HRSA-25-008 Final - For Posting.pdf

Notice of Funding Opportunity

Application due March 18, 2025

Federal Office of Rural Health Policy Policy Research Division

Rural Residency Planning and Development Technical Assistance (RRPD-TA) Program Opportunity number: HRSA-25-008

Modified on 1/28/25 Updated TA Webinar information

Contents Before you begin 4

Step 1: Review the Opportunity 5

Basic information 6

Eligibility 7

Program description 10

Award information 12

Step 2: Get Ready to Apply 16

Get registered 17

Find the application package 17

Application writing help 17

Step 3: Prepare Your Application 19

Application contents and format 20

Step 4: Learn About Review and Award 33

Application review 34

Selection process 39

Award notices 39

Step 5: Submit Your Application 40

Application submission and deadlines 41

Application checklist 43

Step 6: Learn What Happens After Award 45

Post-award requirements and administration 46

Contacts and Support 50

Appendix A: Glossary 53

Contents 2

Endnotes 55

Contents 3

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks)

You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days)

You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date

Applications are due by 11:59 p.m. Eastern Time on March 18, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 4 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 6

Eligibility 7

Program description 10

Award information 12

Basic information Health Resources and Services Administration (HRSA)

Federal Office of Rural Health Policy

Policy Research Division

Providing technical assistance to new, sustainable medical residency programs to improve access to health care in America’s rural communities

Have questions?

Go to Contacts and Support.

Key facts Opportunity name:

Rural Residency Planning and Development Technical Assistance Program

Opportunity number:

HRSA-25-008

Announcement version:

Modification #1

Federal assistance listing:

93.155

Statutory authority:

42 U.S.C. § 912(b)(5) (§711(b)(5) of the Social

Security Act)

Key dates NOFO issue date:

January 17, 2025

Informational webinar:

See Webinar Section

Application deadline:

March 18, 2025

Expected award date is by: August 31, 2025

Expected start date:

September 30, 2025

See other submissions for other time frames that may apply to this NOFO.

Summary This program will fund a technical assistance center to help create and sustain new rural residency programs, including Rural Track Programs, that will expand the rural physician workforce. Rural residencies are physician residency programs that train residents primarily in rural clinical settings and focus on producing physicians who will practice in rural communities. This program aims to address physician workforce shortages and challenges faced by rural communities.

Funding details Application types: Competing continuation, New

Expected total available funding in FY 2025: $1,250,000

Expected number and type of awards: One cooperative agreement

Funding range per award: Up to $1,250,000 per year

We plan to fund this award in five 12-month budget periods, for a total five-year period of performance from September 30, 2025, to September 29, 2030.

The program and awards depend on the appropriation of funds and are subject to change based on the availability and amount of appropriations.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 6 https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section912&num=0&edition=prelim https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section912&num=0&edition=prelim https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section912&num=0&edition=prelim https://www.acgme.org/initiatives/medically-underserved-areas-and-populations/rural-tracks/ https://www.grants.gov/learn-grants/grant-terminology#c

Eligibility Who can apply You can apply if you are a domestic public or private, non-profit or for-profit, entity.

Types of eligible organizations These types of domestic* organizations may apply:

• Public institutions of higher education.

• Private institutions of higher education.

• Nonprofits with or without a 501(c)(3) IRS status.

• For-profit organizations, including small businesses.

• State, county, city, township, and special district governments, including the District of Columbia, domestic territories, and freely associated states.

• Independent school districts.

• Native American tribal governments.

• Native American tribal organizations.

* “Domestic” means the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Individuals are not eligible applicants under this NOFO.

Other eligibility criteria If you have an active Rural Residency Planning and Development (RRPD) grant (HRSA-20-107, HRSA-22-094, HRSA 23-037, or HRSA-24-022) as of the closing date of this notice, you are not eligible to receive funding under this notice. Similarly, the recipient of this award will not be eligible for funding under the RRPD grant program in future funding opportunities during the period of performance of this award.

Entities must have the capability to be national in scope—that is, much broader than a local, multistate, or regional focus—to reflect the distribution of current and future rural residency programs. HRSA strongly encourages applicants to have partnerships or establish and sustain a consortium to carry out the full range of activities outlined in this notice. A consortium can contribute a broad range of expertise and experience in residency development and accreditation and extensive knowledge of the variety of residency program funding mechanisms.

