Part 1. Overview Information

Key Dates

All applications are due by 5:00 PM local time of applicant organization. 

Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.

It is critical that applicants follow the instructions in the Research (R) Instructions in the How to Apply - Application Guide, except where instructed to do otherwise (in this NOFO or in a Notice from NIH Guide for Grants and Contracts).

Conformance to all requirements (both in the Application Guide and the NOFO) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions.

Applications that do not comply with these instructions may be delayed or not accepted for review.

There are several options available to submit your application through Grants.gov to NIH and Department of Health and Human Services partners. You must use one of these submission options to access the application forms for this opportunity.

1. Use the NIH ASSIST system to prepare, submit and track your application online.
2. Use an institutional system-to-system (S2S) solution to prepare and submit your application to Grants.gov and eRA Commons to track your application. Check with your institutional officials regarding availability.
   
   
3. Use Grants.gov Workspace to prepare and submit your application and eRA Commons to track your application.



Table of Contents
Part 1. Overview Information
Key Dates
Part 2. Full Text of Announcement
Section I. Notice of Funding Opportunity Description
Section II. Award Information
Section III. Eligibility Information
Section IV. Application and Submission Information
Section V. Application Review Information
Section VI. Award Administration Information
Section VII. Agency Contacts
Section VIII. Other Information

Part 2. Full Text of Announcement

Section I. Notice of Funding Opportunity Description

 Key Definitions

The term “older adult” refers to the chronologic definition of an older adult- arbitrarily set as individuals aged 65 and older.

The term “populations that experience health/health care disparities” refers to NIH-designated populations that experience health disparities in the United States: racial and/or ethnic minority populations, less privileged socioeconomic groups status (SES), underserved rural populations, persons with disabilities, and sexual and gender minority (SGMs) groups (https://www.nimhd.nih.gov/about/overview/).

The term “multi-level” refers to the multi-dimensional framework of determinants relevant to understand and address minority health and health disparities. This concept is further described under the NIMHD Research Framework (https://www.nimhd.nih.gov/about/overview/research-framework/).

The term “care coordination” refers to deliberately organizing patient care activities and sharing information among all the participants concerned with a patient's care to achieve safer and more effective care. Examples of broad care coordination include care management, medication management, home safety, and others.

The term “care transition” refers to the movement of a patient from one setting of care to another. Settings of care are defined as acute care hospitals, ambulatory primary care practices, ambulatory specialty care practices, long-term care facilities, home health, and rehabilitation or skill nursing facilities.

The term “shared decision making” refers to when a clinician and a patient/ their caregivers work together to make a health care decision that is best for the patient and consistent with the patient’s preferences. The optimal decision takes into consideration evidence-based information about available treatment and care options, the clinician's knowledge, experience, and ethos to do no harm and minimize risks, and the patient's values and preferences.

The term “caregiver” refers to a person or persons who provide care in a paid/ formal or unpaid/ informal capacity to people who need help taking care of themselves. This may include health professionals, family members, non-family members, friends, social workers, or members of the clergy. They may provide care at home or in a hospital or other health care setting.

The term “diagnostic and clinical guidelines” refers to evidence-based and evidence-informed recommendations that summarize current medical knowledge, weigh the benefits and harms of diagnostic procedures, treatments, and follow-up, and give specific recommendations or rely on empirical approaches on how to diagnose and treat a medical condition. In addition, within the context of the healthcare of older adults, some diagnostic and treatment decisions may be informed by expert consensus, up-to-date scientific knowledge, or patient preferences. In clinical scenarios in which there is not sufficient evidence, the diagnostic and/or treatment course of action may be based on the patient, caregiver and clinician shared decision in which “do no harm” principle and the best patient-centered outcomes and quality of life are considered.

Background:

The U.S. older adult (those aged 65 and over) population is rapidly growing and becoming more diverse. By year 2060, it is projected that nearly half of this population will be comprised of persons from racial and/or ethnic minority populations. Older adults from populations that experience health disparities are more likely to report poorer physical health, mental health, and quality of life. They also tend to have more coexisting health conditions including cognitive impairment and functional limitations, less access to timely diagnosis and optimal quality of care, and experience more hospital admissions, readmissions, and multiple care transitions. Furthermore, disparities in health and healthcare continue to persist among these populations and were magnified during the COVID-19 pandemic. Therefore, the current U.S. health care systems and workforce’s lack of preparedness to meet the challenges of caring for older adults, especially those from populations that experience health disparities is a serious public health and societal concern.

There is ample research evidence indicating that there are many factors that may lead to omissions and commissions of care for older adults that often result in preventable adverse outcomes including delays in or over-screening, missed or delayed diagnoses, and untimely treatment or over-treatment. Such factors include ageism, mistreatment, delivery of substandard care, errors in clinical judgement, providing care that may do more harm than good, and dismissal of health concerns by healthcare providers and/or caregivers. All of these can negatively affect the physical and mental health of older adults and co-occur with other forms of discrimination (e.g., racism).

