oppHRSA-18-006-cfda93.124-cidHRSA-18-006-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Nurse Anesthetist Traineeship (NAT) Program

Funding Opportunity Number: HRSA-18-006

Funding Opportunity Type: New, Competing Continuation

Catalog of Federal Domestic Assistance (CFDA) Number: 93.124

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: February 28, 2018

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

Deadline extensions are not granted for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: December 21, 2017

Karen Delia Breeden, MPA Public Health Analyst, Division of Nursing and Public Health Telephone: (301) 443-5787 Email: KBreeden@HRSA.gov

Authority: Public Health Service Act, Section 811(a)(2) of the Public Health Service Act (42 U.S.C.

296j(a)(2)).

mailto:KBreeden@HRSA.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Bureau of Health Workforce, Division of Nursing and Public Health is accepting applications for the fiscal year (FY) 2018 Nurse Anesthetist Traineeship (NAT) Program. The purpose of this program is to support eligible entities to meet the cost of traineeships for individuals in nurse anesthesia degree programs. Grants are awarded to accredited institutions that educate registered nurses to become nurse anesthetists; recipient institutions, in turn, disburse funds to students in the form of traineeship support. NAT students may use traineeship funds during the period for which the traineeship is provided for full or partial costs of the tuition and fees, books/e-books, reasonable living expenses (stipends) and to attend workshops or conferences on topics including, but not limited to, reduced opioid use disorder, multi-modal pain management, and enhanced recovery. The funds appropriated for the NAT Program are distributed among all eligible applicant institutions based on a formula. The FY 2018 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds awarded in a timely manner. Applicants should note that this program may be cancelled prior to award recommendations.

Funding Opportunity Title: Nurse Anesthetist Traineeship Program Funding Opportunity Number: HRSA-18-006 Due Date for Applications: February 28, 2018 Anticipated Total Annual Available FY18 Funding:

$4,850,000

Estimated Number and Type of Award(s): Up to 80 grants Estimated Award Amount: Award amount determined by formula;

minimum award amount is $1,000.

Cost Sharing/Match Required: No Project Period/Period of Performance: July 1, 2018 – June 30, 2019 (1 year) Eligible Applicants: Eligible applicants are schools of nursing, nursing centers, academic health centers, State or local governments, and other public or private nonprofit entities determined appropriate by the Secretary.

See Section III-1 of this notice of funding opportunity (NOFO), formerly known as the funding opportunity announcement (FOA), for complete eligibility information.

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise. A short video for applicants explaining the Application Guide is available at http://www.hrsa.gov/grants/apply/applicationguide/.

Technical Assistance

The following technical assistance webinar has been scheduled to help applicants understand, prepare, and submit an application for this notice of funding opportunity (NOFO). The webinar is scheduled for:

Day and Date: Wednesday, January 17, 2018 Time: 1:15 p.m. Eastern Time Adobe Connect Link: https://hrsa.connectsolutions.com/nurse_anesthetist_traineeship_ta/ Call-In Number: 888-593-8430 Participant Code: 3083287

The webinar will be recorded - replays are generally available one hour after the call ends.

Playback Number: 800-925-4166; toll 402-220-4167 Passcode: 0075 End date: March 17, 2018 at 11:59 p.m. (ET) http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/ https://hrsa.connectsolutions.com/nurse_anesthetist_traineeship_ta/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. NAT Program Specific Data Forms

vi. Attachments

3. DUN AND BRADSTREET UNIVERSAL NUMBERING SYSTEM (DUNS) AND SYSTEM FOR AWARD

MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

APPENDIX

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I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the fiscal year (FY) 2018 Nurse Anesthetist Traineeship (NAT) Program.

Program Purpose The purpose of this program is to support eligible entities to meet the cost of traineeships for individuals in Nurse Anesthesia degree programs. Nurse Anesthetists are on the front lines of the opioid epidemic, especially in rural areas, where they are often the sole provider of anesthesia services. As part of their training, these individuals learn about multi-modal pain management and opioid addition and treatment, which are a key part of helping communities address the opioid crisis.

Grants are awarded to accredited institutions that educate registered nurses to become nurse anesthetists; recipient institutions, in turn, disburse funds to students in the form of traineeship support. The funds for the NAT Program are distributed among all eligible applicant institutions based on a formula.

