text:
Participating Organization(s)
Agency for Healthcare Research and Quality (AHRQ)
NOTE: The policies, guidelines, terms, and conditions stated in this announcement may differ from those used by the NIH. Where this Funding Opportunity Announcement (FOA) provides specific written guidance that may differ from the general guidance provided in the grant application form, please follow the instructions given in this FOA
Improving Quality of Care and Patient Outcomes During Care Transitions (R01)
Activity Code
R01 Research Project Grant
Related Notices
January 10, 2020 - AHRQ Guide Notice on Implementation of the Use of a Single Institutional Review Board (IRB) for Cooperative Research at 45 CFR 46.114 (b). See Notice NOT-HS-20-005.
November 22, 2019 - New NIH "FORMS-F" Grant Application Forms and Instructions Coming for Due Dates on or after May 25, 2020. See Notice NOT-OD-20-026.
January 11, 2019 - AHRQ Implementation of Final Rule on the Federal Policy for the Protection of Human Subjects (Common Rule). See Notice NOT-HS-19-008.
January 11, 2019 - AHRQ Announces Change in Grant Recipient Purchasing of Identifiable CMS Data, effective FY2019. See Notice NOT-HS-19-007.
NOT-HS-19-007
Funding Opportunity Announcement (FOA) Number
Companion Funding Opportunity
Number of Applications
See Section III. 3. Additional Information on Eligibility.
Funding Opportunity Purpose
The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, of higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.
The purpose of this Funding Opportunity Announcement (FOA) is to invite applications to produce health services research that will rigorously test promising interventions aimed at improving communication and coordination during care transitions.
Open Date (Earliest Submission Date)
Letter of Intent Due Date(s)
Application Due Date(s)
Standard dates apply, by 5:00 PM local time of applicant organization.
Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.
AIDS Application Due Date(s)
Scientific Merit Review
Generally, four months after receipt date.
Advisory Council Review
Generally, four months after peer review date.
Due Dates for E.O. 12372
Required Application Instructions
It is critical that applicants follow the Research (R) Instructions in the SF424 (R&R) Application Guide, except where instructed to do otherwise (in this FOA or in a Notice from the NIH Guide for Grants and Contracts). Conformance to all requirements (both in the Application Guide and the FOA) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV, and follow the AHRQ Grants Policy and Guidance found on the AHRQ website at http://www.ahrq.gov/funding/policies/foaguidance/index.html.
Applicants who propose the use of identifiable CMS data are advised to review NOT-HS-19-007 (https://grants.nih.gov/grants/guide/notice-files/NOT-HS-19-007.html) for important changes to how applicants are to budget for the cost of this data.
When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.
There are several options available to submit your application through Grants.gov to NIH and Department of Health and Human Services partners. You must use one of these submission options to access the application forms for this opportunity.
Use the NIH ASSIST system to prepare, submit and track your application online.
Use an institutional system-to-system (S2S) solution to prepare and submit your application to Grants.gov and eRA Commons to track your application. Check with your institutional officials regarding availability.
Use Grants.gov Workspace to prepare and submit your application and eRA Commons to track your application.
Part 2. Full Text of the Announcement
Section I. Funding Opportunity Description
Section II. Award Information
Section III. Eligibility Information
Section IV. Application and Submission Information
Section V. Application Review Information
Section VI. Award Administration Information
Section VII. Agency Contacts
Section VIII. Other Information
Part 2. Full Text of Announcement
This Funding Opportunity Announcement (FOA) invites R01 grant applications for funding health services research that improves the quality of care and patient outcomes during transitions of care. The purpose of this FOA is to support large-scale research projects that rigorously test promising interventions aimed at improving communication and coordination during care transitions.
Transitions of care are the movements of patients between providers or clinical settings which typically occur when primary care providers refer patients to specialty care, or when patients are discharged from the hospital to subsequent care settings. During care transitions, critical information aimed to improve the patient's condition and health outcomes needs to be accurately communicated and coordinated between health professionals, the patient, and the family to ensure that safe, high-quality care is provided and care continuity is maintained.
