NIH GUIDE, Volume 23, Number 19, May 20, 1994

PA NUMBER:  PA-94-068

P.T. 22


  Biomedical Research Training 

  Health Services Delivery 

Agency for Health Care Policy and Research

Application Receipt Dates:  August 5, December 5, and April 5


The Agency for Health Care Policy and Research (AHCPR) announces the

continuing availability of postdoctoral National Research Service

Award (NRSA) individual fellowships (F32) in health services

research.  These postdoctoral research fellowships provide

opportunities for one or more years of academic training and

supervised experience in applying quantitative research methods to

the systematic analysis and evaluation of health services.  Women,

minorities, and individuals with disabilities are encouraged to



The Public Health Service (PHS) is committed to achieving the health

promotion and disease prevention objectives of "Healthy People 2000,"

a PHS-led national activity for setting priority areas.  The AHCPR

urges applicants to submit grant applications with relevance to the

specific objectives of this initiative.  Potential applicants may

obtain a copy of "Healthy People 2000" (Full Report:  Stock No.

017-001-00474-0, or Summary Report:  Stock No. 017-001-004374-1)

through the Superintendent of Documents, Government Printing Office,

Washington, DC 20402-9325 (telephone 202-783-3238).


Applicants for postdoctoral fellowships must, at the time they apply,

be citizens of the United States, noncitizen nationals, or

noncitizens who have been lawfully admitted to the United States for

permanent residence and have in their possession an Alien

Registration Receipt Card I-551 or I-151 or other legal verification

of such status at the time of application.  Individuals on temporary

or student visas are not eligible.

Applicants must have received, by the activation date of the NRSA

fellowship, a Ph.D., M.D., D.D.S., D.M.D., Sc.D., Dr.P.H., D.Pharm.,

or equivalent doctoral degree from an accredited domestic or foreign

institution.  Certification from an authorized official of the

degree-granting institution that all degree requirements have been

met is acceptable.  (Persons possessing the J.D. degree as the sole

advanced degree are not considered postdoctoral for NRSA purposes.)

NRSA fellowships may not be used to support studies leading to the

M.D., D.O., D.D.S., D.M.D., or equivalent health professional degree

nor do they support residency training.


This program announcement (PA) uses the National Research Service

Award individual postdoctoral fellowship (F32) mechanism.

Responsibility for the planning, direction, and execution of the

proposed project will be solely that of the applicant and the

sponsoring institution.  This program announcement replaces PA-92-08.


AHCPR-sponsored NRSA fellowships emphasize multidisciplinary health

services research training.  This training should provide a rigorous

conceptual and methodological foundation for investigating topics

that include, but are not limited to, the following:

o  Determinants of successful health care market reform, including

incentives for selection of efficient health 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, access to care, and costs and

outcomes of care;

o  Evaluation of managed care and other 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 minority


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  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.




It is the policy of AHCPR that women and members of minority groups

must be included in all AHCPR supported health services research

projects involving human subjects, unless a clear and compelling

rationale and justification are provided that inclusion is

inappropriate with respect to the health of the subjects or the

purpose of the research.

A new NIH policy resulting from the NIH Revitalization Act of 1993

(Section 492B of Public Law 103-43) supersedes and strengthens NIH's

previous policies (Concerning the Inclusion of Women in Study

Populations, and Concerning the Inclusion of Minorities in Study

Populations), which were in effect since 1990 and which AHCPR had

adopted.  The new NIH policy contains some provisions that are

substantially different from the 1990 policies.  AHCPR plans to

publish guidelines specific to AHCPR.  In the interim, AHCPR will

follow the NIH guidelines, as applicable.

All investigators proposing research involving human subjects should

read the "NIH Guidelines for Inclusion of Women and Minorities as

Subjects in Clinical Research," published in the Federal Register of

March 9, 1994 (FR 59 11146-11151) and reprinted in the NIH Guide for

Grants and Contracts, Volume 23, Number 11, March 18, 1994.

