Full Text PAR-95-002


NIH GUIDE, Volume 23, Number 36, October 14, 1994

PA NUMBER:  PAR-95-002

P.T. 44

  Biomedical Research Training 
  Health Services Delivery 

Agency for Health Care Policy and Research


The Agency for Health Care Policy and Research (AHCPR) awards
National Research Service Award (NRSA) institutional training grants
(T32) to eligible institutions to develop or enhance research
training opportunities for qualified individuals selected by the
institution who have demonstrated an interest in health services
research and who seek to prepare for careers in the systematic
examination of the organization, provision, and financing of health
care services.  The purpose of the NRSA program is to help ensure
that adequate numbers of highly trained individuals are available to
carry out the Nation's health services research agenda.

NRSA institutional training grants assist domestic institutions in
supporting predoctoral and postdoctoral academic training.  The
awards allow trainees to gain one or more years of experience in
applying research methods to the evaluation of health services.  The
AHCPR does not support short-term training.


Applicant Institutions

Domestic non-profit private and public institutions may apply for
grants to support doctoral and postdoctoral health services research
training programs.  The applicant institution must have the staff and
facilities required for the proposed program.  The training program
director at the institution will be responsible for the selection and
appointment of trainees and for the overall direction of the program.
Institutions may apply for support for predoctoral students,
postdoctoral students, or a combination.  Applicants should include a
rationale for their proposed choice of supporting the level(s) of
students requested.  An applicant may request as many postdoctoral or
predoctoral positions as the proposed program can adequately
accommodate; but the number of positions awarded will be determined
by the review process, program needs, and availability of funds.


Trainees appointed to the proposed training program must have the
opportunity to carry out supervised health services research with the
primary objective of extending their research skills and knowledge in
preparation for a health services research career.  Prospective
trainees must be U.S. citizens or noncitizen nationals or permanent
residents of the United States in possession of an Alien Registration
Receipt Card I-551 or I-151, or other legal verification of such
status at the time of appointment.  Individuals on temporary or
student visas are not eligible.

A postdoctoral student, as of the beginning date of the NRSA
appointment, must have a Ph.D., M.D., Dr.P.H., Sc.D, D.N.Sc. or other
doctoral degree, or an equivalent degree from any accredited domestic
or foreign institution.  (Persons holding the J.D. as the sole
advanced degree are not considered postdoctoral for purposes of NRSA
appointments.) Certification by an authorized official of the
degree-granting institution that all requirements for the doctoral
degree have been met is acceptable.

Predoctoral trainees must have received a baccalaureate degree as of
the beginning date of the NRSA appointment and must be enrolled in a
program leading to a Ph.D., Dr.P.H., or equivalent doctoral degree.
Individuals working toward a medical or dental degree who wish to
interrupt their studies to engage in full-time research training for
a year or more before completing their health professional degree are
eligible for NRSA support with approval from AHCPR.


The mechanism of support will be the National Research Service Award
(NRSA) institutional training grant (T32).


Areas of Training

AHCPR-sponsored NRSA Awards emphasize multidisciplinary health
services research training.  Training should provide individuals with
rigorous academic and health services research experiences.  At the
conclusion of the training program, trainees should have the
conceptual and methodological foundation for investigating some or
all of the following health care areas:

o  Determinants of successful health care market reform, including
incentives for selection of efficient plans by health care purchasers
and effective management by health care providers;

o  Cost-effectiveness and cost-benefit analysis, including allocation
of health care resources and its relationship to health status;

o  Analysis of service delivery, resource use, and costs of care for
persons with HIV-related illnesses;

o  Primary care issues, including relationships between the structure
and organization of service delivery, and access to and costs and
outcomes of care;

o  Evaluation of managed care and other alternative approaches to
organizing, financing, and reimbursing health care services;

o  Alternative delivery systems, providers, and practice patterns in
long-term care including home and community-based care;

o  Medical treatment effectiveness issues, including evaluation of
outcomes associated with the use of clinical practice guidelines;

o  Availability, accessibility, effectiveness, and quality of care
for underserved populations such as low-income groups and minorities;

o  Rural health issues, including primary care access, service
delivery, technology diffusion, and supply of health professionals;

o  Medical malpractice and liability;

o  Appropriateness and effectiveness, including cost effectiveness,
of alternative treatments and technologies;

o  Factors affecting dissemination and assimilation of health and
clinical information to practitioners and patients;

o  The development of measures, methods, and technologies to support
quality assurance and foster quality improvement in health care; and

o  Application of medical informatics to developing and improving
expert systems for clinical diagnosis and treatment selection.

