Full Text HS-93-02


NIH GUIDE, Volume 21, Number 38, October 23, 1992

RFA:  HS-93-02

P.T. 44

  Health Services Delivery 
  Biomedical Research Training 

Agency for Health Care Policy and Research

Application Receipt Date:  January 11, 1993


The Agency for Health Care Policy and Research (AHCPR) awards
National Research Service Award (NRSA) institutional grants (T32) to
eligible institutions to develop or enhance research training
opportunities for qualified individuals selected by the institution
who have demonstrated an interest in health services research and who
seek to prepare for careers in the systematic examination of the
organization, provision, and financing of health care services.

The purpose of these awards is to assist domestic institutions in
supporting predoctoral and postdoctoral academic training.  The
awards allow trainees to gain at least one year of experience in
applying research methods to the evaluation of health services.  The
AHCPR does not support short-term training.


AHCPR-sponsored NRSA grants emphasize multidisciplinary health
services research training.  This training should provide the
conceptual and methodological foundation for investigating some or
all of the following health care areas:

o   Primary care issues, including the development of techniques to
measure the effectiveness of managing health care conditions.

o   Appropriateness and effectiveness of alternative treatments in
terms of patient outcomes and use of services.

o   Factors affecting the dissemination and assimilation of
information on health care technologies and other aspects of clinical

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

o   Alternative approaches to organizing, financing, and reimbursing
for health care services and their effects on cost, quality, and

o   Application of medical informatics to the development of expert
systems for treatment selection and diagnosis.

o   Practice-based research, including clinical practice variations
and guideline development.

o   Availability, accessibility, effectiveness, and quality of care
for low-income groups, minorities, and the elderly.

o   Medical malpractice and liability.

o   Delivery of health services to the medically underserved,
especially in rural areas.

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

o   Organizational structure, resource use, and costs of care for
persons with HIV-related illnesses.

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


For Institutions

Domestic non-profit private and public institutions may apply for
grants to support doctoral and postdoctoral health services research
training programs.  The applicant institution must have the staff and
facilities required for the proposed program.  The training program
director at the institution will be responsible for the selection and
appointment of trainees and for the overall direction of the program.

Institutions may apply for support for predoctoral students,
postdoctoral students, or a combination.  Applicants should include a
rationale for their proposed choice of supporting the level(s) of
students requested.  An applicant may request as many postdoctoral or
predoctoral positions as the proposed program can adequately
accommodate; but the number of positions awarded will be determined
by the review process, program needs, and availability of funds.

For Trainees

Individuals to be trained must be citizens or noncitizen nationals of
the United States or have been lawfully admitted for permanent
residence (that is, in possession of the Alien Registration Receipt
Card I-551 or I-151) at the time of appointment.  Individuals on
temporary or student visas are not eligible.

A postdoctoral student, as of the beginning date of the NRSA
appointment, must have a Ph.D., M.D., D.O., or other doctoral degree,
or an equivalent degree from any accredited domestic or foreign
institution.  Certification by an authorized official of the
degree-granting institution that all requirements for the doctoral
degree have been met is acceptable.

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


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

General Provisions

Levels and Types of Training Permitted

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

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

Research trainees who are clinicians are expected to devote full time
to the proposed research training.  Clinical duties are limited to
those which are part of the training experience.  Trainees appointed
to the program are expected to carry out supervised health services
research with the primary objective of extending their quantitative
research skills and substantive knowledge in preparation for a career
in academic health services research.

Institutional training grants are a desirable mechanism for
postdoctoral training of physicians and other individuals with health
professional degrees whose doctoral training has usually involved
limited health services research experience.  For such individuals,
the training may be part of a research degree program.  In such
cases, health professional postdoctoral trainees should agree to
engage in at least two years of research training beginning at the
time of appointment.

Duration of Support

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

Recruitment of Trainees

The primary objective of the NRSA program is to prepare qualified
individuals for careers in health services research.  Within the
framework of the program's commitment to excellence and projected
needs for investigators in particular areas of health services
research, attention must be given to recruiting individuals from
minority groups that are underrepresented nationally in health
services research. Information on plans for the recruitment of
trainees must include a description of steps to be taken for the
recruitment of individuals from underrepresented minority groups.
Competing continuation applications should include cumulative
information on the recruitment of minority trainees and the
subsequent career development of all trainees, including information
about their minority status.

