diana_trunnell@nih.gov

SUBMITTING AN APPLICATION

RAPID applications involve expedited peer review and funding consideration 
processes.  Potential applicants are strongly encouraged to contact Dr. Farris 
Tuma (child studies) or Dr. Regina T. Dolan-Sewell (adult studies) before 
submitting a RAPID application to determine whether the proposed work meets the 
guidelines of this program, whether requested RAPID funding is likely to be 
available, and whether the idea should be considered for initial submission as a 
fully developed application.  Inquires not meeting the RAPID guidelines will be 
guided to other grant mechanisms and to program contacts to discuss 
alternatives.

To meet the goals of the RAPID program, applications should be submitted within 
approximately 6 weeks of the identified disaster event.  RAPID applications will 
be handled on an expedited external peer review and award basis to meet the 
goals of this program.

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001).  The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone (301) 435-0714, 
Email:  GrantsInfo@nih.gov.

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS:  Applications requesting 
up to $250,000 per year in direct costs must be submitted in a modular grant 
format.  The modular grant format simplifies the preparation of the budget in 
these applications by limiting the level of budgetary detail.  Applicants 
request direct costs in $25,000 modules.  Section C of the research grant 
application instructions for the PHS 398 (rev. 5/2001) at 
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step 
guidance for preparing modular grants.  Additional information on modular grants 
is available at http://grants.nih.gov/grants/funding/modular/modular.htm.

SENDING AN APPLICATION TO THE NIH 

The title and number "RAPID ASSESSMENT POST-IMPACT OF DISASTER--PAR-02-133" must 
be entered in Section 2 of the face page of the application.  In addition, "NIMH 
Expedited Review" must be typed in the top margin of the face page.  Submit a 
signed, typewritten original of the application, including the checklist, and 
three signed photocopies in one package to:

Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for express/courier service)

In addition, applicants must simultaneously send two complete copies to the 
Program Officer, Farris Tuma, Sc.D. at the address listed under INQUIRIES, in 
order to permit an expedited review of the application.

The project description should be brief (not to exceed 10 pages for both the R03 
and R21) and include clear statements as to why the proposed research should be 
considered urgent, how this effort would relate to future research plans, and 
why a RAPID award is the appropriate mechanism for supporting the work.  
Applications should propose a clearly discernible research design, involving 
generation and/or testing of hypotheses, and a justification for the proposed 
methodology.

Brief biographical information is required for principal or co-principal 
investigators only, and should list no more than five significant publications 
or other research products.  Additional material (e.g., an elaborate literature 
review, an extended discussion of significance) is discouraged.  In all other 
respects, applications must meet the conditions set out in form PHS 398 (rev. 
5/01), including a standard cover page, a statement of current and pending 
research support, and a budget.

PEER REVIEW PROCESS

An appropriate scientific review group convened by the NIMH will evaluate 
applications for scientific and technical merit.  As part of the initial merit 
review, applications will:

o  Receive a written critique
o  Exploratory/Developmental Grant (R21) applications will receive a second 
level review by the National Advisory Mental Health Council.  This second level 
review will be expedited to the extent possible.
o  Small Grant (R03) applications will not necessarily receive a second level 
review by the National Advisory Mental Health Council

REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  The 
NIMH mission is to diminish the burden of mental illness through research.  In 
the written comments, reviewers will be asked to discuss the following aspects 
of your application in order to judge the likelihood that the proposed research 
will have a substantial impact on the pursuit of these goals:

o  Significance
o  Approach
o  Innovation
o  Investigator
o  Environment

The scientific review group will address and consider each of these criteria in 
assigning your application"s overall score, weighting them as appropriate for 
each application.  Your application does not need to be strong in all categories 
to be judged likely to have major scientific impact and thus deserve a high 
priority score.  For example, you may propose to carry out important work that 
by its nature is not innovative but is essential to move a field forward.

(1) SIGNIFICANCE:  Does your study address an important problem?  If the aims of 
your application are achieved, how do they advance scientific knowledge?  What 
will be the effect of these studies on the concepts or methods that drive this 
field?

(2) APPROACH:  Are the conceptual framework, design, methods, and analyses  
clearly discernible, adequately developed, well integrated, and appropriate to 
the aims of the project?  Do you acknowledge potential problem areas and 
consider alternative tactics?  Do you discuss the relationship between proposed 
methodology and that employed in prior disaster research?

(3) INNOVATION:  Does your project employ novel concepts, approaches or methods?  
Are the aims original and innovative?  Does your project challenge existing 
paradigms or develop new methodologies or technologies?

(4) INVESTIGATOR:  Are you appropriately trained and well suited to carry out 
this work?  Do you have experience with trauma/disaster research?  Is the work 
proposed appropriate to your experience level as the principal investigator and 
to that of other researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your work will be 
done contribute to the probability of success?  Do the proposed activities take 
advantage of unique features of the scientific environment or employ useful 
collaborative arrangements?  Is there evidence of existing collaborative 
relationships with community contacts where participants will be recruited from?  
Is there evidence of institutional support?

ADDITIONAL REVIEW CRITERIA:  In addition to the above criteria, your application 
will also be reviewed with respect to the following:

PROTECTIONS:  The adequacy of the proposed protection for humans, animals, or 
the environment, to the extent they may be adversely affected by the project 
proposed in the application.

