Geriatric Academic Career Awards

Health Resources and Services Administration
Academic Year: 2024-2025

Bureau of Health Workforce
OMB Number: 0906-0086

Annual Performance Report
OMB Expiration Date: 03/31/2027

IND-GEN: Individual Characteristics

IND-GEN - Setup

Do you have either a) new trainees OR b) updates to provide for trainees from a previous reporting period?

Yes (complete IND-GEN) No (click Save and Validate button to proceed to the next form)

Figure 1. IND-GEN - Setup

Do you have either a) new trainees OR b) updates to provide for trainees from a previous reporting period?:

IND-GEN - Excel Upload (Optional)

Warning

Users must download and use the Excel template provided in your Annual Performance Report because it populates with prior year records if you have any, and it’s customized for your grant program. Templates must be downloaded each year to make sure the most up-to-date data and the latest configurations are included. Users cannot use the prior year’s template. Be sure to save the Excel template to a folder other than the downloads folder.

Do not modify the format. For example: renaming the columns, adding columns, deleting columns, or renaming worksheets. Users must download and use the template from EHBs. The system will not upload/process spreadsheets with changes or those in a different format.

Types of Data Fields:

Data Entry field – For these type of fields, users can copy/paste allowable values and/or enter valid data in the cell or in the formula bar (if required). Ex.) ‘Trainee Unique ID’ (Column 2)

Single-Select dropdown field – For these type of fields, users can copy/paste allowable values (note they must match the selection option exactly), select an option from the list of pre-set choices in the dropdown box, and/or enter the valid selection in the cell or in the formula bar. Ex.) ‘Select Individual’s Training or Awardee Category’ (Column 3)

Multi-Select dropdown field – For these types of fields, users can copy/paste allowable values (note they must match the selection options exactly) and/or select one or more options from the list of pre-set choices in the dropdown box. Ex.) ‘Select any HHS Priority Topic Area on which an Individual Received Training’ (Column 26b).
Do not try to enter data into the cell or into the formula bar for this type of field as it may cause errors.

General Instructions:

Previously reported training programs (i.e., prior records) will be auto populated and displayed at the top of the spreadsheet. Cells that are gray are not editable. If new rows are added in the IND-GEN form, columns that auto-populate remain non-editable and empty (see below for additional details).

To enter a new record, users should start on the next blank row. Users must select the ‘Type of Training Program’ (Column 1) and enter the ‘Trainee Unique ID’ (Column 2). If not, the data for that row will not upload into the EHBs. While the ‘Record Status’ will be new, that column is not editable and will remain empty. Once the template is uploaded and processed, the ‘New Record’ status will be displayed in EHBs.

Awardees with at least one ‘ongoing’ structured or unstructured training program or at least one ‘active’ Fellowship Program, Major Participating Site/Rotation Site, Degree/Diploma/Certification, Practica/Field Placement, or Residency Program will be populated in the ‘Type of Training Program’ dropdown list in the IND-GEN template. The list is derived from the Training Program – Setup form.

The ‘City’ and ‘State’ Columns 58 and 59 are not editable and will remain empty even if the user enters the Zip Code in Column 57. Once the template is uploaded and processed, as long as a valid Zip Code is provided, the City and State will be populated in EHBs.

The ‘Academic Year Total’ Column 21b is not editable and will remain empty if the user enters financial award amounts (Columns 13-20a). Once the template is uploaded and processed, as long as a valid financial award amount is provided within Columns 13-20a, the academic year total will be populated in EHBs.

Copying and Pasting Data:

Users can copy and paste data from another source/file into Data Entry, Single-Select Dropdown, and Multi-Select Dropdown fields.

The values provided for Single-Select or Multi-Select fields must exactly match the values that exist in the system. This includes having the same spelling, spacing, and punctuation (hyphens, etc.). Capitalization does not matter. Values for Multi-Select fields must be separated by a comma and a space.

Multi-Selecting and Unselecting Pre-Set Options:

For the multi-select fields, users can select one or more pre-set options in the dropdown list. Users will have to select the options one at a time. However, the pre-set options will be shown together as comma separated values in the field.

