OMB ANEW Program Specific Data Tables Renewal Package_tracked changes

Bureau of Health Workforce

Division of Nursing and Public Health

Advanced Nursing Education Workforce (ANEW) Program

Program Specific Data Forms – OMB Renewal

Funding Opportunity Announcement

Effective Fiscal Year 2018

Janice B. Young, PhD, MPH, RN

Nurse Consultant, Division of Nursing and Public Health

Phone 301-443-6739

Email: [email protected]

ANEW Program Specific Data Forms

As part of the application submitted through the Grants.gov, applicants must also complete and electronically submit the ANEW Program Specific Data Forms. The ANEW Program Specific Data are essential in determining the traineeship monetary award, the statutory funding preference, and the special consideration. The ANEW Tables are part of the Grants.gov application package.

Copies of the ANEW Program Specific Data Forms are included in the appendix for your reference. The tables must be completed electronically as part of the ANEW application package.

Appendix A

LIST OF ANEW ATTACHMENTS AND ANEW PROGRAM SPECIFIC DATA FORMS

ANEW Program Specific OMB Approved Data Collection Forms and Instructions

Table 1 - ANEW: Graduate Data – Rural, Underserved, or Public Health Practice Settings

Table 2- ANEW Enrollment, Traineeship Support Projected Data

Applicants must adhere to the table instructions to ensure that the data provided are accurate and complete. Schools are encouraged to consult with Program Staff for technical assistance prior to submitting the grant application.

Table 1 - ANEW: Rural, Underserved, and/or Public Health Practice Settings Data

Graduate Data from 7/01/201X to 6/30/201X

Practice Settings	PC-NP	PNMCCNS	NMW CertificateNMW	CRNA NMW Master’s	Grand Total
Community Health Centers
Migrant Health Centers
Health Care for the Homeless Grantees
Rural Health Clinics
National Health Service Corps Sites
Indian Health Service / Tribal Health Sites
Federally Qualified Health Centers
State or Local Health Departments
Ambulatory Practice Sites Designated by State Governors
Health Professional Shortage Areas (HPSAs)
Rural Populations / Settings
Medically Underserved Populations / Settings
1. Total Number of Graduates Employed in these Settings (from 07/01/201X – 06/30/201X)
2. Total Number of Graduates (from 07/01/201X – 06/30/201X)
3. Percentage of Graduates Employed in these Settings (SFP) (Number 1 divided by Number 2)
Health Professional Shortage Areas
4. Percentage of Graduates Employed in HPSAs (SPC) Total Number of Graduates Employed in HPSAs divided by Total Number of Graduates (from 07/01/201X-06/30/201X)

Post Nursing Master’s Certificate students who complete all program requirements are recognized as graduates.

Instructions for Completing Table 1A - ANEW: Rural, Underserved, and/or Public Health Practice Settings & HPSA Data - Graduate Data from 7/01/201X to 6/30/201X

In order to be eligible for the Funding Preference and/or the Special Consideration, applicants must complete Table 1.

Data on Table 1 should reflect graduate totals for nurse practitioners (NP), clinical nurse specialists (CNS), nurse-midwives (NMW) and certified registered nurse anesthetists (CRNA) the Master’s and Post Nursing Master’s Certificate Primary Care Nurse Practitioner, Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, and Nurse-Midwifery Post-BSN to Doctoral students who completed program/degree requirements between 07/01/201X and 6/30/201X.

Complete Table 1, as appropriate, providing data on the number of graduates in academic year 7/1/201X-6/30/201X who spend at least 50 percent of their employment in clinical practice sites substantially benefiting rural or medically underserved populations, or in State or local health departments. Each graduate is to be counted only once. Table 1 is used to determine if the institution meets the Statutory Funding Preference and also used to determine if the institution meets the Special Consideration.

In the “Total Number of Graduates Employed in These Settings” row, the system will automatically calculate the total number of graduates per specialty employed in these settings. The grand total will be system generated. This is a subset of “Total Number of Graduates”.

In the “Total Number of Graduates” row, enter the total number of graduates who completed degree requirements between 7/01/201X and 6/30/201X in the appropriate column. Enter the grand total: The Grand Total will be system generated. Numbers omitted in this row of Table 1 will not be counted.

In the “Percentage of Graduates Employed in these Settings” row, the system will automatically calculate this figure.  Percentage of Graduates Employed in these Settings = Total Number of Graduates Employed in these Settings (from 07/01/201X– 06/30/201X) divided by Total Number of Graduates (from 07/01/201X – 06/30/201X).

In the “Percentage of Graduates Employed in HPSAs” row, the system will automatically calculate this figure.  Percentage of Graduates Employed in HPSA’s = Total Number of graduates employed in HPSAs divided by Total Number of Graduates (from 07/01/201X-06/30/201X).