Step 1: Review the Opportunity 7

Examples of potential collaborators or consortium members include:

• Academic health centers affiliated with rural residencies, including family medicine department chairs and medical school deans.

• State Offices of Rural Health.

• Area Health Education Centers.

• National graduate medical education organizations, such as the Accreditation Council for Graduate Medical Education and the National Resident Matching Program.

• Medical and professional associations involved in residency training, such as the American Osteopathic Association, the American Academy for Family Physicians, and the American College of Obstetricians and Gynecologists.

• Teaching Health Centers.

• National rural health care associations.

See the organizational capacity section for more information on the roles of consortium members.

Completeness and responsiveness criteria We will review your application to make sure it meets these basic requirements to move forward in the competition.

We will not consider an application that:

• Is from an organization that does not meet all eligibility criteria.

• Requests funding above the award ceiling shown in the funding range.

• Is submitted after the deadline.

• Is non-responsive to the purpose of this notice of funding opportunity, which is to provide technical assistance to organizations to create and sustain new rural residency programs that will expand the rural physician workforce.

• Requests funding for activities prohibited in the program-specific limitations.

• Is missing required sections of the application, such as the project narrative or attachments.

Application limits You may not submit more than one application. If you submit more than one application, we will only accept the last on-time submission.

Step 1: Review the Opportunity 8

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. We will hold you accountable for any funds you add, including through reporting.

Step 1: Review the Opportunity 9

Program description Purpose HRSA’s Rural Residency Planning and Development (RRPD) initiative improves and expands access to health care in rural areas by developing new, sustainable rural residency programs. This initiative comprises two programs: the RRPD grants program, which funds organizations to create new, sustainable rural residency programs, and this RRPD technical assistance (TA) program.

The purpose of this cooperative agreement is to provide TA to organizations to create and sustain new rural residency programs that will expand the rural physician workforce. If you receive this award, you will provide TA, tools, and resources to organizations developing rural residency programs, such as RRPD award recipients and applicants, to help overcome the significant challenges and barriers they face.

For this notice of funding opportunity (NOFO), rural residency programs:

• Are accredited physician residency programs.

• Train residents in rural training sites for greater than 50 percent of their time in residency.

• Focus on producing physicians who will practice in rural communities.

This includes programs that meet the Accreditation Council for Graduate Medical Education (ACGME) Rural Track Program (RTP) designation, including both new programs seeking accreditation and existing programs that apply for a permanent complement increase to train additional residents at new rural training site(s).

Program objectives

• Promote the rural residency–to–rural workforce pathway by supporting the development of new rural residency programs in the following specialties:

◦ Family medicine.

◦ Internal medicine.

◦ Psychiatry.

◦ Obstetrics and gynecology.

◦ General surgery.

◦ Preventive medicine.

◦ Other specialties as determined by HRSA in future rural residency planning and development funding opportunities.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10

• Provide TA on topics, such as:

◦ Residency curriculum development.

◦ Faculty recruitment and development.

◦ Clinical and community partnerships.

◦ Program financial planning.

◦ Program administration.

• Help organizations establish and maintain new rural residency programs and become accredited by the ACGME.

• Help rural residency programs identify, qualify for, and secure (as applicable) Medicare graduate medical education (GME) funding and/or other sustainable pathways for funding, such as Medicaid, state, or private funding.

• Identify, track, analyze, and translate key policy, regulatory, and programmatic issues to inform rural residency programs and other rural GME stakeholders and policy makers about changes, knowledge gaps, or other challenges impacting rural residency programs and rural GME funding.

• Analyze the impact of rural residency activities and funding on rural communities (such as effects on the rural physician workforce), in consultation with HRSA.

• Promote rural residency training to medical students.

