Instructions for phs 398 and sf 424(R&R) Form Approved Through 08/31/2015




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2.17 Kirschstein-NRSA Payback Assurance


This is applicable ONLY to the F32 (postdoctoral fellows) and F33 (senior fellows).

Section 487 of the Public Health Service Act, as, amended (42 U.S.C. 288), and implementing regulations (42 CFR part 66) require satisfactory assurance from a prospective recipient of a Kirschstein-NRSA Individual Fellowship that, in the first 12 months of Kirschstein-NRSA postdoctoral support, he or she will meet the following service requirement. Kirschstein-NRSA predoctoral fellows or other fellows who have already had 12 months of Kirschstein-NRSA postdoctoral support do not incur a service payback obligation.

Kirschstein-NRSA Individual Fellowships will be governed by the service payback requirements articulated in the National Research Service Award Guidelines for Individual Awards and Institutional Grants. These guidelines can be found in the NRSA portion of the most recent version of the NIH Grants Policy Statement found at: http://grants.nih.gov/grants/policy/policy.htm#gps. Applicants accepting an approved Kirschstein-NRSA Individual Fellowship agree to the following assurance:

I. Service Requirement - In accepting a Ruth L. Kirschstein National Research Service Award to support my postdoctoral research training, I understand that my first 12 months of Kirschstein-NRSA Individual Fellowship support for postdoctoral research training carry with it a payback obligation. I hereby agree to engage in a month of health-related research, health-related research training, health-related teaching, and/or health-related activities for each month I receive a Kirschstein-NRSA Individual Fellowship for postdoctoral research training up to and including 12 months. If I receive a Kirschstein-NRSA Individual Fellowship for postdoctoral research training for more than 12 months, I agree that the 13th month and each subsequent month of Kirschstein-NRSA-supported postdoctoral research training will satisfy a month of my payback obligation incurred in the first 12 months. This service shall be initiated within 2 years after the end of Kirschstein-NRSA support. The health-related research, teaching, and/or activities shall be on a continuous basis and shall average more than 20 hours per week of a full work year.

II. Financial Payback Provisions - I understand that if I fail to undertake or perform such service in accordance with Section I above, the United States will be entitled to recover from me an amount determined in accordance with the following formula:

A = F [(t-s)/t]

where "A" is the amount the United States is entitled to recover; "F" is the sum of the total amount paid to me under the initial 12 months of my postdoctoral Ruth L. Kirschstein National Research Service Award support; "t" is the total number of months in my service obligation; and "s" is the number of months of such obligation served.

Except as provided in Section III below, any amount the United States is entitled to recover from me shall be paid within the 3-year period beginning on the date the United States becomes entitled to recover such amount. The United States becomes entitled to recover such amount 2 years after termination of my Ruth L. Kirschstein National Research Service Award support if I do not engage in acceptable service payback activities in accordance with Section I. If I elect to engage in financial repayment before the end of the 2-year period, the United States becomes entitled to recover such amount on the date of my election. Interest on the amount begins on the date the United States becomes entitled to recover such amount and is at the rate fixed by the Secretary of the Treasury after taking into consideration private consumer rates prevailing on that date. I understand that I will be allowed an initial 30-day interest-free period in which to fully pay such amount, and that I may prepay any outstanding balance after that period to avoid additional interest. I further understand that I will be subject to authorized debt collection action(s) (including any accrued interest and late fees) should I fail to comply with the payback provisions of this Section II.



III. Conditions for Break in Service, Waiver, and Cancellation - I hereby understand that the Secretary of Health and Human Services:

A. May extend the period for undertaking service, permit breaks in service, or extend the period for repayment, if it is determined that:

1. Such an extension or break in service is necessary to complete my clinical training or to participate in a NIH Loan Repayment Program;

2. Completion would be impossible because of temporary disability; or

3. Completion would involve a substantial hardship and failure to extend such period would be against equity and good conscience;

B. May waive my obligation, in whole or in part, if it is determined that:

1. Fulfillment would be impossible because I have been permanently or totally disabled; or

2. Fulfillment would involve a substantial hardship and the enforcement of such obligation would be against equity and good conscience;

C. Will, in the event of my death, cancel any obligation incurred under this payback agreement.

IV. Termination Notice-Annual Report of Employment-Change of Address and/or Name - I agree to complete and submit a termination notice immediately upon completion of support. Thereafter, on an annual basis I agree to complete and submit all Payback Activities Certification forms sent to me by the National Institutes of Health or the Agency for Healthcare Research and Quality concerning post-award activities, and agree to keep those agencies advised of any change of address and/or name until such time as my total obligation is fulfilled.

V. Program Evaluation - I understand that I also may be contacted from time to time, but no more frequently than once every 2 years, after the end of this award to determine how the training obtained has influenced my career. Any information thus obtained would be used only for statistical purposes and would not identify me individually.

VI. Certification - By signing the certification block on the application form, I certify that I have read and understood the requirements and provisions of this assurance and that I will abide by them if an award is made.

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