In addition, making a correct and timely diagnosis and care plan for older adults is a process influenced by a myriad of factors that can influence screening and diagnostic tests’ performance and accuracy. Some of these include:

• Underrepresentation of older adults, especially those over the age of 75, in clinical research.
• Age-dependent variations in sensitivity and/or specificity of screening and/or diagnostic tests.
• Screening tests for which diagnostic and/or treatment benefit is unclear after a certain age, or within the context of health status, quality of life, and/or projected life expectancy.
• Screening tests recommendations that consider patient preferences and weigh benefits versus risks/ harms.
• Symptoms and signs that are different from the clinical profiles observed in younger populations.
• Delayed recognition of health conditions by patients and caregivers/family members due to attribution of symptoms as part of the normal aging process.
• Family dynamics, built environment, and sociocultural environment factors that influence optimal care and quality of life.
• Diagnostic protocols or guidelines that create gaps in care delivery.
• Diagnostic, treatment, and continuity of care complexities associated with multiple coexisting chronic conditions.
• Side effects and adverse events associated with complex pharmacological therapy.
• Unfamiliarity or lack of proficiency in key cultural factors across different levels in the healthcare continuum and across various stages of the aging continuum.
• Limited health system resources and infrastructure, and health care policies that may limit coverage eligibility or access to optimal care and health equity.
• Lack of shared decision-making that is guided by principles of aging with dignity, self-determination, and autonomy.

Well synchronized care coordination within and across care teams and care settings can mitigate health disparities in older adults. For example, well-coordinated in-home health care can allow individuals to remain living at home and maintain their independence by receiving care and support from a family caregiver or home health aide. Also, transitional care interventions for older adults are associated with reductions in preventable hospital and emergency room readmissions. On the other hand, many in-home caregivers may not be trained to properly handle the complex demands of providing and coordinating care. In addition, the effectiveness of care coordination may be impaired by the fragmentation of care, and breakdowns in coordination, communication, and collaboration processes between care team members, including the older adults and caregivers. These could result in delayed or missed diagnoses and timely treatment. Furthermore, interventions on care coordination involving in long-term care, palliative and/or end-of-life care settings -where most hospice care takes place-, and for patients from populations that experience health disparities are sparse.

Hence, crucial research gaps remain for improving the prevention, diagnosis, and treatment for many health conditions that burden older adults from populations that experience health disparities. Similarly, novel interventions that explore the role of shared decision-making and care coordination are needed.

Neglect and mistreatment of older adults would be expected to impair the effectiveness of medical care/diagnostic recommendations, care coordination and shared decision making. However, the risk and protective factors associated with mistreatment of older adults from populations that experience health disparities - and interventions to address it- are understudied. Therefore, the design, study and/or evaluation of strategies or interventions that address neglect and/or mistreatment within the context of care coordination across care teams, care settings, and agencies (e.g., protective services, home health, financial, legal services, housing) of older adults from populations that experience health disparities is another crucial research gap to be filled.   

Research Objectives:

In addition to the goals stated under the Purpose, the overarching aim of this NOFO is to identify and understand best practices to engage older adults and their caregivers in providing appropriate care that is central to the attainment of optimal physical and mental health and wellbeing of older adults and the reduction of health disparities in this population.

Projects should focus on one or more NIH-designated health disparity populations living in the 50 states, the District of Columbia, Tribal Nations, and the U.S. territories. Projects that focus on racial and ethnic minority populations and/or low socioeconomic status (SES) persons are of particular interest. For all other categories, projects that explore the intersectionality of age, sex, race, and ethnicity and/or low SES with rural populations or SGM groups, and people with disabilities are encouraged. Applications proposing approaches which consider multi-level determinants of health (e.g., patient, clinician, health care system, community) to address health disparities while optimizing the health and well-being of older adults from populations that experience health disparities are encouraged. Please refer to the NIMHD Research Framework for additional detail. Applications that plan to collect primary data from older adults, caregivers, clinicians and other persons are strongly encouraged to use the measures on social determinants of health in the PhenX tool kit.

This initiative will support research in outpatient, inpatient, institutional-based long term care settings, home-based care, and emergency care facilities serving diverse older adults. In addition, research that involves a partnership with relevant agencies (such as area agencies on aging, state units on aging, senior services, advocacy organizations for older adults, faith-based services) that offer home and community-based services for the older adult such as home-delivered meals, case management, companionship programs, are welcome. Outpatient settings include primary care, specialty clinics and specialty care settings such as dialysis or chemotherapy centers. Inpatient and institutional long-term care settings include hospitals, assisted living facilities, skilled nursing facilities, and long-term chronic care institutions. Research within the context of transitional care (e.g., hospital to home, or rehabilitation to home), palliative care, end-of-life care, and long-term care, where patients interact with clinicians on a regular basis, is also of interest. Studies may involve in-person and/or telemedicine encounters. This initiative is not solely focused on clinical health outcomes. Research on intermediary measures of non-clinical outcomes (e.g., trust, self-efficacy, self-autonomy, empowerment, safety, and resilience) are of interest.

Research Methodology

This NOFO seeks to support descriptive studies, interventions (especially multi-component, multi-sectoral, and/or or multi-level interventions), clinical trials (including cluster-randomized trials, and pragmatic trials), quasi-experimental studies, natural experiments (e.g., impact of policy), quality improvement studies, mixed methods research, and simulation modeling. Projects focused on rural populations, SGM groups, and people with disabilities are encouraged to examine intersections with race and/or ethnicity, and SES. Comparison groups/populations may also be included as appropriate for the research questions posed. It is expected that lessons learned from this initiative can help build research evidence regarding approaches to improve health outcomes for older adults from populations that experience health disparities.

