Part 1. Overview Information

Key Dates

It is critical that applicants follow the instructions in the Research (R) Instructions in the SF424 (R&R) Application Guide,except where instructed to do otherwise (in this FOA or in a Notice from NIH Guide for Grants and Contracts ).

Conformance to all requirements (both in the Application Guide and the FOA) 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.

Part 2. Full Text of Announcement

Section I. Funding Opportunity Description

Background

Early detection of cognitive decline may be critical to the efforts to stop dementia progression, including Alzheimer’s disease (AD) and AD-related dementias (ADRD). Dementia and mild cognitive impairment (MCI) are under-diagnosed, and analyses using claims data, as well as other methods, indicate that clinical diagnoses occur late in the process of cognitive decline. As noted by the United States Preventive Service Task Force (USPSTF), fewer than 50% of persons with dementia are diagnosed, and rates are even lower for persons with MCI. Furthermore, detection and diagnosis rates are worse in minority populations. The inability to diagnose and treat cognitive impairment results in prolonged and expensive medical care. Early detection could help persons with dementia and their care partners plan for the future. Additionally, early detection will become increasingly important both for recruitment of individuals for clinical trials and, as effective treatments become available, for assuring that people receive early treatment. In October 2017, NIA supported a meeting titled “Cost-Effective Early Detection of Cognitive Decline,” which highlighted the need for development, validation, and translation of screening and assessment tools for measuring cognitive decline. This FOA seeks applications which will develop (Stage I creation, adaptation, and piloting of an intervention), validate (Stage I ), and translate (State IV pragmatic trial) cognitive assessment tools in clinical settings.

Development Work:

1. Develop and test technologies that enable new approaches to assessing intra-individual change in cognition, in part by assessing process as well as product to identify subtle signs of early impairment that are overlooked because of compensatory strategies.
2. Develop and test self-administered assessments with low false-positive rates.
3. Develop and test longitudinal assessments to understand indicators of possible decline.
4. Where possible, embed or associate new assessment methods with existing ongoing studies to leverage resources, including machine learning approaches for detecting cognitive decline.
5. Personalize cognitive assessment for physicians and patients for take up in the clinic and/or at home.

Validation Work: Validation research is needed to assess computerized or digital screening tools, automated EHR tools, and/or machine learning approaches used to develop risk indices of early cognitive decline against gold standard measures. Validation work under this FOA may include the following:

1. Validate computerized test batteries, digital assessment tools, machine learning algorithms, and/or risk indices to establish sensitivity and specificity for biomarker evidence of preclinical AD/ADRD and to compare performance against existing measures, where appropriate.
2. Evaluate fit-for-purpose, community, and clinical meaningfulness of computerized test batteries, digital assessment tools, machine learning algorithms, and/or risk indices.
3. Consider whether a multisite platform and coalition for validating and comparing various tools for predicting and measuring change, possibly modeled on the Alzheimer’s Disease Neuroimaging Initiative (ADNI) approach, could be useful to the research community for organizing these efforts.
4. Ensure cognitive assessments are appropriately normed for age, gender, and ethnic subpopulations.

Translation Work: Assessment and screening tools, administrative data analysis methods, and risk indices to detect early signs of cognitive decline are often developed in research contexts. More research is needed to adapt, test, and implement such tools in clinical settings and to link them to clinically meaningful care. Researchers are expected to incorporate cognitive assessment into EHRs for patients' Medicare Annual Wellness Visit. Translation work under this FOA may include the following:

1. Adapt existing tools and methods, with input from stakeholders, to fit the needs of a clinical workflow. Ideally, screeners, instruments, or machine learning algorithms would have utility at the individual level as both predictors and indicators of change.
2. Test existing tools and methods in a variety of diverse regions, with diverse and populations, and with different modalities (such as telemedicine).
3. Identify and provide evidence for the link between screening and assessment tools and clinically meaningful care recommendations.
4. Conduct usability studies in a variety of geographic regions, with diverse populations, and with different modalities (such as telemedicine), and leverage substantial existing work from the U.S. Department of Veterans Affairs.

This FOA requires all applicants to create tools and develop interventions for both providers and patients which will address health disparities in diagnosis of cognitive impairment.

