[Federal Register: July 8, 2008 (Volume 73, Number 131)]
[Notices]
[Page 39000-39005]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08jy08-55]
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DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research
(NIDRR)--Disability and Rehabilitation Research Projects and Centers
Program--Rehabilitation Research and Training Centers (RRTCs)
AGENCY: Office of Special Education and Rehabilitative Services,
Department of Education.
ACTION: Notice of final priorities for RRTCs.
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SUMMARY: The Assistant Secretary for Special Education and
Rehabilitative Services announces four priorities for RRTCs under the
Disability and Rehabilitation Research Projects and Centers Program
administered by NIDRR. The Assistant Secretary may use one or more of
these priorities for competitions in fiscal year (FY) 2008 and later
years. We take this action to focus research attention on areas of
national need. We intend these priorities to improve rehabilitation
services and outcomes for individuals with disabilities.
DATES: Effective Date: These priorities are effective August 7, 2008.
FOR FURTHER INFORMATION CONTACT: Donna Nangle, U.S. Department of
Education, 400 Maryland Avenue, SW., room 6029, Potomac Center Plaza
(PCP), Washington, DC 20202. Telephone: (202) 245-7462 or by e-mail:
donna.nangle@ed.gov.
If you use a telecommunications device for the deaf (TDD), call the
Federal Relay Service (FRS), toll free, at 1-800-877-8339.
Individuals with disabilities can obtain this document in an
alternative format (e.g., Braille, large print, audiotape, or computer
diskette) on request to the contact person listed under FOR FURTHER
INFORMATION CONTACT.
SUPPLEMENTARY INFORMATION: We published a notice of proposed priorities
(NPP) for NIDRR's RRTC program in the Federal Register on April 28,
2008 (73 FR 22932). The NPP included background statements that
described our rationale for the priorities proposed in that notice.
There are differences between the NPP and this notice of final
priorities (NFP) as discussed in the following section.
Analysis of Comments and Changes
In response to our invitation in the NPP, five parties submitted
comments on the proposed priorities. An analysis of the comments and of
any changes in the priorities since publication of the NPP follows.
Generally, we do not address technical and other minor changes, or
suggested changes the law does not authorize us to make under the
applicable statutory authority. In addition, we do not address comments
that raised concerns not directly related to the proposed priorities.
General Comments
Comment: With regard to priorities 1 through 3, one commenter noted
that ``scientifically based research'' is required only for research
activities that require testing interventions. This commenter
recommended that all research conducted under these priorities be
``scientifically based.''
Discussion: NIDRR only requires ``scientifically based research''
for research activities that involve testing interventions. The
definition of ``scientifically based research'' used in
[[Page 39001]]
all of the priorities in this notice emphasizes the use of
``experimental or quasi-experimental designs in which individuals,
entities, programs, or activities are assigned to different conditions
and with appropriate controls to evaluate the effects of the condition
of interest, with a preference for random-assignment experiments'' (See
section 9101(37) of the Elementary and Secondary Education Act of 1965,
as amended by the No Child Left Behind Act of 2001 for the definition
of the term ``scientifically based research.''). NIDRR believes that
experimental research designs are appropriate for research that
involves testing interventions, but not necessarily for the other
research activities to be carried out under these priorities. For
example, experimental designs are not generally appropriate or
necessary in the initial stages of developing new measures and methods,
identifying or developing interventions, or determining the experiences
and outcomes of individuals with disabilities who seek to return to
work.
Changes: None.
Comment: One commenter noted that each of the proposed priorities
included an incorrect reference for the Department's definition of the
term scientifically based research.
Discussion: We agree and will make this change.
Changes: In all four priorities, we have changed the reference for
the Department's definition of scientifically based research to section
9101(37) of the Elementary and Secondary Education Act of 1965, as
amended by the No Child Left Behind Act of 2001.
Comment: Two commenters recommended that NIDRR remove all
references to employment from priorities 1 through 3. One of these
commenters noted that NIDRR's Long Range Plan for fiscal years 2005-
2009 (Plan) acknowledges the continued need for research on medical
rehabilitation interventions to improve function, as well as health
research to improve outcomes such as health and wellness. This
commenter suggested that including an employment-related outcome in the
priorities that focus primarily on health and function topics will
dilute the impact of research carried out under NIDRR's employment and
health and function domains. This commenter also expressed concern that
the focus on employment outcomes would preclude research on community
participation outcomes and recommended that NIDRR include in each
priority a statement from its Plan that acknowledges the importance of
health and function among people with disabilities to achieve NIDRR's
mission and the goals of employment and community participation.