Specific Areas of Research Interest

NIMHD areas of research interests include but are not limited to the following:

Optimization of screening, diagnostic and clinical care guidelines for commonly experienced conditions

• Addressing gaps in timely assessment, diagnosis, and treatment of highly prevalent conditions (infectious and chronic non-communicable conditions) and coexisting conditions in this population. This may include:
  • Establishing or modifying diagnostic criteria or identifying phenotypes that may be different in older adults.
  • Developing and/or tailoring, testing, and evaluating existing tools to assess symptom burden, quality of life, and/or function, or implementing diagnostic and care guidelines that are adaptable to this population.
• Studies that seek to understand optimal practices for the recommendation of screening tests and assessments while considering tradeoffs of harm (e.g., false-positives, over-diagnosis) and benefits (e.g., quality of life) as well as optimal time for screening (e.g., intervals, stopping age) and discontinuation of screening.

Shared medical decision-making to enhance care planning and patient agency.

• Studies that explore the concept of shared decision-making between clinicians/care team and the older adult and their caregiver(s). These may include:
  • Addressing conflicting recommendations for care as well as balancing clinician recommendations, patient preferences, and caregiver perspectives regarding harms, benefits, and outcomes. This may include point of care interventions that incorporate clinical decision support (CDS) within electronic health records (EHRs).
  • Considering patient agency and the legal aspects and cultural norms of decision making (e.g., advance directives), especially within the context of major junctions in care, like invasive procedures, aggressive therapy with significant adverse reactions, or treatment or procedures for which there is insufficient prognostic evidence in older adults.
• Developing, testing and/or evaluating interventions in the health care settings that mitigate ageism, racism, and/or other forms of discrimination, prejudices, and stereotypes against older adults.
• Developing, testing and/or evaluating culturally tailored interventions that strengthen care settings and/or their workforce to care for older adults while being responsive to their diverse racial, ethnic, cultural, religious, social, economic, and geographical backgrounds.
• Developing, testing and/or evaluating culturally tailored interventions designed to facilitate coordination of legal assistance for older adults and their effect on strengthening patient agency, improving shared decision making, and in preventing financial exploitation.

Effective strategies for coordinating care for older adults from populations that experience health disparities.

• Developing, testing and/or evaluating care coordination strategies. These could address:
  • Challenges or breakdowns in the diagnostic and care pathways from one care setting or level to another.
  • Multiple care transitions to and from the home, care facilities, palliative care, and end-of-life care settings.
  • Care team functioning (e.g., communication), including the role of geriatric case managers and care coordinators.
  • Care setting infrastructures (e.g., coordination tools) to optimize care delivery both within and across care teams (including the patient and caregivers/family), care settings, and other agencies involved in meeting the needs of older adults.
• Evaluating the effect of policies that may drive health care disparities in older adults (e.g., affordable care, expanded coverage, drug pricing, health care accessibility and financing) on the effectiveness of optimal care coordination and health outcomes.
• Studies that evaluate the role or effect of neglect, mistreatment and/or exploitation of older adults and established policies to protect them on the effectiveness of care coordination and other healthcare-based strategies.

Specific Areas of Research Interest for Participating Organizations:

National Cancer Institute (NCI)

NCI is interested in studies that will advance the development and implementation of innovative healthcare strategies across the cancer care continuum for older adults from populations that experience health disparities. Research areas of interest to NCI include, but are not limited to:

• Increasing the integration and uptake of validated assessments (e.g., geriatric assessment, cognitive/physical function assessment) as well as refining and tailoring measures for specific older adult populations that experience health disparities to evaluate symptom burden, quality of life, and/or function across the cancer care continuum. Recommendations for discontinuation of screening tests should consider tradeoffs of harm and benefits as well as the optimal time for screening discontinuation or for extending the interval between repeat surveillance testing.
• Enhancing patient-centered communication and shared decision-making processes that are personalized to the values and preferences for care, quality of life, and independence of older adults and their families. This may include the development or cultural tailoring of communication approaches (e.g., decision aids) and efforts to balance the preferences for care and trade-offs of screening, diagnosis, cancer treatment, and end-of-life care for older adults from populations that experience health disparities.
• Understanding and supporting caregiving for older adults with cancer, including care training, promote coping skills, and care management across diverse healthcare settings. Tailored or adapting caregiving interventions that target medically underserved and underrepresented patient populations are of interest.
• Understanding and improving teamwork and coordination of comprehensive care for older adults from populations experiencing health disparities across the cancer care continuum, particularly as it relates to the management of multiple chronic conditions and during transitions in care from specialist to primary care. This may include healthcare delivery related factors, such as organizational readiness/capacity, teamwork processes, and care delivery approaches (i.e., in-person/telehealth), as well as communication of survivorship care planning and navigation of care and services tailored to older adult cancer survivors.
• Understanding and addressing barriers to equitable cancer care among older adults from populations experiencing health disparities, especially as it relates to ageism, digital divide, and access to cancer screening, diagnosis, treatment, survivorship care, palliative care, and end-of-life care.
• Examining the use of patient-reported outcomes (PROs) to stratify risk, support decision-making, and optimize cancer outcomes specific for older adult cancer survivors from populations that experience health disparities.
• Addressing the rehabilitation needs of older adults before, during, and after cancer treatment to reduce the adverse impacts from cancer treatment and to increase cognitive, functional, physical, and psychological resilience.
• Addressing the integration of social care into clinical care through the design and testing of interventions that adjust care to the personalized social needs of the older adult cancer survivor as well as connect and coordinate with social care services and resources. Examples include addressing poverty, food insecurity, housing instability, transportation-related barriers, employment-related impacts, and social isolation/loneliness to optimize the delivery of quality cancer care and improve health outcomes for older adults.
• Identifying strategies to increase representation of older adults from populations that experience health disparities in studies of cancer survivorship.
• Understanding and addressing the divide in access to and use of digital health tools and interventions where technology, online, digital, and mHealth components of interventions (e.g., PROs portals, decision aids, telehealth) can act as barriers to care and further exacerbate health disparities.