To unselect one or more pre-set options, users can click on the pre-set option(s) a second time. This will remove the option from the field.

Validations:

Validations are embedded within the Excel template.

Validation messages will appear:
- When a required field is missing,
- When there is a conditional validation on two or more columns, and
- When a pre-set selection option cannot be combined with other pre-set options (specifically for multi-select fields).

When the value of the cell is changed a new validation message may appear if the data is deleted, it conflicts with a conditional validation, or the text field does not match the data type or pre-set option.

When a validation message appears, the user has the option to correct the field or leave it as is. If a user ignores the validation error in the Excel template, then the validation will still show in the EHB after the data has been processed. In this case, the user must fix the validation error in the EHB. All validation errors must be fixed to save and validate the form.

Uploading the Excel File in EHBs:

Users can upload the template and process it in EHBs as long as data has been selected/entered in Column 1 and Column 2. This is true if there are missing values as well as if there are validation errors. Both can be fixed once the data is uploaded into EHBs.

Once you have completed the Excel template, log into HRSA EHBs to access the Annual Performance Report. Navigate to the IND-GEN form, attach the file, upload the file, and then click the Process Data button. Users must select the Process Data button for the data to appear in the EHBs. Users will be unable to save and validate the IND-GEN form if the data is not processed. If you do not wish to process the data, you must delete the template from EHB.

Be sure to confirm that the data transferred successfully, enter any missing fields, and read all validation error messages carefully. Note: the row numbers in EHBs will not match the row numbers in the Excel template.

If users need to make changes or work on the offline template again, then a new Excel template must be generated with the most recent data and then downloaded. Failure to download a new Excel template may lead to missing, incomplete, or incorrect data.

Only one file can be uploaded to the EHBs at a time. If data was updated in the new file, then the old file must be deleted and the new file added to the EHBs. Deleting a file will remove it from the EHBs but the data will remain in the EHBs if it has already been processed.

Warning

The Type of Training Program (Column 1) and Trainee Unique ID (Column 2) are key columns. These columns need to be complete in order for the row to be uploaded and processed into EHBs. If one or both of these columns are not complete, then the row of data will not be processed in EHBs.

Note

The row numbers in EHBs will not match the row numbers in the Excel template.

IND-GEN - Entering Trainee Unique ID

Trainee Unique ID
(2) Block 1

Figure 2. IND-GEN - Entering Trainee Unique ID

Trainee Unique ID: Enter a seven (7) character alphanumeric unique identifier for each individual in the textbox in Column 2 (Block 1).

Warning
It is the responsibility of each grantee to generate each unique ID and keep a log of all unique IDs used, as these will be required to provide annual updates and 1-year follow-up data for each individual.

Note
This Block will prepopulate for prior records with data submitted in previous reporting periods.

IND-GEN - Entering NPI Number

NPI Number
(2a)

Figure 3. IND-GEN - Entering NPI Number

NPI Number: Enter the 10-digit National Provider Identifier (NPI) number for each individual in the textbox in Column 2a. To apply for an NPI number, go to: https://nppes.cms.hhs.gov.

IND-GEN - Selecting Individual's Training or Awardee Category

Select Individual's Training or Awardee Category
(3) Block 2

Figure 4. IND-GEN - Selecting Individual's Training or Awardee Category

Select Individual's Training or Awardee Category: Select each faculty member’s training category by clicking on the drop-down menu under Column 3 (Block 2) and choosing one of the following options:

Faculty

Note
This field will prepopulate for prior records with data submitted in previous reporting periods. It will appear in gray shading and will not be editable.

IND-GEN - Selecting Individual's Enrollment/Employment Status

Select Individual's Enrollment / Employment Status
(4) Block 3

Figure 5. IND-GEN - Selecting Individual's Enrollment/Employment Status

Select Individual's Enrollment / Employment Status: Select each faculty member’s current employment status by clicking on the drop-down menu under Block 3 and choosing one of the following options:

Full-time
Part-time
On leave of absence

IND-GEN - Selecting Individuals Sex

Select Individual's Sex
(5a)

Figure 6. IND-GEN - Selecting Individuals Sex

Select Individual's Sex: Select the sex that applies to each individual by clicking on the drop-down menu under column 5a and choosing the option that applies:

Female
Male
Not reported

Warning
If "Not Reported" was selected for a record during a previous reporting period, you are expected to provide updated information.

