08_DIR_T F_RFS_Field.doc

HRSA Objective Review Manual

Date Received:

Task Order No.:

Contractor Task Leader:

Appendix IV.3

Request for Services for Objective Review Support Division of Independent Review/Health Resources and Services Administration

FIELD READER REVIEW

This form is for Federal Review Administrators to request assistance with their respective reviews. It should be filled out as completely as possible and submitted to the Project Officer, who will in turn, submit to the contractor. Submit this form approximately 3 months before the scheduled review. In order to fill this out, RAs will need to meet with program staff regarding the details of the review. Please keep cost economies in mind.

Program Name:

Activity Code:

HRSA Announcement Number:

Funding Cycle Number:

New Program: FORMCHECKBOX Yes

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No

Amount of Funding: _________________________ No. of Awards Anticipated: _________

Application Due Date:________________________ Award Date: _____________________

Check the Bureau/Office of Origination and Funding of Task:

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OHIT

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Other

Program Contact:

Grant Specialist:

DIR RA:

FORMTEXT

FORMTEXT

FORMTEXT

DIR RA and Branch Chiefs’ Signatures:

Name FORMTEXT

(Operations Branch) Date FORMTEXT

Name FORMTEXT

(Policy Branch) Date FORMTEXT

Project Officer Approval:

Name FORMTEXT

Date

Review Specifications

Title of the Review:

No. of Applications:

Proposed Dates:

No. of Panels:

Total No. of Days for the Review:

No. of Applications per Reviewer:

Ending Time on Last Day of Review:

Length of Application:

Estimated Total Attendance

Reviewers:

Federal Staff (Program, Grants, and DIR):

Total:

Contractor Staff

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Summary Statement Operators (SSOs)

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Data Entry (at Parklawn Only)

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Contract Manager

Pre-Review Reviewer Correspondence—All Review Approaches

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E-mail Availability Letter to Potential Reviewers

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Confirmation of Reviewers

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Update Reviewer Information

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Arrange Pre-Review Conference Call(s)

Internal Materials

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Assignments

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Assign Applications to Reviewers

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Provide RA with Assignment Lists

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Pre-Review Activities

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Pick Up Applications From DIR

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Prepare and Distribute the Mail-out Package*.

Mail-out Package always contains the following:

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List of applications for review with PI’s/PD’s

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Reviewer Assignments (list and applications)

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Application Guidance

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Applications

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Reviewer Instruction Guides

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Reviewer Worksheets

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Feedback Form

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COI and Confidentiality Certification

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Specifics about pre-review orientation call

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Instructions and Federal Express Labels

Mail-out Package May Include:

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Program-specific reviewer information

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Model Summary Statement

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Forms for reviewer payment

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Other:

*Reviewers receive hard copies of their assigned applications, the program guidance, and a single copy of the worksheet. On CD, reviewers receive all applications for their panels and a template of the worksheet.

Summary Statements

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Receive Draft Summary Statements From Reviewers

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Consolidate Draft Summary Statements

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Highlight duplications, inconsistencies, etc and fill out Field Results Summary Chart

Post-Review Summary Statements

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Draft Summary Statements are transmitted to the DIR RA in preferred mode:

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a. 1 Full Hard Copy

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b. 1 Electronic (email) copy

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Final Summaries are produced by Contractors and provided to DIR

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2 Full Hard Copies (with scores and budget data)– 1 for Grants, 1 for Program

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1 Ready to Mail Hard Copy (without budget data)– 1 for Program

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1 Full Copy (Electronic) (with scores and budget data) – DIR will forward a copy to Program

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1 Ready to Mail copy (Electronic) (without budget data) – DIR will forward a copy to Program

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1 Full Copy CD (with scores and budget data)

Hard Copy Summary Statements*:

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Sorted by Grants and Program Copies

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Sorted by Panel

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Sorted by Numerical Order

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Sorted by Panel and Numerical Order

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Stapled Ready to Mail Copies

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Unstapled Ready to Mail Copies

* RA should consult with Program regarding how they would like to receive their summary statements.

Prepare and Submit Rank Order List

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Validate the Data

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Run the Rank Order List (s)

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Calculate 80th Percentile (if applicable)

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Submit Rank Order List

Number of Rank Order Lists Submitted

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One

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More, Please Specify:

Other Activities after the Review Meeting

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Enter Evaluation Form Data

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Dispose of Review Materials

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Develop and Mail Thank-You Letters to Reviewers

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Completion of DIR folder form and deliver all contents to RA

Reimburse Review Participants

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Honorarium

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Other:

ADDITIONAL NOTES:

Critical Dates: Field Reader Reviews

Assign Contractor Point Person and Conduct Initial Meeting with DIR

Identify Reviewers and Create Mail-out Packages

Invite all Reviewers and Prepare Roster (with Demographics)

Receive and Inventory Applications

Confirm all Reviewers and Alternates

Assign Reviewers

Mail Mail-out Packages to Reviewers Submit a Full Copy to DIR RA

Schedule and Conduct Pre-Review Conference Call(s)

Receive all COI forms from review participants

Fax “problem” COI forms to DIR RA, along with COI problems report (Missing COI forms, listed COI’s, missing signatures, etc…)

Receive Objective Review Checklist Worksheets and Score Sheets

Combine Worksheets, highlight duplications, inconsistencies, etc…. and merge into Summary Statement Checklist Template

Submit Contractor edited copies of summary statements with scores and budget data and provide written analysis of Summary Statement Checklist Templates to DIR RA

Arrange for Reviewer Call-Backs (if necessary)

Enter Scores into DIR Spreadsheet and Generate Rank Order List

Submit Final Summary Statements which include DIR edits

Send Thank-you Letters to Reviewers

Contractor confirmation certifying return and disposal of all review materials.

Delivery of official file contents to DIR RA

Last Update: October, 2006

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