National Institute of Nursing Research (NINR) 

The National Institute of Nursing Research (NINR) supports research aligned with our mission and strategic priorities, conducted by scientists from any discipline. NINR discovers solutions to health challenges through the lenses of health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. Drawing on the strengths of nursing’s holistic, contextualized perspective, core values, and broad reach, NINR funds multilevel and cross-sectoral research that examines the factors that impact health across the many settings in which nurses practice, including homes, schools, workplaces, clinics, justice settings, and the community.

National Institute on Aging (NIA)

The mission of NIA is to support and conduct genetic, biological, clinical, behavioral, social, and economic research on aging; foster the development of research and clinician scientists in aging; provide research resources; and disseminate information about aging and advances in research to the public, health care professionals, and the scientific community, among a variety of audiences. Work should be guided by the NIA Health Disparities Framework and intervention development aligned with the NIH Stage Model for Behavioral Intervention Development and Science of Behavior Change.

NIA supports research that involves primary data collection as well as secondary data analysis.

NIA areas of research interests related to older adults from minoritized populations include, but are not limited to, the following:

• Clinical Care for Older Adults: Improving diagnostic and clinical care guidelines for older adults from minoritized populations experiencing health disparities.
• Interventions to Ameliorate Health Disparities in Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD): Research to address health inequities, including prevention, detection, and treatment of AD/ADRD.
• Shared Decision-Making: Enhancing shared decision-making between clinicians, care teams, older adults, and their caregivers to improve communication, care planning, and decision-making tools. NIA is especially interested in Shared Decision-Making in Palliative Care.
• Care Coordination: Focus on addressing care coordination challenges for persons with multiple chronic conditions and across various care settings and transitions, aiming to mitigate delayed or missed diagnoses and treatments.
• Interventions that test approaches to reduce interpersonal bias and discrimination in health care settings. Developing and assessing interventions to mitigate ageism, racism, and other forms of bias and discrimination based on stereotypes against older adults. Encouraging research focused on identifying sources of bias and discrimination, considering both individual and institutional levels. Elucidating the types of cognitive biases that can occur, such as confirmation bias, anchoring bias, etc., in interpersonal interactions. Highlighting the contexts in which these biases arise, including clinical decision-making, diagnostic biases, and consideration/presentation of treatment options.
• Evaluating existing methods and developing new strategies for health-system based interventions to prevent, recognize, and address various forms of elder mistreatment, including physical, sexual, emotional, or psychological abuse; neglect; abandonment; and financial or material exploitation. RFA-AG-24-048 contains a more comprehensive description of NIA’s interest in this area.
• Developing and evaluating interventions to achieve equity in access to and receipt of palliative care for medically underserved older adults and their caregivers at the time of diagnosis or during treatment.

Office of Disease Prevention

Ofice of Disease Prevention (ODP): The ODP is the lead office at the NIH responsible for assessing, facilitating, and stimulating research in disease prevention. In partnership with the 27 NIH Institutes and Centers, the ODP strives to increase the scope, quality, dissemination, and impact of NIH-supported prevention research. The ODP provides co-funding support for research that has strong implications for disease and injury prevention, health equity, and research that includes innovative and appropriate research design, measurements, and analysis methods.

The ODP does not award grants; therefore, applications must be relevant to the objectives of at least one of the participating NIH ICs listed in this announcement. The ODP only accepts co-funding requests from NIH ICs. For questions regarding IC research and/or funding priorities, be sure to contact the relevant IC Scientific/Research Contact(s) named in this NOSI. For additional information about ODP, please refer to the ODP Strategic Plan or visit prevention.nih.gov.  

Applications Not Responsive to the NOFO:

• Studies without a focus on racial and ethnic minority populations and/or SES disadvantaged persons or the intersection with other populations that experience health disparities.
• Studies focused on accelerated or accentuated aging in people less than age 65. For example, in people living with HIV, individuals with a disability, etc.
• Research that is exclusively qualitative.
• Projects that test interventions that do not involve more than one level of influence.
• Projects that prospectively test evidence-based interventions without modifications to the intervention content, delivery, or implementation specific to older adults from population that experience health disparities.
• Projects focused solely on the training of the health care workforce without understanding its impact on older adults from populations that experience health disparities or measuring outcomes that matter to this population of older adults.
• Projects that examine the financing of health care or the cost and efficiency of health care service delivery, without linking such economic analysis to measurable health outcomes (See NOT-OD-16-025 for more information).

See Section VIII. Other Information for award authorities and regulations.

Investigators proposing NIH-defined clinical trials may refer to the Research Methods Resources website for information about developing statistical methods and study designs.

Section II. Award Information

NIH grants policies as described in the NIH Grants Policy Statement will apply to the applications submitted and awards made from this NOFO.

