Department of Health and Human Services

Part 1. Overview Information

Participating Organization(s)

National Institutes of Health (NIH)

Components of Participating Organizations

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Funding Opportunity Title
Pilot Interventions to Integrate Social Care and Medical Care to Improve Health Equity (R01 Clinical Trial Required)
Activity Code

R01 Research Project Grant

Announcement Type
New
Related Notices

NOT-DK-23-014 - Notice of Pre-Application Webinar for RFA-DK-22-038, Pilot Interventions to Integrate Social Care and Medical Care to Improve Health Equity (R01- Clinical Trial Required)

NOT-OD-22-195 New NIH "FORMS-H" Grant Application Forms and Instructions Coming for Due Dates on or after January 25, 2023

NOT-OD-22-189 Implementation Details for the NIH Data Management and Sharing Policy

NOT-OD-22-198 Implementation Changes for Genomic Data Sharing Plans Included with Applications Due on or after January 25, 2023

NOT-OD-23-012 Reminder: FORMS-H Grant Application Forms & Instructions Must be Used for Due Dates On or After January 25, 2023 - New Grant Application Instructions Now Available

Funding Opportunity Announcement (FOA) Number
RFA-DK-22-038
Companion Funding Opportunity
None
Assistance Listing Number(s)
93.847
Funding Opportunity Purpose

This NIDDK Funding Opportunity Announcement will support pilot and feasibility trials to test interventions that involve screening for and addressing adverse social determinants of health (SDoH), also called social risks, during a health care visit. Patients endorsed social needs could be addressed by appropriately referring/navigating patients or caregivers to resources that address these issues at social service organizations located externally or co-located in the healthcare system. The trials will determine 1) feasibility and acceptability of screening for social risks, identifying social needs and implementing referral service linkages (e.g., addressing transportation and housing needs, food insecurity, etc.) within the context of a healthcare visit, and 2) preliminary signals of the intervention’s impact on both the social risk/need(s) and NIDDK disease outcomes. Preliminary data regarding intervention efficacy are not required. The proposed pilot and feasibility clinical trials should lay the foundation for larger clinical trials to integrate social care and medical care and improve health outcomes related to the prevention and/or treatment of diseases within the mission of NIDDK. It is expected that these pilot studies will begin to delineate promising practices for future equitable and effective real world implementation of social and medical care integration. The overarching goal of this FOA is to develop pragmatic approaches that can be used in health care settings to reduce health disparities in diseases within the mission of NIDDK and achieve health equity, especially among individuals from racial and ethnic minority groups, rural populations, sexual and gender minority groups, and other socioeconomically disadvantaged and medically underserved communities.

Key Dates

Posted Date
February 13, 2023
Open Date (Earliest Submission Date)
September 19, 2023
Letter of Intent Due Date(s)

September 19, 2023

Application Due Dates Review and Award Cycles
New Renewal / Resubmission / Revision (as allowed) AIDS Scientific Merit Review Advisory Council Review Earliest Start Date
October 19, 2023 Not Applicable Not Applicable March 2024 May 2024 July 2024

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.

Expiration Date
October 20, 2023
Due Dates for E.O. 12372

Not Applicable

Required Application Instructions

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.

Table of Contents

Part 2. Full Text of Announcement

Section I. Funding Opportunity Description

This NIDDK Funding Opportunity Announcement will support pilot and feasibility trials to test interventions that involve screening for and addressing adverse social determinants of health (SDoH), also called social risks, at a health care visit.

SDoH are defined by the World Health Organization as the conditions in which people are born, grow, live, work and age, which are shaped by the distribution of money, power and resources. SDoH include income, education, employment, housing, neighborhood conditions, transportation systems, social connections, and other social factors, and can shape health in both positive and negative ways. Social risks are adverse SDoH associated with poor health (e.g., food insecurity, lack of access to health care, lack of transportation, housing instability, etc.). Social risks should be differentiated from social needs. While a patient may have many social risks that may impact their health, a patient’s social needs reflect the social risks that they feel are most pressing and need to be addressed. A key component of this FOA is supporting patient-centered care and engaging with patients to understand their social context and to identify and meaningfully address their immediate social needs.

