Area Health Education Centers

Health Resources and Services Administration
Academic Year: 2023-2024

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?:

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)

Warning
Do not modify the format. For example: renaming the columns, deleting columns, or renaming worksheets. Users must download and use the file from EHB. The system will not upload/process a different format.

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

Warning
If you edit your INDGEN data in EHB, you must click the “Generate Template with most recent INDGEN data’ button before downloading the template. If you fail to do so, your Excel template will not reflect the changes you made and may cause issues when you upload/process your data.

You can generate and download the Excel template to enter the trainee information on the INDGEN form. Use of the Excel template is optional. If you plan to use it, please read the instructions carefully.

You can generate the Excel template by clicking the ‘Generate Template with most recent INDGEN data’ button.
You can download the Excel template by clicking the ‘Download Template’ button.
After downloading the file, save the INDGEN template on your local computer. To save in a particular location, click the arrow next to the Save button and select the Save As option.
Then you can enter the data in the Excel Template file. After completing the file, click the Browse button to locate your completed INDGEN form on the computer. If applicable, add a description in the textbox field. Click the Upload button to attach the completed INDGEN form.
Click on the ‘Process Data’ button to view the INDGEN data on your screen.
You can add or modify the data within EHB once it is uploaded. Note that the system will check for errors and prompt you to fix them before you can save and validate the form.

Types of Data Fields:

Data Entry fields – For these fields, users can copy/paste allowable values and/or enter valid data in the cell or in the formula bar (if required) – e.g., Trainee Unique ID.
Single-Select dropdown fields – For these 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 – e.g., Select Individual’s Training or Awardee Category.
Multi-Select dropdown fields – For these 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 – e.g., Select Individual’s Race. Please do not try to enter data into the cell or 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 page. Gray cells are not editable. If new rows are added in the IND-GEN form, the Record Status, City, and State columns remain non-editable and empty (see below for additional details).
To enter a new record, users should start on the next blank row, select the ‘Type of Training Program’, and enter the ‘Trainee Unique ID’. 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 EHB.
Training programs with at least one active Fellowship Program, Major Participating Site/Rotation Site, or Residency Program will be populated in the ‘Type of Training Program’ dropdown list in the IND-GEN. The list is derived from the Training Program – Setup form.
The City and State columns are not editable and will remain empty even if the user enters the Zip Code. Once the template is uploaded and processed, as long as a valid Zip Code is provided, the City and State will be populated in EHB.

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 concatenated 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.
Validations will fire:

When a required field is missing,
When there is a conditional validation on two or more columns,
When a pre-set selection option cannot be combined with other pre-set options (specifically for multi-select fields), and
When the value of the cell is changed (i.e., a different selection value is selected, the data is deleted, or the text field does not match the data type).

When a validation fires, the user can correct the field or leave it as is. Users can still upload the template into EHB and fix any remaining validation errors in EHB as long as data has been selected/entered in Column 1 and Column 2.

Uploading the Excel File in EHB:

Once you have completed the Excel file:

Log into HRSA EHB,
Access the Annual Performance Report,
Navigate to the INDGEN form,
Click the "Attach File" button,
Select the completed INDGEN template,
Upload your Excel file
Click the ‘Process Data’ button, and
Confirm that the data transferred successfully, enter missing fields, and fix validation errors.

Note
Once the excel template has been processed in EHBs, the row numbers in EHBs will not match the row numbers in the excel template.

Note
Please see the new INDGEN Excel Upload Tutorial Video for more information.

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:

Select each individual's training program by clicking on the drop-down menu 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 column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted.

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 - 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 individual’s training category by clicking on the drop-down menu in Column 3 (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 previous reporting periods.

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 individual’s current enrollment or employment status by clicking on the drop-down menu in Column 4 (Block 3) and choosing one of the following options:

Full-time
Part-time
Inactive

IND-GEN - Selecting Individuals Gender

Select Individual's Gender(s)
(5a)

Figure 6. IND-GEN - Selecting Individuals Gender

Select Individual's Gender(s): Select the gender option(s) that apply to each individual by clicking on the drop-down menu under column 5a and choosing all that apply:

Female
Male
Transgender or non-binary or another gender
Not reported

Warning
The 'Not Reported' option may not be selected for prior records.

Warning
'Not Reported' cannot be selected in combination with any other options under column 5a.

IND-GEN - Entering Year of Birth

Enter Year of Birth
(6a)

Figure 7. 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 8. IND-GEN - Selecting Individual's Ethnicity

Select Individual's Ethnicity: Select each individual’s ethnicity by clicking on the drop-down menu in Column 7 (Block 6) and choosing one of the following options:

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

Note
This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted.