Section III. Eligibility Information

1. Eligible Applicants

Higher Education Institutions

• Public/State Controlled Institutions of Higher Education
• Private Institutions of Higher Education

The following types of Higher Education Institutions are always encouraged to apply for NIH support as Public or Private Institutions of Higher Education:

• Hispanic-serving Institutions
• Historically Black Colleges and Universities (HBCUs)
• Tribally Controlled Colleges and Universities (TCCUs)
• Alaska Native and Native Hawaiian Serving Institutions
• Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)

Nonprofits Other Than Institutions of Higher Education

• Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
• Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)

For-Profit Organizations

• Small Businesses
• For-Profit Organizations (Other than Small Businesses)

Local Governments

• State Governments
• County Governments
• City or Township Governments
• Special District Governments
• Indian/Native American Tribal Governments (Federally Recognized)
• Indian/Native American Tribal Governments (Other than Federally Recognized).

Federal Governments

• U.S. Territory or Possession

Other

• Independent School Districts
• Public Housing Authorities/Indian Housing Authorities
• Native American Tribal Organizations (other than Federally recognized tribal governments)
• Faith-based or Community-based Organizations
• Regional Organizations

Non-domestic (non-U.S.) Entities (Foreign Organizations) are not eligible to apply.

Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.

Foreign components, as defined in the NIH Grants Policy Statement, are not allowed.

Applicant Organizations

Applicant organizations must complete and maintain the following registrations as described in the How to Apply- Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible. Failure to complete registrations in advance of a due date is not a valid reason for a late submission, please reference the NIH Grants Policy Statement Section 2.3.9.2 Electronically Submitted Applications for additional information.

• System for Award Management (SAM) – Applicants must complete and maintain an active registration, which requires renewal at least annually. The renewal process may require as much time as the initial registration. SAM registration includes the assignment of a Commercial and Government Entity (CAGE) Code for domestic organizations which have not already been assigned a CAGE Code.
  • NATO Commercial and Government Entity (NCAGE) Code – Foreign organizations must obtain an NCAGE code (in lieu of a CAGE code) in order to register in SAM.
  • Unique Entity Identifier (UEI) - A UEI is issued as part of the SAM.gov registration process. The same UEI must be used for all registrations, as well as on the grant application.
• eRA Commons - Once the unique organization identifier is established, organizations can register with eRA Commons in tandem with completing their Grants.gov registrations; all registrations must be in place by time of submission. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
• Grants.gov – Applicants must have an active SAM registration in order to complete the Grants.gov registration.

Program Directors/Principal Investigators (PD(s)/PI(s))

All PD(s)/PI(s) must have an eRA Commons account.  PD(s)/PI(s) should work with their organizational officials to either create a new account or to affiliate their existing account with the applicant organization in eRA Commons. If the PD/PI is also the organizational Signing Official, they must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with their organization to develop an application for support. Individuals from diverse backgrounds, including underrepresented racial and ethnic groups, individuals with disabilities, and women are always encouraged to apply for NIH support. See, Reminder: Notice of NIH's Encouragement of Applications Supporting Individuals from Underrepresented Ethnic and Racial Groups as well as Individuals with Disabilities, NOT-OD-22-019 and Notice of NIH's Interest in Diversity, NOT-OD-20-031.

For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the How to Apply-Application Guide.

2. Cost Sharing

This NOFO does not require cost sharing as defined in the NIH Grants Policy Statement Section 1.2 Definition of Terms.

3. Additional Information on Eligibility

Number of Applications

Applicant organizations may submit more than one application, provided that each application is scientifically distinct.

The NIH will not accept duplicate or highly overlapping applications under review at the same time, per NIH Grants Policy Statement Section 2.3.7.4 Submission of Resubmission Application. This means that the NIH will not accept:

• A new (A0) application that is submitted before issuance of the summary statement from the review of an overlapping new (A0) or resubmission (A1) application.
• A resubmission (A1) application that is submitted before issuance of the summary statement from the review of the previous new (A0) application.
• An application that has substantial overlap with another application pending appeal of initial peer review (see NIH Grants Policy Statement 2.3.9.4 Similar, Essentially Identical, or Identical Applications).

Section IV. Application and Submission Information

1. Requesting an Application Package

The application forms package specific to this opportunity must be accessed through ASSIST, Grants.gov Workspace or an institutional system-to-system solution. Links to apply using ASSIST or Grants.gov Workspace are available in Part 1 of this NOFO. See your administrative office for instructions if you plan to use an institutional system-to-system solution.

2. Content and Form of Application Submission

It is critical that applicants follow the instructions in the Research (R) Instructions in the How to Apply - Application Guide except where instructed in this notice of funding opportunity to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.

Letter of Intent

Not Applicable.

Page Limitations

All page limitations described in the How to Apply- Application Guide and the Table of Page Limits must be followed.

The following section supplements the instructions found in the How to Apply- Application Guide and should be used for preparing an application to this NOFO.

SF424(R&R) Cover

All instructions in the How to Apply - Application Guide must be followed.

SF424(R&R) Project/Performance Site Locations

All instructions in the How to Apply- Application Guide must be followed.

SF424(R&R) Other Project Information

All instructions in the How to Apply- Application Guide must be followed.

SF424(R&R) Senior/Key Person Profile

All instructions in the How to Apply- Application Guide must be followed.

R&R or Modular Budget

All instructions in the How to Apply- Application Guide must be followed.

R&R Subaward Budget

All instructions in the How to Apply-Application Guide must be followed.

PHS 398 Cover Page Supplement

All instructions in the How to Apply- Application Guide must be followed.