Investigators also may obtain copies of the NIH policy from the AHCPR

program staff listed under INQUIRIES.  AHCPR program staff may also

provide additional relevant information concerning this policy.


Prior to making formal application, an individual applicant must be

accepted by an appropriate institution (private or public, for-profit

or non-profit) and by a sponsor who will supervise the training and

research experience.  The applicant's research training plan should

include a description of the proposed activities under the award and

the aims, significance, and experimental design and methods of the

research proposal.  The sponsor must describe in detail the research

training plan and the availability of suitable staff and facilities.

Formal training is not necessarily limited to a single academic

institution or discipline.  The sponsor must be an established

investigator who is active in health services research and who

personally will supervise the applicant's training and research


Fellowship applicants requesting continued training at the doctorate

institution or under the same sponsor in an institution where they

have been training for more than a year should describe those

opportunities for new or additional training experiences that will

broaden the scientific background and perspective.

Applicants must submit the original and two copies of Public Health

Service form PHS 416-1 (rev. 10/91), Individual National Research

Service Award Application.  If the applicant is lawfully admitted to

the United States for permanent residence, a notarized statement

documenting this status is required.  NRSA fellowship material for

AHCPR applications is available from Global Exchange Inc., 7910

Woodmont Ave. Suite 400, Bethesda, MD 20814-3015, telephone

301-656-3100 (FAX 301-652-5264).

Do not send applications to AHCPR.  The completed, signed original

application and two copies must be sent or delivered to:


Division of Research Grants

National Institutes of Health

Westwood Building, Room 240

Bethesda, MD  20892**


The following is the schedule for individual NRSA application receipt

and review:

Application Receipt Date:        Aug 5     Dec 5    Apr 5

Study Section Review:            Oct       Feb      Jun

Earliest Notification of Award:  Dec       Apr      Aug

Earliest Possible Start Date:    Jan       May      Sep

Applications for NRSA fellowships will be reviewed by a review

committee that includes consultants from appropriate scientific

fields.  The committee will use the following criteria in evaluating


o  Applicant's past academic and research accomplishments;

o  Applicant's research and training goals and potential for a health

services research career;

o  Research training program proposed (including the training

potential, as well as the scientific merit of the research project);

o  Qualifications and suitability of the proposed sponsor and

appropriateness of the institutional environment; and

o  References and other relevant information.


For applications assigned to the AHCPR, awards will be made based on

the recommendations of the review committee, relevance of the

application to AHCPR research priorities and training needs, and

availability of funds in making the final selection of awardees.

Stipends and Other Training Costs

A stipend is provided to each NRSA fellow to help defray living

expenses during the research training experience.  The stipend amount

is determined by the number of full years of relevant postdoctoral

experience as of the date the award is issued.  Relevant experience

may include research experience, teaching, internship, residency, or

other time spent in full-time studies in a health-related field

beyond that of the qualifying doctoral degree.

No departure from the standard stipend schedule may be negotiated

between the institution and the fellow.  Current postdoctoral stipend

levels are listed below:

Full years

of relevant    Annual

experience     stipend

None           $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

AHCPR will provide an allowance of $3,000 per 12-month period to

non-Federal, non-profit sponsoring institutions to cover such awardee

expenses as tuition and fees, self-only health insurance, research

supplies, equipment, travel to scientific meetings, and related

items.  There is no institutional allowance for individuals sponsored

by for-profit institutions; but AHCPR will provide up to $2,000 for

the fellow's tuition and fees, self-only health insurance, scientific

meeting travel expenses, and books.  The $2,000 is paid to the

for-profit institution for disbursement to the fellow, and any

unexpended funds are to be returned to AHCPR.

Additional funds may be requested by the institution for

extraordinary costs for fellows who are disabled, as defined by the

Americans with Disabilities Act.  Such additional funds are provided

only in exceptional circumstances and must be fully justified and

explained by the institution.

Supplementation:  Institutions may use non-Federal funds to

supplement NRSA stipends.  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.  An

individual may make use of Federal educational loan funds or VA

benefits when permitted by these programs.  Supplementation, when

provided, must be without obligation to the trainee.