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 in Column 8 (Block 7) and choosing all that apply from the following options. You may select more than one option for individuals of multiple races:

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
The 'Not Reported' option may not be selected for prior records.

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 APR.

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 individual is from a rural residential background by clicking on the drop-down menu in 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 individual is from a disadvantaged background by clicking on the drop-down menu in Column 10 (Block 9) and choosing one of the following options:

Yes
No
Not Reported

Note
This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted.

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 individual's current veteran status by clicking on the drop-down menu in Column 11 (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?	Direct Financial Support	Academic Year Total (Auto-Populates)
(12) Block 11	(20a) 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 student 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): Direct Financial Support:

If the individual did receive a direct BHW-funded financial award, enter the total amount of BHW dollars provided during the current reporting period in the textbox in Column 20a.
If the individual did not receive a direct BHW-funded financial award, enter ""0"" in the textbox in Column 20a.

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 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:

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 resident or dentist has received a financial award for 1 ½ years, please enter 2.

Note
If an individual 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 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:

1
2
3
4
5 or more

IND-GEN - Selecting Topic Area(s) on which Individual was Trained

Select Topic Area(s) on which Individual was Trained
(26a) Block 15

Figure 16. IND-GEN - Selecting Topic Area(s) on which Individual was Trained

Select Topic Area(s) on which Individual was Trained: Use the dropdown menu in Column 26a to select all that apply from the list of topic areas on which the individual was trained.

Behavioral Health Integration
Cultural Competency
Current and Emerging Health Issues
Interprofessional Education
Practice Transformation
Social Determinants of Health
Supporting Health Professionals
Virtual Learning and Telehealth

IND-GEN - Selecting any HHS Priority Topic Area on which an Individual Received Training

Select any HHS Priority Topic Area on which an Individual Received Training
(26b) Block 15

Figure 17. IND-GEN - Selecting any HHS Priority Topic Area on which an Individual Received Training

Select any HHS Priority Topic Area on which an Individual Received Training: Use the dropdown menu in Column 26b to select all that apply from the list of topic areas on which the individual was trained.

Individual received provider resilience training
Individual received training in Health Equity
Individual received training in medications for opioid use disorder (MOUD)
Individual received training in substance use treatment
Individual received training on integrated behavioral health in primary care
Individual received training related to maternal health
None of the above

IND-GEN - Selecting Profession and Discipline/Specialty

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

Figure 18. 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 - Student
Behavioral Health - Student
Dentistry - Student
Medicine
Medicine - Student
Nursing - Student
Other - Student
Paraprofessional - Student
Physician Assistant - Student
Public Health - 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.

ALLIED HEALTH OPTIONS (please select)
Audiology
Certified Nursing Assistant
Community Health Worker
Dental Assistant
Dental Hygiene
Dental Hygiene/Public Health
Dental Therapy
EMT/Paramedic
Home Health Aide
Medical Assistant
Midwife (non-nurse)
Nurse Assistant/Patient Care Associate
Nutritionist/Dietician
Occupational Therapy
Pharmacy Aide/Technician
Phlebotomy Technician
Physical Therapy
Rehabilitation 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
School Counseling
School Psychology
School Social Work
DENTAL SCHOOL OPTIONS (please select)
Dental School
MEDICAL OPTIONS (please select)
Family Medicine
Internal Medicine
Pediatrics
MEDICAL SCHOOL OPTION (please select)
Medical School
NURSING OPTIONS (please select)
Clinical Nurse Specialist (CNS)
Community Health Nursing
Licensed Practical/Vocational Nurse (LPN/LVN)
Nurse Educator
Nurse Midwife
Nurse Practitioner (NP)
Registered Nurse (RN)
OTHER OPTIONS (please select)
Exercise Physiology
Pharmacy
PARAPROFESSIONAL OPTIONS (please select)
Behavioral Health Technician/Aide
Mental Health Worker
Substance Use/Addictions Worker
PHYSICIAN ASSISTANT OPTION (please select)
Physician Assistant
PUBLIC HEALTH OPTIONS (please select)
Biostatistics
Disease Prevention/Health Promotion
Environmental Health
Epidemiology
Health Administration
Health Education
Health Policy/Management
Infectious Disease Control
Injury Control/Prevention
Maternal/Child Health
Social/Behavioral Sciences

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	Training in Interprofessional Education and/or Practice
Select Whether Individual Received Training	Enter # of Contact Hours
(27a) Block 16	(27b) Block 16

Figure 19. 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:

Training in Interprofessional Education and/or Practice: Enter # of Contact Hours: If the individual received clinical or experiential training in interprofessional education/practice, enter the total number of hours spent in this type of setting during the current reporting period in the textbox in Column 27b.

