HRSA-26-047_Final.pdf

Federal Office of Rural Health Policy

Notice of Funding Opportunity

Application due 07/08/2026

Rural Residency Planning and Development Program Opportunity number: HRSA-26-047

Contents Before you begin 3

Step 1: Review the Opportunity 4 Basic information 5

Eligibility 6

Program description 8

Award information 20

Step 2: Get Ready to Apply 22 Get registered 23

Find the application package 23

Application writing help 24

Step 3: Build Your Application 25 Application checklist 26

Application contents and format 28

Step 4: Understand Review, Selection, and Award 53 Application review 54

Selection process 64

Award notices 65

Step 5: Submit Your Application 66 Application submission and deadlines 67

Other submissions 68

Step 6: Learn What Happens After Award 69 Post-award requirements and administration 70

Reporting 73

Contacts and Support 74

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 07/08/2026.

All activities proposed in your application and budget narrative must align with applicable law, including but not limited to statutes, executive orders, federal regulations and applicable judicial holdings. Accordingly, discretionary awards shall not be used to fund, promote, encourage, subsidize, or facilitate: racial preferences or other forms of racial discrimination by the recipient, including activities where race or intentional proxies for race will be used as a selection criterion for employment or program participation; denial by the recipient of the sex binary in humans, or the belief that sex is a chosen or mutable characteristic; illegal immigration; or any other initiatives that compromise public safety. If an application does not align, the application will not receive funding to the extent permitted by law and applicable court orders.

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.

https://sam.gov/ https://grants.gov/

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 6

Program description 8

Award information 20

Basic information Health Resources Services Administration Federal Office of Rural Health Policy

Policy Research Division

Creating new, sustainable residency programs to improve access to health care in America’s rural communities.

Summary The Rural Residency Planning and Development (RRPD) program improves and expands access to health care in rural areas by developing new sustainable rural residency programs, including rural track programs (RTPs). Under the program, we provide start-up funding to grant recipients to create accredited rural residency programs in a qualifying medical specialty.

These residency programs are then sustained long-term through viable and stable funding mechanisms, such as Medicare and in states where there is a viable path of support, through Medicaid or other consistent state funding.

Ultimately, this funding opportunity addresses physician workforce shortages and challenges faced by rural communities.

Funding details Application types: New

Expected total available funding in FY26: $11,250,000

Expected number and type of awards: 15 Grants

Funding range per award: Up to $750,000

We plan to fund awards fully in Year 1 for use of over period of performance from 08/01/2026 to 07/31/2029.

Have questions?

Go to Contacts and Support.

name:

Rural Residency Planning and Development Program number:

HRSA-26-047

version:

Initial

93.746

06/05/2026 webinar:

TBD

deadline:

07/08/2026

08/01/2026

08/01/2026

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

https://www.acgme.org/initiatives/Rural-and-Underserved-GME/rural-tracks/

Eligibility Who can apply Types of eligible organizations These types of domestic organizations may apply:

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and State controlled institutions of higher education.

• Native American tribal governments (Federally recognized).

• Native American tribal organizations (other than Federally recognized tribal governments).

• Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education.

• Nonprofits without 501(c)(3) status with the IRS, other than institutions of higher education.

• Private institutions of higher education.

• For profit organizations , including small businesses.

• Small businesses.

• Faith-based providers.

• Others (see text field entitled “Additional Information on Eligibility” for clarification).

Additional information on eligibility Only domestic organizations are eligible.

“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.

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 not responsive to the purpose of the program, the sustainability plan requirements, or requirements for attachments.

• Fails to propose a new rural residency program in a qualifying medical specialty with greater than 50% of training at rural training sites.

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.

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. Recipients agree that once committed, cost sharing amounts are enforceable and subject to reporting and auditing requirements under 2 CFR 200.

Before you apply, make sure you understand the requirements that come with an award.

See Step 6: Learn What Happens After Award for information on regulations that apply, reporting, and more.

Program description Purpose The Rural Residency Planning and Development (RRPD) program improves and expands rural health care access. It does this by developing new, accredited, sustainable rural residency programs, including rural track programs (RTPs).[1]

Newly created rural physician residency programs increase training and ultimately practice in rural areas to address physician shortages.

The RRPD program provides start-up funding to create new rural residency programs in qualifying medical specialties. RRPD award recipients must secure long-term sustainability funding from viable and stable sources, such as Medicare.

Qualifying medical specialties are:

• Family medicine.

• Internal medicine.

• Preventive medicine.

