Full Text HS-94-005


NIH GUIDE, Volume 22, Number 43, November 26, 1993

RFA:  HS-94-005

P.T. 44

  Health Services Delivery 

Agency for Health Care Policy and Research

Application Receipt Date:  February 10, 1994


The Agency for Health Care Policy and Research (AHCPR) awards
National Research Service Award (NRSA) institutional grants 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 one or more years of experience in
applying research methods to the evaluation of health services.  The
AHCPR does not support short-term training.


The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  The AHCPR
urges applicants to submit grant applications with relevance to the
specific objectives of this initiative.  Potential applicants may
obtain a copy of "Healthy People 2000" (Full Report:  Stock No.
017-001-00474-0 or Summary Report:  Stock No. 017-001-004374-1)
through the Superintendent of Documents, Government Printing Office,
Washington, DC 20402-9325 (telephone 202-783-3238).


Applicant 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.


Trainees appointed to the proposed training program must have the
opportunity to carry out supervised health services research with the
primary objective of extending their research skills and knowledge in
preparation for a health services research career.  Prospective
trainees must be U.S. citizens or noncitizen nationals or permanent
residents of the United States in possession of an Alien Registration
Receipt Card I-551 or I-151, or other legal verification of such
status 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., Dr.P.H., Sc.D, D.N.Sc. or other
doctoral degree, or an equivalent degree from any accredited domestic
or foreign institution.  (For purposes of NRSA appointments, persons
holding the J.D. are not considered postdoctoral trainees unless they
also hold the L.L.M. degree.)  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 doctoral degree.
Individuals working toward a medical or dental degree who wish to
interrupt their studies to engage in full-time research training for
a year or more before completing their health professional degree are
eligible for NRSA support with approval from AHCPR.


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


The AHCPR expects to fund approximately three awards in response to
this RFA; the total funds available are not expected to exceed
$500,000.  This is a one-time solicitation and is made subject to
availability of funds.  The AHCPR reserves the right to withdraw this
Request for Applications (RFA) if funds do not become available.


Areas of Training

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

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

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

o  Analysis of service delivery, resource use, and costs of care for
persons with HIV-related illnesses;

o  Primary care issues, including relationships between the structure
and organization of service delivery, and access to and costs and
outcomes of care;

o  Evaluation of managed care and other alternative approaches to
organizing, financing, and reimbursing health care services;

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

o  Medical treatment effectiveness issues, including evaluation of
outcomes associated with the use of clinical practice guidelines;

o  Availability, accessibility, effectiveness, and quality of care
for underserved populations such as low-income groups and minorities;

o  Rural health issues, including primary care access, service
delivery, technology diffusion, and supply of health professionals;

o  Medical malpractice and liability;

o  Appropriateness and effectiveness, including cost effectiveness,
of alternative treatments and technologies;

o  Factors affecting dissemination and assimilation of health and
clinical information to practitioners and patients;

o  The development of measures, methods, and technologies to support
quality assurance and foster quality improvement in health care; and

o  Application of medical informatics to developing and improving
expert systems for clinical diagnosis and treatment selection.

Levels and Types of Training Permitted

NRSA 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 permitted for
up to 10 percent time (four hours per week) within the training
program only if they relate to the training itself.  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 health services research.

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 and Retention 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.  Application 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.  Applications without a description of a minority
recruitment plan will be considered incomplete and will not be
reviewed until this information is provided.

Institutional training grants are a desirable mechanism for
postdoctoral training of physicians and other health professionals
whose doctoral training has usually involved limited health services
research experience.  For such individuals, it is highly recommended
that they agree to engage in at least two years of research training
or comparable experiences at the time of appointment regardless of
whether or not the NRSA training is part of a research degree

Payback Provisions

All postdoctoral trainees must sign an agreement to fulfill the NRSA
payback requirements when they are initially appointed to a training
grant (or receive an individual fellowship).  The NIH Revitalization
Act of 1993 substantially modifies the existing service payback
requirements for individuals supported under NRSA programs. Beginning
with new appointments (or reappointments) made as of June 10, 1993,
the following new guidelines apply:

Predoctoral trainees will not be required to sign the Payback
Agreement Form (PHS Form 6031) and will not incur a service payback

Postdoctoral trainees in the first 12 months of postdoctoral NRSA
support will incur one month of obligation for each month of support.
Postdoctoral trainees in the 13th and subsequent months of NRSA
support will not sign the Payback Agreement Form and will incur no
further obligation.

