Primary Care Training and Enhancement: Physician Assistant Rural Training in Mental and Behav. Hlth

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

To begin providing individual-level data for students who received a BHW-funded financial award or participated in a BHW-supported activity during the annual reporting period or to provide updates for students previously reported on INDGEN, click "Yes" to the initial setup question. Clicking "Yes" will activate the embedded Excel® form that will allow you to begin data entry.

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?:

Warning

If you have used the INDGEN form before, this answer is pre-selected ‘Yes’ for you. You do not need to answer this question again. Please move ahead to the INDGEN form by using the form list located on the left side of your screen.

Warning

If you are unable to enter data into the INDGEN form, edit prior records, or see drop-down menus despite the question above being answered ‘Yes’, you have a browser compatibility problem. Please refer to the Getting Started-Browser Settings page at the beginning of this manual.

Warning

Gray fields in prior records cannot be edited.

Warning: Prior records cannot be deleted.

IND-GEN - Excel Upload (Optional)

IND-GEN - Selecting Type of Training Program

Type of Training Program
(1)

Figure 2. IND-GEN - Selecting Type of Training Program

Type of Training Program: To begin completing the INDGEN subform, select the training program associated with each individual by clicking on the drop-down menu under the column labeled "Type of Training Program" and choosing one of the available options.

Note

The options available under "Type of Training Program" will prepopulate with information entered and saved in the Training Program Setup Form.

Note

This program is no longer able to select "Other" for Type of Training Program. Also, prior records for faculty who had a Type of Training Program of "Other" were deleted.

Note

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

Example: The PA School saved one (1) entry in the Training Program Setup form to reflect the type of degree program supported by the grant. Under "Type of Training Program" the PA School would see the following options:

Degree/Diploma program | MMS

Other

IND-GEN - Entering Trainee Unique ID

Trainee Unique ID
(2) Block 1

Figure 3. 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 4. 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.

Note
NPIs are required as of AY 2022-2023.

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

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

Figure 5. IND-GEN - Selecting Individual's Training or Awardee Category

Select Individual's Training or Awardee Category: Select each individual's training category by clicking on the drop-down menu under Block 2 and choosing one of the following options:

Enrollee (campus-based only)
Enrollee (distance learning only)
Enrollee (hybrid)

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

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

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

Figure 6. IND-GEN - Selecting Individual's Enrollment/Employment Status

Select Individual's Enrollment / Employment Status: Select each individual's enrollment or employment status in the program by clicking on the drop-down menu under Block 3 and choosing one of the following options:

Full-time
Both Full-time and Part-time
Part-time
On leave of absence

IND-GEN - Selecting Individuals Sex

Select Individual's Sex
(5a)

Figure 7. 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 8. IND-GEN - Entering Year of Birth

Enter Year of Birth: Select each individual’s year of birth in the dropdown menu 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 9. IND-GEN - Selecting Individual's Ethnicity

Select Individual's Ethnicity: Select each individual'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 10. 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 11. IND-GEN - Selecting if Individual is from a Rural Residential Background

Select Whether Individual is from a Rural Residential Background: Select whether each individual is from a rural residential background by clicking on the drop-down menu under 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 12. IND-GEN - Selecting if Individual is from a Disadvantaged Background

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

Yes
No
Not Reported

Note
This Block will prepopulate for prior records with data submitted in the previous reporting period. 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 13. IND-GEN - Selecting Individual's Veteran Status

Select Individual's Veteran Status: Select each individual's 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

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?	Stipend	Academic Year Total (Auto-Populates)
(12) Block 11	(13) Block 11	(21b) Block 11

Figure 14. IND-GEN - Entering BHW-Funded Financial Award Information

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

Enter Individual's Financial Award Amount (BHW funds only): Stipend: If the individual is a student, faculty, or community provider and received a BHW-funded stipend, enter the total amount of BHW dollars provided during the annual reporting period in the textbox under the column labeled "Stipend". Total amount reported should account for all BHW dollars including those applied to salary, fringe benefits, travel expenses, conference expenses, tuition, fees, books, and reasonable living expenses, as allowed by federal statutes and regulations (do not report salary or fringe benefits for faculty).
If the individual did not receive a stipend, enter "0" in the textbox.Enter Individual's Financial Award Amount (BHW funds only): Academic Year Total:

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 15. 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:

0
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 an individual has received money for ½ an academic year, please round up. For example, if a student or faculty member has received a financial award for 1 ½ years, please enter 2.