The tools and interventions developed must be simple, inexpensive, and powerful enough to move directly from Stage I (creation, adaptation, and piloting of an intervention) to Stage IV pragmatic trials testing the effectiveness of the intervention (please see the NIH Stage Model). More complex interventions that require additional Stage I work, such as the development and testing of physician/provider training materials or other materials to ensure fidelity, may be included only if such Stage I testing may be conducted within the R61 phase (see below); if a compelling case can be made that traditional Stage III testing (highly-controlled, high internal validity real-world clinical) is not needed before proceeding to Stage IV (high external validity pragmatic trials); and if validation is completed during the R61 phase.

The ultimate goals of this initiative are two-fold: 1) to create tools and assessments—including both adapting existing instruments and developing and validating new ones that can feasibly be integrated into the EHR systems—and 2) to facilitate their integration into existing healthcare settings.

The R61 Phase (Planning/Pilot/Validation Phase, including Stage I research)

During the R61 pilot phase, researchers can conduct development of instruments and validations of such instruments in EHR systems to establish their feasibility. They will conduct Stage I research to create tailored interventions within the EHR system. Interventions, if successful, can then transition to the R33 phase for implementation of Stage IV pragmatic trials. The specific activities and milestones appropriate for the R61 phase will depend on the individual application and its stage of development. The applicant must include the following activities and milestones for the R61 phase:

• Utilize analytical tools, including machine learning approaches, to establish the feasibility of identifying groups of patients in need of cognitive screening or assessment, including (1) identification of high risk and vulnerable patients; and (2) personalization of interventions for patients (e.g., in-home cognitive testing using instruments developed by researchers which can be linked to EHRs) and providers (e.g., development of screeners for in-office assessment and/or provision of access to reports from in-home assessments).
• Obtain access to EHRs.
• Using information gleaned from EHRs, conduct Stage I research. Researchers are required to design interventions which will address not only the supply side (e.g., healthcare providers ordering cognitive assessment services), but also patients completing a cognitive assessment.
• Establish a partnership with healthcare providers (e.g., primary care physicians, neurologists, geriatricians, specialists, HMOs, etc.) and document commitment of the organizations to the project.
• Operationalize definitions and objective measures of the intervention.
• Propose a hypothesized mechanism to achieve the FOA objective.
• Provide preliminary evidence that the mechanism of action can be manipulated reliably and validly through the EHR-supported process.
• Assess, justify the adequacy of, and finalize clinically relevant outcome measures, such as three successive cognitive test administrations to detect cognitive decline. Note that no project will be allowed to move to the translation/implementation phase without validation data from instrument testing during the R61 phase.
• Plan adequately for pilot testing the intervention(s), and produce preliminary data for R33 administrative review showing feasibility, including pragmatic trial protocol.

The R33 Phase (Implementation Phase, including Stage IV pragmatic trial)

During the R33 phase, the PD(s)/PI(s) will implement the intervention in a clinical setting. General activities for this phase include:

• Plan for intervention refinement; standardization; and further testing of feasibility, safety, and acceptability, with preliminary testing of the association between intervention(s) and clinical outcomes.
• Plan to refine estimates of requirements based on R61 findings, with guidance from NIH staff on sample size, numbers of sites, site-to-site heterogeneity, and the implementation timetable based on data derived from the healthcare delivery partners.
• Studies supported by the R33 phase should be adequately powered. It is recommended that the PD(s)/PI(s) provide power calculations for the R33 phase.
• Plan for site implementation, including site staff, method of identification, randomization (as applicable), and participant recruitment and acquisition.
• Plan to address all ethical issues and issues related to human subject safety oversight for the pragmatic trails, including the development of informed consent documents or opt-out consents (if applicable) and finalizing site of IRB review. Applicants must propose a single IRB approach for trial oversight to facilitate both appropriate and timely study implementation.
• Replicate findings in another site. Applicants are required to identify additional implementation sites for replication purposes prior to beginning the R33 phase.