Levels and Types of Training Permitted

NRSA grants may not be used to support studies leading to the M.D. or
other similar professional degrees, or to support residencies, that
is, postgraduate training for health professionals providing health
care directly to patients where the majority of their time is spent
in nonresearch clinical training.  However, if a specified period of
full-time research training is creditable toward specialty or
subspecialty board certification, the NRSA may support such research
training if the trainee intends to pursue a research career.

Trainees are required to pursue their research training on a
full-time basis.  Because of the close relationship between teaching
and research in the academic environment, trainees are permitted,
with the approval of AHCPR, to teach if it can significantly
contribute to their academic training.  Teaching by trainees may not
take up more than 10 percent of work time during the year or exceed
four hours each week.

Research trainees who are clinicians are expected to devote full time
to the proposed research training.  Clinical duties are permitted for
up to 10 percent time (4 hours per week) within the training program
only if they relate to the training itself.

Trainees appointed to the program are expected to carry out
supervised health services research with the primary objective of
extending their quantitative research skills and substantive
knowledge in preparation for a career in health services research.

Duration of Support

Institutional grants are made for competitive segments of five years
and are renewable; individual trainee appointments should be made in
increments of 12 months.  Support for additional years is dependent
on satisfactory progress and continued availability of funds.  No
individual trainee may receive more than five years of aggregate NRSA
support at the predoctoral level and three years of aggregate NRSA
support at the postdoctoral level, including any combination of
support from institutional training grants and individual fellowship
awards, except under certain circumstances.  Any exception to this
policy requires a waiver from AHCPR.

Institutional training grants are a desirable mechanism for
postdoctoral training of physicians and other health professionals
whose doctoral training has usually involved limited health services
research experience.  For such individuals, it is highly recommended
that they agree to engage in at least two years of research training
or comparable experiences at the time of appointment regardless of
whether or not the NRSA training is part of a research degree

Payback Provisions

All postdoctoral trainees must sign an agreement to fulfill the NRSA
payback requirements when they are initially appointed to a training
grant (or receive an individual fellowship).  Officials of the
applicant organization responsible for recruitment of trainees should
familiarize themselves with the terms of the service requirements and
explain them carefully to prospective training candidates before an
appointment at the institution is offered.  The NIH Revitalization
Act of 1993 substantially modifies the existing service payback
requirements for individuals supported under NRSA programs.
Beginning with new appointments (or reappointments) made as of June
10, 1993, the following new guidelines apply:

o  Predoctoral trainees will not be required to sign the Payback
Agreement Form (PHS Form 6031) and will not incur a service payback

o  Postdoctoral trainees in the first 12 months of postdoctoral NRSA
support will incur one month of obligation for each month of support.

o  Postdoctoral trainees in the 13th and subsequent months of NRSA
support will not sign the Payback Agreement Form and will not incur a
service payback obligation.

o  The 13th and each subsequent month of postdoctoral NRSA support
will be considered acceptable payback service; therefore, individuals
who are appointed to their initial NRSA postdoctoral period on or
after June 10, 1993, and continue under that award for two years will
have fulfilled their first year obligation by the end of the second
year.  Service payback obligations can be repaid after the period of
training by engaging in health services related research and/or
teaching for at least 20 hours per week averaged over a full year.

Recipients must undertake the obligated service on a continuous basis
within two years after termination of NRSA support.  The period for
undertaking payback service may be delayed for temporary disability,
for completion of residency requirements, or for completion of the
requirements for a graduate degree.  Requests for an extension must
be made in writing to AHCPR and must specify the need for additional
time and the length of the required extension.  Recipients of NRSA
support are responsible for informing AHCPR of changes in their
status or address.