Patients endorsed social needs could be addressed by appropriately referring/navigating patients or caregivers to resources that address these issues at social service organizations located externally or co-located in the healthcare system. The trials will determine: 1) feasibility and acceptability of screening for social risks, identifying social needs and implementing referral service linkages (e.g., addressing transportation, housing, or food needs, etc.) within the context of a healthcare visit; and 2) preliminary signals of the intervention’s impact on both the social risk/need(s) and NIDDK disease outcomes. Preliminary data regarding intervention efficacy are not required but the premise and rationale of the study should be supported by the available literature.

The proposed pilot and feasibility clinical trials should lay the foundation for larger clinical trials to integrate social care and medical care and improve health outcomes related to the prevention and/or treatment of diseases within the mission of NIDDK. It is expected that these pilot studies will begin to delineate promising practices for future equitable and effective real world implementation of social and medical care integration. The overarching goal of this FOA is to develop pragmatic approaches that can be used in health care settings to reduce health disparities in diseases within the mission of NIDDK and achieve health equity, especially among individuals from racial and ethnic minority groups, rural populations, sexual and gender minority groups, and other socioeconomically disadvantaged and medically underserved communities.

Background

Despite advances in medical treatment for many diseases in NIDDK's mission, racial, ethnic and socioeconomic disparities persist in health outcomes for many of these diseases, including diabetes, obesity and kidney disease. Factors contributing to health disparities are complex and multifactorial. Decades of research indicate that social, environmental, and economic factors, known as the social determinants of health (SDoH), may more powerfully shape health outcomes than other factors (e.g., medical care, biology). It is critical to understand and address the myriad of factors that impose constraints on an individual's ability to achieve optimal health. In general, adverse living conditions, such as overcrowding, isolation, inadequate access to healthy food, transportation barriers, and unstable housing, are linked to poor health outcomes and mortality. Exposure to such health-impeding SDoH or social risks contributes to poor obesity, diabetes, and kidney disease outcomes that disproportionately affect racial/ethnic minorities and other socially disadvantaged communities. Social risks related to the onset and progression of NIDDK-relevant diseases include housing instability, lack of access to affordable quality foods and nutrition, lack of access to transportation to pharmacy or medical appointments, lack of facilities or safe spaces for physical activity, lack of childcare during medical appointments, and/or deficits in other health promoting resources. Social risks are particularly impactful for many diseases in NIDDK’s mission as these are chronic diseases often requiring complex or resource intensive treatment regimens, which may be difficult to adopt in the face of pressing social needs. Fundamentally, social conditions shape individual behaviors, and adverse SDoH constrain people’s capacity to obtain, engage in, or follow through on medical and/or lifestyle treatment plans or engage in healthy behaviors.

In 2019, the National Academies of Sciences, Engineering and Medicine issued a consensus report which found that integrating social care into health care delivery holds the potential to achieve better health outcomes for the nation. The report noted that five activities are required to integrate social care into health care delivery: 1) awareness activities that identify social risks; 2) adjustment activities of the clinical care team to accommodate identified social barriers; 3) assistance activities to reduce social risk by connecting patients with social care resources; 4) alignment activities that enable health care systems to understand and leverage their communities existing social care assets; and 5) advocacy activities that bring health care and social care organizations together as partners.

Approaches to identify and meaningfully address social risks and needs may help accomplish numerous care goals: enhance providers ability to tailor treatment to individual patient needs, intensify effects of existing treatments, help patients follow medical regimens, improve patient-provider relationships and communications, and promote health equity in chronic disease prevention and treatment. However, fundamental scientific research gaps in achieving these goals remain, including optimal screening/management processes and workflows for identification of social risks and needs that most impact health, optimal follow-up time for detecting health changes, how to consider patient-reported experiences, and how to develop robust partnership models with high potential for sustainability.

Research in this area is made possible by the growing awareness of the impact of adverse SDoH on health outcomes, leading to growing interest on the part of health care systems to address social risks and needs within the context of medical care. For example, to improve population health and control the unsustainable increasing medical costs, value-based payment models have emerged that emphasize population-health metrics. Such models implemented in Medicare, Medicaid and other payer programs capitalize on existing resources by incentivizing healthcare systems to treat the whole person and create strategies that bridge medical care with community resources. In addition, advances in health IT make it possible to establish screening and referral programs. Such investments have led to a surge of interest in implementing social risk interventions within clinical care services. However, despite this attention and attempts to integrate medical and social care within clinical services, little evidence exists to guide healthcare systems in how to best develop and adopt such models.