IND-GEN - Entering Year of Birth

Enter Year of Birth
(6a)

Figure 7. IND-GEN - Entering Year of Birth

Enter Year of Birth: Enter each faculty member’s age at the end of the annual reporting period in the textbox under Column 6a.

1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Not Reported

IND-GEN - Selecting Individual's Ethnicity

Select Individual's Ethnicity
(7) Block 6

Figure 8. IND-GEN - Selecting Individual's Ethnicity

Select Individual's Ethnicity: Select each faculty member’s ethnicity by clicking on the drop-down menu under Block 6 and choosing one of the following options:

Hispanic/Latino
Non-Hispanic/Non-Latino
Not Reported

Warning
If "Not Reported" was selected for a record during a previous reporting period, you are expected to provide updated information.

IND-GEN - Selecting Individual's Race

Select Individual's Race
(8) Block 7

Figure 9. IND-GEN - Selecting Individual's Race

Select Individual's Race: Select each individual’s race by clicking on the drop-down menu under Block 7 and choosing all that apply from the following options:

American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Other Pacific Islander
White
Not Reported

Warning
You may not select "Not Reported" in combination with any other option.

Warning
If "Not Reported" was selected for a record during a previous reporting period, you are expected to provide updated information.

IND-GEN - Selecting if Individual is from a Rural Residential Background

Select Whether Individual is from a Rural Residential Background
(9) Block 8

Figure 10. IND-GEN - Selecting if Individual is from a Rural Residential Background

Select Whether Individual is from a Rural Residential Background: Select whether each faculty member is from a rural residential background by clicking on the drop-down menu under Column 9 (Block 8) and choosing one of the following options:

Yes
No
Not Reported

Reference
Refer to the glossary for a definition of rural setting.

IND-GEN - Selecting if Individual is from a Disadvantaged Background

Select Whether Individual is from a Disadvantaged Background
(10) Block 9

Figure 11. IND-GEN - Selecting if Individual is from a Disadvantaged Background

Select Whether Individual is from a Disadvantaged Background: Select whether each faculty member is from a disadvantaged background by clicking on the drop-down menu under Column 10 (Block 9) and choosing one of the following options:

Yes
No
Not Reported

Note
If "Not Reported" was selected for a record during a previous reporting period, you must provide the appropriate updated information in order to successfully submit your PRGCA.

Reference
Refer to the glossary for a definition of disadvantaged background.

IND-GEN - Selecting Individual's Veteran Status

Select Individual's Veteran Status
(11) Block 10

Figure 12. IND-GEN - Selecting Individual's Veteran Status

Select Individual's Veteran Status: Select each faculty member's current veteran status by clicking on the drop-down menu under Block 10 and choosing one of the following options:

Active Duty Military
Individual is not a Veteran
National Guard
Reservist
Veteran - Prior Service
Veteran - Retired
Not Reported

Note
If "Not Reported" was selected for a record during a previous reporting period, you must provide the appropriate updated information in order to successfully submit your PRGCA.

Reference
Refer to the glossary for a definition of the various types of veteran statuses.

IND-GEN - Entering BHW-Funded Financial Award Information

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Select Whether Individual Received BHW Financial Award?	Enter Individual's Financial Award Amount (BHW funds only)	Enter Individual's Financial Award Amount (BHW funds only)
Select Whether Individual Received BHW Financial Award?	Career Award	Academic Year Total (Auto-Populates)
(12) Block 11	(17) Block 11	(21b) Block 11

Figure 13. IND-GEN - Entering BHW-Funded Financial Award Information

Select Whether Individual Received BHW Financial Award?: Select whether each faculty member received a BHW-funded financial award during the annual reporting period by clicking on the drop-down menu in Column 12 (Block 11) and choosing one of the following options:

Enter Individual's Financial Award Amount (BHW funds only): Career Award:

If the faculty member did receive a BHW-funded financial award, select “Yes” in Column 12 (Block 11) and enter the total amount of BHW dollars provided during the annual reporting period in the textbox in Column 17 (“Career Award”).
If the faculty member did not receive a BHW-funded financial award, select “No” in Column 12 (Block 11) and enter "0" in the textbox in Column 13.