Discussion: NIDRR does not agree with these comments and the
associated recommendations. In the Plan, we state: ``While the proposed
plan is organized along domains of research [e.g., employment, health
and function, participation and community living] for the sake of
manageability, it also makes clear that disability is a holistic
phenomenon that involves many overlapping and cross-domain issues.''
(See 71 FR 8166, 8166.) We also note, ``In addition, with respect to
those programs for which NIDRR establishes annual priorities--
Rehabilitation Research and Training Centers (RRTCs), Rehabilitation
Engineering Research Centers (RERCs), and Disability and Rehabilitation
Research Projects (DRRPs)--NIDRR may require applicants to focus on one
or more target populations or issues that cut across domains.'' We
indicate clearly in the Plan that RRTCs are expected to be
multidisciplinary--in other words, to combine the strengths and
perspectives of researchers from multiple disciplines and areas of
expertise. (See 71 FR 8166, 8177.) Therefore, we believe that a focus
on employment in priorities 1 through 3 is consistent with the
multidisciplinary approach in the Plan.
Although a mandatory focus on employment outcomes in these
priorities may limit research activities related to outcomes in other
domains, NIDRR believes that research involving both the health and
function and employment domains will generate knowledge that can be
used to improve both medical rehabilitation and vocational
rehabilitation (VR) services for individuals with disabilities. NIDRR
recognizes that there are many factors likely to affect the
relationship between health and functional abilities, on the one hand,
and employment outcomes, on the other. Research under these priorities
can help provide insight into this relationship so that medical and VR
services can be optimized and targeted appropriately.
Changes: None.
Comment: Referring to priorities 1 through 3, one commenter
recommended removing the requirement that the centers recruit research
participants from VR populations. The commenter noted that such a
requirement would unnecessarily limit study populations, create
recruitment barriers, and result in unnecessarily expensive and lengthy
studies to demonstrate empirical relationships between health and
functional status and employment outcomes.
Discussion: Proposed priorities 1 through 3 did not require
recruitment of research participants from populations of individuals
who are served by State VR programs. The priorities state that the
center must conduct research on individuals who are served by the State
VR Services program, or who receive rehabilitation services from other
sources.
Changes: None.
Priority 2--Enhancing the Functional and Employment Outcomes of
Individuals With Multiple Sclerosis
Comment: In reference to language in paragraph (b) of this
priority, one commenter noted that research and clinical information
indicate that the vast majority of individuals with multiple sclerosis
(MS) already live in community settings. The commenter stated that it
is important to support research that improves the ability of
individuals with MS to participate in the community and suggested that
NIDRR revise the priority to reflect that focus.
Discussion: We intended to emphasize the need for research to
improve employment and community participation outcomes in this
priority. We will change the priority to clarify our intent.
Changes: In paragraph (b) of this priority, we have clarified that
the grantee must examine, among other things, interventions to enhance
community participation.
Comment: One commenter stated that there is a need for research on
strategies and assistive devices that enhance the functional and
community participation outcomes among individuals with MS.
Discussion: While NIDRR agrees with the commenter that there is a
need for research about strategies and assistive devices to enhance the
functional and community participation outcomes for individuals with
MS, NIDRR does not believe that it is necessary to revise the priority
to address this specific need. Applicants under this priority already
have flexibility to choose the types of interventions they propose to
identify, or to develop and evaluate. Assistive devices are one
specific type of intervention that could be examined under this
priority.
Changes: None.
Priority 3--Aging With Physical Disability: Reducing Secondary
Conditions and Enhancing Health and Participation, Including Employment
Comment: One commenter asked whether applicants under this priority
must choose from the list of impairment groups in the second paragraph
of the
[[Page 39002]]
priority when selecting the groups that will be the focus of their
research.
Discussion: The short list of impairment groups in the priority
provides examples; applicants are not restricted to this list.
Applicants are free to select the group or groups that will be the
focus of their research.
Changes: None.