The 13th and each subsequent month of postdoctoral NRSA support will
be considered acceptable payback service; therefore, individuals who
are appointed to their initial NRSA postdoctoral period on or after
June 10, 1993, and continue under that award for two years will have
fulfilled their first year obligation by the end of the second year.

Service payback obligations can be repaid after the period of
training by engaging in health services related research and/or
teaching for at least 20 hours per week averaged over a full year.

Recipients must undertake the obligated service on a continuous basis
within two years after termination of NRSA support.  The period for
undertaking payback service may be delayed for temporary disability,
for completion of residency requirements, or for completion of the
requirements for a graduate degree.  Requests for an extension must
be made in writing to AHCPR and must specify the need for additional
time and the length of the required extension.  Recipients of NRSA
support are responsible for informing AHCPR of changes in their
status or address.

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

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 Trainee Support


National Research Service Awards provide funds in the form of
stipends to predoctoral and postdoctoral trainees.  A stipend is
provided as an allowance for trainees to help defray living expenses
during the research training experience.  It is not provided as a
condition of employment with either the Federal Government or the
institution.  Trainees may not receive stipends for periods during
which they are not enrolled in the training program.

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 full 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

Full years of relevant experience       Stipend

         None                           $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

Supplementation and Compensation

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
programs.  Supplementation, when provided, must be without obligation
to the trainee.

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 either stipend
supplementation or student compensation for coincidental employment
detract from or prolong the research training.  Further information
on stipend supplementation and compensation is available in "National
Research Service Awards -- Guidelines for Individual Awards -
Institutional Grants," NIH Guide for Grants and Contracts (special
edition), Volume 13, Number 1, January 6, 1984.

Tax Liability of Stipends

Section 117 of the Internal Revenue Code applies to the tax treatment
of all scholarships and fellowships.  Under that section, degree
candidates may exclude from gross income, reported for tax purposes,
any amount used for tuition and related expenses such as fees, books,
supplies, and equipment required for courses of instruction at the
educational institution.  Nondegree candidates are required to report
as gross income all stipends and monies paid on their behalf for
course tuition and required fees.

The taxability of stipends in no way alters 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 AHCPR or with the institution in which they are pursuing
research training, nor are they considered to be self-employed.
Stipends are not subject to employment or self-employment tax (FICA).

It must be emphasized that the interpretation and implementation of
tax laws are the domain of the Internal Revenue Service (IRS).  AHCPR
is not in a position to advise students or institutions about their
tax liability.  Individuals should consult their local IRS office for
more detailed information on the proper steps to be taken regarding
their tax obligations.

Other Training Costs

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 for postdoctoral trainees not
enrolled in a degree program is limited to that required for specific
courses in support of the approved training program; tuition for
other courses must be justified.  Annual increments in tuition costs
beyond the first year of the award may not exceed six percent for an
equivalent number of trainees.

Domestic travel by trainees, 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 expenses related to the training program.
Salaries of the program director and faculty are not reimbursed.

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.


The research grant application form PHS 398 (rev. 9/91) is to be
used.  (State and local government agencies may use form PHS 5161 and
follow those requirements for copy submission.)  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.

These forms are available at most institutional offices of sponsored
research; the Office of Grant Information, Division of Research
Grants, National Institutes of Health, Westwood Building, Room 449,
Bethesda, MD 20892, telephone 301-710-0267; and the Scientific Review
Branch, Agency for Health Care Policy and Research, 2101 East
Jefferson Street, Suite 602, Rockville, MD 20852, telephone

Insert the title of this RFA (National Research Service
Award--Institutional Grants) and RFA number (HS-94-005) on line 2a of
the application face page and the YES box must be marked.  The RFA
label found in the 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 the application such that
it will not reach the review committee in time for review.

Applications must be received at the Division of Research Grants,
NIH, by February 10, 1994.  Late applications will be returned to the
applicant.  The completed, signed, original application and three
legible copies of the form PHS 398 must be sent or delivered to:

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

Two information copies must be submitted simultaneously to:

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

Failure to provide these information copies will result in the return
of the application to the applicant.