Poorly managed transitions can lead to costly, unsafe, and low quality health care. The Centers for Medicare & Medicaid Services (CMS) notes that Medicare patients typically experience multiple provider transfers during post-acute care at a cost to the U.S. health care system of approximately $15 billion per year (CMS, 2018). In particular, people with multiple chronic conditions (MCC) undergo many care transitions across settings and providers and are particularly at risk for avoidable adverse events during these many transitions. MCC patients are high cost, high need patients that account for 65% of health care spending and mitigating their risks during care transitions has the potential to greatly reduce care costs and improve care quality. Additionally, uncoordinated care transitions result in unneeded stress and burden on patients and caregivers as well as considerable burden on clinicians who don't have the necessary information to deliver high quality care and must expend a great deal of effort to obtain this information.
Applying innovative patient-centric solutions into the transitional care management process has the potential to improve care transitions by enhancing communication and coordination, thereby reducing duplicate services and mitigating adverse events. New and improved health information technology solutions can facilitate an integrated multi-disciplinary approach to improving care transitions by defragmenting information, improving communication, and assuring the care team and other stakeholders have access to reliable and complete health information that may be located in other care settings or disparate systems. Additionally, these solutions have the capability to empower providers, patients, and caregivers in sharing the responsibility of improving health outcomes while reducing adverse events and costs.
Health Services Research on using innovative patient-centric solutions to improve care transitions aligns with the Department of Health and Human Services (DHHS) goals to increase the value derived from health care spending while delivering whole person 360 degree care. Developing effective approaches to care coordination across care transitions will also support the aims of reducing burden on patients, their caregivers, and clinicians. Furthermore, this announcement will support proposed regulatory efforts to create a more interoperable health care system that improves patient access to their electronic health information, seamless and secure data exchange, and enhanced care coordination.
Objective and Scope
The overarching objective for this FOA is to improve the quality of care and patient outcomes during care transitions. This FOA aims to support large-scale health services research projects that seek to test promising health information technology solutions to facilitate communication and care coordination as patients transition between providers, health care settings, and their communities.
Research should be designed to rigorously test solutions that enable or facilitate care transitions between providers, health care settings, and the community. A theoretical framework should inform the research study and incorporate the use of a Care Transitions Model (e.g., Chronic Care Model (CCM), Project Re-engineered Discharge (RED), Care Transitions Intervention (CTI), and INTERACT) when appropriate.
Optimizing communication and coordination of services is critical to maintaining continuity of timely, safe, and high-quality care during transitions. Coordination and arrangement of care, communication amongst all stakeholders, and patient and family education are pivotal to optimizing the management of care transitions.
Accordingly, this FOA is focused on three research areas of interest. Examples of research projects responsive to this FOA include but are not limited to those expressed within the following research areas of interest:
Care transitions between primary care, acute care, and specialty providers
Finding required patient data at the point of care is too often an issue when multiple providers maintain different pieces of a patient's health data. When patients navigate between primary care and specialty care providers, data sharing and coordination of care are key ingredients to ensure that the care is value-based. Ineffective data sharing and care coordination can result in delayed diagnosis, medication errors, and even mortality. There is a need to (1) understand the types of information exchange that will optimize patient care during these transitions and (2) provide evidence-based, solutions to enable the exchange.
AHRQ is interested in receiving applications that will rigorously test innovative solutions that facilitate data sharing and care coordination activities (i.e., care planning, medication reconciliation, referral tracking, and follow up appointment tracking) during care transitions between primary care, acute care, and specialty providers.
AHRQ is also interested in understanding if the utilization of telehealth modalities requires different types of exchange and would welcome applications that conduct the care transition research when specialty care is provided via telehealth.
Care transitions between different institutional care settings
Information exchange is critical to high-quality care transitions between institutional care settings particularly between acute and post-acute care settings. Too often, patients are readmitted to acute care facilities just a few days after their admission to the post-acute setting. Additionally, patients often have hospital readmissions upon discharge from post-acute settings to home, which could be prevented with better information sharing and coordination. Employing better, evidenced-based solutions to facilitate information exchange between these care settings is required.
AHRQ is interested in receiving applications that will rigorously test innovative solutions that facilitate communication and coordination for patients that are transferred between institutional care settings during care transitions and from these settings to home.
AHRQ has a particular interest in improving care for MCC patients and would welcome applications that will rigorously test innovative solutions that facilitate the sharing of information about treatment decisions, care coordination, and care integration for MCC patients during various institutional care transitions.
Care transitions with a focus on patients, their families and communities
Patients, family care givers, and community resources including home care, long-term care services and supports are critical to maintaining optimum health during care transitions. There is a need to understand how new approaches can improve health outcomes by engaging patients and family caregivers and facilitating communication and coordination with needed community resources.