This FOA is designed to advance the science of integrating medical and social care through interventions that meaningfully address social risks and needs to improve outcomes and health equity relevant to diseases in NIDDK's mission. The goal of this initiative is to initiate a program that ultimately leads to pragmatic research efforts to stimulate collaborations between healthcare systems, community-based organizations, and social service entities for testing of interventions that would screen and address patient endorsed social risks and needs, especially among individuals from racial and ethnic minority groups, rural populations, sexual and gender minority groups, and other socioeconomically disadvantaged and medically underserved communities.

Research Objectives

Pilot and feasibility trials funded through this initiative will study interventions that involve screening for and addressing social risks and needs at a health care visit. Screening for social risks must be accompanied by provision of resources to meet the patient’s most important identified needs. Screening should include a dialogue to ascertain the patient’s endorsed social needs, which could be addressed by appropriately referring/navigating patients to resources to address these issues using social service organizations located externally or co-located in the healthcare system. Thus, shared decision making and meaningful conversations between patient and provider are fundamental components to the studies proposed under this FOA. The trials must: 1) determine feasibility and acceptability of screening for social risks, identifying social needs and implementing referral service linkages (e.g., addressing transportation, housing, food, and other health-related social needs) within the context of a healthcare visit; 2) assess fidelity of implementation of the proposed intervention; and 3) follow participants to assess preliminary signals of the intervention’s impact on the social risks and health outcomes for diseases in NIDDK’s mission.

The expectation is that the social need(s) referral(s) will not represent a unilateral action from the health care provider team but will be part of a closed loop referral process that results in ongoing communication among the provider(s), patient and social service/community organization(s). The processes put into place for screening and referral should promote social needs informed care i.e., the health care team should engage in shared decision making to develop a care plan that works to address or resolve social needs, accommodates the social context of the patient and is adapted over time as social risks and needs are met or change. There should be ongoing assessment of whether the patient acted upon social needs related referrals and whether the social needs are being mitigated. The proposal should include a plan for assessing whether these processes are successfully achieved. Interventions may also include a component involving and/or evaluating training or other programs designed to mitigate implicit biases and interpersonal racism in health care teams as part of efforts to promote social needs informed care equitably across patient groups.

While direct preliminary data supporting the efficacy of the proposed intervention are not required, there should be evidence from the PD/PI or the literature supporting the scientific premise and sufficient justification of operational feasibility to conduct a pilot trial. There should be evidence that the PD/PI or co-investigators have the requisite knowledge, skills and experience to conduct the trial. In general, the goal of these pilot studies would be to acquire data to support the rationale, design and feasibility of a fully powered clinical trial. The expectation would be that the proposed pilot and feasibility clinical trial, if successful, would lead to an application to support a larger trial powered to detect improvement in an important health outcome for a disease in NIDDK's mission.

Proposals should leverage partnership models between the healthcare sector, community resources such as social service organizations, and relevant stakeholders (e.g., people with NIDDK diseases, medical, community, and home-based practitioners, researchers, local businesses, etc.). Studies will be allowed up to 1-year of the award period to conduct some formative and preparatory work for the trial, if needed. Although some formative work may be appropriate, the purpose of this FOA is to support pilot and feasibility testing of the proposed intervention and not for intervention development. While qualitative measures and patient-reported outcomes are encouraged, the trials must measure an objective, clinically meaningful outcome for NIDDK diseases and the status of social risks/needs (i.e., improved or not). Grant funds may not be used to build new screening tools, although refinement of these tools may be done before starting the trial. Likewise, the collaboration model and entities (healthcare system, referral organizations) must be in place prior to application. Funding to support building health IT systems or directly provide social services is not allowed.

It is expected that the intervention(s) studied in the proposed pilot and feasibility trial will enhance the development of equitable partnership models between healthcare delivery and social services sectors. The long-term goal should be to build community-linkages that foster mutually beneficial and sustainable services beyond the funding period, should a subsequent fully-powered trial be efficacious.

