FAQ: Advanced Nursing Education Nurse Practitioner Residency Program

Funding Opportunity Number: HRSA-19-001

Prospective Applicants

Webinar: July 10, 2019

TA Call: October 2, 2019

TA Call: December 12, 2019

Prospective Applicants

General Questions

1. What is the Advanced Nursing Education-Nurse Practitioner Residency Program FY 2019 (ANE-NPR)?
   The ANE-NPR program’s purpose is to prepare new nurse practitioners (NPs) and Nurse Midwives in primary care practice in community-based settings through clinical and academic focused 12-month Nurse Practitioner Residency (NPR) programs with a preference for those projects that benefit rural or underserved populations. This FY 2019 ANE-NPR Program Notice of Funding Opportunity (NOFO) seeks to increase Advanced Practice Registered Nurses (APRN) primary care providers in community-based settings.
   1. Track 1 - Development and Start-Up: an applicant that needs up to a 12 month start-up period to develop and implement an ANE-NPR Program by no later than the start of year two; or
   2. Track 2 - Enhancement and/or Expansion: an applicant that is ready to launch an active ANE-NPR Program with participants, or that has the ability to enhance and/or expand their existing NPR Program, particularly in rural or underserved areas in the second quarter of the first year of funding. (p. 1)
2. What are the ANE-NPR program priorities?
   Applicants are required to address their use and adoption of telehealth and other health care technology, as applicable, which increase readiness to practice and prepare advanced NPs in primary care to expand access to high quality care where its’ most needed. Applicants are encouraged to select and address one of the priorities below which include the United States Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) priorities as they relate to the following:* If your application discusses opioids as a priority, HRSA has a number of investments targeting opioid use disorder and substance use disorder across its Bureaus and Offices that you may be able to leverage. For information on HRSA-supported resources, TA, and training, visit HRSA's Opioid Crisis page. (pp. 1-2)
   • Combatting the opioid crisis/Mental Health (Either, or)
   • Value-based care delivery and quality improvement initiatives
   • Transforming the workforce –targeting the need
   • Telehealth
   • Childhood obesity
   • Maternal Mortality
3. What is the timeline for implementation for this Notice of Funding Opportunity announcement (NOFO)?
   ANE-NPR is accepting applications until March 4, 2019. ANE-NPR funding will begin 1 July 2019. ANE-NPR has a four year project period pending appropriation of funds.
4. When will ANE-NPR be offered again? Is it an annual offering?
   ANE-NPR has a four year project period pending appropriation of funds. Funding is based on the annual appropriations received from the President’s budget. (p. 5)
5. Is this considered a training grant?
   The FY19 ANE-NPR funding opportunity is not considered a training grant, and is not subject to the 8% indirect cost for training grants.

Application Submission Process

6. When is the HRSA-19-001 funding opportunity submission due date?
   The HRSA-19-001 funding opportunity application submission due date is March 4, 2019, no later than 11:59 PM Eastern Time. (page 33 & title page)
7. How do I access the notice of funding opportunity application?
   HRSA requires all applicants to apply electronically through Grants.gov. You can access the funding opportunity announcement online, then click “Package” tab. Next, click on “Select Package,” type in your email address to receive notifications of any changes to the funding opportunity or select the box to not be notified. Finally, click “Download Instructions” and “Download Package.”
8. Who do I contact if I am having technical difficulties submitting my ANE-NPR application to Grants.gov?
   You may need assistance when working online to submit your application forms electronically. Always obtain a case number when calling for support. For assistance with submitting the application in Grants.gov, contact Grants.gov 24 hours a day, 7 days a week, excluding federal holidays at (p. 47):
   Grants.gov Contact Center
   Telephone: 1-800-518-4726 (International Callers, please dial 606-545-5035)
   Email: support@grants.gov
   Web Help: Self-Service Knowledge Base, (p. 47)
9. Is the HRSA-19-001 Notice of Funding Opportunity announcement (NOFO) open to new applicants only, or will the funding be available to previous or current HRSA program recipients?
   New and current awardees are eligible to apply if they meet all the eligibility requirements outlined in the HRSA-19-001 NOFO.
10. Are applicants required to submit an application annually for ANE-NPR?
    The FY19 ANE-NPR funding opportunity is a four-year program. Applicants who apply for this FY 2019 funding opportunity by March 4, 2019 should anticipate a four-year project period, pending availability of appropriated funds. HRSA makes a determination on the funding guidelines each year. Funding beyond the first year of the project is contingent upon available appropriations, satisfactory process and continued support is in the best interest of the federal government.
11. Do MOUs have to be signed individually by partners and supporters?
    Each academic clinical partnership must have a signed Memorandum of Understanding (MOU), which outlines specific aspects of the partnership: name of partnership lead organization (primary applicant), name and address of partner(s) and timeframe of agreement. The MOU must also document the mutual benefit of the academic practice partnership, telehealth collaboration, agreement to participate in RCQI meetings and carry out related activities, and strategize for sustainability, curriculum development, and other types of support to be provided by members of the partnership (placement of NP graduates, curriculum development, etc.). (p. 12)
12. Do the MOUs have to be in place prior to application submission?
    Ideally, MOUs are in place as outlined in the response to question #10. In the absence of delineated and signed MOUs, applicants must submit documentation of activities toward this goal, and estimated time of completion. Please provide this documentation in Attachment 8. (pp. 31-32)

    Letters of Support (LoS)
    An applicant may submit a list of partners/organizations and signatures with which they have Letters of Support (LoS), and assure the LoS documents as outlined above are available for review. Please provide this documentation in Attachment 8. (p. 31)

13. Can an organization or campus submit more than one application?
    Multiple applications from an organization are not allowable. Eligible applicants can submit only one application per campus or clinical organization; multiple applications from a single campus or organization are not allowable.

    A campus is defined as a division of a university that has its own grounds, buildings (e.g., school of nursing) and faculty. A clinical organization must have a separate geographical location, staff, providers, and directors. (p. 8), and DUNS number.
    Independent organizations are those that have unique DUNS numbers.

Applicant Eligibility

14. Who is eligible to apply for the HRSA-19-001 funding opportunity?
    Eligible applicants are schools of nursing, nurse managed health clinics/centers, academic health centers, state or local governments and other private or public nonprofit entities determined appropriate by the Secretary.
    Consortiums may apply for these funds, if otherwise eligible. HRSA’s will make one award per consortium to a lead entity for the consortium provided it is an eligible entity and has the legal authority to apply for and to receive the award on behalf of the other consortium members. Domestic faith-based and community-based organizations, tribes, and tribal organizations may apply for these funds, if otherwise eligible. (p. 6)

    Individuals and for-profit entities are not eligible applicants under this NOFO.