AHRQ is interested in receiving applications that will rigorously test innovative solutions that support patient self-management activities during care transitions back home.
AHRQ is also interested in applications that rigorously test innovative solutions that automatically link patient and family caregivers to community resources.
AHRQ recognizes there may be cases where grant applicants will propose research that crosses the research categories of interest mentioned above. For example, an applicant may propose to study an innovation that not only better connects primary and specialty providers, but also involves coordination with community resources. The agency welcomes these research proposals for funding consideration.
All projects must:
Describe the healthcare practice setting(s) for the research;
Describe the patient population(s) impacted by the research;
Describe the intervention and earlier work indicating its readiness for a large research project;
Evaluate the usability of the solutions in care transitions;
Evaluate and measure:
The extent that the information exchanged during the care transition was used, easily used, and useful;
Improvement in relevant patient outcomes and reduction in adverse events;
Describe how technology modifications, systems, or tools will be designed from the outset to be easily adopted by other providers and teams in the organization and how the project will be designed to scale across the organization and beyond to other, similar organizations. Successful applications will clearly demonstrate how the resulting innovation can be sustained and adopted by other settings, and will develop an innovative and leading-edge dissemination strategy that will be implemented during the final year of the grant.
National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report. Baltimore, MD: US Department of Health and Human Services, Centers for Medicare & Medicaid Services; February 28, 2018. p 35.
U.S. Department of Health and Human Services. (2019, February 11). HHS Proposes New Rules to Improve the Interoperability of Electronic Health Information. Retrieved from https://www.hhs.gov/about/news/2019/02/11/hhs-proposes-new-rules-improve-interoperability-electronic-health-information.html.
American Association of Critical Care Nurses (AACN) Care Transitions Models Summary Table retrieved from https://www.aaacn.org/sites/default/files/documents/SummaryComparisonTables.pdf
See Section VIII. Other Information for award authorities and regulations.
Funding Instrument
Grant: A support mechanism providing money, property, or both to an eligible entity to carry out an approved project or activity.
Application Types Allowed
Resubmission
The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types.
Clinical Trial?
Funds Available and Anticipated Number of Awards
The number of awards is contingent upon the submission of a sufficient number of meritorious applications and the availability of funds. Future year funding will depend on funding availability.
Award Budget
The total costs (direct and indirect) for a project awarded under this FOA will not exceed $400,000 in any given year and $2 million for the entire project period.
Funds may be used only for those expenses that are directly related and necessary to the project and must be expended in compliance with applicable OMB Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR Part 75) and the HHS Grants Policy Statement.
Award Project Period
The project period may not exceed 5 years. .
These projects are authorized by 42 U.S.C. 299a, which provides that AHRQ shall conduct and support research, support demonstration projects, and disseminate information on health care and on systems for the delivery of such care, including activities with respect to the quality, effectiveness, efficiency, appropriateness, and value of health care services.
All applications submitted and AHRQ grants made in response to this FOA are subject to 45 CFR Part 75 (Uniform Administrative Requirements, Cost Principles and Audit Requirements for HHS Awards; http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75), the HHS Grants Policy Statement (see http://www.ahrq.gov/funding/policies/hhspolicy/index.html), and the terms and conditions set forth in the Notice of Award.
1. Eligible Applicants
Eligible Organizations
Public/State Controlled Institutions of Higher Education
Private Institutions of Higher Education
The following types of Higher Education Institutions are always encouraged to apply for AHRQ support as Public or Private Institutions of Higher Education: Hispanic-serving Institutions
Historically Black Colleges and Universities (HBCUs)
Tribally Controlled Colleges and Universities (TCCUs)
Alaska Native and Native Hawaiian Serving Institutions
Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)
Nonprofits Other Than Institutions of Higher Education
Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)
State Governments
City or Township Governments
Special District Governments
Indian/Native American Tribal Governments (Federally Recognized)
Indian/Native American Tribal Governments (Other than Federally Recognized)
Eligible Agencies of the Federal Government
U.S. Territory or Possession
Native American Tribal Organizations (other than Federally recognized tribal governments)
Faith-based or Community-based Organizations
AHRQ's authorizing legislation does not allow for-profit organizations to be eligible to lead applications under this research mechanism. For-profit organizations may participate in projects as members of consortia or as subcontractors only. Because the purpose of this program is to improve healthcare in the United States, foreign institutions may participate in projects as members of consortia or as subcontractors only. Applications submitted by for-profit organizations or foreign institutions will not be reviewed. Organizations described in section 501(c) 4 of the Internal Revenue Code that engage in lobbying are not eligible.