PHS 398 Research Plan

All instructions in the How to Apply- Application Guide must be followed, with the following additional instructions:

Describe to what extent the project will contribute to advancing approaches to improving health outcomes for older adults from populations that experience health disparities across multiple levels and/or multiple domains of influence.

Describe the conceptual framework for the multi-level analysis. 

Resource Sharing Plan: Individuals are required to comply with the instructions for the Resource Sharing Plans as provided in the How to Apply- Application Guide.

Other Plan(s): 

All instructions in the How to Apply-Application Guide must be followed, with the following additional instructions:

• All applicants planning research (funded or conducted in whole or in part by NIH) that results in the generation of scientific data are required to comply with the instructions for the Data Management and Sharing Plan. All applications, regardless of the amount of direct costs requested for any one year, must address a Data Management and Sharing Plan.

Appendix: Only limited Appendix materials are allowed. Follow all instructions for the Appendix as described in the How to Apply- Application Guide.

• No publications or other material, with the exception of blank questionnaires or blank surveys, may be included in the Appendix.

PHS Human Subjects and Clinical Trials Information

When involving human subjects research, clinical research, and/or NIH-defined clinical trials (and when applicable, clinical trials research experience) follow all instructions for the PHS Human Subjects and Clinical Trials Information form in the How to Apply- Application Guide, with the following additional instructions:

If you answered “Yes” to the question “Are Human Subjects Involved?” on the R&R Other Project Information form, you must include at least one human subjects study record using the Study Record: PHS Human Subjects and Clinical Trials Information form or Delayed Onset Study record.

Study Record: PHS Human Subjects and Clinical Trials Information

All instructions in the How to Apply- Application Guide must be followed.

Delayed Onset Study

Note: Delayed onset does NOT apply to a study that can be described but will not start immediately (i.e., delayed start).All instructions in the How to Apply- Application Guide must be followed.

PHS Assignment Request Form

All instructions in the How to Apply- Application Guide must be followed.

3. Unique Entity Identifier and System for Award Management (SAM)

See Part 2. Section III.1 for information regarding the requirement for obtaining a unique entity identifier and for completing and maintaining active registrations in System for Award Management (SAM), NATO Commercial and Government Entity (NCAGE) Code (if applicable), eRA Commons, and Grants.gov

4. Submission Dates and Times

Part I. contains information about Key Dates and times. Applicants are encouraged to submit applications before the due date to ensure they have time to make any application corrections that might be necessary for successful submission. When a submission date falls on a weekend or Federal holiday, the application deadline is automatically extended to the next business day.

Organizations must submit applications to Grants.gov (the online portal to find and apply for grants across all Federal agencies). Applicants must then complete the submission process by tracking the status of the application in the eRA Commons, NIH’s electronic system for grants administration. NIH and Grants.gov systems check the application against many of the application instructions upon submission. Errors must be corrected and a changed/corrected application must be submitted to Grants.gov on or before the application due date and time.  If a Changed/Corrected application is submitted after the deadline, the application will be considered late. Applications that miss the due date and time are subjected to the NIH Grants Policy Statement Section 2.3.9.2 Electronically Submitted Applications.

Applicants are responsible for viewing their application before the due date in the eRA Commons to ensure accurate and successful submission.

Information on the submission process and a definition of on-time submission are provided in the How to Apply-Application Guide.

5. Intergovernmental Review (E.O. 12372)

This initiative is not subject to intergovernmental review.

6. Funding Restrictions

All NIH awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement.

Pre-award costs are allowable only as described in the NIH Grants Policy Statement Section 7.9.1 Selected Items of Cost.

Applications must be submitted electronically following the instructions described in the How to Apply Application Guide. Paper applications will not be accepted.

Applicants must complete all required registrations before the application due date. Section III. Eligibility Information contains information about registration.

For assistance with your electronic application or for more information on the electronic submission process, visit How to Apply – Application Guide. If you encounter a system issue beyond your control that threatens your ability to complete the submission process on-time, you must follow the Dealing with System Issues guidance. For assistance with application submission, contact the Application Submission Contacts in Section VII.

Important reminders:

All PD(s)/PI(s) must include their eRA Commons ID in the Credential field of the Senior/Key Person Profile form. Failure to register in the Commons and to include a valid PD/PI Commons ID in the credential field will prevent the successful submission of an electronic application to NIH. See Section III of this NOFO for information on registration requirements.

The applicant organization must ensure that the unique entity identifier provided on the application is the same identifier used in the organization’s profile in the eRA Commons and for the System for Award Management. Additional information may be found in the How to Apply Application Guide.

See more tips for avoiding common errors.

Upon receipt, applications will be evaluated for completeness and compliance with application instructions by the Center for Scientific Review and responsiveness by components of participating organizations, NIH. Applications that are incomplete, non-compliant and/or nonresponsive will not be reviewed.

Requests of $500,000 or more for direct costs in any year 

Applicants requesting $500,000 or more in direct costs in any year (excluding consortium F&A) must contact a Scientific/ Research Contact at least 6 weeks before submitting the application and follow the Policy on the Acceptance for Review of Unsolicited Applications that Request $500,000 or More in Direct Costs as described in the SF424 (R&R) Application Guide.

Recipients or subrecipients must submit any information related to violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the federal award. See Mandatory Disclosures, 2 CFR 200.113 and NIH Grants Policy Statement Section 4.1.35.