Milestones and R61/R33 Transition

The application must propose a well-defined set of milestones (see required milestones above) for the planning phase (R61) and annual milestones for the implementation phase (R33). Specifically, the transition from the R61 to the R33 phase of the award will be administratively reviewed for successful completion of the go/no-go criteria that will be clearly specified in the R61 phase. Generally, the application could include the following activities and milestones for the R61 phase:

(1) Establishment of partnerships with healthcare providers and documentation of the commitment of the organization(s) to the project

(2) Ability to obtain access to EHRs and modify and implement pilot interventions

(3) Operationalization of definitions and objective measures of the intervention (i.e., the hypothesized mechanism of action)

(4) Provision of preliminary evidence that the mechanism of action can be manipulated reliably and validly through the EHR-linked process

(5) Assessment and justification of adequacy and finalization of clinically-relevant outcome measures

(6) Results of the pilot test intervention(s) and preliminary data for R33 administrative review showing feasibility of the intervention and completion of pragmatic trial protocol

At the completion of the R61 planning phase, the applicant will be required to submit a detailed transition request for the R33 implementation phase. R33 transition requests will undergo an administrative review to determine whether the milestones have been met. Unless the R61 meets go/no-go criteria, the R61 may not transition to the R33 phase.

Prospective applicants should note that funding of the R61 phase of a grant application does not guarantee support of the R33 phase. Transition to the R33 phase of the project will occur only if an administrative review process recommends that the R61 planning activities have been successful, the implementation phase of the project can proceed with confidence of success, and funds are available.

Partnerships and Access to EHRs

Partnerships with healthcare delivery organizations will be critical to implementing this FOA. It is anticipated that interventions will generally be performed with electronically-supported, integrated healthcare delivery organizations to establish efficiencies. The partnership must facilitate access to all EHR data sources relevant to the project (modifying the system when necessary). Further, we encourage collaborations with retail EHR vendors (EPIC, eClinical, MedSeek, etc.) to scale the adoption of successful interventions to solo and small-group practices.

Duration of R61/R33 Phases

It is expected that during the first 1-3 years the PD(s)/PI(s) will conduct development and validation work to test the feasibility of predicting cognitive decline (R61). Researchers who complete development work are encouraged to apply to R61 transition to the implementation phase (R33) in large clinical settings  and encourage subsequent adoption across multiple EHR systems for the remaining 2-4 years of the grant.

Responsiveness Criteria

The following types of applications will not be considered nonresponsive and will not be reviewed:    

• Trials without a control group identified (i.e. open trials)
• Trials which require complex or expensive implementation or monitoring during the R33 phase (i.e. trials not classified under Stage IV pragmatic trials)
• Trials which do not leverage EHR opportunities.
• Trials which fail to address health disparities
• Trials which do not personalize tools/interventions for patients and providers
• Applications which fail to conduct Stage IV trials during the R33 phase
• Trials which fail to address power calculations for the R33 phase

Additionally, extensive data collection (i.e. direct cost exceeding $200,000 for the full R61 phase or direct cost exceeding $300,000 for the full R33 phase) is not permissible for this announcement. Researchers are encouraged to use administrative data sources, such as EHRs; Centers for Medicare and Medicaid Services claims data; other nursing home, federal, or state administrative data; and low- to no-cost smartphone or web-based interventions. It is expected that PD(s)/PI(s) will highlight data collection cost in their budget justification.

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

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 FOA.

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)

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)

• Eligible Agencies of the Federal Government

• 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 Institutions) 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 allowed. 

Applicant organizations

Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) 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. The NIH Policy on Late Submission of Grant Applications states that failure to complete registrations in advance of a due date is not a valid reason for a late submission.

• Dun and Bradstreet Universal Numbering System (DUNS) - All registrations require that applicants be issued a DUNS number. After obtaining a DUNS number, applicants can begin both SAM and eRA Commons registrations. The same DUNS number must be used for all registrations, as well as on the grant application.
• 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. 
• eRA Commons - Applicants must have an active DUNS number to register in eRA Commons. Organizations can register with the eRA Commons as they are working through their SAM or Grants.gov registration , but 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 DUNS number and 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 his/her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH support.

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 SF424 (R&R) Application Guide.

2. Cost Sharing

This FOA does not require cost sharing as defined in the NIH Grants Policy Statement.

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.  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 NOT-OD-11-101)

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 FOA. 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 SF424 (R&R) Application Guide except where instructed in this funding opportunity announcement 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  

Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows IC staff to estimate the potential review workload and plan the review.