HHS grants policy requires that the grant recipient perform a substantive role in the conduct of the planned project or program activity and not merely serve as a conduit of funds to another party or parties. If consortium/contractual activities represent a significant portion of the overall project, the applicant must justify why the applicant organization, rather than the party(s) performing this portion of the overall project, should be the grantee and what substantive role the applicant organization will play. Justification can be provided in the Specific Aims or Research Strategy section of the PHS398 Research Plan Component sections of the SF424 (R&R) application. There is no budget allocation guideline for determining substantial involvement; determination of substantial involvement is based on a review of the primary project activities for which grant support is provided and the organization(s) that will be performing those activities.
Required Registrations
Applicant Organizations
Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible.
Dun and Bradstreet Universal Numbering System (DUNS) - All registrations require that applicants be issued a DUNS number. After obtaining a DUNS number, applicants can begin both SAM and eRA Commons registrations. The same DUNS number must be used for all registrations, as well as on the grant application.
System for Award Management (https://www.sam.gov/portal/SAM/#1) (formerly CCR) – Applicants must complete and maintain an active registration, which requires renewal at least annually. The renewal process may require as much time as the initial registration. SAM registration includes the assignment of a Commercial and Government Entity (CAGE) Code for domestic organizations which have not already been assigned a CAGE Code.
eRA Commons - Applicants must have an active DUNS number and SAM registration in order to complete the eRA Commons registration. Organizations can register with the eRA Commons as they are working through their SAM or Grants.gov registration. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
Grants.gov – Applicants must have an active DUNS number and SAM registration in order to complete the Grants.gov registration.
Program Directors/Principal Investigators (PD(s)/PI(s))
All PD(s)/PI(s) must have an eRA Commons account. PD(s)/PI(s) should work with their organizational officials to either create a new account or to affiliate their existing account with the applicant organization in eRA Commons. If the PD/PI is also the organizational Signing Official, they must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.
Eligible Individuals (Program Director/Principal Investigator)
Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with his/her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for AHRQ support.
For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the SF424 (R&R) Application Guide. See also AHRQ's NOT-HS-16-018 related to Multiple PD/PI via https://grants.nih.gov/grants/guide/notice-files/NOT-HS-16-018.html.
A single PD/PI, or the multiple PD(s)/PI(s) combined, must devote at least 20% minimum full-time effort (i.e. at least 8 hours per week) in each given year of the project.
2. Cost Sharing
This FOA does not require cost sharing.
While there is no cost sharing requirement included in this RFA, AHRQ welcomes applicant institutions, including any collaborating institutions, to devote resources to this effort. An indication of institutional support from the applicant and its collaborators indicates a greater potential of success and sustainability of the project. Examples of institutional support would include: donated equipment and space, institutional funded staff time and effort, or other resource investments. Applicant institutions should indicate institutional support by outlining the specific contributions to the project and providing assurances that their organization and any collaborators are committed to providing these funds and resources to the project. This information can be included at the end of the budget justification section of the application, but institutional support dollars are not to be shown/included in the detailed budget request.
3. Additional Information on Eligibility
Applicant organizations may submit more than one application, provided that each application is scientifically distinct.
The AHRQ will not accept duplicate or highly overlapping applications under review at the same time. This means that the AHRQ will not accept:
A new (A0) application that is submitted before issuance of the summary statement from the review of an overlapping new (A0) or resubmission (A1) application.
A resubmission (A1) application that is submitted before issuance of the summary statement from the review of the previous new (A0) application.
An application that has substantial overlap with another application pending appeal of initial peer review (seehttps://grants.nih.gov/grants/guide/notice-files/NOT-OD-18-197.html).
1. Requesting an Application Package
Buttons to access the online ASSIST system or to download application forms are available in Part 1 of this FOA. See your administrative office for instructions if you plan to use an institutional system-to-system solution.
2. Content and Form of Application Submission
It is critical that applicants follow the Research (R) Instructions in the SF424 (R&R) Application Guide, except where instructed in this funding opportunity announcement to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.
For information on Application Submission and Receipt, visit Frequently Asked Questions – Application Guide, Electronic Submission of Grant Applications.