This funding opportunity will help address U.S. Department of Health and Human Services’ (HHS) clinical priority of addressing opioid abuse by providing funds to support Student Registered Nurse Anesthetists (SRNAs) training or continuing education related to pain management, opioid abuse prevention and treatment. SRNAs may use traineeship funds during the period for which the traineeship is provided for full or partial costs of the tuition and fees, books/e-books, reasonable living expenses (stipends) and to attend workshops or conferences on topics including, but not limited to, reduced opioid abuse, multi-modal pain management, and recovery.

Program Requirements Successful applicants will be required to conduct the following activities:

1. Identify eligible students enrolled in its accredited, full-time graduate-level nurse anesthesia degree programs;

2. Provide traineeship awards to those eligible students (minimum $1,000 and maximum $22,000 per student) consistent with terms outlined in Section II.2 (Summary of Funding); and

3. Collect and report student and graduate-level data to allow for accurate and timely reporting of required performance measures.

Funding Preference As authorized by Section 805 of the Public Health Service Act (42 U.S.C. § 296d), funding preference shall be given to applicants with projects that will substantially benefit rural or underserved populations, or help meet public health nursing needs in State or local health departments.

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To be considered for the Statutory Funding Preference, you must supply all supporting data in the NAT Program Specific Data Forms (Table 2). Refer to Section V.2 of this funding opportunity for additional guidance on this funding preference.

Special Consideration As authorized by Section 811(g)(2) of the Public Health Service Act (42 U.S.C. § 296j(g)(2)), special consideration shall be given to an eligible entity that agrees to expend the award to train advanced education nurses who will practice in health professional shortage areas (HPSAs).

To be considered for the Special Consideration, you must supply all supporting data in the NAT Program Specific Data Forms (Table 2). Refer to Section V.2 of this funding opportunity for additional guidance on this statutory funding factor.

2. Background

Legislation This program is authorized by Title VIII, Section 811(a)(2) of the Public Health Service Act, (42 U.S.C. 296j(a)(2)).

Role of Certified Registered Nurse Anesthetists (CRNAs) in addressing opioid abuse in rural areas

HRSA strives to improve health and achieve health equity by strengthening the health workforce and connecting skilled professionals to communities in need. In October 2017, the President declared a public health emergency to address the national opioid crisis.1 According to the American Society of Addiction Medicine, 1.9 million Americans age 12 and older had a substance use disorder.

While every state in the nation has been impacted by this epidemic, rural states such as New Hampshire, Kentucky, Ohio, and West Virginia are most affected.2,3 CRNAs are at the frontline of the opioid crisis because they are more likely to practice in rural areas where the opioid crisis is most acute. In fact, CRNAs are the sole anesthesia providers in more than many rural hospitals in the United States.

Nurse Anesthesia programs including training students in a holistic approach to pain management and patient care to prevent drug overdoses and death, opioid abuse and substance use disorder.4 This can include training in multimodal pain management providing “a range of multiple and different types of therapies that may include medical, 1 HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html 2 Centers for Disease Control (December 30, 2016) Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015, Retrieved from https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm655051e1.pdf 3 Harvard Business Review. (October 26, 2017). To Combat the Opioid Epidemic, We Must Be Honest About All Its Causes. Retrieved from https://hbr.org/2017/10/to-combat-the-opioid-epidemic-we-must-be-honest-about-all-its-causes 4 American Association of Nurse Anesthetists. (2016, September 22). Holistic Approach to Pain Management Helps Curb Opioid Overuse. Retrieved from https://www.aana.com/news/news-detail/2017/05/17/holistic-approach-to-pain-management-helps-curb-opioid-overuse https://hbr.org/2017/10/to-combat-the-opioid-epidemic-we-must-be-honest-about-all-its-causes https://www.aana.com/news/news-detail/2017/05/17/holistic-approach-to-pain-management-helps-curb-opioid-overuse https://www.aana.com/news/news-detail/2017/05/17/holistic-approach-to-pain-management-helps-curb-opioid-overuse

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surgical, psychological, behavioral, and integrative approaches as needed.”5 In addition, these programs regularly use tools like the Substance Abuse and Mental Health Services Administration (SAMHSA) Providers’ Clinical Support System For Opioid Therapies in supporting the training of the Nurse Anesthesia students.6

By educating and providing clinical training for NAT students in opioid addiction management and treatment, the NAT award recipients will be supporting HHS’s priority to combat the opioid abuse epidemic.