Payback Provisions

At the time of appointment, trainees must sign an agreement that they
will fulfill the NRSA payback requirements.  Recipients agree to
engage in health services research and/or teaching for a period equal
to the period of NRSA support in excess of 12 months.  Once an
individual has had 12 months of postbaccalaureate NRSA support, all
subsequent NRSA support is subject to payback.

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

Officials of the applicant organization responsible for recruitment
of trainees should familiarize themselves with the terms of the
service requirements and explain them carefully to prospective
training candidates before an appointment at the institution is

Stipends and Other Training Costs

For predoctoral trainees at all levels of experience, the stipend
level (effective October 1, 1990) is $8,800 per year.

For postdoctoral trainees, the stipend for the first year of support
is determined by the number of years of relevant postdoctoral
experience at the time of appointment.  Relevant experience may
include research experience (including industrial), teaching,
internship, residency, clinical practice, or other time spent in
full-time studies in a health-related field beyond that of the
qualifying doctoral degree.  The stipend for each additional year of
NRSA support is the next level on the stipend scale. Current
postdoctoral stipend levels, effective October 1, 1990, are as

Years of relevant experience       Stipend

0                                  $18,600
1                                   19,700
2                                   25,600
3                                   26,900
4                                   28,200
5                                   29,500
6                                   30,800
7 or more                           32,300

NRSA stipends may be supplemented by an institution from non-Federal
funds.  Federal funds may be used for stipend supplementation only if
specifically authorized under the terms of the program from which the
supplemental funds are derived.  An individual may make use of
Federal educational loan funds or VA benefits when permitted by those

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

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

The Tax Reform Act of 1986, Public Law 99-514, affects the tax
liability of all individuals supported under the NRSA program.
Degree candidates who, prior to the enactment of Public Law 99-514,
were able to exclude all monies received under a NRSA award from
their reported income, may now exclude only course tuition, fees,
books, supplies, and equipment required for attendance.  Nondegree
candidates, who formerly were able to exclude from stipends $300 a
month for a period not to exceed three years, are now required to
report all stipends and any monies paid on their behalf for course
tuition and fees required for attendance.  These statutory
requirements became effective January 1, 1987.

The AHCPR is not in a position to advise students or institutions
about their tax liability.  In any event, changes in the taxability
of stipends in no way alter the relationship between NRSA trainees
and their institutions.  NRSA stipends are not now, and never have
been, salaries.  Trainees supported under a National Research Service
Award are not in an employer-employee relationship with the AHCPR or
with the institution in which they are pursuing research training.

Tuition and fees, including medical insurance for the trainee, are
allowable trainee costs if such charges are required of all persons
in a similar training status at the institution, regardless of their
source of support; family medical insurance is not an appropriate
charge to the NRSA grant.  Tuition at the postdoctoral level, if
justifiable, is limited to that required for specific courses in
support of the approved training program.  Annual increments in
tuition costs beyond the first year of a multiyear award (generally
five years) may not exceed six percent.

Trainee travel, including attendance at scientific meetings, that the
institution determines to be necessary to the individual's training
is an allowable cost.

Institutional costs of $1,500 per year for each predoctoral trainee
and $2,500 per year for each postdoctoral trainee may be requested to
defray the cost of other training-related expenses, such as staff
salaries, consultant costs, equipment, research supplies, and staff
travel.  Also, the institution will receive indirect costs based on
eight percent of total allowable direct costs (exclusive of tuition,
fees, and health insurance) or their actual indirect cost rate,
whichever is less.  Applications from State and local government
agencies may request full indirect cost reimbursement.


AHCPR expects to fund approximately three to five awards in response
to this RFA; the total amount available is not expected to exceed

This announcement is made subject to availability of funds.  The
AHCPR reserves the right to withdraw this announcement if funds do
not become available.


Application are to be made on grant application form PHS 398 (rev.
9/91).  This revision includes special instructions for institutional
NRSA research training grants.  Applicants are reminded that the
25-page limit on the narrative section must be observed.