Comment: One commenter asked whether the focus of this priority is
exclusively on individuals with disabilities who are 65 years of age or
older, or if the focus is also on adults with disabilities in middle
age.
Discussion: NIDRR does not intend for this center to focus only on
individuals with disabilities who are 65 years of age or older. As we
describe in the background statement for this priority, NIDRR is
interested in the experience of individuals who acquired their
disability at birth, childhood, or early adulthood and who are now
aging. We will add language to the priority to make this clear.
Changes: We have changed the language to clarify that the center
funded under this priority must focus its research on individuals with
a physical disability, including those who acquired their disability at
birth, in childhood, or in early adulthood and who are now aging into
middle or late adulthood.
Comment: One commenter noted that the prevention of falls among
individuals with physical disabilities should be a key research
priority.
Discussion: NIDRR agrees that the prevention of falls is a topic
that is relevant to individuals who are aging with physical
disabilities. Applicants are free to propose research on this topic
under this priority.
Changes: None.
Priority 4--Participation and Community Living for Individuals With
Psychiatric Disabilities
Comment: One commenter requested that NIDRR provide references to
the Substance Abuse and Mental Health Services Administration's
(SAMHSA's) Best Practices Planning and Implementation Grants program,
to facilitate collaboration of the center funded under this priority
with this program.
Discussion: NIDRR agrees that SAMHSA's Best Practices Planning and
Implementation Grants program may be a potential source of information
for, or potential collaborator of, the center funded under this
priority. NIDRR typically references in its priorities only those
programs or entities with which the grantee is required to collaborate.
In this case, NIDRR does not believe it is appropriate to require all
applicants to propose to collaborate with this SAMHSA program. For this
reason, NIDRR declines to reference the SAMHSA program in the text of
this priority.
Changes: None.
Note: This notice does not solicit applications. In any year in
which we choose to use these final priorities, we invite
applications through a notice in the Federal Register. When inviting
applications we designate each priority as absolute, competitive
preference, or invitational. The effect of each type of priority
follows:
Absolute priority: Under an absolute priority, we consider only
applications that meet the priority (34 CFR 75.105(c)(3)).
Competitive preference priority: Under a competitive preference
priority, we give competitive preference to an application by either
(1) awarding additional points, depending on how well or the extent
to which the application meets the competitive preference priority
(34 CFR 75.105(c)(2)(i)); or (2) selecting an application that meets
the competitive preference priority over an application of
comparable merit that does not meet the priority (34 CFR
75.105(c)(2)(ii)).
Invitational priority: Under an invitational priority, we are
particularly interested in applications that meet the invitational
priority. However, we do not give an application that meets the
invitational priority a competitive or absolute preference over
other applications (34 CFR 75.105(c)(1)).
This notice of final priorities (NFP) is in concert with President
George W. Bush's New Freedom Initiative (NFI) and NIDRR's Final Long-
Range Plan for FY 2005-2009 (Plan). Background information on the NFI
can be accessed on the Internet at the following site: http://
www.whitehouse.gov/infocus/newfreedom.
The Plan, which was published in the Federal Register on February
15, 2006 (71 FR 8165), can be accessed on the Internet at the following
site: http://www.ed.gov/about/offices/list/osers/nidrr/policy.html.
Through the implementation of the NFI and the Plan, NIDRR seeks to:
(1) Improve the quality and utility of disability and rehabilitation
research; (2) foster an exchange of expertise, information, and
training to facilitate the advancement of knowledge and understanding
of the unique needs of traditionally underserved populations; (3)
determine best strategies and programs to improve rehabilitation
outcomes for underserved populations; (4) identify research gaps; (5)
identify mechanisms of integrating research and practice; and (6)
disseminate findings.
Priorities
In this notice, we are announcing four priorities for RRTCs.
Priority 1--Enhancing the Functional and Employment
Outcomes of Individuals Who Experience a Stroke.
Priority 2--Enhancing the Functional and Employment
Outcomes of Individuals With Multiple Sclerosis.
Priority 3--Aging With Physical Disability: Reducing
Secondary Conditions and Enhancing Health and Participation, Including
Employment.
Priority 4--Participation and Community Living for
Individuals With Psychiatric Disabilities.