3. Program Definitions

The following definitions apply to the NAT Program for Fiscal Year 2018.

1. New Funding Opportunity Type is an application that is being submitted to HRSA for the first time and has not previously received an NAT award.

2. Competing Continuation Funding Opportunity Type is an application or an award made for additional funding/budget period for a project with a projected completion date, through a competing process.

3. Health Professional Shortage Areas (HPSAs)7 is a federal designation used to identify areas, populations, and facilities, which have a shortage of either primary care, dental, and/or mental health providers as measured by the ratio of available discipline-specific providers to: the population of the area; a specific population group; or the number of those served by the facility. All federally qualified health centers and rural health clinics, as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)) and that meet the requirements of section 334 in PHSA, (related to charging for services,) shall be automatically designated as having such a shortage. More information on the HPSA criteria can be found at:

http://bhw.hrsa.gov/shortage/hpsas/designationcriteria/designationcriteria.html.

4. New Appointment means the appointment of a student to receive NAT funds during the current budget/project year who has not received NAT support during any previous budget/project period.

5. Reappointment means any appointment of a student to receive NAT funds during the current budget/project year who has received NAT support during any previous budget/project period(s).

6. Rural area8 is a geographical area located in a non-metropolitan county, or an area located in a metropolitan county designated by the Federal Office of Rural Health Policy as being considered rural.

7. Underserved Area is a geographic location or population of individuals that is eligible for designation by the federal government as a Health Professional Shortage Area, Medically Underserved Area, Medically Underserved Population, or Governor’s Certified Shortage Area for Rural Health Clinic purposes. As an umbrella term, Medically Underserved Community (MUC) also includes populations such as

5 National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. The Interagency Pain Research Coordinating Committee, National Institutes of Health, 2016.

6 Providers’ Clinical Support System for Opioid Therapies https://pcss-o.org/ Accessed November 7, 2017 7 See HRSA’s HPSA Finder Tool at https://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.aspx 8 More information can be found at: http://www.hrsa.gov/ruralhealth/policy/definition_of_rural.html. Note: To determine whether a geographical area is considered rural, go to HRSA's Rural Health Grants Eligibility Analyzer.

https://pcss-o.org/ https://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.aspx

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homeless individuals, migrant or seasonal workers, and residents of public housing.

More information on HRSA shortage designations is available at:

http://www.hrsa.gov/shortage/.

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce can be located at the Health Workforce Glossary.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New and Competing Continuation

Funding will be provided in the form of a grant.

2. Summary of Funding

Approximately $4,850,000 is expected to be available in FY 2018 to fund approximately eighty (80) recipients. Awards will be distributed among all eligible institutions based on a formula calculation using data supplied by applicants in the NAT Program Specific Data Forms (see appendix). Applicants that fail to submit this information will not be considered for funding. The actual amount available will not be determined until enactment of the final FY 2018 federal appropriation. The FY 2018 President’s Budget does not request funding for this program. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds can be awarded in a timely manner.

Current recipients of an NAT award must submit a New/Competing Continuation application (see program definitions in Section VIII) for each annual open competition to be considered for funding beyond the previous project period.

The project period is July 1, 2018 through June 30, 2019 (1 year).

Allowable costs are limited to traineeship support only, with a minimum award amount of $1,000 per student and not to exceed $22,000 per student. A trainee may be appointed at the beginning of any academic period, including summer session, which falls within the budget period specified by the current Notice of Award (NOA).

Traineeship support may cover the following:

• Full or partial tuition and fees;

• Stipends, i.e., reasonable living expenses; and

• Required textbooks (including e-Books).

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles and Audit Requirements at 45 CFR part 75.

http://www.hrsa.gov/shortage/ https://bhw.hrsa.gov/grants/resourcecenter/glossary http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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Indirect costs are not authorized under this award.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants are schools of nursing, nursing centers, academic health centers, State or local governments, and other public or private nonprofit entities determined appropriate by the Secretary.