Page Limitations
All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.
Instructions for Application Submission
The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this FOA.
SF424(R&R) Cover
All instructions in the SF424 (R&R) Application Guide must be followed.
SF424(R&R) Project/Performance Site Locations
SF424(R&R) Other Project Information
SF424(R&R) Senior/Key Person Profile
R&R or Modular Budget
All instructions in the SF424 (R&R) Application Guide must be followed. All instructions in the SF424 (R&R) Application Guide must be followed.
Budget Component: Special Instructions for AHRQ applications
AHRQ is not using the Modular Grant Application and Award Process. Applicants applying for funding from AHRQ are to ignore application instructions concerning the Modular Grant Application and Award Process, and prepare applications using instructions for the Research and Related Budget Components of the SF 424 (R&R). Applications submitted in the Modular format will not be reviewed.
R&R Subaward Budget
PHS 398 Cover Page Supplement
PHS 398 Research Plan
All instructions in the SF424 (R&R) Application Guide must be followed, with the following additional instructions:
Research Strategy:
Applicants should describe their approach to rigorously test promising interventions aimed at improving communication and coordination during care transitions.
In describing this approach, applicants must address the following elements:
Describe the patient population(s) impacted by the research; and
Describe the innovative intervention and earlier work indicating its readiness for a large research project.
Applicants are to describe their approach to rigorously test the innovative intervention(s). Applicants should consider a wide range of scientific methods, including quantitative, qualitative, and other novel methods. The study design and analytical plan should be well-justified and consistent with the specific aims and study type. In describing this plan, applicants must also address the following elements:
Applicants must evaluate the usability of the solution(s) during transitions of care.
Applicants must describe how the research will measure the following:
Interoperability: the extent that the information exchanged during the care transition was used, easily used, and useful; and
Improvement in relevant patient outcomes and reduction in adverse events.
Sustainability and Scalability:
Applicants are to describe how technology modifications, systems, or tools will be designed from the outset to be sustainable and easily adopted by other providers and teams in the organization and how the project will be designed to scale across the organization and beyond to other, similar organizations.
Dissemination:
Applicants are to describe their approach to disseminate research findings during the final year of the research grant. Applicants should consider applying innovative and leading edge dissemination strategies and methods that enhance the broader applicability, reproducibility, and scalability of the research findings.
Applicants must submit a dissemination plan that describes how the team will effectively communicate and disseminate research evidence and findings to diverse audiences.
Applicants should consider the following items when developing the dissemination plan:
Describe the target audiences, materials that will be developed, plans to disseminate evidence, and the strategy to evaluate the dissemination activities; and
Incorporate innovative and novel dissemination methods and strategies to communicate compelling stories, inform policy makers, and educate new audiences who may benefit from the knowledge.
Project Administration:
Grant applications must fully address the administration of the project. This is especially crucial for projects that require the coordination of multiple team members' efforts across disciplines, institutions, and geographic regions.
Grant applications must include a detailed project timeline that shows major milestones.
Letters of Support:
Applicants should include letters of support from stakeholder organizations (e.g., professional medical societies, patient/family representative organizations, provider organizations) who have agreed to participate in and collaborate as part of the proposed project.
Letters of support, recommendation, or endorsement should NOT be included from any entity or individual who is not directly participating in the proposed project. These types of letters may impede the review and/or selection process.
Resource Sharing Plan: Individuals are required to comply with the instructions for the Resource Sharing Plans as provided in the SF424 (R&R) Application Guide, with the following modification:
Generally, Resource Sharing Plans are expected, but they are not applicable for this FOA.
Only limited Appendix materials are allowed. Follow all instructions for the Appendix as described in the SF424 (R&R) Application Guide.
Do not use the Appendix to circumvent page limits. Follow all instructions for the Appendix as described in the SF424 (R&R) Application Guide. See NIH/NIOSH/AHRQ New Policy Appendix Guide located at NOT-OD-18-126.
PHS Human Subjects and Clinical Trials Information
When involving human subjects research, clinical research, and/or clinical trials (and when applicable, clinical trials research experience) follow all instructions for the PHS Human Subjects and Clinical Trials Information form in the SF424 (R&R) Application Guide, with the following additional instructions:
If you answered "Yes" to the question "Are Human Subjects Involved?" on the R&R Other Project Information form, you must include at least one human subjects study record using the Study Record: PHS Human Subjects and Clinical Trials Information form or Delayed Onset Study record.