Rehabilitation Research and Training Centers (RRTCs)
The purpose of the RRTC program is to improve the effectiveness of
services authorized under the Rehabilitation Act of 1973, as amended,
through advanced research, training, technical assistance, and
dissemination activities in general problem areas, as specified by
NIDRR. Such activities are designed to benefit rehabilitation service
providers, individuals with disabilities, and the family members or
other authorized representatives of individuals with disabilities. In
addition, NIDRR intends to require all RRTC applicants to meet the
requirements of the General Rehabilitation Research and Training
Centers (RRTC) Requirements priority, which was published in a notice
of final priorities in the Federal Register on February 1, 2008 (73 FR
6132). Additional information on the RRTC program can be found at:
http://www.ed.gov/rschstat/research/pubs/res-program.html#RRTC.
Statutory and Regulatory Requirements of RRTCs
RRTCs must--
Carry out coordinated advanced programs of rehabilitation
research;
Provide training, including graduate, pre-service, and in-
service training, to help rehabilitation personnel more effectively
provide rehabilitation services to individuals with disabilities;
Provide technical assistance to individuals with
disabilities, their representatives, providers, and other interested
parties;
Demonstrate in their applications how they will address,
in whole or in part, the needs of individuals with disabilities from
minority backgrounds;
Disseminate informational materials to individuals with
disabilities, their representatives, providers, and other interested
parties; and
Serve as centers of national excellence in rehabilitation
research for individuals with disabilities, their representatives,
providers, and other interested parties.
[[Page 39003]]
Priorities
Priority 1--Enhancing the Functional and Employment Outcomes of
Individuals Who Experience a Stroke
The Assistant Secretary for Special Education and Rehabilitative
Services announces a priority for a Rehabilitation Research and
Training Center (RRTC) on Enhancing the Functional and Employment
Outcomes of Individuals Who Experience a Stroke. This RRTC must conduct
rigorous research, training, technical assistance, and dissemination
activities to enhance the functional and employment outcomes of
individuals who experience a stroke.
In doing so, the RRTC must focus on no more than two of the
following dimensions: Improved mobility, secondary conditions (e.g.,
pain, fatigue), and emotional well-being. Under this priority, the RRTC
must be designed to contribute to the following outcomes:
(a) Improved outcome measures for use with individuals who
experience a stroke. The RRTC must contribute to this outcome by
identifying or developing and testing methods and measures to assess
outcomes in the dimensions that the RRTC chooses to focus on (e.g.,
mobility, secondary conditions, emotional well-being).
(b) Improved medical rehabilitation or community-based
rehabilitation interventions for individuals who experience a stroke.
The RRTC must contribute to this outcome by identifying or developing
and testing new rehabilitation interventions that are designed to
improve mobility, reduce the onset of secondary conditions, or improve
emotional well-being among individuals who experience a stroke. Where
possible, the RRTC must use scientifically based research (as this term
is defined in section 9101(37) of the Elementary and Secondary
Education Act of 1965, as amended by the No Child Left Behind Act of
2001) methods to test these interventions.
(c) Improved employment outcomes among individuals who experience a
stroke. The RRTC must contribute to this outcome by conducting research
on the experiences and outcomes of individuals who experience a stroke
and who seek to return to work. The RRTC's research must include
research on individuals who are served by the State Vocational
Rehabilitation (VR) Services program or who receive stroke/neuro-
rehabilitation services from other sources, and must identify neuro-
rehabilitation services that are associated with positive outcomes in
the treatment of specific stroke-related impairments and functional
limitations thereby allowing individuals to return to work.
Priority 2--Enhancing the Functional and Employment Outcomes of
Individuals With Multiple Sclerosis
The Assistant Secretary for Special Education and Rehabilitative
Services announces a priority for a Rehabilitation Research and
Training Center (RRTC) on Enhancing the Functional and Employment
Outcomes of Individuals With Multiple Sclerosis. This RRTC must conduct
rigorous research, training, technical assistance, and dissemination
activities to enhance the functional and employment outcomes of
individuals with multiple sclerosis (MS).
In doing so, the RRTC must focus on how one or both of the
following dimensions affect the employment outcomes of individuals with
MS: The prevention or reduction of secondary conditions (e.g., pain,
fatigue, depression, cognitive impairment) and improved mobility. Under
this priority, the RRTC must be designed to contribute to the following
outcomes:
(a) Improved outcome measures for use with individuals with MS. The
RRTC must contribute to this outcome by identifying or developing and
testing methods and measures to assess outcomes in the dimensions on
which the RRTC chooses to focus.