Foreign entities are not eligible for this HRSA award.

Individuals are not eligible to apply to the NAT Program funding opportunity.

Any school(s) of nursing affiliated with this application must be accredited to provide graduate nurse anesthesia education at the time of application – and for the duration of the award – by the Council on Accreditation of Nurse Anesthesia Educational Programs.

Applicants must submit official documentation of accreditation in Attachment 1 for all affiliated nursing programs. Applicants who fail to submit accreditation documentation will be considered nonresponsive and deemed ineligible under this funding announcement.

In addition to the 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau may apply. Tribes and Tribal organizations may apply for these funds, if otherwise eligible.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Due Date Any application that fails to satisfy the deadline requirements referenced in Section IV.4 will be considered non-responsive and will not be considered for funding under this notice.

Maintenance of Effort (MoE) The recipient must agree to maintain non-federal funding for award activities at a level which is not less than expenditures for such activities during the fiscal year prior to receiving the award, as required by Section 803(b) of the Public Health Service Act.

Complete the Maintenance of Effort document and submit as Attachment 2.

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Multiple Applications Multiple applications from an organization are not allowable; however, applicants can submit one application per campus (must have unique DUNS numbers). A campus is defined as a division of a university that has the same name yet is separate with its own grounds, buildings (e.g., school of nursing) and faculty. For example, the University of Homestate at Smalltown and the University of Homestate at Anytown can each submit an application for this program.

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates), an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

Beneficiary Eligibility Requirements To receive NAT traineeship support from a recipient institution, an individual must be

• Enrolled full-time in an accredited course of study leading to a graduate degree in nurse anesthesia and

• A citizen of the United States, a non-citizen national, or a foreign national having in his/her possession a visa permitting permanent residence in the United States.

• Eligible to sit for the certification examination administered by the American Association of Nurse Anesthetists Council on Certification of Nurse Anesthetists to become a Certified Registered Nurse Anesthetist upon program completion.

NOTE: Individuals on temporary student visas are not eligible to receive NAT traineeship support.

Length of Support

• A trainee may be appointed at the beginning of any academic period, including a summer session, which falls within the budget period specified by the current Notice of Award (NoA).

• Any new appointment (see program definitions in Section VIII) must be made for a period of not fewer than nine months and not to exceed a period of 12 months.

The only exception to the minimum appointment is to allow a student to complete the program.

• Trainees may receive a reappointment (see program definitions in Section VIII).

• The cumulative traineeship support may not exceed 36 months and must be continuous from the start of the initial appointment.

Completeness and Eligibility Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive. Applications received without the appropriate tables will be considered non-responsive to the NOFO and will not be considered for funding under this notice.

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IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov. You must download the SF-424 Research and Related (R&R) application package associated with this NOFO following the directions provided at https://www.grants.gov/applicants/apply-for-grants.html.

Effective December 31, 2017 – You must use the Grants.gov Workspace to complete the workspace forms and submit your application workspace package. After this date, you will no longer be able to use PDF Application Packages.

HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page and when accessing the NOFO (also known as “instructions” on Grants.gov) or application package. This allows Grants.gov to email organizations that supply an email address in the event the NOFO is changed and/or republished on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note, you are ultimately responsible for reviewing the Find Grant Opportunities page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. For the NAT Program, budgets and staffing plans are not required. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. Applications must be submitted in the English language and must be in terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files should not exceed the equivalent of 30 pages when printed by HRSA. The page limit includes the abstract, project narrative, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO. For the NAT Program, letters of commitment and support are not required. Standard OMB-approved forms that are included in the application package do NOT count in the page limitation. Biographical Sketches do count in the page limitation. Indirect Cost Rate Agreement and proof of nonprofit status (not applicable for NAT) will not be counted in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

https://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/web/grants/applicants/workspace-overview.html http://www.grants.gov/search-grants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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Applications must be complete, within the specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the due date to be considered under this notice.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) The prospective recipient certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. 3321).

3) Where the prospective recipient is unable to attest to any of the statements in this certification, an explanation shall be included in Attachment 4: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 R&R Application Guide for additional information on all certifications.