Background One in five Americans live in rural communities. Compared to their urban counterparts, people living in rural communities have higher rates of chronic conditions and preventable hospitalizations.[1] They also lack access to timely care.[2] In fact, 70% of areas designated as primary medical health professional shortage areas (HPSAs) [PDF] are in rural or partially rural areas. At the same time, national trends show the demand for physicians will continue to grow, outpacing the projected supply. Recent data from HRSA’s Bureau of Health Workforce projects a shortage of 187,130 physicians across primary care and non-primary care specialties by 2037. The maldistribution of the physician workforce contributes to these shortages. Urban areas have more physicians, while rural and underserved communities have the greatest unmet need for health care providers.

Recruiting and retaining physicians is a critical issue for rural communities. One proven strategy to address the problem is rural residency training. A recent study found that rural exposure during family medicine residency training is associated with a five- to sixfold increase in the likelihood of choosing rural practice.[3] Another recent study found that rural training is more strongly associated with rural practice than having a rural background.[4] Despite the demonstrated successes of rural training, research finds that opportunities for physician residents to train in rural areas remain limited.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 11 https://www.hrsa.gov/rural-health/about-us/what-is-rural https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand

According to the U.S. Government Accountability Office, only 2% of residency training occurred in rural areas between 2014 to 2015 and 2019 to 2020. Instead, residency training is highly concentrated in urban areas, particularly in the southern and northeastern U.S.

Rural residency programs often face limited financial, human resource, and organizational capacity. These constraints include lack of sustainable financing, limited faculty support, and difficulties recruiting residents. Due to these challenges, few new residency programs started in rural areas in the past. However, recent experience shows that rural residency programs can overcome these challenges through strong partnerships, community champions, and start-up resources. Further, current Medicare GME payment policy includes several provisions to fund new residency programs in rural health care facilities. These Medicare GME payments can be an important part of a program’s financial sustainability.

The urgent need to develop new rural training opportunities resulted in the HRSA RRPD Initiative. We first funded this RRPD Technical Assistance Program in 2018 to create a technical assistance center to identify and share resources and support organizations to develop new, accredited, sustainable rural residency programs. Since then, we have also made RRPD grant program awards to organizations across 38 states and 1 territory to develop rural residencies. To navigate the complexities of accreditation and GME financing, RRPD grant program recipients are required to collaborate with you throughout their period of performance.

Award information Cooperative agreement terms The program requirements also include these terms.

Our responsibilities Aside from monitoring and providing you with technical assistance, we also get involved in these ways:

• Providing consultation and technical assistance to you in planning, developing, operating, and evaluating activities, including technical guidance on key policy issues, projects, priorities, and topics for TA.

• Providing technical assistance to you on opportunities to share information on emerging policy issues affecting rural residency programs.

• Reviewing and providing feedback and recommendations on TA products, including presentations, program plans, work plans, budgets, contracts, key

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 12 https://www.gao.gov/products/gao-21-329 https://www.gao.gov/products/gao-21-329 https://www.hrsa.gov/rural-health/grants/rural-health-research-policy/rrpd/ https://www.hrsa.gov/rural-health/grants/rural-health-research-policy/rrpd/ https://www.hrsa.gov/rural-health/grants/rural-health-research-policy/rrpd/awards personnel lists, and policy briefs, before they are printed, disseminated, or implemented.

• Using HRSA communications resources to support the cooperative agreement.

• Participating, as appropriate, in the planning and implementation of any meetings, webinars, or work groups that you conduct during the period of performance.

Your responsibilities You must follow all relevant laws and policies. Your other responsibilities will include:

• Conducting any necessary support activities to ensure that you successfully complete work under the award, including:

◦ Developing and managing a website and portal to house TA tools, assessments, and resources.

◦ Developing, updating, and hosting TA products, tools, and learning activities, such as webinars.

◦ Convening meetings with program participants, collaborating organizations, and key stakeholders.

◦ Engaging with rural medical educators, rural health care providers, rural health researchers, policy makers, and medical students and potential residents interested in rural practice.

• Proposing and implementing a method to prioritize how you provide TA to targeted programs—those are developing and recently established rural residency programs.

• Providing direct TA to these programs. TA may include assistance in:

◦ Achieving ACGME accreditation.

◦ Recruiting, retaining, and developing faculty.

◦ Recruiting residents.

◦ Identifying sustainable pathways for funding individual rural residency programs, such as Medicare GME funding, Medicaid, state, or private funding.