Enter Individual's Financial Award Amount (BHW funds only): Academic Year Total:

Note
The amount reported under the column labeled "Career Award" should be the total monies from the grant provided to an individual during the current annual reporting period for the purposes of participating in the training program that was selected under the column labeled "Type of Training Program." The total amount reported should account for all BHW dollars including those applied to tuition, fees, and reasonable living expenses, as allowed by federal statutes and regulations. Do not include dollars that came from other sources of funding.

IND-GEN - Entering # of Academic Years the Individual has Received BHW Funding

Enter # of Academic Years the Individual has Received BHW Funding
(22) Block 12

Figure 14. IND-GEN - Entering # of Academic Years the Individual has Received BHW Funding

Enter # of Academic Years the Individual has Received BHW Funding: Select the cumulative number of academic years that each student has received a BHW-funded financial award by clicking on the drop-down menu under Column 22 and choosing one of the following options:

1
2
3
4
5 or more

Note
The number of academic years receiving BHW-funded financial awards does not need to be consecutive; rather, the cumulative total number of years should be reported.

Note
If a faculty member has received money for ½ an academic year, please round up to the nearest whole number. For example, if a faculty member has received a financial award for 1 ½ years, please enter 2 in Column 22 (Block 12).

Note
If a faculty member received a BHW-funded financial award for the first time during the current annual reporting period, select "1" under Column 22 (Block 12).

IND-GEN - Selecting Individual's Academic or Training Year

Select Individual's Academic or Training Year
(26) Block 15

Figure 15. IND-GEN - Selecting Individual's Academic or Training Year

Select Individual's Academic or Training Year: Select each student's current training year by clicking on the drop-down menu under Block 15 and choosing one of the following options:

Non-degree Training Program Year 1
Non-degree Training Program Year 2
Non-degree Training Program Year 3
Non-degree Training Program Year 4
Non-degree Training Program Year 5

IND-GEN - Selecting Profession and Discipline/Specialty

Select Individual's Profession	Select Individual's Primary Discipline/Specialty
(26c)	(26d)

Figure 16. IND-GEN - Selecting Profession and Discipline/Specialty

Select Individual's Profession: Select the individual’s profession by clicking on the drop-down menu in Column 26c and selecting one of the available options.

Allied Health
Behavioral Health
Dentistry
Medicine
Nursing
Other
Public Health

Select Individual's Primary Discipline/Specialty: Select the individual’s discipline/specialty by clicking on the drop-down menu in Column 26d and choosing from one of the available options. Please note that you must select a discipline/specialty that is associated with the profession you selected in Column 26c. The disciplines/specialties are organized by profession in the drop-down; please scroll to find the correct option.

ALLIED HEALTH OPTIONS (please select)
Community Health Worker
Dental Hygiene
EMT/Paramedic
Nutritionist/Dietician
Occupational Therapy
Optometry
Pharmacy
Physical Therapy
Respiratory Therapy
Speech Pathology/Therapy
BEHAVIORAL HEALTH OPTIONS (please select)
Addictions Counseling
Clinical Mental Health Counseling
Clinical Psychology
Clinical Social Work
Counseling Psychology
Marriage and Family Therapy
Pastoral/Spiritual Care
DENTISTRY OPTIONS (please select)
Advanced General Dentistry
Dental Anesthesiology
Dental Public Health
Endodontics
General Dentistry
Oral and Maxillofacial Pathology
Oral and Maxillofacial Radiology
Oral and Maxillofacial Surgery
Oral Medicine
Orofacial Pain
Orthodontics and Dentofacial Orthopedics
Periodontics
Prosthodontics
MEDICAL OPTIONS (please select)
Family Medicine
Geriatric Medicine
Geriatric Psychiatry
Integrative Medicine
Internal Medicine
Internal Medicine/Family Medicine
Preventive Medicine
Preventive Medicine/Family Medicine
Preventive Medicine/Internal Medicine
Preventive Medicine/Public Health
Psychiatry
NURSING OPTIONS (please select)
Clinical Nurse Specialist (CNS)
Nurse Practitioner (NP)
OTHER OPTIONS (please select)
Health Informatics/Information Technology
PUBLIC HEALTH OPTIONS (please select)
Disease Prevention/Health Promotion
Health Education