    Federal organizations are not included in the list of eligible applicants.

15. Can individual entities apply for this Program?
    This award is not for individuals. The ANE-NPR HRSA-19-001 is an academic clinical partnership program. Academic setting applicants must partner with at least one clinical partner. Clinical setting applicants must partner with at least one academic partner. Applicants may have more than one partner. (p. 10)
16. Can an FQHC be eligible to apply for this Program?
    Yes. FQHCs are considered health clinics/centers, and therefore eligible entities. However the FQHC applicant also needs to follow all of the requirements outlined in the Notice of Funding Opportunity.
17. Can a single health system partner with more than one academic center (with the school of nursing) apply as the applicant)?
    Academic setting applicants must partner with at least one clinical partner. Clinical setting applicants must partner with at least one academic partner. Applicants may have more than one partner. (p. 10)
18. Could an Area Health Education Center (AHEC) be paid to coordinate these activities?
    An AHEC could be a partner in the program and have staff who coordinate activities.
19. Must the applicant be in a Health Professional Shortage Area (HPSA)?
    The applicant applying for the ANE-NPR funding opportunity does not have to be in a HPSA or a Medically Underserved Community (MUC). However, the announcement offers a funding preference related to rural and underserved populations or communities and public health nursing needs.

    A funding preference will be applied for eligible applicants with projects that will substantially benefit rural or underserved populations, or help meet public health nursing needs in State or local health departments. If applicants are applying for the ANE-NPR funding preference, they must meet the criteria for the funding preference outlined in the NOFO.

20. What accrediting bodies are acceptable for clinical facilities accreditation?
    Clinical Facilities Accreditation
    Non-profit health care facilities responding to this funding opportunity announcement must provide documentation of accreditation by a national, regional or state accrediting agency or body, such as The Joint Commission, or Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), etc. This information must be clearly documented, to include the start and expiration dates, in Attachment 1 submitted with this application. Clinical facilities applying to this funding announcement that are partnering with Schools of Nursing must also include the academic accreditation for each nursing program to be supported under this announcement, as described above.
21. Can state accreditation be acceptable since we don’t have national accreditation for our clinical facility?
    HRSA accepts documentation of state accreditation for clinical facilities applying as the primary applicant, however documentation of national professional accreditation is required for educational institution partners.
22. Can the partnership site be an affiliate of the institution? Example: community or school based health centers affiliated with the larger institution?
    Your partnership can be an affiliate of the institution as long as they have their own DUNS and EIN number, have a separate leadership structure, and meets the requirements of the NOFO.
23. Does the Project Director have to be doctorally prepared with a PhD degree or can they have a DNP degree?
    The Project Director for the proposed project must be a master’s or doctorally prepared registered nurse with demonstrated competence (e.g., publications, funded research) in the specialty with appropriate academic preparation, clinical expertise, and experience as an educator. NOTE: there may only be one Project Director for the ANE-NPR project.
24. Does the applicant school of nursing partner have to have an accredited Master’s or Doctoral degree program or is the post-master’s certificate allowed?
    Eligible school of nursing partners include entities that provide registered nurses (RN) with training that leads to master’s and/or doctoral degrees that prepare nurses to serve as primary care nurse practitioners, and nurse-midwives.
25. How does an applicant’s Rapid Cycle Quality Improvement (RCQI) plan affect the page limit? How detailed should it be?
    An applicant’s RCQI plan is counted toward the application’s page limit. The applicant determines the level of detail of their RCQI plan.
26. Are Clinical Nurse Specialists eligible for the ANE-NPR Program?
    Clinical Nurse Specialists aren't eligible for the ANE-NPR program. (p. i)

    For this program, NP specialties that are eligible beneficiaries must have a primary care focus and may include: Family, Adult Family, Adult-Gerontology, Pediatric, Women’s Health Care, Nurse Midwife, Psychiatric-Mental Health, and Psychiatric-Mental Health Family.

27. What are the eligibility requirements for the NP Resident participant?
    To be eligible for the ANE-NPR Program the NP must meet all of the following:
    • Be a licensed RN within 18 months of graduate school completion from a Primary Care NP Program (see list outlined in the Executive Summary) and NP certification;
    • Be a citizen of the United States, a non-citizen national, or a foreign national who possesses a visa permitting permanent residence in the United States (i.e., individuals on temporary or student visas are not eligible to receive ANE-NPR Program support); and
    • Agree to be a full-time participant in the ANE-NPR Program. (p. 6)

Use of ANE-NPR Funds

28. How can ANE-NPR funds be used?
    HRSA expects approximately $20,000,000 to be available annually to fund approximately 20 recipients. HRSA anticipates funding a maximum of 8 recipients under Track 1 and a maximum of 20 recipients under Track 2. (p. 5)

    Track 1 - Development and Start-Up applicants

    Track 2 - Enhancement and/or Expansion applicants may apply for a ceiling amount of up to $100,000 total cost per year for each NP resident supported, not to exceed $1,000,000 total cost (includes both direct and indirect, costs) per year. You are expected to train no less than four NP residents each year of the project.

    The period of performance is July 1, 2019 through June 30, 2023 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for ANE-NPR in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

    All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles and Audit Requirements at 45 CFR part 75. (p. 5)

    The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) incurred by the recipient to carry out a HRSA-supported project or activity. Total project or program costs include costs charged to the award and costs borne by the recipient to supplement the cost of the project as applicable. (p. 27)

    • Year 1: applicants may apply for a ceiling amount up to $500,000 total cost (includes both direct and indirect).
    • Years 2 – 4: applicants may apply for a ceiling amount of up to $100,000 total cost per year for each NP resident support. You are expected to train no less than four NP residents each year in years 2, 3 and 4.
29. What are the notable funding restrictions?
    You may request funding for a period of performance of up to 4 years, at no more than $1,000,000 per year in total costs (inclusive of direct and indirect costs). See Section II.2 Summary of Funding regarding funding limitations for each track.
    Awards to support projects beyond the first budget year will be contingent upon Congressional appropriation, satisfactory progress in meeting the project’s objectives, and a determination that continued funding would be in the best interest of the federal government.

    The General Provisions in Division B of the Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (P.L. 115-952) 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 the following fiscal year, as required by law.