Proposed trials may test a single approach to screening and linkage or may be designed to determine optimal strategies for screening, linkage, patient uptake, and/or follow-up of resource referrals. Examples of social risks/needs that could be targeted include, but are not limited to:

  • Referral to/uptake of food bank or other services to address food insecurity in coordination with medical nutrition therapy (e.g., medically tailored diets to improve glycemic control in diabetes and/or hyperphosphatemia and/or hyperkalemia in progressive CKD; or to provide calorie restricted diets to promote weight loss in patients with obesity).
  • Connection to resources to address housing insecurity or related needs (e.g., HUD-supported or community programs) to improve or intensify treatment effects of efficacious interventions for NIDDK mission area diseases and patients adherence to medical treatments.
  • Access to transportation services to facilitate travel to healthcare appointments to improve screening, prevention, and management strategies for diseases in NIDDK’s mission.
  • Referral to existing national and local programs (e.g., home visiting programs, WIC) that can address multiple social needs that hinder efforts to prevent or treat diseases in NIDDK's mission.

Applications are expected to use community engagement approaches in designing and implementing the proposed trial and to clearly describe the process they will use to facilitate meaningful sustainable collaboration with patients, caregivers, family members, community members, community-based organizations, clinicians, health care systems, and other relevant stakeholders throughout the research process. Meaningful and equitable engagement must entail more than focus groups, surveys or other activities where stakeholders are only involved as participants or respondents. Authentic engagement and meaningful partnership with communities who disproportionately experience social risks are essential to effective health equity interventions. In addition, community-engaged research brings to bear the lived experience and expertise of the affected communities, which may yield interventions that are more likely to be appropriate, acceptable, and feasible, and less likely to cause harm. Community and stakeholder engagement that involves trust building, use of culturally appropriate research designs, questions, and materials (i.e., outreach, recruitment, retention, informed consents) is an important method to enhance and assess research outcomes including participation goals, health specific outcomes and sustainability. Ideally, relevant stakeholders are integrated into the research team.

Investigators should employ an equity lens to guide their intervention development and implementation. Employing an equity lens considers at each decision point how processes, values, assumptions, actions, and interventions may: 1) affect meaningful involvement, inclusion and participation of people affected by the health disparities being studied; and 2) mitigate or exacerbate inequalities in opportunities and outcomes, especially for communities who experience historical and contemporary forms of marginalization, discrimination, or oppression. An equity lens also acknowledges that social conditions influence health, including laws, policies and other structural and social determinants of health and views individuals and populations through an asset-based frame that recognizes their strengths and resources.

Applications should include a multidisciplinary research team with diverse perspectives and backgrounds and with relevant expertise for the proposed research project, including appropriate health care expertise, healthy equity and disparities researchers, people with or at risk for NIDDK diseases/conditions, and community-based organization or social service agency representatives.

Applications must include a Plan for Enhancing Diverse Perspectives (PEDP) submitted as Other Project Information as an attachment (see Section IV). The PEDP will be assessed as part of the scientific and technical peer review evaluation, as well as considered among programmatic matters with respect to funding decisions (https://braininitiative.nih.gov/about/plan-enhancing-diverse-perspectives-pedp).

To facilitate establishing common data elements (CDE), applicants are strongly encouraged to consider use of the PhenX Social Determinants of Health (SDOH) Assessments Collection (https://www.nimhd.nih.gov/programs/collab/phenx/), SDOH data standards established by the Gravity Project and incorporated in the US Core for Data Interoperability, and/or the NIH CDE repository (https://cde.nlm.nih.gov/home).

To promote progress in this area, NIDDK will host a series of virtual meetings with all awardees and their study teams to facilitate sharing information about barriers, problem-solving, promising approaches and best practices related to integrating social and medical care. It is anticipated that these virtual meetings will take place at approximately six months and 18 months after the award is made, and near study end; meetings could take place more frequently if helpful for the awardees.

NIDDK will conduct a Technical Assistance webinar for prospective applicants; details will be forthcoming through a future guide notice.

Applications Not Responsive to this FOA

Only research within the mission of NIDDK is appropriate for this FOA. Research applications in areas that are primarily within the missions of other NIH Institutes and Centers are not responsive to this FOA and will not be reviewed. NIDDK has many research areas within its mission, but all research related to relevant diseases may not be appropriate for NIDDK. Applicants to this FOA are strongly encouraged to contact NIDDK staff as soon as possible in the development of the application, so that NIDDK staff can help the applicant understand whether the proposed clinical trial is within the goals and mission of the Institute and is appropriate for this FOA.

Applications proposing any animal or in vitro studies are not responsive to this FOA and will not be reviewed.

Investigators who have adequate preliminary data to support a fully powered clinical trial should consider PA-20-183, Research Project Grant (Parent R01 Clinical Trial Required).