IND-GEN - Selecting Nursing Subspecialty

Select Individual's Specialty
(27aa)

Figure 17. IND-GEN - Selecting Nursing Subspecialty

Select Individual's Specialty: For individuals whose discipline/specialty is Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), select the nursing specialty by clicking on the drop-down menu in 27aa and choosing from one of the available options. If the individual's discipline/specialty is not NP or CNS, then please select N/A.

Acute Care Adult Gerontology
Adult Gerontology
Geropsychiatric
N/A

IND-GEN - Entering Telehealth Training Information

Training in Telehealth	Training in Telehealth
Select Whether Individual Received Training	Enter # of Contact Hours
(27d)	(27e)

Figure 18. IND-GEN - Entering Telehealth Training Information

Training in Telehealth: Select Whether Individual Received Training: Select whether each individual received clinical or experiential training in telehealth during the current reporting period by clicking on the drop-down menu in Column 27d and choosing one of the following options:

Training in Telehealth: Enter # of Contact Hours:

If the individual received clinical or experiential training in Telehealth, enter the total number of hours spent offering telehealth services and/or participating in training about how to offer telehealth services during the current reporting period in the textbox in Column 27e.
If the individual did not receive clinical or experiential training in Telehealth, leave the textbox in Column 27e blank.

IND-GEN - Entering Training Information in a Primary Care Setting

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Training in a Primary Care Setting	Training in a Primary Care Setting
Select Whether Individual Received Training	Enter # of Contact Hours
(28) Block 17	(29) Block 17a

Figure 19. IND-GEN - Entering Training Information in a Primary Care Setting

Training in a Primary Care Setting: Select Whether Individual Received Training: Select whether each resident or fellow received clinical or experiential training in a primary care setting during the current reporting period by clicking on the drop-down menu in Column 28 (Block 17) and choosing one of the following options:

Training in a Primary Care Setting: Enter # of Contact Hours:

If the resident or fellow received clinical or experiential training in a primary care setting, enter the total number of hours spent in this type of setting during the current reporting period in the textbox.
If the resident or fellow did not receive clinical or experiential training in a primary care setting, leave the textbox blank.

IND-GEN - Entering Training Information in a Medically Underserved Community

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Training in a Medically Underserved Community	Training in a Medically Underserved Community
Select Whether Individual Received Training	Enter # of Contact Hours
(31) Block 18	(32) Block 18a

Figure 20. IND-GEN - Entering Training Information in a Medically Underserved Community

Training in a Medically Underserved Community: Select Whether Individual Received Training:

Select whether each individual received clinical or experiential training in a medically underserved community during the current reporting period by clicking on the drop-down menu in Column 31 and choosing one of the following options:

Training in a Medically Underserved Community: Enter # of Contact Hours:

If the individual received clinical or experiential training in a MUC, enter the total number of hours spent in this type of setting during the current reporting period in the textbox in Column 32.
If the individual did not receive clinical or experiential training in a MUC, leave the textbox blank.

IND-GEN - Entering Training Information in a Rural Area

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Training in a Rural Area	Training in a Rural Area
Select Whether Individual Received Training	Enter # of Contact Hours
(33) Block 19	(34) Block 19a

Figure 21. IND-GEN - Entering Training Information in a Rural Area

Training in a Rural Area: Select Whether Individual Received Training:

Select whether each individual received clinical or experiential training in a rural area during the current reporting period by clicking on the drop-down menu in Column 33 (Block 19) and choosing one of the following options:

Training in a Rural Area: Enter # of Contact Hours:

If the individual received clinical or experiential training in a rural area, enter the total number of hours spent in this type of setting during the current reporting period in the textbox.
If the individual did not receive clinical or experiential training in a rural area, leave the textbox blank.