INCLUSION:  The adequacy of plans to include subjects from both genders, all 
racial and ethnic groups (and subgroups), and children as appropriate for the 
scientific goals of the research.  Plans for the recruitment and retention of 
subjects will also be evaluated.(See Inclusion Criteria included in the section 
on Federal Citations, below).

BUDGET:  The reasonableness of the proposed budget and the requested period of 
support in relation to the proposed research.

OTHER REVIEW CRITERIA

o  Urgency and suitability of the research to the RAPID award mechanism 

o  Relation of the project to future research plans 

AWARD CRITERIA

Applications submitted in response to a PA will compete for available funds with 
all other recommended applications.  The following will be considered in making 
funding decisions:

o  Scientific merit of the proposed project as determined by peer review
o  Availability of funds
o  Relevance to program priorities

REQUIRED FEDERAL CITATIONS

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD:  Research components 
involving Phase I and II clinical trials must include provisions for assessment 
of patient eligibility and status, rigorous data management, quality assurance, 
and auditing procedures.  In addition, it is NIH policy that all clinical trials 
require data and safety monitoring, with the method and degree of monitoring 
being commensurate with the risks (NIH Policy for Data Safety and Monitoring,
NIH Guide for Grants and Contracts, June 12, 1998:  
http://grants.nih.gov/grants/guide/notice-files/not98-084.html).

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH:  It is the policy of the 
NIH that women and members of minority groups and their sub-populations must be 
included in all NIH-supported clinical research projects unless a clear and 
compelling justification is provided indicating that inclusion is inappropriate 
with respect to the health of the subjects or the purpose of the research.  This 
policy results from the NIH Revitalization Act of 1993 (Section 492B of Public 
Law 103-43).

All investigators proposing clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research 
- Amended, October, 2001," published in the NIH Guide for Grants and Contracts 
on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html), a complete 
copy of the updated Guidelines are available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.  
The amended policy incorporates:  the use of an NIH definition of clinical 
research, updated racial and ethnic categories in compliance with the new OMB 
standards, clarification of language governing NIH-defined Phase III clinical 
trials consistent with the new PHS Form 398, and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that:  a) all 
applications or proposals and/or protocols must provide a description of plans 
to conduct analyses, as appropriate, to address differences by sex/gender and/or 
racial/ethnic groups, including subgroups if applicable, and b) investigators 
must report annual accrual and progress in conducting analyses, as appropriate, 
by sex/gender and/or racial/ethnic group differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS:  The 
NIH maintains a policy that children (i.e., individuals under the age of 21) 
must be included in all human subjects research, conducted or supported by the 
NIH, unless there are scientific and ethical reasons not to include them.  This 
policy applies to all initial (Type 1) applications submitted for receipt dates 
after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines" on the inclusion of children as participants in 
research involving human subjects that is available at 
http://grants.nih.gov/grants/funding/children/children.htm.

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS:  NIH policy 
requires education on the protection of human subject participants for all 
investigators submitting NIH proposals for research involving human subjects.  
You will find this policy announcement in the NIH Guide for Grants and Contracts 
Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT:  The 
Office of Management and Budget (OMB) Circular A-110 has been revised to provide 
public access to research data through the Freedom of Information Act (FOIA) 
under some circumstances.  Data that are (1) first produced in a project that is 
supported in whole or in part with Federal funds and (2) cited publicly and 
officially by a Federal agency in support of an action that has the force and 
effect of law (i.e., a regulation) may be accessed through FOIA.  It is 
important for applicants to understand the basic scope of this amendment.  NIH 
has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this PA in a public archive, 
which can provide protections for the data and manage the distribution for an 
indefinite period of time.  If so, the application should include a description 
of the archiving plan in the study design and include information about this in 
the budget justification section of the application.  In addition, applicants 
should think about how to structure informed consent statements and other human 
subjects procedures given the potential for wider use of data collected under 
this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES:  All applications and proposals 
for NIH funding must be self-contained within specified page limitations.  
Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) 
should not be used to provide information necessary to the review because 
reviewers are under no obligation to view the Internet sites.  Furthermore, we 
caution reviewers that their anonymity may be compromised when they directly 
access an Internet site.

HEALTHY PEOPLE 2010:  The Public Health Service (PHS) is committed to achieving 
the health promotion and disease prevention objectives of "Healthy People 2010," 
a PHS-led national activity for setting priority areas.  This PA is related to 
one or more of the priority areas.  Potential applicants may obtain a copy of 
"Healthy People 2010" at http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS:  This program is described in the Catalog of Federal 
Domestic Assistance No. 93.242, and is not subject to the intergovernmental 
review requirements of Executive Order 12372 or Health Systems Agency review.  
Awards are made under authorization of Sections 301 and 405 of the Public Health 
Service Act as amended (42 USC 241 and 284) and administered under NIH grants 
policies described at http://grants.nih.gov/grants/policy/policy.htm and under 
Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92.

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the use of all tobacco products.  In addition, Public 
Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain 
facilities (or in some cases, any portion of a facility) in which regular or 
routine education, library, day care, health care, or early childhood 
development services are provided to children.  This is consistent with the PHS 
mission to protect and advance the physical and mental health of the American 
people.

Weekly TOC for this Announcement
NIH Funding Opportunities and Notices

	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)
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