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APPENDIX A NATIONAL RESEARCH SERVICE AWARD AUTHORITY A. l: Pub' ic Law 93-348, as Amended A.2: Public Law 95 -622 A. 3: Legislative History \

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A. 1 RATIONAL RESEARCH SERVICE AWARD AUTHORI] Y Public Law 93-348, as Unended winnows =8~Cn sR"cz two SECO 1` 2. (a) ( 1) The Secretary shall 2J9t'~c. (A) provide Nations] Reseal Seduce Awards for- (i) biomedica3 and behavioral research a2 the National Institutes of Health and the Alcohol9 Drug Abuses and Ifental Health Administre- tion or under pronouns administered by the Division of Nursing of the Health Resources Administration. in matters relating to th C8USeG diagnosis. preventions and treatn~ent of the diseases or other health problems or Division of Nursing. (~) training at the Institutes and .tdm~nis- tration of mSi`-iduals to ~deHake such re search9 (iii) biomedical and behavioral research at public institutions and at nonprofit prig ate in- stitutions, and (iv) prep and post doctoral training at such public and private institutions of individuals to undertal~e such research; and (B) make ~ant' to public Notions and to nonprofit private Angst Studious ~ enable such in- stitutions to make to individuals selected by them ationa1 Research Service Awards for research (and training to undertake such research) in the matters described in subparagraph (ok) (i). .\ reference in this subsection to the ~ ational Institutes of Health or the Alcohol Drug Muse, and )lental Hesith Administration shall ~ considered to include the insti- tutes, divisions, ant} bureaus included in the Institutes or under the Administrations as the case may be. (I) ~'ational Research Service Award may not be used to SUDDOr~ residencies. ~ . . . , . (3) E de, tile .TulY 1~197o, National Research Semce .Awards ma, be made for research or research training in only those subject areas for which, as determined under section ~ ~ 3. them is a need for personnel. (~1) No National Research Service Award may be made be,- the S:ecretan to an' in`1i`-idual Inlet (ok) the India idual has submitted to the Secretary an application therefor end the Secretary has ap- pro~ ed the application; (B) the India pro`-ides, in such form and manner us the Secretory shin by reran pre- scribe. assurances satisfactory to the Secretary that the individual will meet the senice requirement of subsection (c) ~ t ); and (C) in the case of a ~'ationa] Research Service Award for a purpose described is subsection (a>~1) (A) (iii) or ta) (~) (A) (~` ), the indi`-idual has bun sponsored (in such manner ~ the Secretary may by .0~2~0.n-V-L~.u 80

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(ii) if authorized under subpare~aph (8)., serve as ~ member of the hationst Health Sernce Corps or serf e in his specialty, or (iii ~ if authorized under subparagraph (C), serve a h"I~ related activity approved under that sum PI, for a period computed ~ amordanec with paragraph (B) Any individual who received a National Research Service Award and who is a physician, dentist, nurse, or other India idua] trained to provide health care directly to ind.ividual patients ma'-, upon application to the Ssc- retar,, be authorized by the Secretary tom (i, serve as ~ member of ibe ~'ational Health . .. ~ _ A ~ Sernce Corps' < ~ . . ~ (id) se we in his specialty' in private practice In geographic area designated by the Secrete., as te- quiring that specialty, or (iii) provides serf ices ibis specialty for a health maintenance organization to which payments ma, made under section 18~6 of title XNJIll of the Social Security Act and which serves a Medicaid underser~ed population (as defined In section 1302 (7) of this Act ), in lieu of engaging in health research or teaching if the Secretary determines that there are no suitable health "search or teaching positions available to such indiv~clual. (C) Where appropriate the Secretary ma`, upon application, authorize a recipient of a 'atonal Research Service .4~ward. who is not trained to provide health care direct]` to indi, idua2 patients. to engage in a health- related acti, it, in lieu of engaging in fie-~Ith research or teaching if the Secret are dete`.~nes that there are no suitable health research or teaching positions available to such ind~ividual. (~) For each near for which an individual r~ives National Research Service Award he shall- (A) for twelve months engage in health reseal or teaching or any combination thereof which is in accordance with the `2sual patterns of academic em- plo~ment. or, if so authorized. serve as ~ member of the National Health Service Corps or (B) if authorized under paragraph (1) (8) or (S) (C)' for twenty months serve us his specialty or engage in a healt}i-related activity. (3) The requirement of paragraph (1) shall be com- plied with by ant individual to whom it applies within such reasonable period of time, after the completion of such India idusl's .\warci, as the Secretsr, shall by regu- lation prescribe. The tSecretarv shall (A) by regulation ptexn~be (i) the type of research and teaching which an 81 t