• Psychiatry.

• General surgery.

• Obstetrics and gynecology.

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

• Are accredited physician residency programs.

• Train residents in clinical training sites that are physically located in a rural area as defined by HRSA’s Federal Office of Rural Health Policy (FORHP)[2] for greater than 50 percent of their total time in residency.

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

Definition of new programs You must propose a new rural residency program. This includes:

• Programs seeking accreditation for the first time.

• Existing programs applying for a permanent complement increase to train additional residents at new rural training sites as part of an RTP.

https://data.hrsa.gov/topics/rural-health/rural-health-eligibility

What does not qualify as new We do not consider the following to be new programs:

• Programs already accredited before the application due date that are not proposing an RTP expansion.

• Programs that already received a permanent complement increase for the proposed RTP before the application due date.

• Programs seeking only to add resident full-time equivalents at an existing RTP site.

Program goal The program’s goal is for each recipient to establish a new rural residency program in a qualifying specialty by the end of the period of performance.

Programs must:

• Be accredited by the Accreditation Council for Graduate Medical Education (ACGME).

• Show they can be sustained long-term through stable funding streams, such as Medicare.

RRPD-created programs will:

• Train physicians to practice in rural communities.

• Improve access to care and meet clinical needs of rural populations.

We expect more graduates from these rural programs to choose rural practice compared to traditional urban-based residency programs.

Funding opportunity goal

• Each recipient will establish a new, accredited rural residency program in a qualifying specialty by the end of the period of performance.

Background Rural health challenges One in five Americans live in rural communities.[3]

Compared to their urban counterparts, people living in rural communities face:

• Higher rates of chronic conditions and preventable hospitalizations.[4]

• Less access to timely care.[5]

73% of areas designated as primary medical health professional shortage area (HPSA) are in rural or partially rural areas.[6] National trends show the demand for physicians is growing faster than the projected supply:

• HRSA’s Bureau of Health Workforce projects a shortage of 141,160 physicians in 2038.[7]

• Projected workforce shortages are worse in rural communities, while urban areas have more physicians.[8]

Rural residency training as a strategy Retaining and recruiting physicians in rural communities is a critical issue.

One proven strategy is rural residency training.

• A recent study found family medicine residents with rural training are five to six times more likely to choose rural practice.[9]

• A second study found rural training is a stronger predictor of rural practice than having a rural background.[10]

Despite this, opportunities for rural physician residency training are limited:

• Only 2% of residency training occurred in rural areas between 2014 to 2015 and 2019 to 2020.[11]

• Training is concentrated in urban areas, especially in the South and Northeast.[12]

Historically, few new residency programs started in rural areas. This is likely due to challenges rural residency programs often face, such as:

• Lack of sustainable financing.

• Limited faculty support.

• Difficulties recruiting residents.

However, in recent years, HRSA-funded grantees have shown that rural residency programs can overcome these challenges through strong partnerships, community champions, and start-up resources that include customized technical assistance through the RRPD Program.

RRPD helps advance the Making America Healthy Again (MAHA) priorities, which include:

• Preventive health.

• Reducing chronic disease.

• Mental or behavioral health.

• Nutrition.

• Primary and value-based care.

https://www.hhs.gov/maha/index.html

• Culturally appropriate services for tribes.

• Early childhood health and autism support.

RRPD program history The RRPD program came out of the urgent need to develop new rural training opportunities.

HRSA funded its inaugural cohort in FY2019 and additional cohorts in FY2020–24. HRSA has awarded 103 RRPD grants to organizations in 36 states and 1 territory to develop rural residency programs across six specialties.

As of October 1, 2025:

• 62 program recipients have created new rural residency programs.

• These programs have resulted in 752 approved residency positions.

• 54 programs have enrolled more than 660 physician residents to train in rural areas.

Please see helpful websites for additional resources.

Program requirements and expectations We expect all applicants funded under this funding opportunity to develop strong and sustainable residency programs in qualifying medical specialties under one of two program pathways. To achieve the program’s goal, you must meet each of the program objectives during the three-year period of performance. Each objective has related critical milestones. Customized technical assistance is provided throughout the period of performance to help you achieve these milestones.

In addition to achieving accreditation, you must also finalize a validated sustainability plan and develop a structured plan to track and report your residency program’s graduate outcomes.

Program pathways and qualifying medical specialties There are two pathways for this program. In your application, you will specify to which pathway your proposed residency program corresponds.

Pathway 1: General primary care and high-need specialty This pathway supports the development of new rural residency training programs that focus on training to meet significant rural health needs.