    Funds under this announcement may not be used for purposes specified in HRSA’s SF-424 R&R Application Guide or other certain purposes, including but not limited to:

    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, program generated income, gun control, abortion, etc. Like those for all other applicable grants requirements, the effectiveness of these policies, procedures, and controls is subject to audit. (p.34)

    • Subsidies or paid release time for project faculty;
    • Payment of temporary personnel replacement costs for the time faculty/ preceptors/participants are away from usual worksite during involvement in project activities;
    • Accreditation, including accreditation related costs/fees, credentialing, licensing, continuing education (costs for preparation and awarding continuing education hours), and franchise fees and expenses; preadmission costs, promotional items and memorabilia; and animal laboratories;
    • Incentive payments are not allowed for program participants, including but not limited to purchasing gift cards or gas cards;
    • Construction or renovations;
    • Foreign travel;
    • There may be only one Master’s or doctorally prepared Registered Nurse Project Director for the ANE-NPR project; and
    • Co-PDs are not permissible for this funding.

30. What is the indirect cost rate?
    There are no stated restrictions regarding indirect costs in this funding opportunity announcement, therefore applicants may request indirect costs in accordance with 45 CFR part 75:

    • Their approved negotiated indirect cost rate, or
    • The 10 percent de minimis indirect cost rate - non-federal entities that have never received a negotiated indirect cost rate may elect to charge a de minimis rate of 10 percent of modified total direct costs, which may be used indefinitely.
    • For more information, please review page 48 of the HRSA SF-424 R&R Application Guide (PDF - 640 KB).
31. Do we have to submit a budget with our application?
    Yes, an SF 424 R&R budget form and budget justification narrative is required for each year of the project. Follow the instructions included in the HRSA SF-424 R&R Application Guide (PDF - 640 KB) and the additional budget instructions provided in the NOFO. (p. 26)
32. Can equipment be purchased with grant funding?
    Equipment budgeted in the ANE-NPR NOFO application must include a narrative description and itemized detail cost breakdown in the budget justification to support why the cost is necessary to carry out the goals and objectives of the proposed project. The costs must be reasonable and necessary, allowable and allocable. Please refer to 45 CFR part 75 and the HRSA SF-424 R&R Application Guide (PDF - 640 KB) for further information regarding equipment and funding restrictions.
33. Can funds be shared with the clinical or academic partner site?
    Funds can be shared with the both partner sites.
34. If we have a lead coordinator at the site, can we use funds to pay for their time?
    Personnel may be paid a percentage of their time for activities that support the mission, goals, and objectives of the proposed project. The subcontract budget line items can identify how funds are being used as it pertains to the goals and objectives of the project. (p.42-43)
35. Can funds be used to pay a project director and a project manager?
    Funds can be used to pay key personnel within the academic-clinical partnership for time and activities devoted to meeting the goals of the proposed project. (p. 42-43)
36. Can applicants have key personnel in the clinical setting?
    Applicants are encouraged to have key personnel in both settings. Personnel may be paid a percentage of their time for activities that support the mission, goals, and objectives of the proposed project. The ANE-NPR program does not support individuals’ paid release time. Funds may be used to support NPRs. (p.42-43)
37. Is there any percent minimum effort for the Project Director?
    HRSA does not have a minimum effort requirement for a grant’s Project Director. This is determined by the applicant. Project Director’s time may not exceed 100% FTE.
38. Can new faculty lines be developed as part of the award, i.e. adjunct practice positions?
    A faculty member can be an employee at the school of nursing with duties/responsibilities at the clinical site or a faculty member employed by the clinical practice with duties/responsibilities at the school of nursing for NPR training.
39. Is a period for development and planning for our organization’s ANE-NPR Program allowed?
    Yes, under track one as follows:
    For the Track 1 Development and Start-Up Applicants:
    You must identify and address barriers and resolutions to recruitment, training, retention and employment of diverse NP residents, preceptors, and faculty, which impact development and/or starting up an ANE-NPR Program focused in primary care in up to one year’s time to ensure a commitment no later than July 1, 2020 of a minimum of four active participants in the program.

    No, under track two, which requires the following:
    For the Track 2 Enhancement and/or Expansion Applicants:
    Identify and address barriers and resolutions to recruitment, training, retention and employment of NP residents, preceptors, and faculty that reflect the population served and which impact the starting period of the ANE-NPR Program to ensure a commitment no later than October 31, 2019 of a minimum of four active participants in the program. (p.38)

40. Would a faculty member at the applicant institution, who is not part of the project, be considered a consultant?
    No, the faculty member would not automatically be considered a consultant. A faculty member’s LOE may be budgeted under salaries if they are to provide specific services in support of the project. However, there are certain conditions that may require special consideration. One such special consideration is Intra-institution of Higher Education (IHE) consulting which may be an allowable costs. Please refer to 45 CFR part 75.430 for Compensation –Personal Services as well as your institution’s policies and procedures.

    Intra-Institution of Higher Education (IHE) consulting. Intra-IHE consulting by faculty is assumed to be undertaken as an IHE obligation requiring no compensation in addition to IBS. However, in unusual cases where consultation is across departmental lines or involves a separate or remote operation, and the work performed by the faculty member is in addition to his or her regular responsibilities, any charges for such work representing additional compensation above IBS are allowable provided that such consulting arrangements are specifically provided for in the Federal award or approved in writing by the HHS awarding agency.

41. What is Maintenance of Effort (MoE)?
    The recipient must agree to maintain non-federal funding for award activities at a level that 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 MOE information and submit as Attachment 5. (P. 8)
    The underlying principle is to ensure that federal grantees (and cooperative agreement awardees) are committed to maintaining the same level of services already being provided (and as described in their application) after receipt of a federal grant award. The MOE intent is to ensure federal funds “supplement” rather than “supplant” (replace) normal activities.
42. Is this program subject to the General Provisions of P.L. 115-141?
    Yes, this program is subject to the general provisions. Salary Limitation:
    The Consolidated Appropriations Act, 2018 (P.L. 115-141), Division H, Section 202 provides a salary rate limitation. The law limits the salary amount that may be awarded and charged to HRSA grants and cooperative agreements. Award funds may not be used to pay the salary of an individual at a rate in excess of Executive Level II, which is $189,600. This amount reflects an individual’s base salary exclusive of fringe and any income that an individual may be permitted to earn outside of the duties to your organization. This salary limitation also applies to subrecipients under a HRSA grant or cooperative agreement. Note that these or other salary limitations will apply in the following FY, as required by law.
43. Salary for NPs:
    The program must provide NP resident support in the form of salaries to full-time residents who are licensed and certified NPs receiving at least 12 continual months of immersive clinical and didactic training at a primary care community-based entity. Please note: Grant fund support for NP resident must not exceed 70% of geographical market rate for a comparable NP Primary Care specialty salary.

