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HRSA Electronic Handbooks

Primary Care Training and Enhancement: Physician Assistant Rural Training Program

  • Health Resources and Services Administration
  • Academic Year: 2022-2023
  • Bureau of Health Workforce
  • OMB Number: 0915-0061
  • Annual Performance Report
  • OMB Expiration Date: 01/31/2025

IND-GEN: Individual Characteristics

The IND-GEN form captures individual-level information about students, faculty, or other types of awardees who either received direct financial support (e.g., loans, loan repayment, scholarships, or stipends) through a HRSA grant or participated in specific types of HRSA-supported training. Please complete this form in its entirety. If you have any questions about how to complete this form, please refer to the instruction manual and/or contact your Government Project Officer. If you wish to view data that were submitted in the prior reporting period, click on the ‘View Prior Period Data’ link and a read-only version of your most recent prior performance report will pop-up in a new screen. Also, records about ongoing training programs or activities from the prior reporting period will auto-populate into this form and are identified as ‘Prior Records’ under the column labeled "Record Status".

Do you have either a) new trainees OR b) updates to provide for trainees from a previous reporting period?
(complete IND-GEN)(click Save and Validate button to proceed to the next form)
No.Record StatusType of Training Program
Trainee Unique ID
Block 1
NPI Number
Select Individual's Training or Awardee Category
Block 2
Select Individual's Enrollment / Employment Status
Block 3
Select Individual's Gender(s)
Enter Year of Birth
Select Individual's Ethnicity
Block 6
Select Individual's Race
Block 7
Select Whether Individual is from a Rural Residential Background
Block 8
Select Whether Individual is from a Disadvantaged Background
Block 9
Select Individual's Veteran Status
Block 10
Select Whether Individual Received BHW Financial Award?
Block 11
Enter Individual's Financial Award Amount (BHW funds only)Enter # of Academic Years the Individual has Received BHW Funding
Block 12
Select Individual's Academic or Training Year
Block 15
Select any HHS Priority Topic Area on which an Individual Received Training
Block 15
Select Individual's Profession
Select Individual's Primary Discipline/Specialty
Training in TelehealthTraining in a Primary Care SettingTraining in a Medically Underserved CommunityTraining in a Rural AreaSelect Whether Individual Left the Program Before Completion
Block 21
Select Whether Individual Graduated/Completed the Program
Block 22
Select Degree Earned
Block 22a
Select Individual's Post-Graduation/Completion Intentions
Block 22b
Select whether Employment Data is available?
Select Whether Your Organization Hired this Individual
Select Whether a Partner Organization Hired this Individual
Enter Zip Code
Select Type of Employment
Select Individual's Employment Location Settings
Block 11
Academic Year Total
Block 11
Select Whether Individual Received Training
Enter # of Contact Hours
Enter # of Patient Encounters
Select Whether Individual Received Training
Block 17
Enter # of Contact Hours
Block 17a
Enter # of Patient Encounters
Block 17b
Select Whether Individual Received Training
Block 18
Enter # of Contact Hours
Block 18a
Enter # of Patient Encounters
Block 19
Select Whether Individual Received Training
Block 19
Enter # of Contact Hours
Block 19a
Enter # of Patient Encounters
Block 19
Page Total
Form Total

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