The qualifying specialties in this pathway are family medicine, internal medicine, preventive medicine[13], psychiatry, and general surgery.

Pathway 2: Maternal health and obstetrics This pathway supports the development of new rural residency programs with a focus on training to provide high-quality, evidence-based maternity care and obstetrical services in rural areas.

Qualifying specialties in this pathway are obstetrics and gynecology, and family medicine with enhanced obstetrical training.

Family medicine with enhanced obstetrical residency training must:

• Provide family medicine residents with extensive clinical experience in comprehensive maternity care. This is outlined in ACGME’s program requirements.

• Include dedicated training on labor and delivery.

• Have faculty with clinical expertise to prepare family medicine residents for the independent practice of obstetrics in rural communities.[14]

Program objectives To achieve the program’s goal, you must achieve the following objectives if funded:

• Develop a new rural residency program that is accredited by ACGME.

• Finalize a validated sustainability plan that includes ongoing funding streams to sustain long-term resident training after the program is established.

• Develop a structured plan to track and publicly report on resident career outcomes after graduation for at least 5 years after the first graduating class, to assess retention in rural communities.

Program milestones You must meet critical milestones for each program objective. This NOFO lists the milestones by grant year.

Table: Timeline and key dates

Time period Date

Start of the period of performance 8/1/2026

End of the first year 7/31/2027

End of the second year 7/31/2028

End of the period of performance 7/31/2029

First academic year after the period of performance ends Academic year beginning in 2030

Objective 1: Residency program development

• Appoint a residency program director or identify a residency program director in development by the end of the first year.

• Submit the ACGME application for the new rural residency program’s accreditation or rural track program’s permanent complement increase by the end of the second year.

• Establish the new accredited rural residency program by the end of the period of performance.

• Begin training the first resident class no later than the first academic year (AY) after the RRPD period of performance ends.

Objective 2: Program sustainability

• Finalize detailed pro forma for program sustainability by the end of the first year.

Objective 3: Graduate tracking plan

• Finalize and submit detailed graduate outcome tracking plan by the end of the second year.

RRPD Technical Assistance Center To navigate the complexities of accreditation and graduate medical education (GME) financing, all recipients must:

• Collaborate with the HRSA-funded RRPD Technical Assistance Center, which includes:

◦ Providing key parts of your application to the Center to inform technical assistance provision.

◦ Meeting quarterly with an assigned technical assistance advisor to discuss residency development progress.

• Attend a 2-day annual RRPD program meeting during their period of performance.

Program sustainability You must finalize a validated sustainability plan that includes ongoing funding streams to sustain long-term resident training through one or more of the following options:

• Qualifying under current regulatory authority for viable Medicare payments for GME, such as Indirect Medical Education (IME) or Direct Graduate Medical Education (DGME) payments, for hospitals starting a new residency training program.

• Expanding a rural track program to a new rural site in accordance with Medicare regulations that qualifies for viable IME or DGME payments.[15]

• Qualifying for other public or private support that is not based on federal discretionary appropriations.

• Combining multiple funding streams (for example, a hospital may have a mix of Medicare and other public funding).

Medicare sustainability options Hospitals with approved GME programs are paid for costs associated with training residents under Medicare. Due to limits imposed by law, established teaching hospitals are often unable to receive Medicare payment for new residency programs; however, there are pathways for new rural residency programs to qualify for Medicare support.

If your sustainability plan relies on Medicare GME, you must select one or more of the options that follow. While these options provide pathways for rural residency programs to qualify for Medicare funding, you must also consider your hospitals classification type among other factors. You can learn more in Appendix A. You may register for free to use the RRPD-TA Center’s Rural GME Hospital Analyzer tool as a starting point for determining your program’s best path to sustainability. This tool is for information purposes only.

https://ruralgme.org/ https://ruralgme.org/portal/register

Option 1 – Rural hospital new residency program

Rural teaching hospitals in non-metropolitan counties may qualify for a Medicare full-time equivalent (FTE) resident cap increase if they start a new medical residency training program in their hospital.

Example:

A non-metropolitan hospital with an accredited family medicine residency may qualify for a cap increase if it starts training residents in a new psychiatry program.

However, current Medicare regulations do not provide cap increase when:

• A rural hospital adds more FTE residents to an existing program after that program’s FTE caps is set.

• An existing residency program transfers to a new training site.