Funding Preference

44. What is the funding preference for the ANE-NPR Program?
    For this program, HRSA will use a Statutory Funding Preference. Section 805 of the Public Health Service Act requires a funding preference be applied for applicants with projects that will substantially benefit rural or underserved populations, or help meet public health nursing needs in State or local health departments. HRSA will review all applications for this funding opportunity and calculate the median rate of graduates from the previous academic year who are currently employed in rural or underserved settings or in State or local health departments. HRSA will award the funding preference to those applicants that have a rate higher than the median rate. This funding factor eligibility will be determined by HRSA Staff. (NOFO, page 46)
45. When reporting the number of graduates working in underserved or rural areas, should that number be derived from the total number of students enrolled in the program during the previous year or the graduates from the previous year?
    That number should be derived from the graduates from the previous year.
46. What program specific forms are needed to specify funding preference?
    Applicants must request the funding preference in the abstract All applicants must complete the program specific Table 1 – ANE (see Appendix A of the NOFO), referring to program’s academic partner’s past performance in the three funding preference areas to be considered for funding preference. HRSA will award the funding preference to those applicants that have a rate higher than the median rate

    Additionally, to determine their eligibility for the rural preference, applicants must input the address of the community-based entity in the HRSA’s Rural Health Grants Eligibility Analyzer and include a copy of the output with the application (Attachment 7) (p. 44). In order to determine their eligibility for the underserved preference, applicants must input the address of the community-based entity in the HRSA’s HPSA (Health Professional Shortage Area) Finder and include a copy of the output with the application. In order to determine their eligibility for helping to meet the public health nursing needs in State or local Health Department preference, applicants must complete ANE Table 1, referring to program’s academic partner’s past performance in this area (pg. 46-7).

Attachments

47. What counts in the page limit?
    The total size of all uploaded files may not exceed the equivalent of 65 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO. (p. 9)

    Standard OMB-approved forms that are included in the workspace application package do NOT count in the page limit. Biographical Sketches do count in the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit. (p. 9)

    Applications must be complete, within the specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline to be considered under this notice. (p. 9)

48. What happens if my application does not include all of the accreditation documents or requested documents?
    HRSA will consider any application that fails to include the required accreditation documentation in Attachment 1 non-responsive and will not consider it for funding under this notice. (p. 8)
49. What happens if the application goes over the page limit?
    Applications must be complete, within the specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline to be considered under this notice. (p. 9)

Review and Selection Process

50. How are applications evaluated?
    The applications are evaluated by an Objective Review Process, consisting of peers, who discuss the applications as a group and score applications based on merit. The entire proposal will be considered during objective review. (p. 35)
51. What criteria are used to score the applications?
    HRSA has instituted procedures for assessing the technical merit of applications to provide for an objective review of applications and to assist you in understanding the standards against which your application will be judged. HRSA has developed critical indicators for each review criterion to assist you in presenting pertinent information related to that criterion and to provide the reviewer with a standard for evaluation. See the review criteria outlined in the NOFO with specific detail and scoring points. (p. 35)

Preceptors

52. Who can be a preceptor?
    Preceptors should be primary care providers; Nurse Practitioners, physicians, Physician Assistants, with two or more years of practitioner experience in a primary care setting who are program collaborators to enhance NP resident, preceptor, and clinical staff professional development.
53. What are expectations and requirements for recruitment, developing, and retaining preceptors?
    Recruit, train, develop, support, and evaluate preceptors as program collaborators to enhance NP resident, preceptor, and clinical staff professional development. (p. 12)
54. Can preceptors be funded for academic contributions (e.g. lectures, facilitating workshops, planning meetings)?
    Preceptors, and Faculty/staff may be hired and funded for academic and clinical contributions that meet the program’s purpose and goals. See Budget and Budget Narrative guidelines. (p. 26)
55. What types of information are expected when reporting "Characteristics of Preceptors"?
    Applicants must describe their capacity to collect and report characteristics of preceptors, which may include demographics, profession, faculty status, specialty, etc. (p. 23-25)
56. May we hire preceptors as clinical instructors and train them as adjuncts?
    You may recruit faculty to serve as preceptors who provide oversight and guidance to NPRs.

    Funds under this announcement may not be used for purposes specified in HRSA’s SF-424 R&R Application Guide or other certain purposes, including but not limited those which are outlined in the funding opportunity announcement. (p. 34)

57. Can applicants utilize faculty employees of the school of nursing as preceptors for the day at partnership sites?
    A faculty member would have to be an employee of the school of nursing with duties/responsibilities at the clinical site.
58. Can we pay our preceptors?
    Funds can be used to pay key personnel within the academic-clinical partnership for time and activities devoted to meeting the goals of the proposed project. (p. 42-43)
59. Can funding be used for nurse practitioner student training?
    Funds cannot be used for nurse practitioner student training. The funds are to support ANE-NPR award beneficiary primary care nurse practitioner residents. All participants must be certified nurse practitioners.
60. Who can be a preceptor?
    Preceptors should be primary care providers with two or more years of practitioner experience in a primary care setting who are program collaborators to enhance NP resident, preceptor, and clinical staff professional development.

    Most competitive applicants build a pipeline of preceptors for the ANE-NPR Program using nursing staff at primary care delivery sites in rural and underserved areas such as Community Health Centers and Rural Health Clinics. (p. 14)

    NURSE Corps and NHSC loan repayment alumni could also serve as preceptors for the ANE-NPR program. Since they would have already completed their service obligations, they would have first-hand experience working with rural or underserved populations—thus a benefit to the site and to the community being served. (p. 14)