Applicants are reminded of the NIH policy on the use of a single Institutional Review Board for multi-center clinical trials (see https://grants.nih.gov/grants/guide/notice-files/NOT-OD-18-004.html) as well as the NIH policy on the registration and reporting of the results of clinical trials (https://grants.nih.gov/grants/guide/notice-files/NOT-OD-16-149.html).

The NIDDK strongly encourages Research on Sex/Gender Differences, Sexual and Gender Minority-Related Research and Race/Ethnic Diversity (see NOT-DK-22-003).

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

Funding Instrument

Grant: A support mechanism providing money, property, or both to an eligible entity to carry out an approved project or activity.

Application Types Allowed
New

The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types. Only those application types listed here are allowed for this FOA.

Clinical Trial?

Required: Only accepting applications that propose clinical trial(s).

Funds Available and Anticipated Number of Awards

NIDDK intends to commit $1.2 million in FY 2024 to fund three awards. The number of awards is contingent upon NIH appropriations and the submission of a sufficient number of meritorious applications.

Award Budget

Application budgets are limited to $300,000 direct costs per year but need to reflect the actual needs of the proposed project.

Award Project Period

The maximum project period is 3 years.

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

Eligible Organizations

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

  • 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
Foreign Institutions

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 not allowed.

Required Registrations

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.

  • 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.

Eligible Individuals (Program Director/Principal Investigator)

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 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.

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, per 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 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 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:

John Connaughton, Ph.D.
Chief, Scientific Review Branch
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Telephone: 301-594-7797
Email: NIDDKletterofintent@mail.nih.gov

Page Limitations

All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.

Instructions for Application Submission

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.

Note: Effective for due dates on or after January 25, 2023, the Data Management and Sharing Plan will be attached in the Other Plan(s) attachment in FORMS-H application forms packages.

SF424(R&R) Cover

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

SF424(R&R) Project/Performance Site Locations

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

SF424(R&R) Other Project Information

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

Plan for Enhancing Diverse Perspectives (PEDP): The filename Plan for Enhancing Diverse Perspectives.pdf should be used.

In an "Other Attachment" entitled "Plan for Enhancing Diverse Perspectives," all applicants must include a summary of strategies to advance the scientific and technical merit of the proposed project through expanded inclusivity. The PEDP should provide a holistic and integrated view of how enhancing diverse perspectives is viewed and supported throughout the application and can incorporate elements with relevance to any review criteria (significance, investigator(s), innovation, approach, and environment) as appropriate. Where possible, applicant(s) should align their description with these required elements within the research strategy section. The PEDP will vary depending on the scientific aims, expertise required, the environment and performance site(s), as well as how the project aims are structured. The PEDP may be no more than 1-page in length and should include a timeline and milestones for relevant components that will be considered as part of the review. Examples of items that advance inclusivity in research and may be part of the PEDP can include, but are not limited to:

  1. Discussion of engagement with different types of institutions and organizations (e.g., research-intensive, undergraduate-focused, minority-serving, community-based).
  2. Description of any planned partnerships that may enhance geographic and regional diversity.
  3. Plan to enhance recruiting of women and individuals from groups traditionally under-represented in the biomedical, behavioral, and clinical research workforce.
  4. Proposed monitoring activities to identify and measure PEDP progress benchmarks.
  5. Plan to utilize the project infrastructure (i.e., research and structure) to support career-enhancing research opportunities for diverse junior, early- and mid-career researchers.
  6. Description of any training and/or mentoring opportunities available to encourage participation of students, postdoctoral researchers and co-investigators from diverse backgrounds.
  7. Plan to develop transdisciplinary collaboration(s) that require unique expertise and/or solicit diverse perspectives to address research question(s).
  8. Publication plan that enumerates planned manuscripts and proposed lead authorship.
  9. Outreach and planned engagement activities to enhance recruitment of individuals from diverse groups as research participants including those from under-represented backgrounds.

For further information on the Plan for Enhancing Diverse Perspectives (PEDP), please see https://braininitiative.nih.gov/about/plan-enhancing-diverse-perspectives-pedp.

Applications lacking the Plan for Enhancing Diverse Perspectives are incomplete and will not be reviewed.

Milestone Plan: The filename "Milestone Plan.pdf" should be used.

Applicants should provide detailed interim performance measures and timelines for completing key objectives and administrative functions for the proposed clinical trial. The Milestone Plan is separate and distinct from the Study Timeline and the PEDP milestones. Milestones should be easily measurable and realistic.