Option 2 – Medicare FTE resident cap expansion for an RTP

Urban and rural hospitals may qualify for an adjustment to their Medicare GME FTE resident caps if they collaborate to establish an RTP. To do this, they can either:

• Establish a new RTP.

OR

• Expand an existing ACGME-accredited program by adding a new rural track.

Definition of a rural track program:

• An ACGME-accredited program in which residents gain both urban and rural training experience with more than half of their residency training taking place in a rural area (as defined at 42 CFR 412.62(f)(iii)).

• For this regulation, rural areas are defined as areas outside a metropolitan statistical area.[16]

Option 3 – Establishing a Medicare FTE resident cap for the first time

Rural hospitals that have not established a per resident amount (PRA) nor set their GME FTE resident caps (also known as “never claimers”) can choose this option.

If relying on this option, a hospital must show that in past cost reports going back to 1996:

• No residency training has taken place at the hospital.

• No per resident amount nor caps have been set.[17] https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-412/subpart-D/section-412.62#p-412.62(f)(1)(iii)

Option 4 – Medicare FTE cap adjustment for rural reclassified hospitals

An Inpatient Prospective Payment System (IPPS) hospital in a metropolitan area may reclassify as administratively rural under 42 CFR 412.103 if it meets certain criteria. An administratively rural hospital may qualify to increase its Medicare resident caps when it begins a new residency program.[18] A hospital may qualify for one or both:

• An IME new program adjustment.

• A DGME rural track program FTE cap increase, but only if serving as the urban partner in a rural track program.

Do not select option 4 if the administratively rural hospital is partnering with a geographically rural (non-metropolitan) hospital to create an RTP. Instead, select sustainability option 2.

If relying on this option, you should consider:

• Medicare does not increase IME caps when hospitals add more resident FTEs to an existing program.[19]

• IME funding can help support the program, but it is typically not enough to sustain the residency program by itself.

• If your sustainability plan relies on a hospital’s administratively rural status outside of a rural track program, you must include other realistic, long-term funding sources to ensure program sustainability.

Option 5 – Medicare reasonable cost payments for Critical Access Hospitals

Critical access hospitals (CAHs) can serve as training sites for rural residency programs.

Because CAHs are not IPPS hospitals, typical GME Medicare payment formulas do not apply.

GME payments for CAHs:

• Medicare pays CAHs 101% of reasonable costs that the CAH itself incurs for residency programs.

• Payments are prorated to reflect the share of Medicare patients.

These payments alone are usually not enough to cover the full cost of teaching and sustain a residency program.

If you plan to use CAH reasonable cost payments as a part of your sustainability plan, you must also include other realistic, long-term funding sources to ensure program sustainability.

Instead of claiming training costs directly, a CAH may function as a non-provider site for an IPPS hospital.

• If you plan to use a CAH as a non-provider site, do not choose Option 5.

https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-412/subpart-G/section-412.103

• Instead, select the most appropriate sustainability option for the IPPS hospital partner from Medicare sustainability options 1, 2, or 3.

• We discuss how CAHs can function as a non-provider site below, as this still may be key to a program’s sustainability.

CAH participation as a non-provider site:

• Under current regulation:

◦ An IPPS hospital may claim residents’ training time at the CAH, using the CAH as a non-provider site for GME payment purposes.

◦ The IPPS hospital must pay residents’ salary and benefits while they train at the CAH.

• The CAH and partnering IPPS hospital typically set up funds flow agreements to share the CAH’s costs for hosting the residency training.

Non-Medicare sustainability options Option 6 – Other public or private funding

Rural residency programs can also receive support from funding sources other than Medicare. For the RRPD program, we focus solely on public payer sources or other state and private sources. We do not include Teaching Health Center Graduate Medical Education (THCGME). If you intend to rely on the THCGME funding model, you should apply to that program rather than RRPD, as THCGME is precluded from allowable RRPD sustainability options.

Examples of these funding sources:

• Medicaid.

• State sources.

• Other public or private funding streams.

Considerations:

• Non-Medicare public funding tends to be less stable than Medicare. If your sustainability plan relies mainly on these sources, you must include a backup plan in case the funding is unavailable or not enough.

• Medicaid funding for GME varies from state to state. If your plan relies on Medicaid, your plan must account for Medicaid GME payments in your state and include an approximate funding amount per resident. Reimbursement for clinical services cannot be included.

• You may not include public funds that rely on discretionary federal appropriations as part of your sustainability plan.

Graduate tracking plan If funded, you must develop and submit a structured plan to track and publicly report on resident career outcomes after graduation.