Webinar: July 10, 2019

1. What’s required within the first 30 days that Nurse Practitioner (NP) awardees may not be aware of, but need to do?
   Each award recipient needs to review their Notice of Award. If you have a “Condition,” it will be due within the first 30 days that you receive your notice of award. There will also be a task in the Electronic Handbook (EHB) as a deliverable, so it is important that within that first 30 days that you get everyone on your ANE-NPR project team registered and all privileges set up. This way you will be able to submit any conditions that are required. You may not necessarily have a “Condition,” however, check your Notice of Award.
2. Were Psychiatric-Mental Health Nurse Practitioners (PMHNP) included in the NP resident type?
   The Executive Summary of the Notice of Funding Opportunity (NOFO) lists the various specialties related to this primary care NOFO, the nurse practitioners (NP) specialties that have a primary care focus may include family, adult family, adult gerontology, pediatrics, women's healthcare, nurse midwife, psychiatric mental health, and psychiatric mental health family.
3. Where do awardees obtain a list of other awardees to facilitate communication?
   An ANE-NPR Program Award Table is posted via a link from the right menu of the HRSA ANE-NPR Program website.
   You may also download this data with added details (i.e. email addresses) from the HRSA Data Warehouse website (select “Tools”, then “Find Grants”,  using program activity code (T14), name and year).
   In addition to the table of awardees that will be on the ANE-NPR website, the email blast received for the ANE-NPR Orientation Webinar has contact information for all the awardee colleagues in this program. You may recognize some names or institutions, so feel free to reach out to them until the ANE-NPR Program Award Table is posted on the website.
4. Are there any of the other ANE-NPR grantees who were also awarded an Advanced Nursing Education Workforce grant?
   You may search for HRSA grantees by program on the HRSA Data Warehouse website using program activity code (T14), name and year. We encourage you to reach out to your ANE-NPR cohort to learn if there is anyone else who has another Bureau of Health Workforce (BHW) award.  Award recipients can create synergy as they work together. This is one of the aims of these HRSA programs, to leverage our program towards work to create a collaborative synergy.
5. Is accreditation required in the first year for clinical sites that received the planning grant?
   You may search for HRSA grantees by program on the HRSA Data Warehouse website using program activity code (T14), name and year. We encourage you to reach out to your ANE-NPR cohort to learn if there is anyone else who has another Bureau of Health Workforce (BHW) award.  Award recipients can create synergy as they work together. This is one of the aims of these HRSA programs, to leverage our program towards work to create a collaborative synergy.
6. Do applicants have to receive residency accreditation or accreditation through the Accreditation Association for Ambulatory Health Care or the Joint Commission on Accreditation of Health Care Organizations?

   To ensure that community-based entities are organizations dedicated to ongoing and continuous compliance with the highest standard of quality health care requires accreditation/approval/recognition to provide health care. Community-based entities applying under this NOFO must provide documentation of accreditation by a national, regional, or state accrediting agency or body, such as the Joint Commission on Accreditation Association for Ambulatory Health Care, Inc., or provide documentation of certification/licensure by federal/state/local government supported agency. This information must be clearly documented, to include the period of time covered by the accreditation or recognition document.
   While residency accreditation of your ANE-NPR Program is not required, it is desirable. Some resources for NP residency accreditation include:

   • American Nurses Credentialing Corporation Practice Transition Accreditation Program
   • National NPR and Fellowship Training
7. Are NPR residents eligible for other loan repayment programs, like HRSA’s Nurse Corps Loan Repayment Program that has a service obligation? Is a NP resident eligible for loan repayment in the time they are completing the ANE-NPR Program?
   If you apply for a HRSA program that has an obligation, the service obligation associated with that HRSA program must be met, before the applicant can incur another potentially conflicting service obligation. In the case of the ANE-NPR Program, there is no obligation attached other than the NP resident has to complete the full 12-month residency program.  After participation in the NP residency program, the NP resident would go to work at a healthcare facility that serves rural or underserved populations.
8. What can a NP resident do to find employment in a healthcare facility that serves rural or underserved populations?
   The Health Workforce Connector connects skilled health professionals to communities in need. Each NP resident can create a user profile in the Health Workforce Connector to help discover the right fit and enhance their career.
9. Regarding reporting and evaluation, are awardees required to report on everything discussed in the application, items described in the Notice of Funding Opportunity on pages 21 and 22, as well as, add other project details as awardees see fit?
   The award recipient will report on measures identified in the NOFO and progress of their project goals and objectives. Additional project details are provided in the reports to provide a picture of the overall ANE-NPR project progress. The reports are qualitative and quantitative in nature. The Noncompeting Continuation (NCC) Progress Report, a qualitative report that supports a narrative format, must be submitted in March of budget years 1, 2 and 3. The Annual Performance Report (APR), is a quantitative report that requires data entry and must be completed annually in July.  There are also quarterly and annual Federal Financial Reports.
10. For Track 1 award recipients, can the 12-month residency begin at any time during the first of four project years?
    This question is specific to the Track 1 awardees, which is the development and startup group who has until July 1, 2020, to have an active program launched with active participants.  Your program can be launched any time during that first year as long as your program is completely launched, with a minimum of four NP residents by July 1, 2020.
    This ANE-NPR Program Track 2 awardees must begin actively training participants no later than October 31, 2019 (the second quarter of the ANE-NPR project start date).  HRSA may reduce funding levels, or withhold future funding beyond the first year if you are unable to fully succeed in achieving this requirement.
11. Can ANE-NPR grant projects stagger NP resident start times if you have four residents trained by 2020?
    The ANE-NPR Program includes a 12-month residency program.

    The ANE-NPR Program Track 1 awardees must begin actively training participants no later than July 1, 2020 (year two of the ANE-NPR project start date). You are expected to train no less than four NP residents each year in years 2, 3 and 4.

    The ANE-NPR Program Track 2 awardees must begin actively training participants no later than October 31, 2019 (the second quarter of the ANE-NPR project start date).  You are expected to train no less than four NP residents each year of the project.

12. Is it a requirement (for Track 2) to train four residents in year one to maintain the grant?
    Recipients are required to meet not only the minimum requirements set forth in the NOFO, but are expected to carry out the project as proposed in their application. HRSA takes recipient performance very seriously and bases funding recommendations during the annual review of the recipient’s progress report. If HRSA determines that a recipient is not meeting the program requirements as stated in the NOFO as well as the approved application, HRSA may consider reducing out-year support by the number of NPR residents not recruited. It is at HRSA’s discretion to make funding recommendations based on the availability of funds, recipient progress and continued funding is in the best interest of the Federal government.
13. Is it possible to add clinical partners throughout the duration of the grant?
    Yes - Growing your ANE-NPR Program into a larger number of academic-clinical partnerships can lead to project enhancements. Adding clinical partners is acceptable, especially to assure that you have the training space for your NP residents. Please be certain that any clinical partner added to your project meets all of the requirements of the clinical partnership that are outlined in the ANE-NPR NOFO, and that they have some licensure or documentation that they meet certain standards of practice. Adding a partner requires a detailed Memorandum of Understanding, as outlined in the ANE-NPR Notice of Funding Opportunity, and is signed by the awardee and partner(s).
14. Is the HRSA Prior Approval only required if the new partner receives funds?
    The HRSA Project Officer decides if adding a clinical partner changes the project scope.  If the ANE-NPR project provides additional funds to a new third-party, which is a contractual relationship, then this scenario requires a HRSA prior approval in accordance with federal regulations. Even though the funds do not fall within the 25 percent budgeting rule, it is a new contract and needs HRSA approval.
15. What does it mean that the grant can only fund 70 percent of the residents’ salaries within the geographic market rate?
    The ANE-NPR grant project can only fund a salary/support amount of up to a maximum of 70 percent of your geographic location market NP salary value for each resident you are training.
16. Are there recommendations or resources on calculating the geographic market rate?
    Each ANE-NPR award recipient will have to work with their available resources to determine the 70 percent geographical location market rate for the NP Primary Care resident specialty salary.  For example, the award recipient can review their local market surveys to learn about the average salary for that geographical area.
17. Can an individual accept a NP resident if they are 18 months or greater out of school?  Example – Family Nurse Practitioner out of school for two years to enter a PMHNP residency.
    No, you cannot. A NP resident candidate who has been out of school for greater than 18 months does not meet the eligibility criteria.