Below is a list of potentially useful milestones; please tailor this list to each of your clinical trial aims and provide approximate dates or project year and quarters (e.g., Yr01/Q1, Yr01/Q2, Yr01/Q3, etc.) when each will be conducted/completed.

  • Completion of all required regulatory approvals (e.g., IND/IDE from the FDA or agencies in other countries)
  • Finalize contracts/third party agreements
  • Finalize clinical protocol(s)
  • Finalize consent forms
  • Finalize recruitment materials, surveys and data collection tools
  • Approval from safety monitoring entity (e.g., safety monitor, SMC, DSMB, etc.) as appropriate
  • IRB approval
  • Finalize data entry forms/system
  • Finalize training manuals and manuals of operations
  • Good Clinical Practice (GCP) and other relevant technical training of study staff
  • Training of staff on study protocol and procedures
  • Registration of clinical trial in ClinicalTrials.gov
  • Anticipated dates of:
    • Enrollment of the first participant
    • Enrollment of 25% of the target sample size
    • Enrollment of 50% of the target sample size
    • Enrollment of 75% of the target sample size
    • Enrollment of 100% of the target sample size
  • Posting of consent forms on ClinicalTrials.gov
  • Completion of intervention (i.e., date of last intervention visit)
  • Completion of data collection (i.e., date of last study visit)
  • Completion of primary endpoint and secondary endpoint data analyses
  • Completion of primary outcome paper
  • Closeout plans/communication of results to participants
  • Reporting of results in ClinicalTrials.gov
  • Sharing of study data per NIH policies

These milestones will be negotiated at the time of the award, as appropriate. Future year support is contingent on satisfactory achievement of performance milestones. Investigators should track and report milestone achievement in the annual progress report. If milestones are not achieved fully, NIDDK may request development of a remedial plan and more frequent monitoring of progress, or take other remedial actions.

Applications lacking the Milestone Plan are incomplete and will not be reviewed.

SF424(R&R) Senior/Key Person Profile

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

R&R or Modular Budget

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

R&R Subaward Budget

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

PHS 398 Cover Page Supplement

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

PHS 398 Research Plan

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

Research Strategy: The applicant should clearly articulate the significance of the proposed study including why the clinical trial is needed, and what evidence gap the trial will address. Investigators should clearly articulate why the long-term goal of the study is of high clinical significance and how data obtained in the pilot and feasibility trial will be used in a future clinical trial to improve health outcomes i.e., a hypothesis-driven "next step" should be proposed. The proposal of next steps should include how lessons learned from the pilot trial can be leveraged to develop implementation strategies for a larger, fully powered study, and a discussion of the potential for sustainability and dissemination beyond a research award.

Although direct preliminary data of intervention efficacy are not required, any discussion of supporting data that provide the basis for the trial must address the adequacy and quality of previous studies. Applicants must describe past experience in health disparity/health equity research and community-engaged approaches.

The application should include a detailed description and scientific rationale for the study design, addressing the intervention chosen, the population to be studied, and the outcomes being assessed. The proposed trial must assess the effect of the intervention on both social need(s) and a NIDDK disease outcome.The applicant must provide a justification or rationale for the disease outcome(s) that will be measured. The description must reflect the process of intervention development, particularly how an equity lens has been applied to intervention development and implementation.The design must include a description of how screening for social risks will be accomplished (e.g., survey, conversation guide, computer-assisted with a follow-up discussion with the provider, etc.); who will screen; how patient-identified social needs and preferences will be determined; how social needs referrals will be made and how tracking of uptake of these referrals will be accomplished, including what services were delivered to each participant; and how fidelity to the intervention will be assessed. The application should clearly describe the planned ongoing loops of communication among provider, patient and social service/community agency, and how the information obtained will be used to adapt or change the medical treatment plan based on the patient’s changing situation. The application should also discuss processes to be used to protect patient privacy and dignity during the screening for social risks and needs and the discussion of referrals.

There must be clear feasibility objectives and clear criteria for how feasibility will be assessed and judged to be successful. Investigators must consider how to determine acceptability of the proposed intervention to all stakeholders, including the perspectives of patients, providers, health care systems and social service providers. There must be an assessment of whether there has been uptake by the patient of any referral(s) and whether the identified social risks/needs have been addressed or mitigated and whether health outcomes have been affected. While it is not expected that these pilot and feasibility studies will be fully powered, investigators must collect data on outcomes that would be critical in a fully powered trial; these outcome(s) should be identified in the application.