◦ Sharing successful strategies of other rural residency programs.

• Responding to TA recipients’ requests, comments, and questions on a timely basis.

• Identifying, tracking, analyzing, and translating key policy, regulatory, and programmatic issues affecting rural residency programs and the creation of rural residencies to help targeted programs. Such issues include:

◦ The changing landscape of rural hospitals eligible to receive Medicare support if they start new rural residency programs.

◦ Regulatory changes that impact financial sustainability.

Step 1: Review the Opportunity 13

◦ Recruitment, development, and retention of high-quality physicians and residency faculty and staff to rural communities.

• Supporting TA strategies and addressing issues affecting rural residency programs, such as sustainable GME financing, rural health workforce, and recruitment and retention, in consultation with HRSA and other HHS agencies and external stakeholders.

• Evaluating and measuring the impact of TA activities, in consultation with HRSA.

• Evaluating and measuring the progress of developing rural residency programs, in consultation with HRSA.

• Assessing organizations’ readiness to establish new rural residency programs and achieve their goals and objectives.

• Identifying and analyzing successful rural residency programs to help develop best practices models and strategies for TA tools and resources.

• Disseminating TA tools and resources to TA recipients and the broader public, such as through publication.

• Promoting rural residencies to medical students and working with rural residency programs to develop strategies to recruit medical school graduates.

• Managing the fiscal and administrative aspects of the proposed project.

• Including an acknowledgment and disclaimer on all products produced by HRSA award funds.

• Adhering to Section 508 of the Rehabilitation Act of 1973, as amended.

Funding policies and limitations Policies

• We will only make awards if this program receives funding. If Congress appropriates funds for this purpose, we will move forward with the review and award process.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Your satisfactory progress in meeting the project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we may:

◦ Fund more applicants from the rank order list.

◦ Extend the period of performance.

◦ Award supplemental funding.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 14 https://www.section508.gov/manage/laws-and-policies/section-508-law/

General limitations

• For guidance on some types of costs we do not allow or restrict, see Project

Budget Information in Section 3.1.4 of the Application Guide. You can also see 45 CFR part 75, or any superseding regulation, General Provisions for Selected Items of Cost.

• You cannot earn profit from the federal award. See 45 CFR 75.400(g).

• Congress’s current appropriations act includes a salary limitation, which applies to this program. As of January 2025, the salary rate limitation is $225,700. This limitation may be updated.

Program-specific statutory or regulatory limitations You cannot use funds under this notice for:

• Acquiring or building real property.

• Major construction or major renovation of any space.

• Direct provision of health care services.

See Manage Your Grant for other information on costs and financial management.

Indirect costs Indirect costs are costs you charge across more than one project that cannot be easily separated by project. For example, this could include utilities for a building that supports multiple projects.

To charge indirect costs you can select one of two methods:

Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency at the time of award.

Method 2 – De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

Program income Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 45 CFR 75.307.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 15 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=14 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.400 https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

Step 2:

Get Ready to Apply

In this step

Get registered 17

Find the application package 17

Application writing help 17

Get registered SAM.gov You must have an active account with SAM.gov to apply. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist to find out what you’ll need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-25-008.

After you select the opportunity, we recommend that you click the Subscribe button to get updates.

Application writing help Visit HHS Tips for Preparing Grant Proposals.

Visit HRSA’s How to Prepare Your Application page for more guidance.

See Apply for a Grant for other help and resources.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 17 https://sam.gov/content/entity-registration https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant

Join the webinar More information on this NOFO's webinar will be posted at a later date to the related documents tab here.

We recommend you “Subscribe” to the NOFO on Grants.gov to receive updates when documents are posted.

The Webinar will be recorded.

Have questions? Go to Contacts and Support.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 18 https://www.grants.gov/search-results-detail/355375

Step 3:

Prepare Your Application

In this step

Application contents and format 20

Application contents and format Applications include five main components. This section includes guidance on each.

Application page limit: 65 pages.

Submit your information in English and express whole number budget figures using U.S. dollars.

Make sure you include each of these:

Components Submission format

Project abstract Use the Project Abstract Summary form.

Project narrative Use the Project Narrative Attachment form.

Budget narrative Use the Budget Narrative Attachment form.