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i i ! 1 I e~lotion Squire) ~ the institution ~ Chid the arch or training under the Ward ail conducted. ~ "ppli~tion for ~ Award ~aI1 ~ in =~ ~~, sum mated in such m~er$ and contain such ~~stion Me cry ma ~ ablation pocky (2) ye a=~ of National Ranch Seance Award tytbeSk~r~ - u~dersubse~ion (~)and Be ma~ngof gibbons for such ~ wards sb~U be sulky ~ ~ ash and pprovalb~tbe~ppropri~te.~sor~councUs witkinthe epa~mept pf Besltb, Education and V[dfa~ (~) =~ ~C~1- ~ ate ~ the ah ort~ining under 4, A=.rds,or (B) fit Flab such n~srch or cs~b~g (3) No g ant ma be mods under subsection (~1~(B) unless on applkation tbere~rhes ban subs flatted to and app=ved lathe Secretary Such ~ppllce. honspaD beinsucb fonn~submitted iD such manner,ond cont.= suchinfonm~tionlastbe Sec~t.'y mar by regu. lotion pr~cribe.Subiettothe prodsionsoftEissection other than paragraph (1) of this subsection, ~itiona1 Re~a=h Serv~e Awards madeunderagT'"tundersu~ action (s)(l)(B)sheU be made ~ accordance withsucb gulations~sthsS=retaryshallpre~hLe (4) The period of gnu Nadonal R ~ ar:b Service Awerdmadeto.~.~BuaIundersu~tioD (a) ask ~_~ tray forgood cage sbown Bang die ppUc~donofibe tbr--,e~rlUn~tosueb ~ ~ gradual (3) Natipn.I Recomb Service Awardssh.D pm aide for!ucb appends and aBowance (l~cludingtraveIand su~tenceexpenesand dependenc''Dowances) Robe n~lplents of the Awards as the Secretary may deem neck. ~ National ~~arcb Serbia Agog made to an 1~d~idusl far arch or rewash timing at ~ noo- Fed-1 public or nonprofit private incaution shall ago provide for patent to ~ made to the insUtution for Me ant Of support Grace (includlag the ~ of Scuba Eke Upped equipment Anew ee.=b Spew. find related items) provided sum individual ~ such auk. we groat of any such payment to any- b~Ututiondballbedetermined bytheS~creta~yandstall Beak ~ pin~trelationship totbe ~ssonablecos~ oftbe ns!"utl~n fo!establisbing and Maytag Bathe quality ogle Come and behaviora1 no and training programs. (c)(l)(A) Each i~vidua1 -ho have ~ 3ition.1 Beneath Sara ~ A=.rdsh~lt ~ accordance with par.- gr~ph(3~1engageb-- (i) health e esehorteschingoranvoomblnstion thereof which ~ in accordant Dab Gsu'1 patrons of acedendc emplq~en4 82