By the date listed in Part 1. Overview Information, prospective applicants are asked to submit a letter of intent that includes the following information:

• Descriptive title of proposed activity
• Name(s), address(es), and telephone number(s) of the PD(s)/PI(s)
• Names of other key personnel
• Participating institution(s)
• Number and title of this funding opportunity

The letter of intent should be sent to:

Partha Bhattacharyya, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-496-3136
Email: bhattacharyyap@mail.nih.gov 

All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this FOA. All instructions in the SF424 (R&R) Application Guide must be followed. All instructions in the SF424 (R&R) Application Guide must be followed. All instructions in the SF424 (R&R) Application Guide must be followed. All instructions in the SF424 (R&R) Application Guide must be followed.
R&R Budget  

All instructions in the SF424 (R&R) Application Guide must be followed.

All instructions in the SF424 (R&R) Application Guide must be followed.

Applicants should budget for travel to an annual investigators meeting to be held in the Washington, D.C. area.

All instructions in the SF424 (R&R) Application Guide must be followed. All instructions in the SF424 (R&R) Application Guide must be followed, with the following additional instructions:

Specific Aims: Specific aims should be presented in one page and must separate the specific aims for R61 and R33 phase.

Research Strategy: The Research Strategy should contain separate sections for development, validation, and translation phases. It is not necessary to repeat shared information or details across both sections.

Preliminary data are NOT required. Any preliminary data that will support or justify the proposed hypothesis, including literature from prior development in areas such as applications of machine learning algorithms to predict and/or measure cognitive decline or analyze EHR data, may be included.

PDs/PIs should propose to follow best practices for the conduct of their randomized trial and, in particular, clearly state how randomization will be performed. For example, if randomization is performed at the hospital level, the applicant should describe the number of effective observations after accounting for intra-cluster correlation. If the randomization is at a lower level than the hospital (e.g., memory clinic or primary care practice), PDs/PIs should address potential threats to validity that could occur due to contamination across treatment groups. PDs/PIs must clearly present power calculations that reflect a range of effect sizes of clinical significance. Specifically, it is recommended that PDs/PIs provide beta ranges to assess the sample size and effect size across multiple sites.

Applicants should provide a description of how the study designs, methods, and assessments are complementary such that outcomes from the development/validation phase will enhance the interpretation of outcomes during the translation phase across multiple sites.

Rigor and Reproducibility: For replication purposes, applicants must identify additional implementation sites for translation work (R33 phase).

Since the intent of this FOA is to leverage findings from planning phase to implementation phase and to increase the potential for translation research, PDs/PIs are encouraged to collaborate with EHR vendors to maximize translation potential.

Milestones and the R61/R33 Transition

The application must include milestones the researchers expect to achieve by the end of the R61 phase, as well as milestones for the R33 phase. Milestones should be specific, quantifiable, and scientifically justified; they should not be simply a restatement of the specific aims for the R61 phase. It is recommended that PD(s)/PI(s) include a section labeled "milestones" describing milestones to be achieved during the R61 phase to qualify for the transition to the R33.

It is understood that the proposed milestones for the R33 phase may be revised based on activities during the R61 phase. In the event of an award, the PD(s)/PI(s) and NIH staff will negotiate a list of milestones for each year of support.

Resource Sharing Plan: Individuals are required to comply with the instructions for the Resource Sharing Plans as provided in the SF424 (R&R) Application Guide.

The following modifications also apply:

• All applications, regardless of the amount of direct costs requested for any one year, should address a Data Sharing Plan.
• In order to encourage rigor and reproducibility, all applications where the development of statistical codes (e.g., STATA, SAS, R, etc.) or other resources (e.g., instruments, algorithms for machine learning, codes associated with development of prompts for EHRs, instruments for measuring cognitive decline, etc.) must describe  a specific plan for sharing and distributing unique research resources generated using NIH funding or state why such sharing is restricted or not possible.
• Investigators should describe how they will curate data and what documentation they will provide (“metadata”), in what format, and whether any data will be held back.
• For studies involving human participants, the investigators should describe how they will de-identify data; whether that procedure is compliant with HIPAA, IRB, or other institutional guidance; and how they will secure participants' personal and private information.
• Investigators should identify any restrictions on sharing (beyond temporal restrictions) and justify them. For example, restrictions may apply to commercial use of data, users' qualifications, or attempts to reveal subjects' personal or private information. Investigators may also set different levels of access, for example, for expert users and novice users.
• Investigators should describe and justify the data release timetable. Generally, the data from a publication should be made available by the online publication date unless NIH policy specifies an earlier date. Investigators should justify exceptions to that timing.
• Investigators should describe any transformations to the data (application of algorithms or tools) that will be applied.
• Investigators should include a dissemination plan through a website which will share resources (e.g., pre-drafted letter justifying the utility of the intervention (citing the paper generated from this FOA), tools/codes/algorithms generated from this FOA which can be adopted by other institution, including use if the pre-drafted letter which will allow other institution to insert their logo, etc).