Attachments Insert each in the Attachments form.

Other required forms Upload using each required form.

Required format You must format your narratives and attachments using our required formats for fonts, size, color, format, and margins. See the formatting guidelines in Section 3.2 of the Application Guide.

Project abstract Complete the information in the Project Abstract Summary form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. For more information, see Section 3.1.2 of the Application Guide.

Project abstract basic information First include the following items in list format, followed by the narrative content:

• Project title.

• Applicant organization name.

• Organization address.

• Funding amount requested.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 20 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf

• Organization website (if applicable).

• Consortium partners (if applicable).

• Program name and grant numbers of recent HRSA awards your organization has received that are relevant to the project (if applicable).

Project abstract narrative content

• Provide a brief overview of the project, describing your organizational capabilities and those of collaborators or consortium members (if applicable).

• Include goals and specific measurable objectives and expected outcomes of the proposed project.

• Describe how you will accomplish what you propose—the “who, what, when, where, why, and how” of the project.

Project narrative In this section, you will describe all aspects of your project. Project activities must comply with the nondiscrimination requirements.

Use the section headers and the order listed.

Introduction See merit review criterion 1: Need

• Briefly describe the purpose of your project.

• Explain the conceptual framework for your project.

• Identify specific goals, objectives, and expected outcomes of your project.

• Summarize how the proposed project will meet the unmet needs of organizations developing rural residency programs and support the creation, vitality, and sustainability of those new programs.

Step 3: Prepare Your Application 21

Need See merit review criterion 1: Need

Describe the issues impacting the development and sustainability of rural residency programs, using and citing data (local, state, or federal) whenever possible to support the information provided. Specifically, you must:

• Use current information and data (within the last three years) to describe the shortages of primary care and specialist physicians in rural areas and the drivers of these shortages.

• Describe:

◦ The health care delivery systems that host rural residency programs, such as urban-rural clinical partnerships, rural health care sites, and various health care payer systems.

◦ The number and types of rural hospitals that are eligible to start new residency programs that could qualify for Medicare support.

◦ These hospitals’ need for TA to develop and sustain new rural residency programs, specifically in the specialties described in the program objectives.

• Outline the needs of rural health care entities and academic partners for TA to strengthen collaborations and networks and recruit, train, and retain high-quality physicians.

• Discuss in detail the need for TA with the intricacies of residency program funding and how Medicare and Medicaid GME regulations affect the viability of rural residencies throughout the U.S.

Approach See merit review criterion 2a: Approach

Provide an overall strategic vision and propose methods that you will use to meet the program goals and objectives—to provide TA on a national scale to organizations that are developing or have recently established rural residency programs to expand the rural physician workforce. You must:

• Discuss how you will prioritize your TA.

• Discuss how you will provide TA to meet the needs of these programs for the targeted specialties.

• Outline the types of TA services and resources you will provide. They may include, but are not limited to:

◦ Assessing organizations’ readiness to establish a new rural residency program, or providing tools to help organizations assess their own readiness.

Step 3: Prepare Your Application 22

◦ Identifying and informing organizations developing rural residency programs of applicable resources and funding, including federal (such as HHS or HRSA grants and technical assistance) and nonfederal (such as state).

◦ Collecting resources and developing training and tools to educate and promote best practices to programs and other key stakeholders through outreach, information sharing, and dissemination of tools and resources.

◦ Ensuring that your TA supports rural residency programs across all stages of development, from planning through implementation and maintenance.

◦ Promoting networking and collaboration among developing and established rural residency programs.

• Describe your plan to identify, track, analyze, and translate key policy and programmatic issues affecting the development of rural residency programs, such as those identified in the program description section.

• Describe how you will help targeted programs understand Medicare GME funding and other financing options (such as Medicaid, state, or private funding) to support the sustainability of medical residency programs and provide successful strategies to secure funding.

• Describe your plan to develop and manage a website and portal to house technical assistance tools, assessments, and resources.

• Describe how you will develop, update, and host TA products, tools, and learning activities, such as webinars. Include information about the types of resources you plan to develop.

• Describe a detailed plan to facilitate an annual convening in each year of the cooperative agreement for staff of targeted programs and other key stakeholders to foster collaborative networks and share learnings to inform program and policy development.