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~ - mdividu~ may nonage in to comply with such requim- ment, and (ii) mcl other requirements respecting such research and teaching and alternative service authorized under paragraph ( 1 ? ( B ' and ~ 1 } t C ) as he deems neces- sary; and (B) to the extent feasible, promise that the members of the National Health Service Corps "ho arc serving in the Corps to meet the requirement, of para- graph ~ ~ ~ shall be assigned to patient care and to posi- tions which utile the clinical twining "d esper~enca of the members. (~) (A) If any ~s~dividua] to whom the requirement of paragraph (1) is applicshie fails, withm tic pe nod pro scribed by paragraph (3), to comply with such require meet, the United States sksI] be entitled to recover from such individual an amount determined ~ accordance with the formula- ,{=~~~) in which "A" is the amount the Indited States Is entitled to recover; "a" is the sum of the total amount paid under one or more >'stional Research Sentence Award to sum individual; "t" is the total number of months ~ such indi~ids:al's service obligation; and-s~ is the number of months of such obligation served by him in accordance with paragraphs (1) and (2) of this subsection ~ (B) ~y amount which the Un~bed States is entitled to recover User subparagraph (~) shall, mthin the three-year period begs on the date the United States Penmen untitled ~ recover such amount, be paid to the United States. Until any amount doe the United States under subparagraph Ha? on accost of "' National Research Service Award is paid, there shall accrue to the United States interest on such amount at a rate fixed by the Secretary of the Treasury after "I;ing into considera- tion private consumer rates of Lutist prevailing on the date the United States becomes entitled to such amount. (~) (if) .\ny obligation of any indindus] under pera- ~raph (3) shall be canceled upon the edema of such Nub. (B ~ The Secretary shell by regulation provide for the Belter or suspension of an, such obligation applicable to en, indi~idus] wheedler comp~iancs-DY such ~~dindus] is impossible or would involve extreme herdshil? to such ~ndi`~dual and if enforcement of such obli~,at~or~ with respect to any indindust would be mind equity "d good consider (~) There are authorized to be sppropmated to make pavrnents under National Research S;ernce Awanis end under grants for such Awards S20`,9~7,000 for the fiscal veer ending June 30, 19~5. 5163.000,000 for fiscal year iS.6. and SlS5.~O.OOO for fiscal year 197~. Of the sums appropriated under this subsection, not less than 23 per 83

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centum shall be merde a, silable for pennants under ~'a- tional Research 5;er~ice .~wards provided by the Secre- tary under subsection (~) ( 1 ) (by. B1.UV~ R=PEC=~-O BIO~DICALO A~ B~A"O~ RE8E~RCH PEON SEC. 4~3. (a) The Secretary shall, in accordance with 2,,u~.c. subsection (b), arrange for tee conduct of a contm~g study t~ (1) establish ~ \) the ~'stion's overall need for biomedical and behavioral research personnel' (B) the subject areas in which such personnel are needed and the number of such personnel needed in each such area, and (C:) the [rinds and extent of trauiing which should be provided such pemo~el; (2) assess ~ ~ ~ current training programs avail- able for the training of biomedical an behanora] research personnel which are conducted under this Act at or through institutes under the National Institutes of Hearth and the .~Icohol9 Drug.\bu~e' and )Iente! Health Administrations and (B) other current training programs Satiable for the train- ~ng of such personnel; (3) identify the binds of research positions avail- able to and held by individuals completing such programs; (~) determine, to the extent feasible, whether the programs referred to in clause (B) of paragraph (2) would be adequate to meet the needs established under paragraph (1) if the programs referred to in clause (A) of paragraph (2) were tes~n~nated; anal (5) detennine what modifications In the programs referred to in paragraph (~) are reotlire.d to meet the needs established under paragraph (1~. (b) (1) The Secretary shsIl request the National Academy of Sciences to conduct the study required by subsection (a) uncler an arrangement tinnier which the actual expenses incurred by such Academy in conducting such study will be paid by the Secretary. If the National Academy of Sciences is willing to do SO9 the Secretary shal] enter into such an arrangement with such Academy for the conduct of such study. (2) If the National Academy of Sciences is unwilling to conduct such study under such an arrangement, then the Secretary shall enter into ~ s''nilar arrangement with other appropriate nonprofit private groups or associa- t~ons un er which such groups or ~oc~st~ons wall con- duct such study and prepare and submit the reports thereon ~ pros ided in scion (c). (3) The National .~sdem' of Sciences or other Sup or association cc~nducting the study required by subeec lion (a) shall conduct such stud' in consultation with the Director of the National Institute of Health. 84

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l l i 1 ; 1 i (c) A report on the results of such study Mall be su~ matted by the Secretary to ~s Committee on Interstate u'd Foreign Conumeree Of the ~0~" of Repre"atati` - and the Committee on Thor and Public V~Ifere of the Senate not later than September 30 of e" year. 85