Study Record: PHS Human Subjects and Clinical Trials Information
Delayed Onset Study
Note: Delayed onset does NOT apply to a study that can be described but will not start immediately (i.e., delayed start).
PHS Assignment Request Form
3. Unique Entity Identifier and System for Award Management (SAM)
See Part 1. Section III.1 for information regarding the requirement for obtaining a unique entity identifier and for completing and maintaining active registrations in System for Award Management (SAM), NATO Commercial and Government Entity (NCAGE) Code (if applicable), eRA Commons, and Grants.gov
4. Submission Dates and Times
Part I. Overview Information contains information about Key Dates and times. Applicants are encouraged to submit applications before the due date to ensure they have time to make any application corrections that might be necessary for successful submission. When a submission date falls on a weekend or Federal holiday, the application deadline is automatically extended to the next business day.
Organizations must submit applications to Grants.gov (the online portal to find and apply for grants across all Federal agencies). Applicants must then complete the submission process by tracking the status of the application in the eRA Commons, NIH's electronic system, for grants administration. AHRQ and Grants.gov systems check the application against many of the application instructions upon submission. Errors must be corrected and a changed/corrected application must be submitted to Grants.gov on or before the application due date and time. If a Changed/Corrected application is submitted after the deadline, the application will be considered late.
Applicants are responsible for viewing their application before the due date in the eRA Commons to ensure accurate and successful submission.
Information on the submission process and a definition of on-time submission are provided in the SF424 (R&R) Application Guide.
5. Intergovernmental Review (E.O. 12372)
This initiative is not subject to intergovernmental review.
6. Funding Restrictions
For efficient grant administration, AHRQ grant administration procedures will be used and conducted in accordance with the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement. The HHS Grants Policy Statement can be found at http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.
Pre-award costs are allowable. A grantee may, at its own risk and without AHRQ prior approval, incur obligations and expenditures to cover costs up to 90 days before the beginning date of the initial budget period of a new award if such costs are necessary to conduct the project and would be allowable under the grant, if awarded, without AHRQ prior approval. If specific expenditures would otherwise require prior approval, the grantee must obtain AHRQ approval before incurring the cost. AHRQ prior approval is required for any costs to be incurred more than 90 days before the beginning date of the initial budget period of a new award.
The incurrence of pre-award costs in anticipation of a competing or non-competing award imposes no obligation on AHRQ either to make the award or to increase the amount of the approved budget if an award is made for less than the amount anticipated and is inadequate to cover the pre-award costs incurred. AHRQ expects the grantee to be fully aware that pre-award costs result in borrowing against future support and that such borrowing must not impair the grantee's ability to accomplish the project objectives in the approved time frame or in any way adversely affect the conduct of the project.
7. Other Submission Requirements and Information
Applications must be submitted electronically following the instructions described in the SF424 (R&R) Application Guide. Paper applications will not be accepted.
Applicants must complete all required registrations before the application due date. Section III. Eligibility Information contains information about registration.
For assistance with your electronic application or for more information on the electronic submission process, visit How to Apply – Application Guide. If you encounter a system issue beyond your control that threatens your ability to complete the submission process on-time, you must follow the Dealing with System Issues guidance. For assistance with application submission, contact the Application Submission Contacts in Section VII.
Important reminders:
All PD(s)/PI(s) must include their eRA Commons ID in the Credential field of the Senior/Key Person Profile Component of the SF424(R&R) Application Package. Failure to register in the Commons and to include a valid PD/PI Commons ID in the credential field will prevent the successful submission of an electronic application to AHRQ. See Section III of this FOA for information on registration requirements.
The applicant organization must ensure that the DUNS number it provides on the application is the same number used in the organization's profile in the eRA Commons and for the System for Award Management. Additional information may be found in the SF424 (R&R) Application Guide.
See more tips for avoiding common errors.
The applicant should pay particular attention to the SF424 (R&R) application guide instructions (https://grants.nih.gov/grants/how-to-apply-application-guide/forms-d/general-forms-d.pdf) concerning letters of support. Letters of support, recommendation, or affirmation from any entity or individual not directly participating in the project should not be included.
Upon receipt, applications will be evaluated for completeness by the Center for Scientific Review, NIH and for responsiveness by AHRQ. Applications that are incomplete will not be reviewed.