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

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

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

Figure 16. 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:

Graduate Year 1
Graduate Year 2
Graduate Year 3

Note
For students, use Undergraduate or Graduate Year. For Practicing Professionals (community providers participating in faculty development), use Non-degree Training Program Year 1 or Year 2.

IND-GEN - Selecting Profession and Discipline/Specialty

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

Figure 17. 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.

Physician Assistant - Student

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.

Physician Assistant

IND-GEN - Selecting Training in Interprofessional Education and/or Practice

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

Training in Interprofessional Education and/or Practice
Select Whether Individual Received Training
(27a) Block 16

Figure 18. IND-GEN - Selecting Training in Interprofessional Education and/or Practice

Training in Interprofessional Education and/or Practice: Select Whether Individual Received Training:

Select whether each individual received experiential training in interprofessional education and/or practice during the annual reporting period by clicking on the drop-down menu under Column 27a and choosing one of the following options:

IND-GEN - Entering Telehealth Training Information

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

Figure 19. 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.

Training in Telehealth: Enter # of Patient Encounters:

If the individual received clinical or experiential training in Telehealth, enter the number of telehealth patient encounters in this setting during the current reporting period in Column 27f.
If the individual did not receive clinical or experiential training in Telehealth, leave the textbox in Column 27f 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	Training in a Primary Care Setting
Select Whether Individual Received Training	Enter # of Contact Hours	Enter # of Patient Encounters
(28) Block 17	(29) Block 17a	(30) Block 17b

Figure 20. IND-GEN - Entering Training Information in a Primary Care Setting

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

Training in a Primary Care Setting: Enter # of Contact Hours: If the student received clinical or experiential training in a primary care setting, enter the total number of hours spent in this type of setting during the annual reporting period in the textbox under Block 17a.
If the student did not receive clinical or experiential training in a primary care setting, leave the textbox under Block 17a blank.Training in a Primary Care Setting: Enter # of Patient Encounters: If the student received clinical or experiential training in a primary care setting, enter the total number of patient encounters in this type of setting during the annual reporting period in the textbox under Block 17b.
If the student did not receive clinical or experiential training in a primary care setting, leave the textbox under Block 17b blank.

Warning
Select "N/A" in the drop-down menu under Block 17 for faculty.

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	Training in a Medically Underserved Community
Select Whether Individual Received Training	Enter # of Contact Hours	Enter # of Patient Encounters
(31) Block 18	(32) Block 18a	(32a) Block 19

Figure 21. 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.

Training in a Medically Underserved Community: Enter # of Patient Encounters :

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

Figure 22. 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.

Training in a Rural Area: Enter # of Patient Encounters:

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

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

Figure 23. IND-GEN - Selecting Whether Individual Left the Program Before Completion

Select Whether Individual Left the Program Before Completion: Select whether each individual permanently left their degree program or faculty development program before completion during the annual reporting period by clicking on the drop-down menu under 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 Degree Earned	Select Individual's Post-Graduation/Completion Intentions
(37) Block 22	(38) Block 22a	(39) Block 22b

Figure 24. 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 Degree Earned:

Master's Degree Not Otherwise Specified
MCHS
MCMSc
MHS
MMS
MMSc-PA
MPA
MPAP
MPAS
MS
MSHS
MSM
MSPA
MSPAS
MSPS
No Degree Earned
N/A

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

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 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 25. 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 26. 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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Program Manual

Primary Care Training and Enhancement: Physician Assistant Rural Training in Mental and Behav. Hlth

IND-GEN: Individual Characteristics

IND-GEN - Setup

IND-GEN - Setup

IND-GEN - Excel Upload (Optional)

IND-GEN - Excel Upload (Optional)

IND-GEN - Selecting Type of Training Program

IND-GEN - Selecting Type of Training Program

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 Training in Interprofessional Education and/or Practice

IND-GEN - Selecting Training in Interprofessional Education and/or Practice

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 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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