The application should address the feasibility of the proposed clinical trial including the available resources, access to the relevant population, and expertise in conducting human subjects research in general and with the targeted population within the investigative team.

There must be a description of all completed, ongoing and planned stakeholder engagement efforts.

Letters of Support: Letters of support must be provided from all participating clinics, health care systems and/or hospitals, and all community or other organizations to which social risk/needs referrals will be made. Letters should address organizations support for a subsequent fully powered trial and the potential for adoption if the studies are efficacious.

In addition, letters of support must be provided from stakeholders who have been involved in the development of the study and/or will continue to be involved during the conduct of the study.

The PI(s)/PD(s) must also provide a letter stating his/her willingness to participate in program-related activities, including sharing of relevant materials (i.e., protocols, screening methods, etc.) and meetings with other awardees, as described in Section I Funding Opportunity Description.

Other Plan(s):

Note: Effective for due dates on or after January 25, 2023, the Data Management and Sharing Plan will be attached in the Other Plan(s) attachment in FORMS-H application forms packages.

All instructions in the SF424 (R&R) 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 SF424 (R&R) 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 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.

Section 2 - Study Population Characteristics

2.5 Recruitment and Retention plan: Please include a discussion of the availability of potential participants for the proposed study and anticipated yield from recruitment and screening efforts. If there is more than one recruitment site, please provide a table showing the expected number and demographics of the population to be recruited at each site and overall. The plan should also include a discussion of past experience in recruiting and retaining similar populations, expected challenges to recruitment and retention, and possible contingency plans.

Section 3 - Protection and Monitoring Plans

3.3 Data and Safety Monitoring Plan: In addition to the description of safety monitoring, address plans to assure fidelity to the protocol and integrity of the data. Information about Data and Safety Monitoring Plans in available on the NIDDK website:https://www.niddk.nih.gov/research-funding/human-subjects-research/policies-clinical-researchers/data-safety-monitoring-plans.

Section 4 - Protocol Synopsis

4.2 Outcome Measures: Please indicate all outcomes measures and all timepoints when an outcome measure will be collected.

4.3 Statistical Design and Power: Pilot and feasibility trials are, by definition, not fully powered to answer a question. The investigator should provide a rationale for the number of participants who will be studied. If a full power calculation is provided, the sample size and statistical power calculations should contain enough detail, including assumptions made, so that a reviewer can readily duplicate the sample size. The application should include a discussion of the anticipated level of adherence to the intervention and rates of follow-up (i.e., drop out/lost to follow up) during key outcome collection contacts. A discussion of how missing data will be handled should be included. Any planned interim analyses should also be described.

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.

PHS Assignment Request Form

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 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 FOA 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 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 the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Applications that are incomplete, non-compliant and/or nonresponsive will not be reviewed.

Post Submission Materials

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

Note: Effective for due dates on or after January 25, 2023, the Data Sharing Plan and Genomic Data Sharing Plan (GDS) will not be evaluated at time of review.

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.

Overall Impact

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).

Scored Review Criteria

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.

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 preliminary data, clinical and/or preclinical studies, or information in 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? For trials focusing on mechanistic, behavioral, physiological, biochemical, or other biomedical endpoints, is this trial needed to advance scientific understanding?

Specific to this FOA:

How likely is it that the proposed intervention(s) will reduce inequities in health, behavioral, patient-centered, psychosocial, organizational or community-level outcomes?

To what extent do the efforts described in the Plan for Enhancing Diverse Perspectives further the significance of the project?

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?

Specific to this FOA:

How experienced is the study team in health disparity/health equity research and community-engaged approaches?

How well do letters of support indicate a commitment for partners and collaborators to be active participants throughout the research process?

To what extent will the efforts described in the Plan for Enhancing Diverse Perspectives strengthen and enhance the expertise required for the project?

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?

Specific to this FOA:

How innovative are the approaches to integrating the medical and social care systems? How likely is it that the proposed approach, if proven effective, could support future equitable and effective real world implementation of social and medical care integration?

To what extent will the efforts described in the Plan for Enhancing Diverse Perspectives meaningfully contribute to innovation?

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?

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?

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?

Specific to this FOA:

Does the design include an appropriate assessment of an NIDDK disease health outcome?