(b) Improved medical rehabilitation or community-based
rehabilitation interventions. The RRTC must contribute to this outcome
by improving the ability of individuals with MS to remain in the
workforce and to participate in the community through identifying or
developing and testing new rehabilitation interventions. Where
possible, the Center must use scientifically based research (as this
term is defined in section 9101(37) of the Elementary and Secondary
Education Act of 1965, as amended by the No Child Left Behind Act of
2001) methods to test these interventions.
(c) Improved employment outcomes among individuals with MS. The
RRTC must contribute to this outcome by conducting research on the
experiences and outcomes of individuals with MS who are served by the
State Vocational Rehabilitation Services (VR) program or who receive
MS-rehabilitation services from other sources, and by identifying
rehabilitation services that are associated with the reduction of
specific MS-related symptoms and functional limitations. Research must
include investigation of job modifications and accommodations
associated with successful employment.
Priority 3--Aging With Physical Disability: Reducing Secondary
Conditions and Enhancing Health and Participation, Including Employment
The Assistant Secretary for Special Education and Rehabilitative
Services announces a priority for a Rehabilitation Research and
Training Center (RRTC) on Aging With Physical Disability: Reducing
Secondary Conditions and Enhancing Health and Participation, Including
Employment. This RRTC must conduct rigorous research, training,
technical assistance, and dissemination activities to improve
rehabilitation outcome measures and rehabilitation interventions that
can be applied in clinical or community-based settings and used by
other researchers. The intended outcome of the RRTC is to enhance
community participation, including employment, of individuals aging
with long-term physical disabilities by advancing knowledge about the
identification, assessment, treatment, and improved management of the
secondary conditions likely experienced by individuals aging with a
physical disability. Individuals aging with a physical disability
include those who acquired their disability at birth, in childhood, or
in early adulthood and who are now aging into middle or late adulthood.
In addressing this priority, the RRTC must propose a limited number
of high-quality, cross-disability research projects to address the
secondary conditions that are most relevant to the lives of individuals
with physical disabilities. To ensure the feasibility of the RRTC's
proposed activities and increase the likelihood of achieving the
planned outcomes, the RRTC must focus on two to four discrete
impairment groups (e.g., spinal cord injury, cerebral palsy, multiple
sclerosis, rheumatoid arthritis, stroke, post-polio) and must limit
intervention strategies to no more than two of the following
modalities: exercise, health promotion, psychological adaptation, life
planning or self-management skills, and environmental or technological
supports. Under this priority, the RRTC must be designed to contribute
to the following outcomes:
(a) Enhanced understanding of the natural course of aging with a
physical disability. The RRTC must contribute to this outcome by
documenting the life trajectories and average age of onset of the major
types of secondary conditions experienced by individuals living with
long-term physical disabilities in the selected impairment groups, and
examining the interrelationships among different types of secondary
conditions
[[Page 39004]]
and the consequences of variations in timing of onset for health and
community participation.
(b) Improved tools and measures for use with individuals aging with
long-term physical disabilities. The RRTC must contribute to this
outcome by identifying, developing or modifying, and testing
measurement tools that improve the identification and assessment of the
major types of secondary conditions affecting individuals in the
selected impairment groups, as well as the outcomes of interventions
designed to prevent or reduce these conditions.
(c) Improved rehabilitation or community-based interventions that
enhance the health and participation in work and the community of
individuals aging with physical disabilities. The RRTC must contribute
to this outcome by identifying, developing or modifying, and testing
interventions that show promise in preventing the onset of or improving
the management and reducing the impact of secondary conditions on
individuals in the selected impairment groups. Where possible, the RRTC
must use scientifically based research (as this term is defined in
section 9101(37) of the Elementary and Secondary Education Act of 1965,
as amended by the No Child Left Behind Act of 2001) methods to test
these interventions.
(d) Improved employment outcomes among working-age individuals
aging with long-term physical disabilities. The RRTC must contribute to
this outcome by conducting research on the experiences, including
employment outcomes, of individuals aging with long-term physical
disabilities in the selected impairment groups who are served by the
State Vocational Rehabilitation (VR) Services program or who receive
rehabilitation services from other sources, and by identifying specific
secondary conditions that require improved and unique VR services and
approaches.