    To be eligible for the ANE-NPR Program the NP must meet all of the following:

    • Be a licensed RN within 18 months of graduate school completion from a Primary Care NP Program (see list outlined in the Executive Summary) and NP certification;
    • Be a citizen of the United States, a non-citizen national, or a foreign national who possesses a visa permitting permanent residence in the United States (i.e. individuals on temporary or student visas are not eligible to receive ANE-NPR Program support); and
    • Agree to be a full-time participant in the ANE-NPR Program.
18. What happens if a resident happens to opt to leave the residency prior to the completion of the 12-month program in regard the HRSA funding?.
    If the ANE-NPR grant project has a NP resident leave the residency prior to the 12-month completion, the award recipient needs to notify their HRSA Project Officer as soon as the awardee is aware of the situation.

    No funds should be owed since the NP resident should not receive HRSA funds/salary support in advance of their training program. They will have to earn the salary so there would not be any funds due back to the ANE-NPR grant project, because they would have already earned the money they are receiving. The institution should have a plan in place and ensure that NP residents joining the program are aware of the requirements that are expected of them.

    The recipient institution is responsible for monitoring the success of each NP resident.

    Termination of an NP resident from the ANE-NPR Program funds applies if the NP resident:

    The ANE-NPR Program awardee should have standard operating procedures in place for the recruitment, training, retention, rescheduling, and termination of participants for the ANE-NPR Program. If a portion of the ANE-NPR Program training needs to be repeated, scheduling this activity to occur immediately following the conclusion of the award recipient cohort’s ANE-NPR Program is strongly encouraged and guidelines on this process should be incorporated into the standard operating procedures. Guidelines on how to recoup costs obligated in the case of termination of participants should also be included in the standard operating procedures.

    • Is unable to complete the residency program supported by the ANE-NPR award;
    • Withdraws from the recipient institution prior to the scheduled completion of the ANE-NPR Program;
    • Fails to meet the predetermined academic standards of the recipient institution; or
    • Requests to terminate the ANE-NPR Program support
19. If a NP resident left the program, would the HRSA budget be reduced in the next year by one slot?
    When your annual progress reports are reviewed, project performance and progress throughout the year is examined. Without further information about the specific ANE-NPR grant project, a decision cannot be made for the subsequent year to reduce the budget because a NP resident left the program.  HRSA reviews all information on an individual basis. HRSA will work with you, we encourage you to keep open communication with your Project Officer (PO) and Grants Management Specialist (GMS).
20. How do awardees contact HRSA Electronic Handbook (EHB)?
    HRSA EHB Contact Center
    8 a.m. – 8 p.m. M-F ET
    Phone: (877) 464-4772
    TTY: (877) 897-9910
    HRSA Grants and Electronic Handbooks Customer Support Center