Applications will be reviewed by an AHCPR initial review group (IRG)
and by the National Advisory Council for Health Care Policy,
Research, and Evaluation.  The NRSA training grant receipt date is
February 10, 1994.  Grants will be awarded by September 30, 1994.

Review Criteria

The initial review group will consider the following criteria in its

o  Qualifications and responsibilities of the program director;

o  Qualifications of the program's faculty, including ongoing health
services research support and ability to serve as effective mentors
for trainees;

o  Objectives and design of the proposed training program and the
probability of achieving stated goals;

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

o  Documentation of availability of qualified candidates and
program's plans for recruitment and selection of 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, including tracking of graduates
after completion of training and record of trainees in obtaining
individual research awards or fellowships following training and in
establishing careers in health services research;

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

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

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.

In addition, applicant institutions will be evaluated on the
acceptability of their proposed plans for instruction in the
responsible conduct of research and for recruiting individuals from
underrepresented minority groups into the proposed training program,
as delineated below.  Prospective applicants should consult the NIH
Guide for Grants and Contracts, Volume 21, Number 43, November 27,
1992, and Volume 22, Number 25, July 16, 1993, for detailed
information on these two issues.

Minority Recruitment Plan

The AHCPR remains committed to increasing the participation of
individuals from underrepresented minority groups in health services
research.  All competing applications must include a plan to recruit
individuals from underrepresented minority groups, and review of any
application received without a plan will be deferred until a plan is

During initial review, reviewers will assign a priority score for the
overall technical and educational merit of the application.  Then,
one or more assigned reviewers will discuss the minority recruitment
plan and any record of recruitment and retention efforts.  The
recruitment components of each application will be judged as either
acceptable or unacceptable.  The findings of the review committee on
the plan for attracting minority individuals will be presented in an
administrative note in the summary statement.  Funding of any
application with a plan for recruiting underrepresented minorities
that is judged unacceptable by the review committee will be withheld
until a revised plan that addresses the deficiencies is received.
AHCPR staff will determine whether or not amended plans submitted
after initial review are acceptable.

Information on the recruitment and retention of underrepresented
minority trainees appointed during the previous budget period must
also be provided in progress reports included in noncompeting
continuation applications.

Training in the Responsible Conduct of Research

Every predoctoral and postdoctoral trainee supported by a NRSA
institutional training grant must receive instruction in the
responsible conduct of research.  Applications must include a
description of formal and any informal instruction that addresses
various aspects of scientific integrity and the responsible conduct
of research.  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.  Although the exact content of the
plan is left to the individual training program, suggested areas of
instruction include conflict of interest, responsible authorship,
policies for handling misconduct, policies regarding the use of human
subjects, and data management.

The plan to provide instruction in the responsible conduct of
research will be assessed on the appropriateness and breadth of
topics; instructional format and materials; amount, nature, and
quality of faculty participation; and frequency and duration of the
training.  Plans will be rated as acceptable or unacceptable by the
initial review group.  The plan and acceptability will be described
in an administrative note in the summary statement.  The plan to
provide instruction in the responsible conduct of research will not
be considered in the assignment of a priority score to the
application.  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 provided.

Council Review

In addition to IRG recommendations on the scientific and technical
merit of the applications and the acceptability of plans for minority
recruitment and training in the responsible conduct of research, the
National Advisory Council for Health Care Policy, Research, and
Evaluation will consider the application within AHCPR's overall
research and training goals.


Funding decisions will be made based on the IRG and Council
recommendations, the need for research personnel in specified program
areas, balance among types of research training supported by AHCPR,
and the availability of funds.


Written and telephone inquiries concerning this RFA are encouraged.
The opportunity to clarify any issues or questions from potential
applicants is welcome.

Direct inquiries regarding programmatic issues to:

DonnaRae Castillo
NRSA Project Officer
Agency for Health Care Policy Research
2101 East Jefferson Street, Suite 501
Rockville, MD  20852
Telephone:  (301) 594-1362

Direct fiscal and administrative inquiries to:

Ralph Sloat
Grants Management Branch
Agency for Health Care Policy Research
2101 East Jefferson Street, Suite 601
Rockville, MD  20852
Telephone:  (301) 594-1447


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


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