• Describe a plan to engage with rural medical educators, rural health care providers, rural health researchers, policy makers, and medical students and potential residents interested in rural practice.

• Describe your plan and proposed timeline that ensures that TA tools and services are promptly available for targeted programs after the project start date.

• Identify how you will collaborate with key stakeholders to plan, design, and implement all activities.

Step 3: Prepare Your Application 23

High-level work plan See merit review criterion 2b: High-level work plan

Provide a detailed work plan in attachment 1 that describes the activities or steps you will use to achieve program objectives and implement a project of national scope.

Additionally use attachment 1 to illustrate your project’s overall design and conceptual framework.

In your narrative, you must also:

• Describe the steps you’ll take to achieve each of the objectives you identified in the approach section.

◦ Identify timeframes, deliverables, and person(s) responsible (faculty, staff, or key collaborators) for completing each activity.

◦ Note: The key faculty and staff identified in the work plan must correspond with the staffing plan in attachment 2 (Staffing plan and job descriptions).

Key collaborators must correspond with attachment 4 (Agreements with other entities), attachment 7 (Consortium member list), and attachment 8 (List of supporting organizations), if applicable.

• Explain how the work plan is appropriate for the program design and is aligned with the project’s conceptual framework, and how the targets fit into the overall timeline of the cooperative agreement.

Resolving challenges See merit review criterion 2c: Resolving challenges

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges. Clearly specify how the methods you propose in the approach section will overcome challenges and barriers identified. You must:

• Include the unique challenges in developing new rural residency programs as compared to urban programs, such as lack of sufficient subspecialty preceptors, low patient volume, and GME funding sustainability issues. Describe reasonable strategies to address these challenges.

Step 3: Prepare Your Application 24

• Discuss any anticipated internal and external challenges that may directly or indirectly affect successful completion of your project and provide details and strategies for how you would resolve them. These challenges might include:

◦ Management of collaboration and expectations among collaborating organizations.

◦ Engagement with new collaborators to support specialty rural programs.

◦ Geographical limitations.

◦ Regulatory changes.

Performance reporting and evaluation See merit review criterion 3: Evaluation measures and impact

Describe how you will monitor ongoing processes and progress toward meeting project goals, objectives, and expected outcomes. You must:

• Describe a performance evaluation strategy that will contribute to continuous quality improvement. Propose clearly defined, viable metrics, including descriptions of the inputs, key processes, and meaningful project outcomes that you will use to measure your effectiveness in providing TA.

• Demonstrate evidence that the evaluative measures you select will be able to assess:

◦ The extent to which the project objectives are met.

◦ The extent to which these results can be attributed to the project.

• Describe the systems and processes that will support your organization’s strategy to collect, manage, analyze, and track data to measure process, impact, and outcomes. Explain how you will use the data to inform program development and service delivery.

• Describe how you will measure the impact of newly developed rural residency programs on physician workforce shortages and access to care in rural communities. For example, you might compile data reported by the RRPD Program award recipients on:

◦ Accredited programs.

◦ Specialty type.

◦ Residency positions.

◦ Location of training.

◦ Percentage of rural training.

◦ Characteristics of residents.

◦ Graduates’ practice outcomes.

Step 3: Prepare Your Application 25

See the reporting section for more information.

Organizational information See merit review criterion 4: Resources and capabilities

Demonstrate that you have the necessary staffing, infrastructure, and capacity to provide TA at a national level, oversee program activities, and serve as the fiscal agent for the project.

Organizational Structure Specifically, you must:

• Describe your organization’s capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project and provide TA to organizations developing new rural residency programs.

• Describe your organization’s current mission, structure, scope of current activities, collaborations, and partnerships. Describe how these elements contribute to your organization’s ability to implement program requirements and meet program expectations. You will include an organizational chart in attachment 5.

• If you are applying on behalf of a consortium made up of multiple partner organizations, you must describe the capabilities of each member organization and their role in ensuring the success of the project. Discuss your organization’s capability to manage the overall program.

◦ If applicable, include a complete list of consortium members in attachment 7 (Consortium member list).