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 from a research

grant that supports the same research that is part of the NRSA

experience.  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 week.

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.

Conditions of the Award

Applications may be for one, two, or three years of fellowship

support.  No one is eligible for more than three years of aggregate

NRSA support at the postdoctoral level, including any combination of

support from institutional training grants and individual


Fellowships are awarded for full-time research training.  However, it

is recognized that a close interrelationship between teaching and

research may exist in the academic environment.  Fellows are

permitted, with the approval of the sponsor, to undertake teaching

that can contribute meaningfully to their academic training.  Any

teaching undertaken by a fellow may not occupy more than 10 percent

of work time during the year or exceed four hours per week.  Fellows

in clinical areas are expected to devote their time to the proposed

research training program and to confine limited clinical duties to

those that are part of the research training.

Concurrent awards:  An NRSA postdoctoral fellowship may not be held

concurrently with another federally sponsored fellowship or similar

Federal award that provides a stipend or otherwise duplicates

provisions of the NRSA.

Activation:  The awardee must start work on the fellowship within six

months of the date the award is issued.  No funds may be disbursed

until the award is activated.

Tax liability of stipends:  Section 117 of the Internal Revenue Code

applies to the tax treatment of all scholarships and fellowships.  It

must be emphasized that the interpretation and implementation of tax

laws are the domain of the Internal Revenue Service (IRS) and U.S.

courts.  AHCPR does not have the authority to advise students or

institutions about their tax liability.  The business office of the

sponsoring institution is responsible for the annual preparation and

issuance of the IRS Form 1099 for postdoctoral fellows training at

the institution. Individuals should consult their local IRS office

for more detailed information on the proper steps to be taken

regarding their tax obligations.

The taxability of stipends in no way alters the relationship between

NRSA fellows and their institutions.  NRSA stipends are not now, and

never have been, salaries.  Fellows 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.  It is inappropriate and unallowable for

institutions to seek funds or to charge individual fellowship awards

for costs normally associated with employee benefits (such as FICA,

workers' compensation, or unemployment insurance).

Termination and postaward reporting:  At the conclusion of the

fellowship, the fellow must submit a termination notice (form PHS

416-7) to AHCPR.  NRSA fellowship recipients are responsible for

informing AHCPR of changes in their status or address and for

submitting the Annual Payback Activities Certification (form PHS

6031-1) yearly until any required payback service obligation is


Payback provision:  Before an award is made, the fellow must sign an

agreement to fulfill the congressionally mandated payback

requirements.  The NIH Revitalization Act of 1993 substantially

modifies the existing service payback requirements for individuals

supported under NRSA programs.  For fellowship awards beginning after

June 10, 1993, only fellows in the first 12 months of postdoctoral

NRSA support will incur a service obligation of one month for each

month of support.  Postdoctoral fellows in the 13th and subsequent

months of NRSA support will not sign the Payback Agreement Form (Form

PHS 6031) and will incur no further obligation.

The 13th and each subsequent month of postdoctoral NRSA support will

be considered acceptable payback service; therefore, individuals who

begin the initial postdoctoral fellowship 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 of


Service payback obligations can also be repaid after the period of

training by engaging in health services related research (including

research assistantships/associateships and fellowships) and/or

teaching for at least 20 hours per week averaged over a full year.

Positions after training are arranged by the individual, not AHCPR.

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.

Individuals who fail to fulfill any required 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 individual.


Written and telephone 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 and Research

2101 East Jefferson Street, Suite 501

Rockville, MD  20852

Telephone:  (301) 594-1362

Direct inquiries regarding fiscal and administrative matters to:

Ralph Sloat

Grants Management Officer

Agency for Health Care Policy and Research

2101 East Jefferson Street, Suite 601

Rockville, MD  20852

Telephone:  (301) 594-1447


NRSA individual postdoctoral fellowships are made under authority of

Section 487 of the Public Health Service 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 and is not subject to the

intergovernmental review requirements of Executive Order 12372.


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