Department of Health and Human Services Public Health Service, Grant Application

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DEPARTMENT OF HEALTH AND HUMAN SERVICES LEAVE BLANK FOR PHSUSE ONLY. r,.,444.
PUBLIC HEALTH SERVICE Thino
GRANT APPLICATION j ReN view Oco- ore
Frr Follow Instuvodone carefully. Type In lbs unsihaded uree only. UACd(Avkf
Type density Imust be 10 o~pi. I - $h, 'Year),. "Date Reaefved;,:.
i.TTEOF RO.A0.t( 'D4 not ayxoed58 tPewrter $psses4. r
Anial.-e.S.tests of the AIDS risks of nitrite inhalants..
2.R SP0.10tOSPE9IFIQ REQUEST FOR (.O PL9T!QNS ORPROGRAM ANN)it.4N.~ I L
NumbV...Cuki? Pf... fl j.co ~a ndM

2.TYPE OF C(RANT PfORA 3:P RINCIPA INVSIGTR/PROGR3AM DIRECTOR;.
Se.NAM4Lat~ f~tmi*eb b. EGRE~s. S SOIAL SCRTY NO
Raabe, Otto (..Ph.D,. 525-90-7445
G4POSITI nrr t4 TITL... ",, J. ~..' - r 3e MAILING AOOR/ ESS (S rj,; iy;satzip cod.%t:.. +
Prof essor-in-Residence - Institute of Toxicology and -DAT T;. V0YO AV
r./. PATNTSEICrLORTORY REUIAETEnvironmental Health
Institute of Toxicology &cErv+Health University of California:J
'M1r.r." '".. A. f /.I!~ t< DvsCafona966School of Veterinar medicine Davis,.California"95616
3b. TELEPHfONE (Aea'cdrenumbersidxnn) m..--2
TL [phone]......
FAX; 916) 752-5300 INET/IN TERNEADRS
4HUMAN SUBJECTS IIrtYES,. - bA9 tur&rtceof 5.VERTEBRATE ANIMALS s YES.' Sb. Anim lwoifexr:.
4aQeepto,or (*fO I'.. ACUC'apprval date asstiryy* no'
ES nr NOJJ X -YESNO02/29/94'...A3433-01
8, DATES'OF EsTIRPOPOSEP 'PROJECT 7, COSTS REQUESTED FRIIIY.CSSROETOFRETR:
-PERIOD.A.U BUDGET PERIOO " PROPOSED PROJECT PEIOD J
From M MMOOYJThrtitj (UMOOVY) 2.OtSt Ctists $- 7b;:T' I CQpats. 8a.DiroectCosts CS) 8b..T6I*I osts4S)->020194 "r 110r 4j13197 1$74,340 i88,390 ' $24,36 K$2805.1

9. PERFORMANCE SITE$ NTnafen n..- IO-NITI ~... r: ' r e '.. ".,,,..In s t i t u t e o f T o x i c o l o g y a n d -rI f,'.P r e v i vc~rwr e tAv r A
Environmental Health, X NO YES:.':YES," e orted---,: re cif':
University of California 1.1: NAME OF APPLICANToRGANiZATiON
Davis, CA 95616., The Regents of the University of California
410 Mrak Hall
University of California
_____________________________Davis, California 95616.
12. TYPE OF OpRANIZATION-A:.,,:;1:: 3;ENT.,TY*IDENTIFICATION NUMBER:: Congresssnal Dtstect:
UXedfar, ~S~r.,Q4c ~1406441.., -.Il
UIPrFVteronproflt - I- - - CEDT'o 1 IMEDICAL RESEARCH SUPPORTANT. CRE" \iT
",., ' colo eey1, AME OF ADMiNISTRATiVE OFFICIAL-TO BE NO~iFIED lF AWARD.;18 NAME OF:OFFICIAL SIGNING FOR APPL ICANT ORGANIZATION2,
Robert Nl.Shelton VrUS MADE r K e ith.".Yo u n g
"TELPHONEt [phone] w TELPilNE;:. 916-752-2075
X [phone] FX 16-52-53
2TIThE ic hacelorReearh:TLj. 7:Contract -& Grant Analyst
OfcofRsac,40MaHalADDRESS.. Office of Research, 410 Mra$
ofivCaliforniaalofarvi
" University o aioni,.A." ai, CA 95616... ";Davis, CA 95616 W\"', - "!"..."
9~RE~t bnt4~-r~6R ~ [email protected]
17-P INCIPAL INVSTIATOR/PMRDIRUORECTR ASSURANCEI agree to accept respen- SIGNATURE OF PERSON NAMED iN Sn DATE
sltbilrty for the scientific conduct of the project and to provide the roqtlrd progress rors if a (nik'e'sgauentacpal.
grant Is awarded as a raeit of this applcalton. Wiflul provisicon of false lnfrmaten Is a airrinal (nik'e'sgauenracpal.
offense (U.S. Code, TitO 18, Secton 1001). I am aware that ary false, ficttkrns, or fraudulent
staement may.,nadiintoohr remedie avaIlable to the Governvent, subjectme t cM
penaitles under the Program Fraud Civi Remedies Act of 1880 (45 CFR 79),
18. CERTK'tCATION AND ACCEPTANCE: I wilyth thet statements herelnare true and complete SIGNATURE OF PERSON NAMED IN 18 DATE
to th. best of my knowledge, and acchetw obligadon to wmpi with Pttlic Health Sarvce (In ink."Pe' s/gnaw,.oat acceptable.)
terms end cendltoils If a grantt Is awarded as a restlt of this applicaton, A witiuly false
cen~ icuion is a c rltnlr.I offen se (U.S. C ode, T hfe 18, S tod a 1001). 1t am aw are that a ry false, c. u rf a d l o s a e e t m y n a d i t o o h r r n e s a u a l o t e G v tn e~,v "
subiect moile t!n u ~n~sthe Proeam Fraud Clvii Ream ajeAct of jj864CFRflk T"t _____

PHS 398 (Rev. l

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