• If you are working with other non consortium organizations to implement your work plan, you must include a complete list of supporting organizations in attachment 8 (List of supporting organizations). Describe each listed organization’s capabilities and role implementing the work plan and include letters of agreement or memoranda of understanding in attachment 4 (Agreements with other entities).

• If you will subaward or subcontract funds, explain how your organization will ensure these funds are properly used and monitored. Describe your policies and procedures regarding subrecipient monitoring and management. These must meet or exceed the requirements in 45 CFR part 75.

Experience conducting similar work You must:

• Demonstrate your organization’s past experience supporting organizations developing residency programs in rural and underserved areas. Include specific examples of:

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 26 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

◦ Expertise in graduate medical education, such as rural residency program funding and financing, including understanding Medicare, Medicaid, and other public and private funding sources.

◦ Experience successfully linking rural residency programs with Medicare and Medicaid support to cover the costs of training.

◦ Expert knowledge and experience helping organizations develop and establish new ACGME-accredited rural residency programs in the targeted specialties.

◦ Supporting research and dissemination of best practices to medical educators on rural health models of care, including emerging patient care or health care delivery strategies that will support high-quality residency training.

◦ Disseminating best practices and supporting programs in recruiting and retaining residency faculty, staff, and residents.

◦ Publishing GME and GME policy-related research and policy briefs in peer-reviewed journals and presenting such research to key stakeholders and policy-making groups.

• Demonstrate your organization’s existing collaborative long-term relationships with key rural constituencies, rural health care delivery sites, academic partners, accrediting organizations, and federal agencies that can enhance rural GME development and long-term success. If relevant, include in attachment 8 a list of any nonconsortium organizations providing substantial support or resources to the project. See the eligibility criteria for examples of potential collaborators.

• Provide evidence demonstrating experience and relationships with both developing and established rural residency programs. Tell us how long your organization has been consistently working with these entities.

• Describe your organizations’ capacity and readiness to implement proposed activities and provide TA to targeted programs as soon as possible after the start of the period of performance.

• Describe in detail your experience working with rural medical educators, potential residents, and medical students interested in rural practice.

• You will provide a staffing plan and job descriptions for key faculty and staff in attachment 2 (Staffing plan and job descriptions) and biographical sketches for each person occupying the key positions in attachment 3 (Biographical sketches).

Step 3: Prepare Your Application 27

Note: You are encouraged to form a consortium of entities with a broad range of expertise and experience in residency development and accreditation, and extensive knowledge of Medicare, Medicaid, and other long-term sustainable funding mechanisms for residency programs. The applicant organization is critical to ensuring the success of this project and must demonstrate extensive prior experience and documented results working with entities developing rural residency programs.

Budget and budget narrative See merit review criterion 5: Support requested

Your budget should follow the instructions in Section 3.1.4 Project Budget Information

– Non-Construction Programs (SF-424A) of the Application Guide and the instructions listed in this section. Your budget should show a well-organized plan.

HHS now uses the definitions for equipment and supply in 2 CFR 200.1. The new definitions change the threshold for equipment to the lesser of the recipient’s capitalization level or $10,000 and the threshold for supplies to below that amount.

The total project or program costs are all allowable (direct and indirect) costs used for the HRSA award activity or project. This includes costs charged to the award and non-federal funds used to satisfy a matching or cost-sharing requirement (which may include maintenance of effort, if applicable).

The budget narrative supports the information you provide in Standard Form 424-A.

See other required forms. It includes an itemized breakdown and a clear justification of the costs you request. The merit review committee reviews both.

As you develop your budget, consider:

• If the costs are reasonable and consistent with your project’s purpose and activities.

• The restrictions on spending funds. See funding policies and limitations.

To create your budget narrative, see detailed instructions in Section 3.1.5 of the Application Guide.

Attachments Place your attachments in this order in the Attachments form. See the application checklist to determine if they count toward the page limit.

Attachment 1: Work plan Attach the project’s work plan. The work plan should include the overall goal of the project as well as the objectives that you have included in your project narrative. In a

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 28 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=14 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/part-200#p-200.1(Supplies) https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=18 table format, you should list the activities that you will take to achieve the goal and objectives you’ve identified. For each activity, identify timeframes, deliverables, and individuals who will be responsible for ensuring completion. We recommend that you include objectives, key tasks, person responsible, start date, and end date in your work plan.