Priority 4--Participation and Community Living for Individuals With
Psychiatric Disabilities
The Assistant Secretary for Special Education and Rehabilitative
Services announces a priority for a Rehabilitation Research and
Training Center (RRTC) on Participation and Community Living for
Individuals With Psychiatric Disabilities. The RRTC must conduct
rigorous research, training, technical assistance, and dissemination
activities that contribute to improved community participation and
community living outcomes for individuals with psychiatric
disabilities. Under this priority, the RRTC must be designed to
contribute to the following outcomes:
(a) Improved individual and system capacity to maximize the
participation of individuals with psychiatric disabilities in community
life. The RRTC must contribute to this outcome by:
(1) Generating new knowledge through research on effective
strategies to meet the needs of individuals with psychiatric
disabilities who are served by centers for independent living and
identifying independent living services and service-delivery approaches
that meet the unique needs of this population.
(2) Increasing the knowledge base and advancing the application of
theories, measures, methods, or interventions that facilitate
participation and community living of individuals with psychiatric
disabilities. In this regard, the RRTC must focus its efforts on at
least three of the following areas: Employment, housing, education,
health and mental health care, recreation, social relationships, or
other public and private sector activities related to community living.
If the RRTC engages in testing interventions, the RRTC must use
scientifically based research (as this term is defined in section
9101(37) of the Elementary and Secondary Education Act of 1965, as
amended by the No Child Left Behind Act of 2001) methods.
(3) Reducing disparities in service delivery and program
development by focusing its work on one or more of the following
understudied areas: (i) Emergency preparedness for individuals with
psychiatric disabilities; (ii) individuals with psychiatric
disabilities from diverse racial, ethnic, and linguistic backgrounds;
or (iii) individuals with psychiatric disabilities who have co-
occurring sensory or physical disabilities.
(b) Increased incorporation of mental health research findings into
practice or policy. The RRTC must contribute to this outcome by
coordinating with appropriate NIDRR-funded knowledge translation
grantees to advance or add to their work in the following areas:
(1) Developing and implementing procedures to evaluate the
readiness of mental health research findings for translation into
practice.
(2) Collaborating with stakeholder groups to develop, evaluate, or
implement strategies to increase utilization of mental health research
findings.
(3) Conducting training, technical assistance, and dissemination
activities to increase utilization of mental health research findings.
Information on knowledge translation projects funded by NIDRR can
be found at http://www.naric.com/research/pd/priority.cfm.
Executive Order 12866
This NFP has been reviewed in accordance with Executive Order
12866. Under the terms of the order, we have assessed the potential
costs and benefits of this regulatory action.
The potential costs associated with this NFP are those resulting
from statutory requirements and those we have determined as necessary
for administering this program effectively and efficiently.
In assessing the potential costs and benefits--both quantitative
and qualitative--of this NFP, we have determined that the benefits of
the final priorities justify the costs.
Summary of Potential Costs and Benefits
The benefits of the Disability and Rehabilitation Research Projects
and Centers Programs have been well established over the years in that
similar projects have been completed successfully. These final
priorities will generate new knowledge and technologies through
research, development, dissemination, utilization, and technical
assistance projects.
Another benefit of these final priorities is that the establishment
of new RRTCs will support the President's NFI and improve the lives of
individuals with disabilities. The new RRTCs will generate,
disseminate, and promote the use of new information that will improve
employment and community living options for individuals with
disabilities.
Applicable Program Regulations: 34 CFR part 350.
Electronic Access to This Document
You may view this document, as well as all other Department of
Education documents published in the Federal Register, in text or Adobe
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Note: The official version of this document is the document
published in the Federal Register. Free Internet access to the
official edition of the Federal Register and the Code of Federal
Regulations is available on GPO Access at:http://www.gpoaccess.gov/
nara/index.html.
[[Page 39005]]
(Catalog of Federal Domestic Assistance Numbers 84.133B
Rehabilitation Research and Training Centers Program)
Program Authority: 29 U.S.C. 762(g) and 764(b)(2).
Dated: July 2, 2008.
Tracy R. Justesen,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. E8-15503 Filed 7-7-08; 8:45 am]
BILLING CODE 4000-01-P