Only limited Appendix materials are allowed. Follow all instructions for the Appendix as described in the SF424 (R&R) Application Guide. 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 SF424 (R&R) 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 SF424 (R&R) 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 SF424 (R&R) Application Guide must be followed.

All instructions in the SF424 (R&R) Application Guide must be followed.

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

See Part 1. 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. Overview Information 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 Policy on Late Application Submission.

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 SF424 (R&R) 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.

7. Other Submission Requirements and Information

Applications must be submitted electronically following the instructions described in the SF424 (R&R) 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 Component of the SF424(R&R) Application Package. 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 FOA for information on registration requirements.

The applicant organization must ensure that the DUNS number it provides on the application is the same number used in the organization’s profile in the eRA Commons and for the System for Award Management. Additional information may be found in the SF424 (R&R) 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.

In order to expedite review, applicants are requested to notify the NIA Referral Office by email at sunejas@mail.nih.gov when the application has been submitted. Please include the FOA number and title, PD/PI name, and title of the application.

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.

For this particular announcement, note the following:

A proposed Clinical Trial application may include study design, methods, and intervention that are not by themselves innovative but address important questions or unmet needs. Additionally, the results of the clinical trial may indicate that further clinical development of the intervention is unwarranted or lead to new avenues of scientific investigation.

The initiative will support interventions integrated with EHRs for early detection of cognitive decline without overruling physicians’ autonomy to exercise clinical judgment. Preliminary data are not required; however, any preliminary data that will support or justify the proposed hypothesis, rationale, or development plan may be included. Since implementation of cognitive decline evaluation through EHRs is an emerging research area, investigators may not have experience working together as a team, as expertise may be necessary from multiple disciplines (e.g. medicine, biostatistics, neurology, data science, machine learning expertise, psychology, etc.).

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 review criteria and additional review criteria (as applicable for the project proposed). Reviewers will consider each of the review criteria below in the determination of scientific merit, and give a separate score for each. An application does not need to be strong in all categories to be judged likely to have major scientific impact. For example, a project that by its nature is not innovative may be essential to advance a field.

Significance  

Does the project address an important problem or a critical barrier to progress in the field? Is the prior research that serves as the key support for the proposed project rigorous? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field?

Are the scientific rationale and need for a clinical trial to test the proposed hypothesis or intervention well supported by the literature or knowledge of biological mechanisms? For trials focusing on clinical or public health endpoints, is this clinical trial necessary for testing the safety, efficacy or effectiveness of an intervention that could lead to a change in clinical practice, community behaviors or health care policy?

Investigator(s)  

Are the PD(s)/PI(s), collaborators, and other researchers well suited to the project? If Early Stage Investigators or those in the early stages of independent careers, do they have appropriate experience and training? If established, have they demonstrated an ongoing record of accomplishments that have advanced their field(s)? If the project is collaborative or multi-PD/PI, do the investigators have complementary and integrated expertise; are their leadership approach, governance and organizational structure appropriate for the project?

With regard to the proposed leadership for the project, do the PD/PI(s) and key personnel have the expertise, experience, and ability to organize, manage and implement the proposed clinical trial and meet milestones and timelines? Do they have appropriate expertise in study coordination, data management and statistics? For a multicenter trial, is the organizational structure appropriate and does the application identify a core of potential center investigators and staffing for a coordinating center?

Innovation  

Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation, or interventions proposed?

Does the design/research plan include innovative elements, as appropriate, that enhance its sensitivity, potential for information or potential to advance scientific knowledge or clinical practice?

Does the design/research plan include the integration of data science (e.g., machine learning or predictive modeling) and/or integrative of developed instruments to measure cognitive decline?

Approach  

Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Have the investigators included plans to address weaknesses in the rigor of prior research that serves as the key support for the proposed project ? Have the investigators presented strategies to ensure a robust and unbiased approach, as appropriate for the work proposed? Are potential problems, alternative strategies, and benchmarks for success presented? If the project is in the early stages of development, will the strategy establish feasibility and will particularly risky aspects be managed? Have the investigators presented adequate plans to address relevant biological variables, such as sex, for studies in vertebrate animals or human subjects?