Individuals who fail to fulfill their obligation through service must
pay back the total amount of NRSA funds paid to them for the
obligation period plus interest at a rate determined by the Secretary
of the Treasury.  Financial payback must be completed within three
years beginning on the date the United States becomes entitled to
recover such amount.  Under certain conditions, the Secretary of
Health and Human Services may extend the period for starting service
or for repayment, permit breaks in the period of service or
repayment, or otherwise waive or suspend the payback obligation of an

Stipends and Other Trainee Support


National Research Service Awards provide funds in the form of
stipends to predoctoral and postdoctoral trainees.  A stipend is
provided as an allowance for trainees to help defray living expenses
during the research training experience.  It is not provided as a
condition of employment with either the Federal Government or the
institution.  Trainees may not receive stipends for periods during
which they are not enrolled in the training program.

For predoctoral trainees at all levels of experience, the stipend
level (effective October 1, 1993) is $10,808 per year.

For postdoctoral trainees, the stipend for the first year of support
is determined by the number of full years of relevant postdoctoral
experience at the time of appointment.  Relevant experience may
include research experience (including industrial), teaching,
internship, residency, clinical practice, or other time spent in
full-time studies in a health-related field beyond that of the
qualifying doctoral degree.  The stipend for each additional year of
NRSA support is the next level on the stipend scale and does not
change mid-year.  No departure from the established stipend schedule
may be negotiated by the institution with the trainee.  Current
postdoctoral stipend levels, effective October 1, 1993, are as

Full years of relevant experience       Stipend

         Less than 1                    $19,608
         1                               20,700
         2                               25,600
         3                               26,900
         4                               28,200
         5                               29,500
         6                               30,800
         7 or more                       32,300

Supplementation and Compensation

Stipend Supplementation:  NRSA stipends may be supplemented by an
institution from non-Federal funds.  Federal funds may be used for
stipend supplementation only if specifically authorized under the
terms of the program from which the supplemental funds are derived.
Supplementation, when provided, must be without obligation to the

Compensation:  Trainees may be permitted to receive compensation for
work in some other position (for example, teaching or laboratory
assistance) when the trainee is in an employee-employer relationship,
the payments are for services rendered, and the situation otherwise
meets conditions for student compensation as specified in the PHS
Grants Policy Statement.  Compensation may not be paid from a
research grant that supports the trainee's dissertation or the same
research as that of the training program. Compensation for services
must occur on a limited, part-time basis apart from the normal
full-time training activities that require a minimum of 40 hours per

Educational loans:  An individual may make use of Federal educational
loan funds and assistance under the Veterans Readjustment Benefits
Act (G.I. Bill).  Such funds are not considered supplementation or

Under no circumstances may the conditions of either stipend
supplementation or student compensation for coincidental employment
detract from or prolong the research training.

Further information on stipend supplementation and compensation is
available in "National Research Service Awards --  Guidelines for
Individual Awards - Institutional Grants," NIH Guide for Grants and
Contracts (special edition), Volume 13, Number 1, January 6, 1984.

Tax Liability of Stipends

Section 117 of the Internal Revenue Code applies to the tax treatment
of all scholarships and fellowships.  Under that section, degree
candidates may exclude from gross income, as reported for tax
purposes, any amounts used for tuition and related expenses such as
fees, books, supplies, and equipment required for courses of
instruction at the educational institution.  Nondegree candidates are
required to report all stipends and monies paid on their behalf for
course tuition and required fees as gross income.

The taxability of stipends in no way alters the relationship between
NRSA trainees and their institutions.  NRSA stipends are not now, and
have never been, considered as salaries.  Trainees supported under a
National Research Service Award are not in an employer-employee
relationship with AHCPR or with the institution in which they are
pursuing research training, nor are they considered to be
self-employed.  NRSA stipends are not subject to employment or
self-employment tax (FICA).

It must be emphasized that the interpretation and implementation of
tax laws are the domain of the Internal Revenue Service (IRS) and the
courts.  AHCPR is not in a position to advise students or
institutions about their tax liability.  Individuals should consult
their local IRS office for information on their tax obligations.

Other Training Costs

Tuition and fees, including medical insurance for the trainee, are
allowable trainee costs if such charges are required of all persons
in a similar training status at the institution, regardless of their
source of support; family medical insurance is not an appropriate
charge to the NRSA grant.  Tuition for postdoctoral trainees not
enrolled in a degree program is limited to that required for specific
courses in support of the approved training program; tuition for
other courses must be justified.  Annual increments in tuition and
fee costs beyond the first year of the award may not exceed 6 percent
for equivalent numbers of trainees.