In addition to the table, include a one-page graphic representation that demonstrates your project’s theory of change—that is, how activities identified in the work plan will result in your proposed outcomes for the project. Use this graphic to help reviewers understand your project’s overall design and conceptual framework.

Together the table of activities and the graphic representation of your theory of change should concisely illustrate what you plan to do and why you plan to do it.

Attachment 2: Staffing plan and job descriptions See Section 3.1.7 of the Application Guide.

Include a staffing plan that shows the staff positions that will support the project, and key information about each. Justify your staffing choices, including their education and experience. Explain your reasons for the amount of time you request for each staff position.

For each key staff member, attach a one-page job description. It must include their role, responsibilities, and qualifications.

Describe your organization’s timekeeping process to ensure that you will comply with the federal standards on documenting personnel costs.

Attachment 3: Biographical sketches Include biographical sketches for people who will hold the key positions you describe in attachment 2.

Each biographical sketch should be no more than two pages. Do not include non-public, personally identifiable information. If you include someone you have not hired yet, provide a letter of commitment from that person along with the biographical sketch.

Biographical sketches should include the following information:

• Name.

• Position title.

• Education and training—beginning with baccalaureate or other initial professional education, such as nursing, including postdoctoral training and residency training, if applicable.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 29 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=21 https://grants.gov/learn-grants/grant-terminology#p

◦ Institution and location.

◦ Degree, if applicable.

◦ Date of degree (MM/YY).

◦ Field of study.

• Experience working with a variety of rural organizations served by your TA program (if applicable).

• Section A (required): Personal statement. Briefly describe why the individual’s experience and qualifications make them particularly well suited for their role in the project.

• Section B (required): Positions and honors. List previous positions in chronological order, ending with the present position. List any honors. Include current membership on any federal government public advisory committees.

• Section C (optional): Other support. List selected ongoing and completed projects from the past three years, federally supported or not. Begin with any projects relevant to the project proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the person identified in the biographical sketch.

Attachment 4: Agreements with other entities Provide any documents that describe working relationships between your organization and others you mention in your project narrative. If you include documents that confirm actual or pending contracts or agreements, the documents should clearly describe the roles of subrecipients and contractors and any deliverables. It is not necessary to include the entire contents of lengthy agreements, so long as the portions you include describe the working relationship between you and the other organization.

Make sure letters of agreement are signed and dated.

Attachment 5: Project organizational chart Provide a one-page diagram that shows the project’s organizational structure, including collaborations and/or consortium members. Your organizational chart must show the applicant organization that is responsible for the overall management of the program. You must also show the relationship of all other involved collaborating organizations.

Step 3: Prepare Your Application 30

Attachment 6: For multiyear budgets, fifth-year budget For the fifth budget year, submit a copy of Section B of the SF-424A as an attachment.

We do not count this form in the page limit, but any related budget narrative does count. See Section 3.1.4 of the Application Guide.

Attachment 7: Consortium member list (if applicable) If applicable, provide a member list for the consortium. Provide the following information for each consortium member in a table:

• Member organization name.

• Member organization address.

• Primary point of contact information, including name, title, email address, and phone number.

• Organization employer identification number (EIN).

• Brief description of organization and project role.

Attachment 8: List of supporting organizations (if applicable) If applicable, provide a clearly labeled list of any nonconsortium organizations that will provide substantial support or resources to the project. Provide the following information for each organization:

• Organization name.

• Organization address.

• Primary point of contact information, including name, title, email address, and phone number.

• Brief description of organization and project role, including the relevant support or resources being provided.

Note: Letters of agreement or memoranda of understanding for these nonconsortium organizations must be included in attachment 4.

Attachments 9-15: Other relevant documents You may use attachments 9 through 15 to add other relevant documents.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 31 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=14

Other required forms You will need to complete some other forms. Upload the following forms at Grants.gov.

You can find them in the NOFO application package or review them and any available instructions at Grants.gov Forms.

Forms Submission Requirement

Application for Federal Assistance (SF-424) With application.

Budget…