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A . 2 NAT ~ ONAL RE S E ARCH S E RVI CE AWARD AUTHORI TY Ruble c Law 95-622 PARS D~"~IOHAL RES=\RCII SERVICE AW - DS ES=.~IO~; OF A~IOnl7"TIOX8 SEC. 251. (~) Subsection (d) of section 4~-2 Is emended by striking out "anal ' .tfter "1!3` In" anal by in~.rtin'~ [mf Ire the. peno`1 at tile en`1 of t!~e first sentence tI~e follo``ing: 669 61~ for the ~-C31 ,~ear end~ng, Septcn~Ixr SO, 19~D, ~ ~u,ooo~noe for the ~`;ca1 ~ear ending Septt nt}~t r "~), 1'~38~', aa~1 S';t' - 0,`3()0 for tI'c fi!icc1 year en~lin~ &{,tem~r 30, IO81" (b) Subsection (d) of such .section is eme~ded (1) bS striking out per ~ntum 1n the ~cond ~ent'nce nn<1 incert~ng in lieu tl~ereof I5 per centum'*, an<1 t;') by in.scrtin~ before the per:ocl b;and not Iess than o0 per co~tum s}~1 ~ m:~cle ;~` ailabIe for Orants un~ler su},section (~) ( I) (B) for ~'at~onal RcsearcI~ Service Awar~ls,'. (c) Sul,.~ctio~ (d) of such sect~on is amended I,S. ;~ OCR for page 79
"(A) for one month endue in health research or teaching, or - ~y combination thereof which is in accordance with the usual pattems of sendemic employment, or, if so authonzed, senre as a member of the ~'ationa1 Health Service Corps, or "(B) if authorized under pam.~,raph (~(B) or (1~(C), for one month serse In the ~n~l~`lual~s specialty or en-~,e In hesIth-related activity." (2) Paragraph (~) ~ 4) of such subsection Is amended by striking out ~,1b 95, i/t~2s`~" ~ t and inserting in lieu thereof ., - ( ) (3) Paragraph Hi) (B) of such sul'~ction amended by striking out "~xtremc hardship" and inserting in lieu thereof "substantial hardship". (b) The amcn~lments made by subsection (a) shall apply only with respect to National Research Service .~ards nude under section 472 of the Public Health Service Act after the date of the enactment of this Ecu REPOXES 0~ S-r~vIES Sac. ~36. Section 4~3(c) is amended by strolling out "not later then Septen~}mr ,30 of each year" and inserting in lieu thereof "at least ones ever, t`vo years '. 87

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A. 3 Legislative History Background . The Publ ic Health Service (PHS) was first given the authority to train researchers through the Ransdell Act of 1930 (PL 71-251~. This Act established the first of the National Institutes of Health (NIH) and created a system of research fellowships for duty at NTH and at other medical and research institutions. Since that time the PHS authority has been broadened on at least 11 occasions r providing opportunities for training as each NIH institute was created. Table ~ presents a summary of the legislative history through 1972. TABLE I: Legislative History of Research Training in the Biosciences ~ 1930-1972) acr Ransdell Act of 1930 National Cancer Institute Act of 1931 Public Health Service Act of 1944 National Mental Health Act of 1946 Natzone1 Heart Act of 1948 National Dental Research Act of 1948 (No title; authorized establi~h~nt of research institutes; 1950). International Health Research Act of 1960 (No title; authorized research training. IRAQIS and NI=D; 1962). (No title; eat -blushes the National Bye Instituter National Cancer Act of 1971 92-21B Training and fellowships for cancer, sac 407{b} t7) . Hat$ona1 Reart. Bload Vessel, Lung, and Blood Act 92-423 Tra$n$ng and fe o hips for h t and related dose en, - SOUL: House of Represen - Adore, Report No. 93-224 "coronal Bic~dic" "e arch Fellowship, Tr~neeship "d Training Act of 19~13., Ha~ngton, D.C. 1973. PL t~ER DESCRIPTION 710251 Authorized biomedical research fellowships. 75-244 Fellowships and training facilities related to cancer. 78-410 General research fellowship and research project grant authority, see . 301 ( c) and ( d) of the act. 79~487 authority for training in mental health, sec. 303. 80~655 Training and fellowships in diseases of the heart Ad circulation, sec. 4$2t7) 80-755 Training and fellowships in dental diseases and condi- tions ~ sec. 422 t c) and ( f) . 81~692 General training and fellowship authority, sec. 433. 86-610 Authority for training and fellowships abroad, sec. 3080 87-838 General research training authority, sec. 301(d) SIGNS and NICHD sees. 442 Ad 444. 90-489 HE] authority, sec. 453. In presenting its budget recommendations for FY 1974, the Administration proposed phasing out this research training and fellowship program over a five year period by making no new awards, honoring only existing program 88