Table 1B - ANEW: - Rural, Underserved, or Public Health Practice Settings Data

Graduates Supported by Traineeship from 7/01/201X to 6/30/201X

Practice Settings	PC-NP	PNMC	NMW Certificate	NMW Master’s	NMW Post- BSN to Doctoral	Grand Total
Community Health Centers
Migrant Health Centers
Health Care for the Homeless Grantees
Rural Health Clinics
National Health Service Corps Sites
Indian Health Service / Tribal Health Sites
Federally Qualified Health Centers
State or Local Health Departments
Ambulatory Practice Sites Designated by State Governors
Health Professional Shortage Areas (HPSAs)
Rural Populations / Settings
Underserved Populations / Settings
1. Total Number of Graduates Supported by Traineeship Employed in these settings (from 07/01/201X – 06/30/201X)
2. Total Number of Graduates (from 07/01/201X – 06/30/201X)
3. Percentage of Graduates Supported by Traineeship Employed in these Settings (Number 1 divided by Number 2)
4. Percentage of Graduates Supported by Traineeship Employed in HPSAs (Total Number of HPSAs divided by Total Number of Graduates from 07/01/201X- 06/30/201X)

Instructions for Completing Table 1B – ANEW: Rural, Underserved, or Public Health Practice Settings Data - Graduates Supported by Traineeship from 7/01/201X to 6/30/201X

Data on Table 1B should reflect graduates supported by ANEW traineeship totals for the Master’s and Post-Nursing Master’s Certificate Primary Care Nurse Practitioner, Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, and Nurse-Midwifery Post-BSN to Doctoral students who completed program/degree requirements and were supported by the ANEW Program between 07/01/201X and 6/30/201X.

Complete Table 1B, as appropriate, providing data on the number of graduates supported by traineeship in academic year 7/1/201X-6/30/201X who spend at least 50 percent of their employment in clinical practice sites substantially benefiting rural or underserved populations, or in State or local health departments. Each graduate is to be counted only once. Table 1B is for data analysis and reporting; thus, all applicant institutions must complete Table 1B.

In the “Total Number of Graduates Supported by Traineeship Employed in these Settings (from 07/01/201X to 06/30/201X)” row, the system will automatically calculate the total number of graduates who received traineeship support and completed degree requirements between 7/01/201X and 6/30/201X and worked in the identified setting. The Grand Total will be system generated. This is a subset of “Total Number of Graduates”.

In the “Total Number of Graduates (from 07/01/201X-06/30/201X)” row, the system will prepopulate data entered on Table 1A.

In the “Percentage of Graduates Supported by Traineeship Employed in these Settings” row, the system will automatically calculate this figure.  Percentage of Graduates Supported by Traineeship Employed in these Settings = Total Number of Graduates Supported by Traineeship Employed in these Settings (from 07/01/201X – 06/30/201X) divided by Total Number of Graduates (from 07/01/201X – 06/30/201X).

In the “Percentage of Graduates Supported by Traineeship Employed in HPSAs” row, the system will automatically calculate this figure.  Percentage of Graduates Supported by Traineeship Employed in HPSAs = Total Number of HPSAs divided by Total Number of Graduates (from 07/01/201X-06/30/201X).Table 2A:  Projected Master’s and/or Doctoral Degree and Post Nursing Master’s Certificate Data

TRAINEESHIP DATA	NURSE PRACTITIONER		NURSE-MIDWIFERYCLINICAL NURSE SPECIALIST		NURSE-MIDWIFE			CERTIFIED REGISTERED NURSE ANESTHETIST
	FT	PT	FT	PT	FT	PT		FT	PT
Total # of Master’s Degree Students Projected to Receive Traineeship – Support in Budget Year 1
Total # of Master’s Degree Students Projected to Receive Traineeship – Support in Budget Year 2
Total # of Master’s Degree Students Projected to Receive Traineeship – Support in Budget Year 3
Total # of Master’s Degree Students Projected to Receive Traineeship – Support in Budget Year 4
Total # of Post Nursing Master’s Certificate Students Projected to Receive Traineeship Support in Budget Year 1
Total # of Post Nursing Master’s Certificate Students Projected to Receive Traineeship Support in Budget Year 2
Total # of Doctoral Degree Students Projected to Receive Traineeship – Support in Budget Year 1
Total # of Doctoral Degree Students Projected to Receive Traineeship – Support in Budget Year 2
Total # of Doctoral Degree Students Projected to Receive Traineeship – Support in Budget Year 3
Total # of Doctoral Degree Students Projected to Receive Traineeship – Support in Budget Year 4

Instructions for Completing ANEW Table 2: Projected Master’s and/or Doctoral Degree Data

• Enter the total number of Master’s and Doctoral Degree students projected to receive traineeship support in Budget Years 1 (July 1, 201X to June 30, 201X), 2, and 3 as appropriate by their enrollment status (FT or PT) and their specialty role.

• If the ANEW FOA is a two-year funding opportunity, please indicate “N/A” for Budget Year 3.

HRSA-17-067 OMB ANEW Program Specific Data Forms Package.