IND-GEN - Selecting Whether Individual Left the Program Before Completion

Select Whether Individual Left the Program Before Completion
(36) Block 21

Figure 22. IND-GEN - Selecting Whether Individual Left the Program Before Completion

Select Whether Individual Left the Program Before Completion: Select whether each faculty member permanently left their training program before completion during the annual reporting period by clicking on the drop-down menu in Column 36 (Block 21) and choosing one of the following options:

IND-GEN - Entering Graduation/Completion Information

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Select Whether Individual Graduated/Completed the Program	Select Individual's Post-Graduation/Completion Intentions
(37) Block 22	(39) Block 22b

Figure 23. IND-GEN - Entering Graduation/Completion Information

Select Whether Individual Graduated/Completed the Program: Select whether each individual completed from their training program during the current reporting period by clicking on the drop-down menu in Column 37 (Block 22) and choosing one of the following options:

Select Individual's Post-Graduation/Completion Intentions:

Individual intends to apply for NHSC Loan Repayment
Individual intends to practice or continue practicing in a medically underserved area
Individual intends to practice or continue practicing in a primary care setting
Individual intends to practice or continue practicing in a rural area
Not Reported
N/A
None of the above
Individual intends to conduct or continue conducting geriatrics-related research
Individual intends to teach or continue teaching geriatrics-related curricula

Warning
None of the above, Not reported, and N/A cannot be selected in combination with any other option.

To Complete the Form: Click on the “Save and Validate” button located on the bottom right corner of your screen. If no errors are found, the BPMH system will automatically route you to the next required subform.

IND-GEN - Entering the % FTE Individual Spent in Different Roles

Enter the % FTE Individual Spent on the Following Roles	Enter the % FTE Individual Spent on the Following Roles	Enter the % FTE Individual Spent on the Following Roles	Enter the % FTE Individual Spent on the Following Roles
Research	Teaching	Administration	Clinical
(40) Block 24a	(41) Block 24b	(42) Block 24c	(43) Block 24d

Figure 24. IND-GEN - Entering the % FTE Individual Spent in Different Roles

Enter the % FTE Individual Spent on the Following Roles: Research: Enter the percentage of GACA-funded time each faculty member spent in 'Research' during the annual reporting period in Column 40 (Block 24a).Enter the % FTE Individual Spent on the Following Roles: Teaching: Enter the percentage of GACA-funded time each faculty member spent in 'Teaching' during the annual reporting period in Column 41 (Block 24b).Enter the % FTE Individual Spent on the Following Roles: Administration: Enter the percentage of GACA-funded time each faculty member spent in 'Administration' during the annual reporting period in Column 42 (Block 24c).Enter the % FTE Individual Spent on the Following Roles: Clinical: Enter the percentage of GACA-funded time each faculty member spent in 'Clinical' during the annual reporting period in Column 43 (Block 24d).

Warning
The sum of these percentages must be 100%.

IND-GEN - Entering # of Articles Published

Enter # of Articles Published in Peer-Reviewed Journals
(44) Block 25

Figure 25. IND-GEN - Entering # of Articles Published

Enter # of Articles Published in Peer-Reviewed Journals: Enter the number of articles published by each faculty member in peer-reviewed journals during the annual reporting period in the textbox in Column 44 (Block 25).

IND-GEN - Entering # of Peer-Reviewed Conference Presentations

Enter # of Peer-Reviewed Conference Presentations
(45) Block 26

Figure 26. IND-GEN - Entering # of Peer-Reviewed Conference Presentations

Enter # of Peer-Reviewed Conference Presentations: Enter the total number of peer-reviewed conference presentations conducted by each faculty member during the annual reporting period in the textbox in Column 45 (Block 25).