Trainee travel, such as attendance at domestic scientific meetings
determined by the institution as necessary to the research training,
is an allowable expense.

Institutional costs of $1,500 per year for each predoctoral trainee
and $2,500 per year for each postdoctoral trainee may be requested to
defray the cost of other expenses related to the training program.
Salaries of the program director and faculty are not reimbursed.

The institution will receive indirect costs based on eight percent of
total allowable direct costs (exclusive of tuition, fees, and health
insurance) or their actual indirect cost rate, whichever is less.
Applications from State and local government agencies may request
full indirect cost reimbursement.


The research grant application form PHS 398 (rev. 9/91) is to be
used.  (State and local government agencies may use form PHS 5161 and
follow those requirements for copy submission.)  This revision
includes special instructions for institutional NRSA research
training grants.  Applicants are reminded that the 25-page limit on
the narrative section must be observed.  Insert the title of this PA
(National Research Service Award -- Institutional Grants) and PA
number on line 2a of the application face page.

These forms are available at most institutional offices of sponsored
research; the Office of Grant Information, Division of Research
Grants, National Institutes of Health, Westwood Building, Room 449,
Bethesda, MD 20892, telephone 301-435-0714.  Application material for
AHCPR NRSA institutional grants is also available from Global
Exchange, Inc., 7910 Woodmont Avenue, Suite 400, Bethesda, MD
20814-3015, telephone 301-656-3100.

The first application receipt date for this program announcement is
January 10, 1995.  Applications received on that date will be for
awards to begin no earlier than December 1, 1995.  Thereafter, AHCPR
will accept applications only on January 10th annually for awards to
begin no earlier than the following December.

Applications must be received at the Division of Research Grants,
NIH, by January 10th each year.  Late applications will be returned
to the applicant.  The completed, signed, original application and
three legible copies of the form PHS 398 must be sent or delivered

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

Two information copies must be submitted simultaneously to:

Director, Scientific Review Branch
Agency for Health Care Policy Research
2101 East Jefferson Street, Suite 602
Rockville, MD  20852

Failure to provide these information copies will result in the return
of the application to the applicant.


Applications will be reviewed for technical and educational merit by
an AHCPR peer review group.  They may also be reviewed by the
National Advisory Council for Health Care Policy, Research, and
Evaluation for applicability to AHCPR's overall research and training

Review Criteria

The peer review group will consider the following criteria in its

o  Qualifications and responsibilities of the program director;

o  Organizational structure of the proposed training program,
including delineation of administrative responsibilities for
planning, oversight, and evaluation;

o  Qualifications of the program's faculty, including ongoing health
services research support and ability to serve as effective mentors
for trainees;

o  Objectives and design of the proposed training program and the
probability of achieving stated goals;

o  Substantive content of the proposed program and its relevance to
current health care concerns, including descriptions of courses

o  Documentation of availability of qualified candidates and
program's plans for recruitment and selection of trainees, including
minority trainees;

o  Institutional commitment to providing a quality training
environment, including availability of space and facilities,
curriculum time, and research support;

o  Demonstration of cooperation by any collaborating facilities,
institutions, or departments in providing experience and research
training sites for trainees and documentation of mechanisms for
integration of trainees into ongoing health services research;

o  Proposed methods for monitoring and evaluating performance of
trainees and of the overall program, including tracking of graduates
after completion of training and record of trainees in obtaining
individual research awards or fellowships following training and in
establishing careers in health services research;

o  Record of the training program in retaining health professional
postdoctoral trainees for more than 1 year of research training; and

o  Reasonableness of the proposed budget, including number and levels
of trainees, in relation to the research training.

Also see "Modification of Existing Review Criteria for NRSA
Institutional Research Training Grants," NIH Guide for Grants and
Contracts, Volume 21, Number 11, March 20, 1992.

Additional Review Considerations

Minority Recruitment Plan:  The AHCPR remains committed to increasing
the participation of individuals from minority groups under-
represented in health services research.  All competing applications
must include a plan to recruit individuals from minority groups
underrepresented in health services research; review of any
application received without such a plan will be deferred until it is
provided. Additional information on this requirement was published in
the NIH Guide for Grants and Contracts, Volume 22, Number 25, July
16, 1993.