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract – a budget is not required for the NAT Program), please include the following:

i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. A brief overview of the project as a whole;

2. Specific, measurable objectives that the project will accomplish;

3. How the proposed project will be accomplished, i.e., the "who, what, when, where, why and how" of a project.

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory and well organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

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PURPOSE AND NEED

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory and well organized so that reviewers can understand the proposed project. Successful applications must describe the purpose and need for the proposed project, including:

• Applicant institution’s vision and mission statements, particularly as relates to the HRSA and BHW mission and the purpose of the NAT Program;

• Community served, including demographics, health status, social determinants of health, unmet health care needs, and barriers to care;

• The applicant organization’s strategy to address substance use disorder;

• The NAT Program’s strategy to prepare HRSA-supported students in experiential training or didactic and clinical experiences to address substance use disorder;

• Current health care delivery system and nursing workforce data;

• Availability and delivery of health care and related services and the factors that impact the strengths and weaknesses of that care system; and

• Characteristics of your particular nurse anesthesia program and student population – to include the success (pass) rate of your graduates on the national certification examination from the American Association of Nurse Anesthetists (AANA) Council on Certification of Nurse Anesthetists – and the projected impact that this award would have on both.

RESPONSE TO PROGRAM PURPOSE.

(a) METHODOLOGY/APPROACH

In this section, you must propose the methods that will be used to address the community and system needs (identified in the Purpose and Need section above) and meet the program requirements (described in the Program Purpose section above).

Specifically, you must

• Identify clear strategies and/or activities to address the community and system needs identified above;

• Explain the rationale and evidence base behind proposed activities;

• Present a clear connection between the identified needs, the proposed activities, the projected outcome measures relative to NAT Program purpose, and the expected impact on the community;

• Describe how trainees will be selected and where they will train, particularly those clinical training sites affiliated with the proposed project that are located in HPSAs, or that benefit rural or underserved populations;9 and

• Describe the approach to making awards to trainees, e.g., timing/frequency of award(s), amount.

9 See HRSA’s HPSA Finder Tool at https://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.aspx https://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.aspx

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(b) WORK PLAN

You must provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope. You must state objectives and sub-objectives that are specific, measurable, achievable, realistic, and time-framed and clearly explain how they will be implemented. A sample work plan can be found here:

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.

The work plan must include:

• Goals of the project (including objectives and sub-objectives);

• Responsible entity/entities (i.e., key staff and partners);

• Activities;

• Timeline;

• Deliverables and/or products; and

• Proposed outcomes including the number of future CRNAs who will be trained each project year.

(c) RESOLUTION OF CHALLENGES

Discuss likely challenges and anticipated major barriers in the design and implementation of the activities described in the work plan and approaches that you will use to resolve such challenges. Describe how you monitor progress towards program objectives and strategies to address challenges or obstacles. Challenges discussed should be specific to the proposed project and relate to either the overall goal(s) or objective(s) proposed within the work plan.

IMPACT

(a) Evaluation and Technical Support Capacity

You must describe your plan for program performance. This plan must monitor ongoing processes and progress toward meeting program goals and objectives and describe how the unique needs of target populations of the communities served are routinely assessed and improved. The evaluation plan must, at a minimum, assess the success of the award-funded efforts and include a continuous quality improvement component for the funded activities. The evaluation plan must include descriptions of the inputs (e.g., key evaluation staff and organizational support, collaborative partners, and other resources); key processes; variables to be measured; expected outcomes of the funded activities; and a description of how all key evaluative measures will be reported. You must demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project.

Programs must report on their findings in their Annual Performance Report. You also must describe the systems and processes that will support the organization's collection of HRSA’s performance measurement requirements for this program. This includes your http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

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capacity to track, validate, and report required performance measures to allow for accurate and timely reporting of project outcomes to HRSA. The following link includes examples of the required program performance measures for this program:

http://bhw.hrsa.gov/grants/reporting/index.html.

(b) Project Sustainability

You must provide a clear sustainability plan for the project after the period of funding ends, including a description of specific actions to:

• Support all program requirements beyond the federal investment;

• Leverage past program participants for future training and partnership opportunities;

• Identify and disseminate key project results and best practices to appropriate audiences; and

• Forecast likely challenges in sustaining the program, and outline approaches to resolve such challenges.