• Outcomes must be tracked for at least 5 years after the first graduating class to assess retention in rural communities.

• To consistently track graduates, you must identify and establish data collection elements for the graduate tracking plan.

At a minimum, the graduate tracking plan must accurately collect the following graduate outcomes:

• National Provider Identifier (NPI).

• Practice locations.

• Medical specialty/sub-specialty.

• Employment status (part-time or full-time).

Examples of other information you might collect include:

• Patient population served.

• Service time committed to the care of safety net patients.

• Part or full-time clinical practice status.

• Services offered.

• Proportion of clinical time in inpatient and outpatient settings.

• Additional training opportunities pursued after residency completion.

You must also track program performance data and should consider adding these measures to your plan for tracking graduate outcomes.

Refer to the Annual Performance Report Program Manual for examples of program performance data that you will report to HRSA.

Advancement of MAHA priorities Activities should advance one or more of the MAHA priorities. Strategies to consider include:

• Address root causes of poor health.

• Improve access to primary care, behavioral health, preventive care, or developmental services.

• Expand nutrition programs or chronic disease prevention.

• Support early childhood development or autism services.

https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/unique-identifiers/npis https://grants4.hrsa.gov/WebBPMHExternal/Interface/ProgramManualHTML.aspx?FormCode=1&IsPM=True&EHBActivityCode=p13

• Prepare systems for value-based care.

• Partner with tribal health systems.

Disclosure of participation in or benefit from CMS Rural Transformation Program You must disclose whether you participate in or benefit from your state’s CMS Rural Transformation Program. If you do, you must coordinate any HRSA-funded work to ensure it is non-duplicative, coordinated, and complementary.

Statutory authority 42 U.S.C. § 912(b)(5) (§711(b)(5) of the Social Security Act)

Award information Funding policies and limitations Changes in HHS regulations As of October 1, 2025, HHS has adopted 2 CFR Part 200, with some modifications included in 2 CFR Part 300. These regulations replace those in 45 CFR Part 75.

Policies

• To make an award, funding must be available and allocated for this program and purpose, at which point we will move forward with the review and award process.

• Have clear policies and good financial practices to avoid spending HRSA funds on unallowable activities. Like other award rules, we may audit your policies, procedures, and controls.

• 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.

General limitations

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

◦ Project Budget Information in the Application Guide [PDF].

◦ 2 CFR Part 200 Subpart E - General Provisions for Selected Items of Cost.

◦ Allowable and Unallowable Costs and Activities in the HHS Grants Policy Statement.

• All cost must be reasonable, necessary, allocable to the award, and adequately documented (2 CFR 200.403).

• You cannot earn profit from the federal award. See 2 CFR § 200.400(g).

• Current appropriations law includes a salary limit of $228,000 as of January 2026 that applies to this program. You may pay salaries at a higher rate if the rate beyond the salary rate limit (Executive Level II) is paid with non-HHS funds. For help calculating salaries under this limit, read more at “salary rate limitation” in the Application Guide [PDF].

https://www.ecfr.gov/current/title-2/part-200 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D13 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.hhs.gov/grants-contracts/grants/grants-policies-regulations/index.html https://www.hhs.gov/grants-contracts/grants/grants-policies-regulations/index.html https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.404 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.405 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.403 https://www.ecfr.gov/current/title-2/part-200#p-200.400(g) https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D15

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

• Providing direct medical services.

• Acquiring or building real property.

• Major construction or major renovation of any space. (Minor alterations or renovations are allowable.)

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 incur 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 do not have a current 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 up to 15% of modified total direct costs (MTDC). See 2 CFR § 200.1 for the definition of MTDC. You can use this rate indefinitely for all your federal awards or until you choose to receive a negotiated rate.

Consider your indirect costs when developing your budget.

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 2 CFR 200.307.

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-2/section-200.307 https://www.ecfr.gov/current/title-2/section-200.307

Step 2:

Get Ready to Apply

Get registered 23

Find the application package 23

Application writing help 24

Get registered SAM.gov You must have an active account with SAM.gov to apply. 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 for the information you will need to register.

• You must agree to the financial assistance general certifications and representations specifically. Those for contracts are different.

When you register, you will also receive your required Unique Entity Identifier (UEI).

Once you register:

• You will have to maintain your registration throughout the life of any award.

• If your organization has multiple UEIs, use the one associated with your physical location.

If you need additional information about user roles in SAM.gov, see “Get registered:

SAM.gov user roles” in the Application Guide [PDF].