Send written disclosures to the NIH Chief Grants Management Officer listed on the Notice of Award for the IC that funded the award and to the HHS Office of Inspector Grant Self Disclosure Program at [email protected].

Post Submission Materials

Applicants are required to follow the instructions for post-submission materials, as described in the policy

Any instructions provided here are in addition to the instructions in the policy.

Section V. Application Review Information

1. Criteria

Only the review criteria described below will be considered in the review process. Applications submitted to the NIH in support of the NIH mission are evaluated for scientific and technical merit through the NIH peer review system.

Reviewers will provide an overall impact score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following scored review criteria and additional review criteria (as applicable for the project proposed). An application does not need to be strong in all categories to be judged likely to have a major scientific impact.

Reviewers will evaluate Factors 1, 2 and 3 in the determination of scientific merit, and in providing an overall impact score. In addition, Factors 1 and 2 will each receive a separate criterion score. 

As applicable for the project proposed, reviewers will consider the following additional items while determining scientific and technical merit, but will not give criterion scores for these items, and should consider them in providing an overall impact score.

As applicable for the project proposed, reviewers will consider each of the following items, but will not give scores for these items, and should not consider them in providing an overall impact score.

2. Review and Selection Process

Applications will be evaluated for scientific and technical merit by (an) appropriate Scientific Review Group(s) convened by Center for Scientific Review, in accordance with NIH peer review policies and practices, using the stated review criteria. Assignment to a Scientific Review Group will be shown in the eRA Commons.

As part of the scientific peer review, all applications will receive a written critique.

Applications may undergo a selection process in which only those applications deemed to have the highest scientific and technical merit (generally the top half of applications under review) will be discussed and assigned an overall impact score.

Applications will be assigned on the basis of established PHS referral guidelines to the appropriate NIH Institute or Center. Applications will compete for available funds with all other recommended applications submitted in response to this NOFO. Following initial peer review, recommended applications will receive a second level of review by the appropriate national Advisory Council or Board. The following will be considered in making funding decisions:

• Scientific and technical merit of the proposed project as determined by scientific peer review.
• Availability of funds.
• Relevance of the proposed project to program priorities.

If the application is under consideration for funding, NIH will request "just-in-time" information from the applicant as described in the NIH Grants Policy Statement Section 2.5.1. Just-in-Time Procedures. This request is not a Notice of Award nor should it be construed to be an indicator of possible funding.

Prior to making an award, NIH reviews an applicant’s federal award history in SAM.gov to ensure sound business practices. An applicant can review and comment on any information in the Responsibility/Qualification records available in SAM.gov. NIH will consider any comments by the applicant in the Responsibility/Qualification records in SAM.gov to ascertain the applicant’s integrity, business ethics, and performance record of managing Federal awards per 2 CFR Part 200.206 “Federal awarding agency review of risk posed by applicants.” This provision will apply to all NIH grants and cooperative agreements except fellowships.

3. Anticipated Announcement and Award Dates

After the peer review of the application is completed, the PD/PI will be able to access his or her Summary Statement (written critique) via the eRA Commons. Refer to Part 1 for dates for peer review, advisory council review, and earliest start date.

Information regarding the disposition of applications is available in the NIH Grants Policy Statement Section 2.4.4 Disposition of Applications.

Section VI. Award Administration Information

1. Award Notices

A Notice of Award (NoA) is the official authorizing document notifying the applicant that an award has been made and that funds may be requested from the designated HHS payment system or office. The NoA is signed by the Grants Management Officer and emailed to the recipient’s business official.

In accepting the award, the recipient agrees that any activities under the award are subject to all provisions currently in effect or implemented during the period of the award, other Department regulations and policies in effect at the time of the award, and applicable statutory provisions.

Recipients must comply with any funding restrictions described in Section IV.6. Funding Restrictions. Any pre-award costs incurred before receipt of the NoA are at the applicant's own risk.  For more information on the Notice of Award, please refer to the NIH Grants Policy Statement Section 5. The Notice of Award and NIH Grants & Funding website, see Award Process.

Individual awards are based on the application submitted to, and as approved by, the NIH and are subject to the IC-specific terms and conditions identified in the NoA.

ClinicalTrials.gov: If an award provides for one or more clinical trials. By law (Title VIII, Section 801 of Public Law 110-85), the "responsible party" must register and submit results information for certain “applicable clinical trials” on the ClinicalTrials.gov Protocol Registration and Results System Information Website (https://register.clinicaltrials.gov). NIH expects registration and results reporting of all trials whether required under the law or not. For more information, see https://grants.nih.gov/policy/clinical-trials/reporting/index.htm

Institutional Review Board or Independent Ethics Committee Approval: Recipient institutions must ensure that all protocols are reviewed by their IRB or IEC. To help ensure the safety of participants enrolled in NIH-funded studies, the recipient must provide NIH copies of documents related to all major changes in the status of ongoing protocols.

Data and Safety Monitoring Requirements: The NIH policy for data and safety monitoring requires oversight and monitoring of all NIH-conducted or -supported human biomedical and behavioral intervention studies (clinical trials) to ensure the safety of participants and the validity and integrity of the data. Further information concerning these requirements is found at http://grants.nih.gov/grants/policy/hs/data_safety.htm and in the application instructions (SF424 (R&R) and PHS 398).