Is there a unifying and testable hypothesis that transcends the validation and translation phases? Are the aims described for development and validation work conducive to accomplishing the study aims in the translation phase? Are the goals of the translation phase based, in part, on findings from the development/validation phase? Did the PDs/PIs establish an appropriate partnership with health care providers (e.g., primary care physicians, specialists, HMOs, etc.) and document the commitment of the organization(s) to the project? Will the PDs/PIs be able to access an EHR system to modify and implement interventions during the validation phase? Did the PDs/PIs provide adequate power calculations and adequate justification?

Did the PDs/PIs operationalize definitions and clinically relevant cognitive outcomes to measure cognitive decline across the intervention timeline? Did the applicant assess and justify adequacy and finalize clinically relevant outcome measures?

Did the PDs/PIs propose plans for validating cognitive decline? How reasonable are the proposed plans? Note: For this FOA, PDs/PIs do not need to validate their findings with emerging biomarkers.

Are the endpoints/outcomes described in the application meaningful to healthcare providers and patients with cognitive decline?

Does the application adequately address the following, if applicable:

Study Design

Is the study design justified and appropriate to address primary and secondary outcome variable(s)/endpoints that will be clear, informative and relevant to the hypothesis being tested? Is the scientific rationale/premise of the study based on previously well-designed preclinical and/or clinical research? Given the methods used to assign participants and deliver interventions, is the study design adequately powered to answer the research question(s), test the proposed hypothesis/hypotheses, and provide interpretable results? Is the trial appropriately designed to conduct the research efficiently? Are the study populations (size, gender, age, demographic group), proposed intervention arms/dose, and duration of the trial, appropriate and well justified?

Are potential ethical issues adequately addressed? Is the process for obtaining informed consent or assent appropriate? Is the eligible population available? Are the plans for recruitment outreach, enrollment, retention, handling dropouts, missed visits, and losses to follow-up appropriate to ensure robust data collection? Are the planned recruitment timelines feasible and is the plan to monitor accrual adequate? Has the need for randomization (or not), masking (if appropriate), controls, and inclusion/exclusion criteria been addressed? Are differences addressed, if applicable, in the intervention effect due to sex/gender and race/ethnicity?

Are the plans to standardize, assure quality of, and monitor adherence to, the trial protocol and data collection or distribution guidelines appropriate? Is there a plan to obtain required study agent(s)? Does the application propose to use existing available resources, as applicable?

Data Management and Statistical Analysis

Are planned analyses and statistical approach appropriate for the proposed study design and methods used to assign participants and deliver interventions? Are the procedures for data management and quality control of data adequate at clinical site(s) or at center laboratories, as applicable? Have the methods for standardization of procedures for data management to assess the effect of the intervention and quality control been addressed? Is there a plan to complete data analysis within the proposed period of the award?

If the project involves human subjects and/or NIH-defined clinical research, are the plans to address 1) the protection of human subjects from research risks, and 2) inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion or exclusion of individuals of all ages (including children and older adults), justified in terms of the scientific goals and research strategy proposed?

Environment  

Will the scientific environment in which the work will be done contribute to the probability of success? Are the institutional support, equipment and other physical resources available to the investigators adequate for the project proposed? Will the project benefit from unique features of the scientific environment, subject populations, or collaborative arrangements?

If proposed, are the administrative, data coordinating, enrollment and laboratory/testing centers, appropriate for the trial proposed?

Does the application adequately address the capability and ability to conduct the trial at the proposed site(s) or centers? Are the plans to add or drop enrollment centers, as needed, appropriate?

If international site(s) is/are proposed, does the application adequately address the complexity of executing the clinical trial?

If multi-sites/centers, is there evidence of the ability of the individual site or center to: (1) enroll the proposed numbers; (2) adhere to the protocol; (3) collect and transmit data in an accurate and timely fashion; and, (4) operate within the proposed organizational structure?

Study Timeline

Is the study timeline described in detail, taking into account start-up activities, the anticipated rate of enrollment, and planned follow-up assessment? Is the projected timeline feasible and well justified? Does the project incorporate efficiencies and utilize existing resources (e.g., CTSAs, practice-based research networks, electronic medical records, administrative database, or patient registries) to increase the efficiency of participant enrollment and data collection, as appropriate?