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 and How to Apply for Grants.

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-26-047.

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

https://sam.gov/content/entity-registration https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D4 https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/search-grants

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.

FAQs will be posted on our TA webpage after the webinar.

Join the webinar For more information about this opportunity, join the webinar:

Webinar information will be posted to the Related Documents tab on Grants.gov. We recommend you “Subscribe” to the NOFO on Grants.gov to receive updates when documents are posted.

Have questions? Go to Contacts and Support.

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

Step 3:

Build Your Application

Application checklist 26

Application contents and format 28

Application checklist There are two types of forms in Grants.gov.

• Some forms allow you to upload components of your application to the form.

These include components like your project narrative, budget and budget narrative, and attachments, as applicable.

• Other forms are more typical, fill-in-the-blank forms.

Make sure that you have everything you need to apply.

Narratives

Component Grants.gov form Included in page limit*?

Project narrative Project Narrative Attachment form. Yes

Budget narrative Budget Narrative Attachment form. Yes

Attachments Insert each in the Attachments Form in this order.

Other required forms Upload using each required form in Grants.gov.

Forms Submission requirement

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

Project Abstract Summary form With application.

Grants.gov Lobbying form With application.

*Only what you attach in these forms counts toward the page limit. The forms themselves do not count.

Included in

1. Work plan Yes

2. Staffing plan and job descriptions Yes

3. Biographical sketches No

4. Agreements with other entities Yes

5. Project organizational chart Yes

6. Rural status documentation No

7. Program sustainability documentation Yes

8. SORH letters of intent No

9. Indirect cost rate agreement (if applicable) No

10. Disclosure of participation in or benefit from CMS Rural Transformation Program (if applicable)

No

11.-15. Other relevant documents Yes

Application contents and format This section includes guidance on each component found in the application checklist.

Application page limit: 60 pages

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

Required format Required format for project summary, project narrative, budget narrative, and attachments.

Font: A readable font like Arial, Courier, CG Times, or Times New Roman.

File format: We only accept the following document formats:

• .PDF - Adobe Portable Document Format

• .DOC/.DOCX - Microsoft Word

• .RTF - Rich Text Format

• .TXT - Text

• .WPD - Word Perfect Document

• .XLS/.XLSX - Microsoft Excel

• .VSD - Microsoft Visio

Size: 12-point font.

Footnotes, charts, graphics, and budget tables may be 10-point or higher.

Ink color: Black.

Spacing: Single-spaced, including all text and tables.

Alignment: Left

Headings: Bold all headings and align left.

Size: 8.5 x 11 (Make sure the print area is set and allows printing to 8.5 x 11.)

Margins: 1-inch on all sides.

Footer: On each page as the footer, include your organization’s name and page numbers. If a competing continuation or competing supplement, also include your 10-digit award number.

Page numbering:

• Do not number the standard OMB-approved forms.

• Number each attachment page sequentially (that is, 1, 2, 3).

• Reset the numbering for each attachment.

• Treat each attachment as a separate section.

File names: You can find guidance for naming your files in the Application Guide [PDF].

Project narrative Introduction See merit review criterion 1: Need

• Briefly describe the purpose of your project.

• Identify specific goals, objectives, and expected outcomes.

• Summarize how your project will address population health needs and expand your proposed medical specialty in your target area.

Need See merit review criterion 1: Need

Summarize the health workforce and health care needs of the target area served by your proposed project. Focus this section on assessing the current health care infrastructure (such as the local or regional GME landscape) and describing the resources needed to develop a new rural residency program.

Use and cite demographic data whenever possible to support the information provided.

Specifically, you must:

• Describe the geographic area where you plan to start the new rural residency program.

◦ Explain why you chose this area.

• Describe the unmet health care needs that the residency program will address.

◦ Whenever possible, include data on:

▪ Demographics.

▪ Community conditions that impact health and well-being.

▪ Health care needs of the population served.

▪ Barriers to accessing care.

https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D26

• Describe the area’s health workforce shortages and need for physicians in your proposed medical specialty.

• Include information from the past 3 years to show the need.

◦ For example, you may indicate the presence of geographic or population Health Professional Shortage Areas (HPSA) for primary care or mental health.

• Describe the rural health care delivery system.

◦ Outline the needs of facilities hosting your proposed rural residency program.

◦ Include information about organization structure and the clinical and faculty capacity to support the new rural residency program.

• List any residency programs (existing or in development) in the proposed medical specialty that serve the area where the proposed new rural residency program will be located.