IND-GEN - Entering # of Grants Awarded by Type & Amount

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Enter # of Grants Awarded by Type and Amount	Enter # of Grants Awarded by Type and Amount	Enter # of Grants Awarded by Type and Amount	Enter # of Grants Awarded by Type and Amount
Research (less than $100,000)	Research (greater than or equal to $100,000)	Education (less than $100,000)	Education (greater than or equal to $100,000)
(46) Block 27	(47) Block 27	(48) Block 27	(49) Block 27

Figure 27. IND-GEN - Entering # of Grants Awarded by Type & Amount

Enter # of Grants Awarded by Type and Amount: Research (<$100,000): Enter the total number of awarded research grants under $100,000 achieved by the individual during the current reporting period in Column 46 (Block 27).Enter # of Grants Awarded by Type and Amount: Research (>=$100,000): Enter the total number of awarded research grants greater than or equal to $100,000 achieved by the individual during the current reporting period in Column 47 (Block 27).Enter # of Grants Awarded by Type and Amount: Education (<$100,000): Enter the total number of awarded education grants under $100,000 achieved by the individual during the current reporting period in Column 48 (Block 27).Enter # of Grants Awarded by Type and Amount: Education (>=$100,000): Enter the total number of awarded education grants greater than or equal to $100,000 achieved by the individual during the current reporting period in Column 49 (Block 27).

IND-GEN - Entering Individual's Employment Data

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Employment Data	Employment Data	Employment Data	Employment Data	Employment Data	Employment Data	Employment Data
Select whether Employment Data is available?	Select Whether Your Organization Hired this Individual	Select Whether a Partner Organization Hired this Individual	Enter Zip Code	City (Auto-Populates)	State (Auto-Populates)	Select Type of Employment
(56)	(56a)	(56b)	(57)	(58)	(59)	(60)

Figure 28. IND-GEN - Entering Individual's Employment Data

Select whether Employment Data is available?: Select whether employment data are available by clicking on the drop-down menu in Column 56 and choosing one of the following options:

Yes
Yes (outside U.S.)
No
N/A

Select Whether Your Organization Hired this Individual:

Select Whether a Partner Organization Hired this Individual:

Enter Zip Code: Enter the zip code for the individual’s Employment Location.Enter City: Enter State: Select Type of Employment:

If ‘Yes’ was selected in Column 56, identify the individual’s type of employment by clicking on the drop-down menu and selecting the best option among those listed below.
If ‘No’ or ‘Yes (outside U.S.)' was selected, select 'N/A' in Column 60.

Academic Institution
Academic Medical Center
Area Health Education Center
Certified Community Behavioral Health Clinic (CCBHC)
Community Behavioral Health/Mental Health Center
Community Health Center (CHC)
Critical Access Hospital
Federal Government
FQHC or Look-Alike
Health Department (local/state/tribal)
Hospital (non-academic)
Indian Health Service (IHS)/Tribal/Urban Indian Health Center
Nursing Home
Other Clinical Health Setting
Other Community-Based Organization
Other Long-term Care Facility
Other Specialty Clinic
Private Industry
Private Practice
Residential Living Facility (including independent and assisted living)
Rural Health Clinic
School-based Clinic
State or Local Government
US Armed Forces
Veterans Affairs Healthcare (e.g. VA hospital or clinic)
Pursuing Additional Education or Training
Not Currently Employed
N/A

Warning
For Column 60, None of the above, not reported, and N/A cannot be selected in combination with any other option.

Note

If an individual has completed the program but is not currently employed, please select “Yes” for Column 56 (Select whether employment data is available). Leave the zip code, city, and state blank and select "N/A" for whether you or a partner organization hired the individual (Columns 56a and 56b). Then, select “Not Currently Employed” for Column 60 and N/A for Column 61.

Note

You must also select “N/A” if you indicated that the person is “Not Currently Employed” in Column 60.

Note

Leave the zip code blank if you indicated that the person is “Not Currently Employed” in Column 60.