If the individual did not receive clinical or experiential training in interprofessional education/practice, leave the textbox in Column 27b blank.

IND-GEN - Entering Telehealth Training Information

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

Figure 20. 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 21. IND-GEN - Entering Training Information in a Primary Care Setting

Training in a Primary Care Setting: Select Whether Individual Received Training: Select whether each individual 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 22. 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 23. 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 Student Services Information

Student Services	Student Services
Select Social Support services used by Trainee	Select Academic Support services used by Trainee
(34a)	(34b)

Figure 24. IND-GEN - Selecting Student Services Information

Student Services: Select Social Support services used by Trainee: Select whether each trainee used social support services by clicking on the drop-down menu under Column 34a and choosing all that apply from the following options:

Faculty or staff led counseling sessions
Other social support services
Peer support advisors
Peer support groups
Service learning opportunities
None of the above

Student Services: Select Academic Support services used by Trainee: Select whether each trainee used academic support services by clicking on the drop-down menu under Column 34b and choosing all that apply from the following options:

Academic coaching
Academic support program
Faculty or staff led advising sessions
Group tutoring
Individual tutoring
Study skills training
Time management training
Other academic support service
None of the above

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

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

Figure 25. 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 training program before completion during the current reporting period by clicking on the drop-down menu in Column 36 (Block 21) and choosing one of the following options:

IND-GEN - Selecting Reason for Attrition or Inactive Status

Select Reason for Attrition or Inactive Status
(36a)

Figure 26. IND-GEN - Selecting Reason for Attrition or Inactive Status

Select Reason for Attrition or Inactive Status: Select the primary reason each individual discontinued participation by clicking on the drop-down menu under Column 36a and choosing one of the following options:

Academic withdrawal
Administrative Error
Change in major
Discontinuous year in training program
Emotional/physical/mental exhaustion (burnout)
Failure to meet program requirements
Family obligations
Financial obligations
Medical leave of absence
Military/Active duty
Too much time commitment/academic overload
Transfer to another institution
Transportation difficulties
Other
None of the Above
N/A

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 27. 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:

AA
AS
BA
Bachelor's Degree not otherwise specified
BPH
BS
BSW
Certificate
DC
DDS
DDS/MPH
DDS/MSPH
DMD
DNAP
DNP
DNSc
DO
DO/DrPH
DO/MPH
DO/MSPH
DO/ScD
DPT
DrPH
DVM
EdD
MA
Master's Degree Not Otherwise Specified
MD
MD/DrPH
MD/MPH
MD/MSPH
MD/PhD
MD/ScD
MEd
MHA
MMS
MMS/DrPH
MMS/MPH
MMS/MSPH
MMS/ScD
MPAS
MPAS/DrPH
MPAS/MPH
MPAS/MSPH
MPAS/ScD
MPH
MS
MS-CTS
MSCR
MSOT
MSPH
MSSW
MSW
PharmD
PhD
Post-Masters Certificate
PsyD
ScD
VMD
Other
N/A

Select Individual's Post-Graduation/Completion Intentions:

Individual has applied to a residency program
Individual intends to apply for NHSC Loan Repayment
Individual intends to become employed or pursue further training in a medically underserved community
Individual intends to become employed or pursue further training in a primary care setting
Individual intends to become employed or pursue further training in a rural setting
None of the above
Not Reported
N/A

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 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: Employment City (Column 58) will auto-populate based on Employment Location Zip Code (Column 57).
Enter State: Employment State (Column 59) will auto-populate based on Employment Location Zip Code (Column 57).
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 - 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 - 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 Gender

IND-GEN - Selecting Individuals Gender

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 Topic Area(s) on which Individual was Trained

IND-GEN - Selecting Topic Area(s) on which Individual was Trained

IND-GEN - Selecting any HHS Priority Topic Area on which an Individual Received Training

IND-GEN - Selecting any HHS Priority Topic Area on which an Individual Received Training

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 Student Services Information

IND-GEN - Selecting Student Services Information

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

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

IND-GEN - Selecting Reason for Attrition or Inactive Status

IND-GEN - Selecting Reason for Attrition or Inactive Status

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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