TA Call: October 2, 2019

Financially-Related Questions

1. Paying NP resident salaries in project year 4: With a funding cycle from July to June, is it realistic to operate a residency from October to September? How does an awardee pay wages for the final year when the NP Residency Program finishes in July, August, and  September after the grant?
   HRSA Response: You have the option to initiate a one-time 12 month No Cost Extension (NCE) under expanded authority at the end of the project period to complete approved activities. Notification is required to HRSA. This does not require prior approval, however, a prior approval (notification) request for a NCE without funds must be submitted via the EHB at least 10 days prior to the end of the project period. The request serves two purposes, it provides the notification and allows all of the dates in EHB to be updated for reporting. A revised Notice of Award (NoA) will then be issued extending the project period.
2. Unobligated funds: Our NP Residency Program is October to September. Is there any way to reallocate unobligated funds from the first quarter of ANE project year one (July, August and September) that weren’t spent on previous residents graduating in September 2019?A new project period will begin while the first cohort of the ANE-NPR project NP residents has completed their NP Residency Program in July, August or September 2020. We would like to use the unobligated funds for this first cohort after the first project year.
   HRSA Response: Recipients may reallocate up to 25% per budget period within approved cost categories without prior approval. Refer to standard term #5 on your Notice of Award. There are some caveats to this rule, refer to 45 CFR part 75.308 - Revision of Budget and Program Goals and significant rebudgeting in the HHS GPS (standard term #2 on your notice of award).
3. Reallocating funds: How do I reallocate the funds that would have been a full-year income for a NP resident?
   HRSA Response: Recipients may reallocate up to 25% per budget period within approved cost categories without prior approval. Refer to standard term #5 on your Notice of Award. There are some caveats to this rule, refer to 45 CFR part 75.308 - Revision of Budget and Program Goals and significant rebudgeting in the HHS GPS (standard term #2 on your notice of award).
4. Residency funding allocation: The first year we had planned to have 10 residents that would go from July 1, 2020 to June 30, 2021; however, we would like to start the second cohort in January 2021. How would we deal with funding if the first year cohort had 10 residents and we wanted to start the second cohort six months early? (Funds are needed six months early.)
   HRSA Response: HRSA may not provide funding prior to the beginning of the next budget period. Non- Competing Continuation (NCC) funding is based on annual appropriations, satisfactory progress and continued funding is in the best interest of the Federal Government. Subsequent budget period funding is not available until the NCC NoA is issued and the start date of the next budget period. Recipients may incur pre-award costs before the beginning date of a non-competing continuation award without regard to time parameters and without prior approval. The incurrence of pre-award costs in anticipation of a non-competing award imposes no obligation on HRSA, either to make the award or to increase the amount of the approved budget, if an award is made for less than the amount anticipated and is inadequate to cover the pre-award costs incurred. Recipients are expected to be fully aware that pre-award costs result in borrowing against future support and that such borrowing must not impair the recipient’s ability to accomplish the project or program objectives in the approved time frame or in any way adversely affect the conduct of the project or program.
5. Billing for services provided by NP residents: When the ANE-NPR grant project generates income from NP resident services, how is this handled?
   1. NP resident bills under their own National Provider Identifier (NPI). The resident sees patients in the preceptor’s panel, but the preceptor’s panel has been opened up to include additional patients assuming the resident will create bandwidth for additional encounters. Is the revenue billed under the resident’s NPI program income?
      HRSA Response: Program Income is income earned as a result of the grant. So yes, the services billed under the NPI would be considered program income, based on your assumptions above. Refer to 45 CFR part 75.305 and 307 and the HHS Grants Policy Statement (PDF - 1 MB) for more information on program income.
   2. The NP resident bills under their own NPI. The resident sees patients that are part of the preceptor’s panel but there is no increase in the preceptor’s panel (no increase in overall revenue to the organization) as the preceptor is spending time on training and has merely shifted some patients to the resident. In this case, where there is no overall increase in patient revenue to the organization, is the revenue billed under the resident’s NPI still considered program income?
      HRSA Response: Program Income is income earned as a result of the grant. So yes, I would assume if the NPI is seeing the preceptor’s panel with no increase, then you have justification that you document the file for why you did not count this as program income. Refer to 45 CFR part 75.305 and 307  and the HHS Grants Policy Statement (PDF - 1 MB) for more information on program income.
   3. The NP resident sees a patient in the preceptor’s panel, however the preceptor reviews and signs off on the chart and the encounter is billed under the preceptor’s NPI (we will be researching to see if this is an allowable option). If billed under the preceptor’s NPI, is any of the revenue associated with the encounter considered program income? Does the answer change depending on whether or not the preceptor’s panel was increased as a result of hiring the resident?
      HRSA Response: Program Income is income earned as a result of the grant. So yes, I would assume if the preceptor’s panel was increased as a result of hiring the resident, this was as a result of the grant. Refer to 45 CFR part 75.305 and 307 and the HHS Grants Policy Statement (PDF - 1 MB) for more information on program income.
   4. Given the fact that the grant will be covering the salary and benefits of the NP residents, would it be inappropriate (double dipping) to bill any payer, but especially governmental payers such as Medicare and Medicaid, for services provided by these residents?
      HRSA Response: Refer to response under question #6.
6. HRSA requirements and billing CMS, Medicare, Medicaid: Are there any HRSA requirements that would indicate whether or not it is actually appropriate or inappropriate to bill third party payers? Especially CMS, Medicare, Medicaid if we are having resident salaries paid by the grant?
   HRSA Response: HRSA does not have any grant related restrictions with billing CMS, Medicare and Medicaid for services.
7. Project income and NP resident salaries: Can the grant project that has income from NP resident billing use the income to pay some of the NP resident salaries?
   HRSA Response: Yes, you can use program income to pay for NP Resident Salaries. The use of program income is additive (addition), refer to box 15 of the Notice of Award and 45 CFR part 75.305 and 307 and the HHS Grants Policy Statement (PDF - 1 MB) for more information on program income.

General Questions

8. Could an Area Health Education Center (AHEC) be paid to coordinate these activities?
   An AHEC could be a partner in the program and have staff who coordinate activities.
9. Must the applicant be in a Health Professional Shortage Area (HPSA)?
   The applicant applying for the ANE-NPR funding opportunity does not have to be in a HPSA or a Medically Underserved Community (MUC). However, the announcement offers a funding preference related to rural and underserved populations or communities and public health nursing needs.
   A funding preference will be applied for eligible applicants with projects that will substantially benefit rural or underserved populations, or help meet public health nursing needs in State or local health departments. If applicants are applying for the ANE-NPR funding preference, they must meet the criteria for the funding preference outlined in the NOFO.

8. Using grant funds for travel: Are we allowed to utilize HRSA ANE-NPR grant funds for travel to attend the in-person BHW Peer Learning Program meeting?
   HRSA Response: If your ANE-NPR grant budget has allocated funds for travel, these funds may be used for travel to attend the face to face BHW Peer Learning Program meeting.
9. Post residency employment: In terms of the individuals selected for this residency, are they committed to working at that institution following the NP residency program, or are the NP residents committed for the year they are there?
   HRSA Response: The ANE-NPR Program Notice of Funding Opportunity (NOFO) seeks to increase primary care providers in community-based settings. This program has been structured in a way so that training programs are encouraged to support the placement of participants in rural and underserved settings and also find ways to assist NP graduates to remain in these settings. The contractual arrangements are between the organization and the NP resident.
10. Employment requirement: When the NP residents are being selected by the clinical partner, can the clinical partner require that the NP residents work for their clinical institution for a period of one or two years? In other words, if the clinical institution recruits a NP resident, can the clinical institution require that the NP resident work for the institution for one or two years?
    HRSA Response: The contractual arrangements are between the organization and the NP resident.
11. HRSA National Health Service Corps Loan Repayment Program: My understanding is that if we have a resident who has already been approved for the HRSA National Health Service Corps Loan Repayment Program, they can do the 12-month residency program. However, their twoyear commitment would start after the residency program because they cannot count the residency as part of the loan repayment work. Is that correct?
    HRSA Response: Please defer to the HRSA National Health Service Corps (NHSC) application for program guidance. The response depends on the terms that were outlined in the guidance in effect when the NHSC contract was signed. Please contact the NHSC project officer or the management analyst to verify the terms of your NHSC contract.
12. Preceptor: Can a HRSA National Health Service Corps loan repayment recipient be a preceptor?
    HRSA Response: Please defer to the HRSA National Health Service Corps (NHSC) application for program guidance. The response depends on the terms that were outlined in the guidance in effect when the NHSC contract was signed. Please also contact the project officer or the management analyst to verify the terms of your NHSC contract. In addition, as an academic clinical partnership, you should have guidelines for recruitment and development of your preceptors as well as your residency programs. Hopefully, your guidelines will include the characteristics of preceptors that you want to recruit and develop to include their time, experience, discipline, etc.
13. Earlier start date: If our Track 1/Development and Start Up ANE-NPR grant project starts on July 1, 2020; is there a possibility we could transition to starting earlier (perhaps in January) for subsequent cohorts in our project?
    HRSA Response: If you started a cohort by 1 July, 2020, and transition into starting again in January 2021 with a new cohort where each cohort completes a 12 month residency and as a Track 1 project still meet the three years of NP resident numbers projected in your project proposal who complete your program; and the scheduling changes still meet the goals and objectives for which you were awarded, along with meeting all of the other requirements in the Notice of Funding Opportunity, this schedule change should be acceptable.
14. June start date for Track 1: Can our Track 1/Development and Start Up ANE-NPR grant project begin in June of 2020?
    HRSA Response: Yes, the requirement is that the project’s NP residency program starts no later than July 1, 2020. There is no restriction for starting the NP residency program before that time.
15. Additional didactic training: In addition to salaries, some community service classes/didactics are available for the NP residents to attend. Would it be necessary to obtain prior authorization approval to send residents of the NP to another didactic training that was not specified in the grant in advance because it was not yet known?
    HRSA Response: This description sounds like an enhancement to your Track 2/Expansion or Enhancement ANE-NPR grant project. Enhancements are encouraged additions to any program. It would be great to have this information shared in your HRSA reports, your Non-Competing Continuation Progress Report (NCC) and your Annual Performance Report (APR) because the details will indicate that you have gone above and beyond what you agreed to do.