Competing renewal applications must include a detailed account of
experiences in recruiting individuals from underrepresented minority
groups during the previous award period.  Information on the types of
successful and unsuccessful recruitment strategies should be
included.  The report should provide information on the ethnic/racial
distribution of predoctoral and postdoctoral students in the
department(s) relevant to the training program, individuals who
applied for research training, individuals who were offered
admission, and individuals who were appointed to the grant.  For
appointees to the grant, the report should include information about
the duration of their training and whether those trainees finished
the training program.

After the overall technical and educational merit of an application
has been assessed, reviewers will examine the minority recruitment
plan and any record of recruitment and retention efforts.  The
recruitment components of each application will be judged as either
acceptable or unacceptable.  The findings of the review committee on
the plan for attracting minority individuals will be presented in an
administrative note in the summary statement.  Funding of any
application with a plan for recruiting underrepresented minorities
that is judged unacceptable by the review committee will be withheld
until a revised plan that addresses the deficiencies is received and
determined to be acceptable by AHCPR.

Information on the recruitment and retention of underrepresented
minority trainees appointed during the previous budget period must
also be provided in progress reports included in noncompeting
continuation applications.

Training in the Responsible Conduct of Research:  Every predoctoral
and postdoctoral trainee supported by a NRSA institutional training
grant must receive instruction in the responsible conduct of
research.  Notice of this requirement was published in the NIH Guide
for Grants and Contracts, Volume 21, Number 43, November 27, 1992,
and republished in the NIH Guide, Volume 23, Number 23, June 17,

Applications must include a description of the program to provide
formal and informal instruction in scientific integrity and the
responsible conduct of research.  Applications without plans for
instruction in the responsible conduct of research will be considered
incomplete and may be returned to the applicant without review.
Although the exact content of the plan is left to the individual
training program, all programs are strongly encouraged to consider
instruction in the following ares:  conflict of interest, responsible
authorship, policies for handling misconduct, policies regarding the
use of human subjects, and data management.  Plans should include a
rationale for the proposed instruction as well as the subject matter,
format, and frequency, degree of faculty participation, and trainee
attendance.  Program reports on the type of instruction provided,
topics covered, and other information such as trainee attendance and
faculty participation must be included in future competing and
noncompeting applications.

The plan to provide instruction in the responsible conduct of
research will be assessed on the appropriateness and breadth of
topics; instructional format and materials; amount, nature, and
quality of faculty participation; and frequency and duration of the
training.  Plans will be rated as acceptable or unacceptable by the
initial review group.  The plan and acceptability will be described
in an administrative note in the summary statement.  The plan to
provide instruction in the responsible conduct of research will not
be considered in the assignment of a priority score to the
application.  Regardless of priority score, applications with
unacceptable plans will be considered incomplete, and awards will not
be made until a revised and adequate plan is provided and determined
to be acceptable by AHCPR.


Funding decisions will be based on peer review, Advisory Council
recommendations when applicable, the need for research personnel in
specified program areas, balance among types of research training
supported by AHCPR, and the availability of funds.


Inquiries are encouraged.  The opportunity to clarify any issues or
questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

DonnaRae Castillo
NRSA Project Officer
Agency for Health Care Policy Research
2101 East Jefferson Street, Suite 400
Rockville, MD  20852
Telephone:  (301) 594-1362
Email:  dcastill@po7.ahcpr.gov

Direct fiscal and administrative inquiries to:

Ralph Sloat
Grants Management Officer
Agency for Health Care Policy Research
2101 East Jefferson Street, Suite 601
Rockville, MD  20852
Telephone:  (301) 594-1447


NRSA institutional research training grants are made under authority
of Section 487 of the Public Health Service (PHS) Act as amended (42
USC 288).  Title 42 of the Code of Federal Regulations, Part 66, is
applicable to this program.  The program is described under Catalog
of Federal Domestic Assistance No. 93.225.  This program is not
subject to the intergovernmental review requirements of Executive
Order 12372.

The Public Health Service strongly encourages all grant recipients to
provide a smoke-free workplace and promote the non-use of all tobacco
products.  This is consistent with the PHS mission to protect and
advance the physical and mental health of the American people.


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