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES

Applicants must describe their capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. In particular, succinctly describe the following:

• Your organization’s mission and structure, scope of current activities, and an organizational chart, and describe how these all contribute to the ability of the organization to conduct the program requirements and meet program expectations;

• Program and/or individual characteristics – to include partnerships between academia and practice partners and/or community organizations – that you feel uniquely positions your organization to successfully implement this program and

• Evidence of past performance of your organization and the Project Director successfully implement work similar to the objectives of the NAT Program.

A biographical sketch for the Project Director (PD) and any other key faculty/staff (See Section IV.2.vi for full list of required attachments) must be uploaded as Attachment 3.

Include biographical sketches for persons occupying key positions, not to exceed TWO pages in length each.

Biographical sketches, not exceeding two pages per person, should include the following:

• Senior/key personnel name

• Position Title

• Education/Training - beginning with baccalaureate or other initial professional education, such as nursing, including postdoctoral training and residency training if applicable:

o Institution and location o Degree (if applicable) o Date of degree (MM/YY) o Field of study http://bhw.hrsa.gov/grants/reporting/index.html

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• Section A (required) Personal Statement. Briefly describe why the individual’s experience and qualifications make him/her particularly well-suited for his/her role (e.g., PD/PI) in the project that is the subject of the award.

• Section B (required) Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors. Include present membership on any Federal Government advisory committee.

• Section C (optional) Peer-reviewed publications or manuscripts in press (in chronological order). You are encouraged to limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15. Do not include manuscripts submitted or in preparation. The individual may choose to include selected publications based on date, importance to the field, and/or relevance to the proposed research. Citations that are publicly available in a free, online format may include URLs along with the full reference (note that copies of publicly available publications are not acceptable as appendix material).

• Section D (optional) Other Support. List both selected ongoing and completed (during the last three years) projects (Federal or non-Federal support). Begin with any projects relevant to the project proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the Senior/Key Person identified on the Biographical Sketch.

iii. Budget

The NAT Program is a formula-based grant program that does not require submission of a budget.

The General Provisions in Division H of the Consolidated Appropriations Act, 2017 (P.L.

115-31) apply to this program. Please see Section 4.1 of HRSA’s SF-424 R&R Application Guide for additional information. Note that these or other restrictions will apply in FY 2018, as required by law.

iv. Budget Justification Narrative

The NAT Program is a formula-based grant program that does not require submission of a Budget Justification Narrative.

v. NAT Program Specific Data Forms

As part of the application submitted through Grants.gov, applicants must also complete and electronically submit the NAT Program Specific Data Forms by the established and published application due date. The NAT Program Specific Data Forms are essential to determining the award calculation. These NAT Program Specific Data Forms are part of the electronic Grants.gov application package. Copies of the NAT Program Specific Data Forms (NAT Tables) are included for reference as an appendix to this NOFO; however, the tables must be completed online as a part of the Grants.gov application package.

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vi. Attachments

Please provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limit. Indirect cost rate agreements and proof of nonprofit status (not applicable for the NAT Program) will not count toward the page limit. Each attachment must be clearly labeled.

Attachment 1: Accreditation Documentation (Required) Approval Documentation (If Applicable) The applicant organization must provide for all affiliated nursing programs: (1) a statement that they hold continuing accreditation from the relevant accrediting body and are not on probation, (2) the name of the accrediting body, (3) the date of initial accreditation, (4) the date of the next expected accrediting body review (or expiration date of current accreditation), and (5) a web link to the accreditation information on the accrediting body website (if available). The full letter of accreditation is not required. Applicants on provisional accreditation status must provide proof of this status. Information that cannot be verified at the accrediting body website and applications that do not include the required accreditation documentation as specified in this NOFO will be considered nonresponsive and deemed ineligible under this funding announcement.

The applicant organization must provide full documentation of all approvals (if applicable) needed to enroll students into a new graduate program (i.e. Doctor of Nursing Practice (DNP/DrNP), Doctor of Nurse Anesthesia Practice (DNAP), Doctor of Philosophy (PhD)).