How meaningful is the plan to engage all appropriate stakeholders likely to be affected by or involved in the proposed trial? How likely is it that the plans proposed will sustain stakeholder engagement throughout the research process? How feasible are the plans for integrating patients and community partners into the study?

To what extent have the investigators applied an equity lens to guide their intervention development, implementation and evaluation?

How appropriate are the proposed plans for capturing data to measure social determinants of health (SDoH) and assess social risks and needs of participants to the overall study design?

Are the timeline and milestones associated with the Milestone Plan and the Plan for Enhancing Diverse Perspectives well-developed and feasible?

Does the application specify appropriate measures for assessing feasibility and acceptability of the proposed intervention?

Does the design include assessment of whether the targeted social risk/need has been mitigated?

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?

To what extent will features of the environment described in the Plan for Enhancing Diverse Perspectives (e.g., collaborative arrangements, geographic diversity, institutional support) contribute to the success of the project?

Additional Review Criteria

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

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)?

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.

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.

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 Animals Section.

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.

Not applicable

Not applicable

Not applicable

Additional Review Considerations

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.

Not applicable

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).

Note: Effective for due dates on or after January 25, 2023, the Data Sharing Plan and Genomic Data Sharing Plan (GDS) will not be evaluated at time of review.

Reviewers will comment on whether the Resource Sharing Plan(s) (i.e., Sharing Model Organisms) or the rationale for not sharing the resources, is reasonable.

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.

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 NIDDK, 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 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.

Appeals of initial peer review will not be accepted for applications submitted in response to this FOA.

Applications will be assigned to the NIDDK. 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 Diabetes and Digestive and Kidney Diseases Advisory Council . 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, including the PEDP

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 recipient's business official.

Recipients must comply with any funding restrictions described in Section IV.6. 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: 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

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, Recipients, and Activities, including of note, but not limited to:

If a recipient is successful and receives a Notice of Award, 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.

Should the applicant organization successfully compete for an award, recipients of federal financial assistance (FFA) from HHS will be required to complete an HHS Assurance of Compliance form (HHS 690) in which the recipient agrees, as a term and condition of receiving the grant, to administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, age, sex and disability, and agreeing to comply with federal conscience laws, where applicable. This includes ensuring that entities take meaningful steps to provide meaningful access to persons with limited English proficiency; and ensuring effective communication with persons with disabilities. Where applicable, Title XI and Section 1557 prohibit discrimination on the basis of sexual orientation, and gender identity. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html and https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html

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. 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.

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.

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 and 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.

Cooperative Agreement Terms and Conditions of Award

Not Applicable

3. Data Management and Sharing

Note: The NIH Policy for Data Management and Sharing is effective for due dates on or after January 25, 2023.

Consistent with the 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.

Awardees will provide updates at least annually on implementation of the PEDP.

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. NIH FOAs 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 45 CFR Part 75.301 and 2 CFR Part 200.301.

The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for recipients of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later. All recipients 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 the threshold. 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 2 CFR Part 200.113 and Appendix XII to 45 CFR Part 75 and 2 CFR Part 200, 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 and 2 CFR Part 200 Award Term and Condition 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.

Application Submission Contacts

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: GrantsInfo@nih.gov (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: support@grants.gov

Scientific/Research Contact(s)

Jenna Norton, Ph.D., M.P.H.
Division of Kidney, Urologic, and Hematologic Diseases
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Telephone: 301-451-7314
Email: jenna.norton@nih.gov

Raquel C. Greer, M.D., M.H.S.
Division of Kidney, Urologic, and Hematologic Diseases
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Telephone: 301-402-0306
Email: raquel.greer@nih.gov

Mary Evans, Ph.D.
Division of Digestive Diseases and Nutrition
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Telephone: 301-594-4578
Email: mary.evans@nih.gov

Shavon Artis Dickerson, Dr.P.H., M.P.H.
Division of Diabetes, Endocrinology, and Metabolic Diseases
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Telephone: 301-435-3055
Email: shavon.artisdickerson@nih.gov

Peer Review Contact(s)

Michele L. Barnard, Ph.D.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Telephone: 301-594-8898
Email:barnardm@extra.niddk.nih.gov

Financial/Grants Management Contact(s)

Eunica Haynes
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Telephone: 301-827-4018
Email: haynese@mail.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.

Authority and Regulations

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 and 2 CFR Part 200.

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