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commitments. The reasons cited as the basis for this recommendation included: (~) the need for such programs and the manpower trained by them had never been adequately justified; (2) people trained in these programs later in life earned incomes which made it reasonable to ask them to bear the cost of their own training; (3) large numbers of those trained did not enter either biomedical research or academic training; (4) alternative federal programs of support for this training were available; and (5) the programs were not equitable because support was not available equally to a, ~ students.\ The Administration's position met with almost universal opposition by the nation's biomedical research community.2 As a result, in July, 1973 the Administration reversed its position, and announced instead that a new, but much smaller, fellowship program would be developed which, in effect, would eliminate all training grant awards and would prov ide f el lowsh ips onI y a t the pos tdoc toral 1 evel . 3 The ~ 9 7 4 Leg i sl a t ion . Concerned the t the Admin i s tra- tion's proposals might significantly damage the national biomedical research effort,4 Congress in 1974 enacted the National Research Act ( PL 93-348 ~ which stated: [T] he success and continued viability of the Federal biomedical and behavioral research ef fort depends on the availability of excellent scientists and a network of institutions of excellence capable of producing superior research personnel (Sec. 1021. 89

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Title ~ of that Act, the National Research Service Award (NRSA) Act of 1974, consolidated existing research .. training and fellowship authorities into a single, new authority. In addition to providing training authority to the NIH and ADAMHA, this new program of support contained several innovative features. While support for both individual fellowships and institutional training grants was retained for pre- and postdoctoral training, it was stipulated that an individual may receive support for no more than three years in the aggregate unless the Secretary, DREW, waives the limitation on a case by case basis. This limitation was subsequently clarified in the 1978 amendments (see below). Another feature of the Act is that each recipient of the award is required to reciprocate the support by engag ing in health research or teaching for a period of 12 months for each year federal support is received. In the case of health professionals this payback provision may be fulfilled by serving in the National Health Service Corps. In writing this legislation Congress admitted that an entirely different approach to training investigators might well be preferred to modifying the older program.5 For this reason, Congress added a provision to the legislation which calls for a continuing study of training needs ~0

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with periodic reports and recommendations to the Congress. The National Academy of Sciences was asked to undertake this study and to examine the training programs "in more detail and more carefully than has been yet possible" with the intention that the results of the study will be given "serious legislative consideration".6 Amendments of 1976. In 1976, the NRSA authority was extended and revised through the Health Research and Health Amendments (PL 94-278~. Training authority was extended to include the programs of the Health Resources Administration's (HRA) Division of Nursing, a unit which - formerly had been a part of the NIH. The so-called "payback provision" was broadened through these amendments to permit engagement in "health research or teaching or any combination thereof which is in accordance with usual patterns of academic employment", thus permitting service in appropriate nonacademic settings. Finally, the 1976 amendments specified that the NAS conduct its study of personnel needs in consultation with NIH. Amendments of 1978. The MRSA authority was extended most recently through the Community Mental Health Centers Extension and the Biomedical Research Extension Acts of 1978 ~ PL 9 5-6 22 ~ . Reauthor i z ing tra in ing supper t through September 30, 1981, the Act made several changes in the earlier legislative provisions: ( 1 ) not less than 50 percent of the program funds shall be made for institutional training grants; ~ 2 ~ the period of award for any individual 91

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may not exceed 5 level and 3 years years in the aggregate at the predoctoral in the aggregate for postdoctoral training; and (3) allowances may now be adjusted annually to reflect cost of living increases. Opportunities for short-term training represent another new feature of the NRSA program introduced with the 1978 amendments e Individuals may now receive up to three months of support for research training without incurring any obligation to pay back such supports Final ly, the 1978 NRSA amendments require the NAS to submit its reports at least once every two years, thereby modifying the previous requirement for annual reports 92

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FOOTNOTES ~ . U. S . Senate, Report No. 93-381, "National Research Service Award Act", Washington, D.C., 1973. ~ . Ibid 3 . Or . Henry S immons, DREW, testimony before the U . S . Senate Committee on Labor and Public Welfare, July ~ 0, 1973. 4. U. S. Senate, op. 5. U. S . House of Representatives, Report No. 93-224, ''National Biomedical Research Fe] lowship, Traineeship and Training Act of 1973," Washington, D.C., 1973. 6. Ibid . 93

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