IND-GEN - Selecting Individual's Employment Location Settings

Employment Data
Select Individual's Employment Location Settings
(61)

Figure 29. IND-GEN - Selecting Individual's Employment Location Settings

Select Individual's Employment Location Settings: For each individual, use the drop-down menu in Column 61 to select all that apply from the list of employment location settings.

Medically Underserved Community
National Health Service Corps (NHSC)-Approved Site
Primary Care Setting
Rural Area
None of the Above
N/A

To Complete the Form: Click on the "Save and Validate" button located on the bottom right corner of your screen. If no errors are found, the BPMH system will automatically route you to the next required subform.

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IND-GEN: Individual Characteristics

IND-GEN - Setup

IND-GEN - Setup

IND-GEN - Excel Upload (Optional)

IND-GEN - Excel Upload (Optional)

IND-GEN - Entering Trainee Unique ID

IND-GEN - Entering Trainee Unique ID

IND-GEN - Entering NPI Number

IND-GEN - Entering NPI Number

IND-GEN - Selecting Individual's Training or Awardee Category

IND-GEN - Selecting Individual's Training or Awardee Category

IND-GEN - Selecting Individual's Enrollment/Employment Status

IND-GEN - Selecting Individual's Enrollment/Employment Status

IND-GEN - Selecting Individuals Sex

IND-GEN - Selecting Individuals Sex

IND-GEN - Entering Year of Birth

IND-GEN - Entering Year of Birth

IND-GEN - Selecting Individual's Ethnicity

IND-GEN - Selecting Individual's Ethnicity

IND-GEN - Selecting Individual's Race

IND-GEN - Selecting Individual's Race

IND-GEN - Selecting if Individual is from a Rural Residential Background

IND-GEN - Selecting if Individual is from a Rural Residential Background

IND-GEN - Selecting if Individual is from a Disadvantaged Background

IND-GEN - Selecting if Individual is from a Disadvantaged Background

IND-GEN - Selecting Individual's Veteran Status

IND-GEN - Selecting Individual's Veteran Status

IND-GEN - Entering BHW-Funded Financial Award Information

IND-GEN - Entering BHW-Funded Financial Award Information

IND-GEN - Entering # of Academic Years the Individual has Received BHW Funding

IND-GEN - Entering # of Academic Years the Individual has Received BHW Funding

IND-GEN - Selecting Individual's Academic or Training Year

IND-GEN - Selecting Individual's Academic or Training Year

IND-GEN - Selecting Profession and Discipline/Specialty

IND-GEN - Selecting Profession and Discipline/Specialty

IND-GEN - Selecting Nursing Subspecialty

IND-GEN - Selecting Nursing Subspecialty

IND-GEN - Entering Telehealth Training Information

IND-GEN - Entering Telehealth Training Information

IND-GEN - Entering Training Information in a Primary Care Setting

IND-GEN - Entering Training Information in a Primary Care Setting

IND-GEN - Entering Training Information in a Medically Underserved Community

IND-GEN - Entering Training Information in a Medically Underserved Community

IND-GEN - Entering Training Information in a Rural Area

IND-GEN - Entering Training Information in a Rural Area

IND-GEN - Selecting Whether Individual Left the Program Before Completion

IND-GEN - Selecting Whether Individual Left the Program Before Completion

IND-GEN - Entering Graduation/Completion Information

IND-GEN - Entering Graduation/Completion Information

IND-GEN - Entering the % FTE Individual Spent in Different Roles

IND-GEN - Entering the % FTE Individual Spent in Different Roles

IND-GEN - Entering # of Articles Published

IND-GEN - Entering # of Articles Published

IND-GEN - Entering # of Peer-Reviewed Conference Presentations

IND-GEN - Entering # of Peer-Reviewed Conference Presentations

IND-GEN - Entering # of Grants Awarded by Type & Amount

IND-GEN - Entering # of Grants Awarded by Type & Amount

IND-GEN - Entering Individual's Employment Data

IND-GEN - Entering Individual's Employment Data

IND-GEN - Selecting Individual's Employment Location Settings

IND-GEN - Selecting Individual's Employment Location Settings

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