Are potential challenges and corresponding solutions discussed (e.g., strategies that can be implemented in the event of enrollment shortfalls)?

Protections for Human Subjects  

For research that involves human subjects but does not involve one of the categories of research that are exempt under 45 CFR Part 46, the committee will evaluate the justification for involvement of human subjects and the proposed protections from research risk relating to their participation according to the following five review criteria: 1) risk to subjects, 2) adequacy of protection against risks, 3) potential benefits to the subjects and others, 4) importance of the knowledge to be gained, and 5) data and safety monitoring for clinical trials.

For research that involves human subjects and meets the criteria for one or more of the categories of research that are exempt under 45 CFR Part 46, the committee will evaluate: 1) the justification for the exemption, 2) human subjects involvement and characteristics, and 3) sources of materials. For additional information on review of the Human Subjects section, please refer to the Guidelines for the Review of Human Subjects.

Inclusion of Women, Minorities, and Individuals Across the Lifespan  

When the proposed project involves human subjects and/or NIH-defined clinical research, the committee will evaluate the proposed plans for the inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion (or exclusion) of individuals of all ages (including children and older adults) to determine if it is justified in terms of the scientific goals and research strategy proposed. For additional information on review of the Inclusion section, please refer to the Guidelines for the Review of Inclusion in Clinical Research.

Vertebrate Animals  

The committee will evaluate the involvement of live vertebrate animals as part of the scientific assessment according to the following criteria: (1) description of proposed procedures involving animals, including species, strains, ages, sex, and total number to be used; (2) justifications for the use of animals versus alternative models and for the appropriateness of the species proposed; (3) interventions to minimize discomfort, distress, pain and injury; and (4) justification for euthanasia method if NOT consistent with the AVMA Guidelines for the Euthanasia of Animals. Reviewers will assess the use of chimpanzees as they would any other application proposing the use of vertebrate animals. For additional information on review of the Vertebrate Animals section, please refer to the Worksheet for Review of the Vertebrate Animal Section.

Biohazards  

Reviewers will assess whether materials or procedures proposed are potentially hazardous to research personnel and/or the environment, and if needed, determine whether adequate protection is proposed.

Resubmissions  

Not Applicable

Renewals  

Not Applicable

Revisions  

Not Applicable

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.

Applications from Foreign Organizations  

Not Applicable    

Select Agent Research  

Reviewers will assess the information provided in this section of the application, including 1) the Select Agent(s) to be used in the proposed research, 2) the registration status of all entities where Select Agent(s) will be used, 3) the procedures that will be used to monitor possession use and transfer of Select Agent(s), and 4) plans for appropriate biosafety, biocontainment, and security of the Select Agent(s).

Resource Sharing Plans  

Reviewers will comment on whether the following Resource Sharing Plans, or the rationale for not sharing the following types of resources, are reasonable: (1) Data Sharing Plan; (2) Sharing Model Organisms; and (3) Genomic Data Sharing Plan (GDS).

Additionally, reviewers will comment on Sharing of Resources such as statistical codes for analyses, machine learning algorithms, digital instruments for detecting cognitive decline, or codes associated with development of prompts for EHR.

Authentication of Key Biological and/or Chemical Resources:  

For projects involving key biological and/or chemical resources, reviewers will comment on the brief plans proposed for identifying and ensuring the validity of those resources.

Budget and Period of Support  

Reviewers will consider whether the budget and the requested period of support are fully justified and reasonable in relation to the proposed research.

2. Review and Selection Process

Applications will be evaluated for scientific and technical merit by (an) appropriate Scientific Review Group(s) convened by the National Institute on Aging, in accordance with NIH peer review policy and procedures, 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:

• 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.

• Will receive a written critique.

Appeals of initial peer review will not be accepted for applications submitted in response to this FOA. Applications will be assigned to the appropriate NIH Institute or Center. Applications will compete for available funds with all other recommended applications submitted in response to this FOA. Following initial peer review, recommended applications will receive a second level of review by the National Advisory Council on Aging. 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.

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 VI. Award Administration Information

1. Award Notices

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.

A formal notification in the form of a Notice of Award (NoA) will be provided to the applicant organization for successful applications. The NoA signed by the grants management officer is the authorizing document and will be sent via email to the grantee’s business official.