TA Call: December 12, 2019

Financially Related Questions

1. Paying Preceptors:  Can preceptors be funded for academic contributions (e.g. lectures, facilitating workshops, planning meetings)?
   HRSA Response:  Preceptors and faculty/staff may be hired and funded for academic and clinical contributions that meet the program’s purpose and goals.
   See Budget and Budget Narrative guidelines (ANE-NPR Notice of Funding Opportunity p. 26).
2. Malpractice Insurance:  If residents are not employees at our FHQC clinical site, do we need to have separate malpractice coverage for them?
   HRSA Response:  Malpractice insurance coverage is not an allowable cost under the ANE-NPR Program.

   It is recommended you discuss how best to manage the residents with the HRSA prime recipient.
   There is no requirement that states the residents can only be employees of the HRSA recipient. The partner sites have the option to hire the NP residents directly and is managed via a subaward.
   Contact your GMS with questions relating to allowable costs and budget revisions. Each ANE-NPR grant project is unique. This individual process will allow a response specific to your project.

3. ANE-NPR Grant Project Income: Do we have to report income generated at partner sites as income to the grant? 
   Yes. Services billed under the NPR is program income, based on your assumptions above. Refer to 45 CFR part 75.305 and 307 and the HHS Grants Policy Statement (PDF - 1 MB) for more information on program income.
   Program Income is income earned from the grant (Oct 2, 2019 FAQs). 
   What kind of documentation you will need in terms of the income and the billing both ends (lead and partner organizations)?
   Services billed under the NPR is program income, based on your assumptions above. Refer to 45 CFR part 75.305 and 307 and the HHS Grants Policy Statement (PDF - 1 MB) for more information on program income.
   Contact your institution’s business/grants office first to discuss. As a follow up, contact your GMS with questions relating to program income as each ANE-NPR grant project is unique. This individual process will allow a response specific to your project.
4. Employment Post Residency:  To encourage the NP resident to stay in a rural placement after completion of the program, we are proposing to value the residency experience at $30K:
   1. If the resident successfully completes the program, $10K would be forgiven.
   2. If they chose to leave at that point, they would be responsible for payment of the remaining $20K.
   3. If they agree to placement in one of our rural facilities, the remaining $20K would be forgiven over the two-year work commitment. 
   4. Should they leave during the 2 years, we would prorate the remainder due. 
   5. If we were unable to place them in a rural setting due to no fault of their own, we would forgive any remaining balance.

   Do you see any conflict with this approach with the terms and conditions of the HRSA award or any applicable regulations?
   HRSA does not support those requirements and are not required by the ANE-NPR program.
   The determination to include the above information in the employment contract is at the discretion of the recipient organization.
   You must demonstrate to HRSA that their ANE-NPR Program will be able to carry out employment assistance post residency. 
   Example: One activity includes connecting program graduates with the HRSA Health Workforce Connector and other existing employment support resources so they can obtain primary care employment with rural and/or underserved populations. Preferably community-based clinical settings.

5. Reallocating Funds – Indirect Costs versus Direct Costs:  Are there any restrictions to reallocate funds when it comes to direct versus indirect costs?
   If we were going to allow salary for administrative oversight and processing, could that be indirect? Can HRSA funds for a NP resident salary be reassign to administrative salary? Can direct funds move into an indirect cost area?
   Contact your institution’s business/grants office first to discuss. As a follow, contact your GMS with questions relating to indirect costs. Each ANE-NPR grant project is unique.This individual process will allow a response specific to your project.

General Questions

6. Copyright: How do we manage the copyright process if we work with a vendor to create materials that distribute through the grant?
   Discuss copyrights with your institutions business office.
   Refer to 45 CFR part 75 for the Administrative Requirement and cost principles for HHS Federal Assistance Awards.
   Find additional information on copyrights in the HHS Grants Policy Statement (PDF - 1 MB) on page II-73 (page 126 of the PDF).
7. Changing Organization that Hires NP Resident:  Does hiring the NP residents require prior approval?
   Yes.  Submit a prior approval and resubmit your SF424 to show exactly where your monies are going.
8. New MOU: What is the best time to turn in a new MOU?
    Email the MOU to your Project Officer as soon as it is signed. Your PO will upload the MOU to your HRSA grant file. 
   Note: The MOU must include key information as stated on page 12 of the ANE-NPR Notice of Funding Opportunity.
9. Annual Performance Report (APR) Manual:  Where on the HRSA website do I locate an example of an advanced nursing education performance reporting Manual?
   You can find examples on the HRSA Report on Your Grant – Nursing Workforce Development Grants website.
   HRSA’s goal is to make the next year’s ANE-NPR APR Manual available in mid-June 2020. 
   A description of the required data collection can be located in the ANE-NPR Notice of Funding Opportunity accessible on the HRSA ANE-NPR website.
10. Report Due Notification:  How many days ahead does the HRSA Electronic Handbook (EHB) send the automatic electronic notification before the report being due?
    Approximately 30 days in advance of the report being due.  HRSA makes every attempt to provide 30 days’ notice.  Refer to your Notice of Award where the report due dates are listed.
11. Preceptor Discipline:  Are ANE-NPR preceptors limited to Nurse Practitioners/Certified Nurse Midwifes, or can they also be physicians or physician assistants?
    ANE-NPR preceptors are not limited to Nurse Practitioners and Certified Nurse Midwives, and may be physicians or PAs as necessary.