• Describe progress you have already made towards planning or developing your proposed rural residency program.

◦ Describe existing residency program collaborations and efforts to develop clinical training sites and to support preceptor development and retention.

◦ Describe any consultations with the State Office of Rural Health related to this new rural residency program.

▪ You must also at a minimum include the required letter of intent and any response received as Attachment 8.

• Describe how your activities will advance one or more MAHA priorities.

• Explain how your activities build from, but do not duplicate, other federal, state, tribal, or local programs.

• If you are pursuing the Maternal Health and Obstetrics Pathway, you must also:

◦ Describe gaps in the obstetrics services and existing resources available to care for individuals and families with high-risk factors in pregnancy.

◦ Include current state or county-level data on demographics and community conditions that impact health of the target population.

◦ Discuss their specific maternal health needs, including prevention and treatment of risk factors during pregnancy, such as diabetes, heart disease, You must notify the State Office of Rural Health in any state where you have proposed to conduct rural training of your intent to apply to this program. We recommend making every effort to contact your state office early in the application process to advise them of your intent to apply. See Attachment 8 for more details.

hypertension, obesity, depression, and opioid use disorder (OUD) and substance use disorder (SUD).

◦ You may use maternal health indicators from HRSA’s Maternal and Infant Mapping Tool.

Approach See merit review criterion 2: Response

Tell us how you’ll address the needs you described and meet the program goal, objectives, and program requirements and expectations.

Specifically, tell us how you will:

• Achieve ACGME accreditation for the new rural residency program, or a permanent complement increase for the new rural track program expansion, in a qualifying specialty by the end of the period of performance. Describe:

◦ Your program’s proposed sponsoring institution and whether it has received institutional accreditation.

▪ If not yet accredited, describe your plans to achieve institutional accreditation.

▪ Your Sponsoring Institution’s plan to meet ACGME requirements for organizational capacity and program governance.

◦ Your program’s proposed clinical training sites in a table in Attachment 6.

▪ Show that greater than 50% of proposed clinical training will take place in facilities physically located in rural areas as defined by HRSA’s Federal Office of Rural Health Policy.

◦ Your plan to make sure your clinical capacity meets ACGME program accreditation requirements, including:

▪ Enough dedicated supervisory faculty.

▪ Adequate patient care volume.

▪ Appropriate resident training time in relevant medical specialties and subspecialties (such as obstetrics training).

▪ If a clinical training partner addresses gaps in clinical capacity to meet ACGME requirements and provides significant support, you must submit a letter of agreement from the partner describing their committed resources and clinical capacity in Attachment 4.

◦ Your plan to appoint a residency program director by the end of year 1 of the grant (if not already hired).

https://data.hrsa.gov/maps/mchb/ https://data.hrsa.gov/maps/mchb/ https://data.hrsa.gov/tools/rural-health

▪ Include your faculty recruitment and development plan, including recruiting specialty faculty to meet ACGME requirements for the proposed specialty.

◦ Your curriculum and training plan, which should include:

▪ Interprofessional training.

▪ Training to address the specific health needs of the patient population in the rural area the residency will serve.

▪ Your curriculum plan must prepare residents for successful board certification and clinical practice after residency.

• Enroll residents in training no later than the academic year immediately after the performance period ends. Describe your plan to:

◦ Recruit a cohort of strong residents who are committed to rural practice.

▪ Describe plans for outreach to medical students with rural backgrounds.

◦ Recruit and train at least the minimum number of residents required for accreditation for the proposed specialty.

◦ Promote resident and graduate retention in rural practice.

• Track residents’ career outcomes for at least 5 years after the first graduating class from the rural residency program. Describe how you’ll:

◦ Develop, enhance, or leverage a graduate tracking system to track and publicly report (e.g., on your program website) on graduates’ career outcomes and retention in rural areas. At a minimum, the graduate tracking plan should accurately collect the following information about graduates:

▪ National Provider Identifier (NPI).

▪ Practice locations.

▪ Medical specialty/sub-specialty.

▪ Employment status (part-time or full-time).

• Describe innovative approaches or unique program characteristics that improve rural residency training, such as:

◦ Patient-centered medical homes.

◦ Telehealth.

◦ Interprofessional education and practice.

◦ Integrating oral health.

◦ Mental health and behavioral health.

◦ Public health emergency preparedness and response training.

• Describe a plan to disseminate reports, products, or project outputs so other rural residency programs can use this model.