Awardees must comply with any funding restrictions described in Section IV.5. Funding Restrictions. Selection of an application for award is not an authorization to begin performance. Any costs incurred before receipt of the NoA are at the recipient's risk. These costs may be reimbursed only to the extent considered allowable pre-award costs.

Any application awarded in response to this FOA will be subject to terms and conditions found on the Award Conditions and Information for NIH Grants website.  This includes any recent legislation and policy applicable to awards that is highlighted on this website.

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: Grantee 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 awardee 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

All NIH grant and cooperative agreement awards include the NIH Grants Policy Statement as part of the NoA. 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, Grantees, and Activities. More information is provided at Award Conditions and Information for NIH Grants.

Recipients of federal financial assistance (FFA) from HHS must administer their programs in compliance with federal civil rights law. This means that recipients of HHS funds must ensure equal access to their programs without regard to a person’s race, color, national origin, disability, age and, in some circumstances, sex and religion. This includes ensuring your programs are accessible to persons with limited English proficiency.  HHS recognizes that 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.

In accordance with the statutory provisions contained in Section 872 of the Duncan Hunter National Defense Authorization Act of Fiscal Year 2009 (Public Law 110-417), NIH awards will be subject to the Federal Awardee Performance and Integrity Information System (FAPIIS) requirements.  FAPIIS requires Federal award making officials to review and consider information about an applicant in the designated integrity and performance system (currently FAPIIS) prior to making an award.  An applicant, at its option, may review information in the designated integrity and performance systems accessible through FAPIIS and comment on any information about itself that a Federal agency previously entered and is currently in FAPIIS.  The Federal awarding agency will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgement about the applicant’s integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR Part 75.205 “Federal awarding agency review of risk posed by applicants.”  This provision will apply to all NIH grants and cooperative agreements except fellowships.

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 FOA. HHS provides general guidance to recipients of FFA on meeting their legal obligation to take reasonable steps to provide meaningful access to their programs by persons with limited English proficiency. Please see https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/index.html. The HHS Office for Civil Rights also provides guidance on complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.htmlhttps://www.hhs.gov/civil-rights/for-providers/laws-regulations-guidance/index.html. Recipients of FFA also have specific legal obligations for serving qualified individuals with disabilities. Please see https://www.hhs.gov/civil-rights/for-individuals/disability/index.html. Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under federal civil rights laws at https://www.hhs.gov/ocr/about-us/contact-us/index.html or call 1-800-368-1019 or TDD 1-800-537-7697. Also note it is an HHS Departmental goal to ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations. For further guidance on providing culturally and linguistically appropriate services, recipients should review the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care at http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53.

Not Applicable

3. Reporting

When multiple years are involved, awardees will be required to submit the Research Performance Progress Report (RPPR) annually and financial statements as required in the NIH Grants Policy Statement. 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.

The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for awardees of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later.  All awardees of applicable NIH grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at www.fsrs.gov on all subawards over $25,000.  See the NIH Grants Policy Statement for additional information on this reporting requirement.

In accordance with the regulatory requirements provided at 45 CFR 75.113 and Appendix XII to 45 CFR Part 75, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts from all Federal awarding agencies with a cumulative total value greater than $10,000,000 for any period of time during the period of performance of a Federal award, must report and maintain the currency of information reported in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period.  The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently FAPIIS).  This is a statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313).  As required by section 3010 of Public Law 111-212, all information posted in the designated integrity and performance system on or after April 15, 2011, except past performance reviews required for Federal procurement contracts, will be publicly available.  Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75 – Award Term and Conditions for Recipient Integrity and Performance Matters.

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: http://grants.nih.gov/support/ (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: GrantsInfo@nih.gov (preferred method of contact)
Telephone: 301-945-7573

Grants.gov Customer Support (Questions regarding Grants.gov registration and Workspace)
Contact Center Telephone: 800-518-4726
Email: support@grants.gov

Partha Bhattacharyya, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-496-3136
Email:bhattacharyyap@mail.nih.gov

Ramesh Vemuri, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-402-7700
Email: ramesh.vemuri@nih.gov

Nia Pree
National Institute on Aging (NIA)
Telephone: 301-827-6374 
Email: nia.pree@nih.gov

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 45 CFR Part 75.