This includes approval from the school, the college/university and the State Board of Nursing, as appropriate. The documentation should be, for example, in the form of meeting minutes, a letter from the State Board of Nursing, or a letter from the Faculty Senate or State Finance Board as appropriate for the school. Applications that do not include the approval documentation (if applicable) as specified in this NOFO will be considered nonresponsive and deemed ineligible under this funding announcement.

Attachment 2: Maintenance of Effort Documentation (Required) You must provide a baseline aggregate expenditure for the prior fiscal year and an estimate for the next fiscal year using a chart similar to the one below. HRSA will enforce statutory MOE requirements through all available mechanisms.

NON-FEDERAL EXPENDITURES

FY 2017 (Actual) Actual FY2017 non-federal funds, including in-kind, expended for activities proposed in this application.

Amount: $_____________

FY 2018 (Estimated) Estimated FY2018 non-federal funds, including in-kind, designated for activities proposed in this application.

Amount: $______________

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Attachment 3: Biographical Sketch of Project Director (Required) Include a biographical sketch for the Project Director, not to exceed two pages in length.

Attachment 4: Other Relevant Documents (If applicable)

3. Dun and Bradstreet Universal Numbering System (DUNS) and System for Award

Management (SAM)

You must obtain a valid DUNS number, also known as the Unique Entity Identifier for your organization/agency and provide that number in your application. You must also register with the System for Award Management (SAM) and continue to maintain active SAM registration with current information at all times during which you have an active federal award or an application or plan under consideration by an agency (unless the applicant is an individual or Federal agency that is exempted from those requirements under 2 CFR § 25.110(b) or (c), or has an exception approved by the agency under 2 CFR § 25.110(d)).

HRSA may not make an award to an applicant until the applicant has complied with all applicable DUNS and SAM requirements and, if an applicant has not fully complied with the requirements by the time HRSA is ready to make an award, HRSA may determine that the applicant is not qualified to receive an award and use that determination as the basis for making an award to another applicant.

If you have already completed Grants.gov registration for HRSA or another federal agency, confirm that the registration is still active and that the Authorized Organization Representative (AOR) has been approved.

The Grants.gov registration process requires information in three separate systems:

• Dun and Bradstreet (http://www.dnb.com/duns-number.html)

• System for Award Management (SAM) (https://www.sam.gov)

• Grants.gov (http://www.grants.gov/)

For further details, see Section 3.1 of HRSA’s SF-424 R&R Application Guide.

If you fail to allow ample time to complete registration with SAM or Grants.gov, you will not be eligible for a deadline extension or waiver of the electronic submission requirement.

4. Submission Dates and Times

Application Due Date The due date for applications under this NOFO is February 28, 2018 at 11:59 p.m. ET.

See Section 8.2.5 – Summary of emails from Grants.gov in HRSA’s SF-424 R&R Application Guide for additional information.

http://www.dnb.com/duns-number.html https://www.sam.gov/ http://www.grants.gov/ http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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5. Intergovernmental Review

The Nurse Anesthetist Traineeship Program is not a program subject to the provisions of Executive Order 12372, as implemented by 45 CFR 100.

See Section 4.1 ii of HRSA’s SF-424 R&R Application Guide for additional information.

6. Funding Restrictions

You may request funding for a period of performance of 1 year in direct costs only. The FY 2018 President’s Budget does not request funding for this program. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds awarded in a timely manner.

Funds under this notice may not be used for purposes specified in HRSA’s SF-424 R&R Application Guide.

NAT funds may only be used to provide traineeships (minimum $1,000 and maximum $22,000 per eligible student) to eligible students enrolled in accredited, graduate-level nurse anesthesia degree programs. Traineeship funds are to be used during the period for which the traineeship is provided for (1) full or partial costs of the tuition and fees, books/e-books, reasonable living expenses (stipends) and (2) to attend workshops or conferences on topics including, but not limited to, reduced opioid abuse, multi-modal pain management, and recovery.

Funds may not be used for:

1. Trainee travel

2. Trainee daily commuting costs

3. Non-trainees’ expenses e.g. personnel costs-staff salaries, consultant costs, equipment, research supplies, travel expenses for the faculty, et cetera.