The application form is usually available at institutional offices of
sponsored research or their equivalent.  If forms are not available
locally, send a request accompanied by a self-addressed mailing label

Office of Scientific Review
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 602
Rockville, MD  20852
Telephone:  (301) 227-8449

Applications must be received at the Division of Research Grants,
NIH, on or before January 11, 1993.  Late applications will be
returned.  An original and three copies of the completed application
must be mailed to:

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

Insert the title of this RFA, National Research Service
Award--Institutional Grants, and the RFA number, HS-93-02, on line 2a
of the application face page.  The RFA label in the form PHS 398 must
be affixed to the bottom of the face page of the original copy of the
application.  Failure to use this label could result in delayed
processing of your application such that it will not reach the review
committee in time for review.

Two information copies must also be sent to:

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


Applications will be evaluated for merit by an AHCPR initial review
group (IRG).  The IRG will consider the following criteria in its

o   Objectives and design of the proposed training program and the
probability of achieving stated goals; for renewal applications,
documentation of past results in meeting goals.

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

o   Qualifications and responsibilities of the program director.

o   Qualifications of the program's faculty, including ongoing health
services research support.

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

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

o   Demonstration of cooperation by any collaborating facilities or
institutions in providing experience and research training sites for
trainees and mechanisms for integration of trainees.

o   Proposed methods for monitoring and evaluating performance of
trainees and of the overall program.  This includes tracking
graduates after completion of training and record of trainees in
establishing careers in health services research.

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

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

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

Minority Recruitment Plan

All applications must include a plan to recruit individuals from
underrepresented minority groups.  If an application is received
without a plan, review may be deferred until a plan is provided.  The
plan to recruit minorities will be evaluated by the initial review
group after the quality of the training grant application has been
assessed and the priority score has been assigned.  The comments of
the review committee on the plan for attracting minority individuals
will be presented in a note in the summary statement.  For renewal
applications, this note will also cover accomplishments in recruiting
and retaining individuals from underrepresented minority groups
during the previous award period.  Funding of an application may be
delayed if the plan for recruiting underrepresented minorities is
considered inadequate or, in the case of competing continuation
applications, if the report of efforts to recruit minorities during
the previous award period is considered inadequate.

Training in the Responsible Conduct of Research

Applications must include a description of formal or informal
instruction that addresses various aspects of scientific integrity
and the responsible conduct of research.  Specific elements of the
plan might include the breadth of topics to be covered,
qualifications of the faculty to be involved, quality of the
materials to be used, and the format and/or schedule of instruction.
Although the exact content of the plan is left to the individual
training program, it is expected that the plan will be appropriate to
the training program and will demonstrate commitment of the
institution in both personnel and materials.  The plan to provide
instruction in the responsible conduct of research will not be
considered in the assignment of a priority score.  However,
applications that do not contain such a plan will be considered
incomplete and an award will not be made until an adequate plan is

Review Schedule

The NRSA training grant receipt date and review cycle for all
applications is indicated below.

Application        Initial review     Council     Earliest possible
receipt date       group meeting      meeting     start date

Jan 11, 1993       May/Jun 1993     Sep 1993       Dec 1993


After IRG review, applications will be reviewed by the National
Advisory Council for Health Care Policy, Research, and Evaluation.
In addition to the recommendations of the initial review group, the
Council will consider the application within the overall research and
training goals of AHCPR.  Funding decisions will be made based on the
review groups' recommendations, the need for research personnel in
specified program areas, and the availability of funds.


Program inquiries may be directed to:

DonnaRae Castillo
NRSA Project Officer
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 501
Rockville, MD  20852
Telephone:  (301) 227-8362

Fiscal and administrative inquiries may be directed to:

Ralph Sloat, Chief
Grants Management Branch
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 601
Rockville, MD  20852
Telephone:  (301) 227-8447

For additional information, see the document entitled "National
Research Service Awards -- Guidelines for Individual Awards -
Institutional Grants," NIH Guide for Grants and Contracts (special
edition), Volume 13, Number 1, January 6, 1984, usually available at
the applicant institution.  Further information is also available in
the program announcement "National Research Service Award
Institutional Research Training Grants (T32)," NIH Guide for Grants
and Contracts, Volume 21, Number 11, March 20, 1992.


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


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