Investigational New Drug or Investigational Device Exemption Requirements: Consistent with federal regulations, clinical research projects involving the use of investigational therapeutics, vaccines, or other medical interventions (including licensed products and devices for a purpose other than that for which they were licensed) in humans under a research protocol must be performed under a Food and Drug Administration (FDA) investigational new drug (IND) or investigational device exemption (IDE).

2. Administrative and National Policy Requirements

The following Federal wide and HHS-specific policy requirements apply to awards funded through NIH:

• The rules listed at 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
• All NIH grant and cooperative agreement awards include the NIH Grants Policy Statement as part of the terms and conditions in the Notice of Award (NoA). The NoA includes the requirements of this NOFO. For these terms of award, see the NIH Grants Policy Statement Part II: Terms and Conditions of NIH Grant Awards, Subpart A: General and Part II: Terms and Conditions of NIH Grant Awards, Subpart B: Terms and Conditions for Specific Types of Grants, Recipients, and Activities.
• If a recipient receives an award, the recipient must follow all applicable nondiscrimination laws. The recipient agrees to this when registering in SAM.gov. The recipient must also submit an Assurance of Compliance (HHS-690). To learn more, see the Laws and Regulations Enforced by the HHS Office for Civil Rights website.
  • HHS recognizes that NIH research projects are often limited in scope for many reasons that are nondiscriminatory, such as the principal investigator’s scientific interest, funding limitations, recruitment requirements, and other considerations. Thus, criteria in research protocols that target or exclude certain populations are warranted where nondiscriminatory justifications establish that such criteria are appropriate with respect to the health or safety of the subjects, the scientific study design, or the purpose of the research. For additional guidance regarding how the provisions apply to NIH grant programs, please contact the Scientific/Research Contact that is identified in Section VII under Agency Contacts of this NOFO.

All federal statutes and regulations relevant to federal financial assistance, including those highlighted in NIH Grants Policy Statement Section 4 Public Policy Requirements, Objectives and Other Appropriation Mandates.

Recipients are responsible for ensuring that their activities comply with all applicable federal regulations.  NIH may terminate awards under certain circumstances.  See 2 CFR Part 200.340 Termination and NIH Grants Policy Statement Section 8.5.2 Remedies for Noncompliance or Enforcement Actions: Suspension, Termination, and Withholding of Support. 

Not Applicable

Consistent with the 2023 NIH Policy for Data Management and Sharing, when data management and sharing is applicable to the award, recipients will be required to adhere to the Data Management and Sharing requirements as outlined in the NIH Grants Policy Statement. Upon the approval of a Data Management and Sharing Plan, it is required for recipients to implement the plan as described.

4. Reporting

When multiple years are involved, recipients will be required to submit the Research Performance Progress Report (RPPR) annually and financial statements as required in the NIH Grants Policy Statement Section 8.4.1 Reporting. To learn more about post-award monitoring and reporting, see the NIH Grants & Funding website, see Post-Award Monitoring and Reporting.

A final RPPR, invention statement, and the expenditure data portion of the Federal Financial Report are required for closeout of an award, as described in the NIH Grants Policy Statement Section 8.6 Closeout. NIH NOFOs outline intended research goals and objectives. Post award, NIH will review and measure performance based on the details and outcomes that are shared within the RPPR, as described at 2 CFR Part 200.301.

Section VII. Agency Contacts

We encourage inquiries concerning this funding opportunity and welcome the opportunity to answer questions from potential applicants.

eRA Service Desk (Questions regarding ASSIST, eRA Commons, application errors and warnings, documenting system problems that threaten submission by the due date, and post-submission issues)

Finding Help Online: https://www.era.nih.gov/need-help (preferred method of contact)
Telephone: 301-402-7469 or 866-504-9552 (Toll Free)

General Grants Information (Questions regarding application instructions, application processes, and NIH grant resources)
Email: [email protected] (preferred method of contact)
Telephone: 301-480-7075

Grants.gov Customer Support (Questions regarding Grants.gov registration and Workspace)
Contact Center Telephone: 800-518-4726
Email: [email protected]

Yewande Oladeinde, PhD
National Institute on Minority Health and Health Disparities (NIMHD)
Telephone: 301-402-4307
Email: [email protected]

Michelle Doose, PhD, MPH
National Cancer Institute (NCI)
Telephone: 240-276-7674
Email: [email protected]

Karen Huss, PhD, RN, ANP-BC, FAAN, FAAAAI, FAHA
National Institute of Nursing Research (NINR)
Telephone: 301-594-5970
Email: [email protected]

Priscilla Novak, PhD, MPH
National Institute on Aging (NIA)
Telephone: 301-496-3136
Email: [email protected]

Robert McNellis, MPH, PA
Office of Disease Prevention (ODP)
Telephone: (301) 435-0824
E-mail: [email protected]

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Priscilla Grant, JD
National Institute on Minority Health and Health Disparities (NIMHD)
Telephone: 301-594-8412
Email: [email protected]

Crystal Wolfrey
National Cancer Institute (NCI)
Telephone: 240-276-6277
Email: [email protected]

Ron Wertz
National Institute of Nursing Research (NINR)
Telephone: 301-594-2807
Email: [email protected]

Jeni Smits
National Institute on Aging (NIA)
E-mail: [email protected]

Section VIII. Other Information

Recently issued trans-NIH policy notices may affect your application submission. A full list of policy notices published by NIH is provided in the NIH Guide for Grants and Contracts. All awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement.

Awards are made under the authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and under Federal Regulations 42 CFR Part 52 and 2 CFR Part 200.