◦ If you are pursuing the Maternal Health and Obstetrics Pathway, you must also:

▪ Describe the types of clinical training sites for obstetrics training and the range of services at these sites, including ambulatory maternal care.

▪ Include the number of anticipated vaginal deliveries and C-sections per year.

▪ List the number of preceptors and faculty who provide maternal health care and describe their maternity and obstetrics services.

▪ Clearly state the percentage of time and types of maternal health/ obstetrics services residents will perform or experience while training in rural communities.

◦ If you are proposing a family medicine with enhanced obstetrical training, you must:

▪ Describe how you plan to enhance the family medicine residency program in maternal health and obstetrical training, referencing current ACGME requirements.

▪ Describe how you’ll effectively train family medicine residents for the independent practice of obstetrics in rural communities.

High-level work plan See merit review criteria 2: Response

• Describe your planned activities to achieve the program goal and each of the identified program objectives during the period of performance.

• Include a detailed work plan in Attachment 1. You should use this plan to show how you will achieve each of the program milestones in the Program requirements and expectations section. A sample work plan is included in Appendix B for your reference.

◦ Your detailed work plan must:

▪ List a start and end date for each activity.

▪ Name the faculty, staff or key collaborator responsible for each. Key faculty/staff must match the staffing plan in Attachment 2.

▪ Provide Letters of Agreement from all key collaborators in Attachment 4.

• Explain how key stakeholders will help plan, design, and carry out all activities, including developing the accreditation application.

◦ Discuss the extent to which these contributors reflect the populations and communities served, and how they helped develop the work plan.

• Explain how the work plan matches the program design.

◦ Show that time frames for proposed activities fit into the overall grant timeline.

• You must disclose whether you participate in or benefit from your state’s CMS Rural Transformation Program.

◦ If you do, you must use Attachment 10 to describe the CMS-supported activities and clearly explain how the proposed HRSA-funded work is non-duplicative, coordinated, and complementary.

Resolving challenges See merit review criterion 2: Response

Discuss challenges that you are likely to face when carrying out the activities in your work plan. Explain how you’ll resolve them.

Specifically, you must:

• Discuss barriers that may limit progress toward the program goal and objectives.

Examples include:

◦ Lack of clinical experiences for residents.

◦ Low patient volumes for residents.

◦ Difficulty recruiting specialty and subspecialty preceptors.

◦ Financial sustainability issues.

• Discuss expected internal challenges, such as managing expectations among clinical training partners.

• Discuss external challenges, like regulatory changes that may affect rural residency program development.

• Describe challenges incorporating interprofessional health care, innovative approaches, and culturally and linguistically appropriate care into the program curriculum.

• Describe challenges recruiting a cohort of strong residents committed to rural practice.

• Propose realistic strategies to address each barrier or challenge you discuss.

Performance management See merit review criteria 3: Performance reporting and evaluation and 5: Resources and capabilities

Describe your proposed plan to monitor ongoing processes and progress towards meeting the project goal, objectives, and expected outcomes.

• Performance measurement and reporting. See our reporting manual for performance measure requirements and examples of reporting forms. Describe how you will collect and report the required performance data accurately and on time.

◦ Specifically, you must include the following performance measures for your residency program, in addition to the plan for tracking characteristics of graduates, practice locations, and intent to be employed in rural areas required in the Approach section:

▪ Accredited positions.

▪ Admissions.

▪ Demographic characteristics of residents.

▪ Location of training.

▪ New curriculum development.

▪ Faculty development.

◦ If funded, you must report on selected characteristics of your residency program and residents you recruit during the period of performance.

◦ Provide a table of anticipated values for the following initial outputs in your application:

▪ Number and type (i.e., model and specialty) of newly established rural residency programs.

▪ Number of residents each rural residency program can support in the first year.

▪ Number of residents each rural residency program will support once fully established (longer-term goal).

▪ Number and type of existing clinical training sites for residents.

▪ Number and type of newly established clinical training sites for residents.

▪ Number of faculty and staff trained to teach, support, and administer the curriculum at each rural residency program site.

https://grants4.hrsa.gov/WebBPMHExternal/Interface/ProgramManualHTML.aspx?FormCode=1&IsPM=True&EHBActivityCode=p13

▪ Number and type of existing collaborations (e.g., non-clinical training site) that support the rural residency program.

▪ Number and type of newly established collaborations (e.g., non-clinical training site) that support the rural residency program.

◦ Describe how you will manage and securely store data.

▪ Explain how you will protect data against cybersecurity threats, breaches, or other loss of data integrity.

◦…