4. Indirect (F&A) Costs

The General Provisions in Division H of the Consolidated Appropriations Act, 2017 (P.L.

115-31) apply to this program. Please see Section 4.1 of HRSA’s SF-424 R&R Application Guide for additional information. Note that these or other restrictions will apply in FY 2018, as required by law.

You are required to have the necessary policies, procedures and financial controls in place to ensure that your organization complies with all legal requirements and restrictions applicable to the receipt of federal funding including statutory restrictions on use of funds for lobbying, executive salaries, gun control, abortion, etc. Like those for all other applicable grants requirements, the effectiveness of these policies, procedures and controls is subject to audit.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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Termination of Trainees The recipient institution is responsible for monitoring the academic success of each trainee and shall ensure the termination of traineeship support under the NAT program in cases where the trainee:

• Is unable to complete the program of study for which the traineeship was awarded;

• Withdraws from the institution prior to the scheduled completion of the program;

• Fails to meet the predetermined academic standards of the institution; or

• Requests to terminate NAT Program support.

The traineeship is not transferable from the recipient institution that provided the support.

An appointment may be provided by more than one institution if the student who has a traineeship at one institution receives an appointment in another institution, but only if the cumulative traineeship support received does not exceed 36 months.

V. Application Review Information

1. Review Criteria

The NAT Program is a formula-based grant program that does not undergo a formal Objective Review. Procedures for assessing the technical merit of applications have been instituted to provide an internal review of applications and to assist the applicant in understanding the standards against which each application will be reviewed. HRSA is responsible for the review of each application for completeness and eligibility, including accreditation documentation, Project Director qualifications, accuracy (including the data reported on the NAT Program Specific Data Forms and all required documents), and compliance with the requirements outlined in this NOFO. NAT Program funds are distributed among eligible entities as formula-payment based grants according to data supplied in the application.

HRSA will calculate FY 2018 award amounts to schools based on the steps below.

Step 1. HRSA determines the number of applicants that meet the funding factors (Statutory Funding Preference and Special Consideration). The total amount allocated for the funding factors is subtracted from the total funds available.

Step 2. The cost (dollar) per eligible trainee is calculated by dividing the remaining balance of funds available by the total number of enrollees for all eligible applicants.

Step 3. The award given to each applicant is calculated by multiplying the cost (dollar) per eligible trainee by the total number of full-time students (Master’s - Doctoral) plus the amount for each funding factor (Statutory Funding Preference $1,000 + Special Consideration $1,000) that is met.

Step 4. Recipients (schools) will then disburse traineeship awards that are no less than $1,000 and no greater than $22,000 to eligible full-time NAT students.

You are reminded that failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive. Applications received without the appropriate tables will be considered non-responsive to the NOFO and will not be considered for funding under this announcement.

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2. Review and Selection Process

The funds appropriated for the NAT Program are distributed among eligible participating institutions as a formula-based payment grant. Applicants are required to provide program data including student enrollment, previous traineeship support (as applicable), and graduate employment status. Program data reported in the NAT Program Specific Data Forms are used to determine funding amounts. All required NAT Program Specific Data Forms must be submitted electronically with the application in Grants.gov.

HRSA may also consider assessment of risk and the other pre-award activities described in Section 3 below.

Please see Section 5.3 of HRSA’s SF-424 R&R Application Guide for more details.

Funding Factors:

The NAT Program has two funding factors, the Statutory Funding Preference and Special Consideration that are described below.

Statutory Funding Preference This program provides a funding preference as authorized by Section 805 of the Public Health Service Act (42 U.S.C. § 296p) where a qualified applicant demonstrates that they “will substantially benefit rural or underserved populations, or help meet public health nursing needs in State or local health departments.” Qualified applicants will demonstrate a high rate of graduates from the preceding academic year (AY) 2016-17 currently employed in clinical practice sites designated a rural or underserved settings, including State or local health departments, as calculated based on data supplied in the NAT Program Specific Data Forms.

For the purpose of this funding announcement, “high rate” is defined as a minimum of 60 percent of graduates in AY2016- 17 employed in rural or underserved clinical practice sites.

Applicants that qualify for the preference will receive a favorable financial adjustment of the NAT formula used to ultimately determine the amount of the NAT award.