Institutional Review Board (IRB) approval of human subjects is not required prior to peer review of an application (see https://grants.nih.gov/grants/guide/notice-files/NOT-HS-00-003.html). However, initiation of IRB review, if necessary or applicable, is strongly encouraged to assure timely commencement of research.
Although there is no immediate acknowledgement of the receipt of an application, applicants are generally notified of the review and funding assignment within eight (8) weeks.
Post Submission Materials
Applicants are required to follow the instructions for post-submission materials, as described in see NOT-OD-18-197. Any instructions provided here are in addition to the instructions in the policy.
AHRQ supports research, evaluations, and demonstration projects concerning the delivery of health care in inner-city and rural areas (including frontier areas), and health care for priority populations. Priority populations include low income groups, minority groups, women, children, the elderly, and individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care. 42 USC 299(c). Women and members of minority groups are included in all AHRQ-supported research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate, e.g. because of the lack of connection between the study and the health of women or particular minorities. Investigators should review the document entitled, "AHRQ Policy on the Inclusion of Priority Populations," which is available at https://grants.nih.gov/grants/guide/notice-files/NOT-HS-03-010.html. Applicants under this FOA should consider and discuss including priority populations in the research design as specified in this Notice.
Public Access to AHRQ-Funded Scientific Publications
Investigators should review the document titled 'AHRQ Announces new Policy for Public Access to AHRQ-Funded Scientific Publications', which is available at (http://grants.nih.gov/grants/guide/notice-files/NOT-HS-16-008.html). For all research arising from AHRQ support, this policy requires that AHRQ-funded authors submit an electronic version of the author's final peer-reviewed accepted manuscript to the National Library of Medicine's PubMed Central (PMC) to be made publicly available within 12 months of the publisher's date of publication.
Plan for Sharing Research Data
The precise content of the data-sharing plan will vary, depending on the data being collected and how the investigator is planning to share the data. Applicants who are planning to share data should describe briefly the expected schedule for data sharing; the format of the final dataset; the documentation to be provided; whether or not any analytic tools also will be provided; whether or not a data-sharing agreement will be required and, if so, a brief description of such an agreement (including the criteria for deciding who can receive the data and whether or not any conditions will be placed on their use); and the mode of data sharing (e.g., under its own auspices by mailing a disk or posting data on its institutional or personal website or through a data archive or enclave). Investigators choosing to share under their own auspices may wish to enter into a data-sharing agreement. References to data sharing may also be appropriate in other sections of the application.
The reasonableness of the data sharing plan or the rationale for not sharing research data will be assessed by the reviewers. However, reviewers will not factor the proposed data sharing plan into the determination of scientific merit or the priority score.
Data Confidentiality
The AHRQ confidentiality statute, 42 USC 299c-3(c), requires that information that is obtained in the course of AHRQ supported activities and that identifies individuals or establishments be used only for the purpose for which it was supplied. Information that is obtained in the course of AHRQ-supported activities and that identifies an individual may be published or released only with the consent of the individual who supplied the information or is described in it. There are civil monetary penalties for violation of the confidentiality provision of the AHRQ statute. 42 USC 299c-3(d). In the Human Subjects section of the application, applicants must describe procedures for ensuring the confidentiality of the identifying information to be collected (see NOT-HS-18-012: Confidentiality in AHRQ-Supported Research). The description of the procedures should include a discussion of who will be permitted access to this information, both raw data and machine readable files, and how personal identifiers and other identifying or identifiable data will be restricted and safeguarded. Identifiable patient health information collected by grantees under this RFA will also be obtained and managed in accordance with the HIPAA Privacy Rule, 45 CFR Parts 160 and 164.
The grantee should ensure that computer systems containing confidential data have a level and scope of security that equals or exceeds that established by the HIPAA Security Rules if applicable (see HIPAA website in prior paragraph) and that established by the Office of Management and Budget (OMB) in OMB Circular No. A-130, Appendix III - Security of Federal Automated Information Systems. The applicability and intended means of applying these confidentiality and security standards to subcontractors and vendors, if any, should be addressed in the application.
Sharing Research Resources: Rights in Data
Unless otherwise provided in grant awards, AHRQ grantees may copyright, or seek patents for, as appropriate, final and interim products and materials developed in whole or in part with AHRQ support, including, but not limited to, methodological tools, measures, software with documentation, literature searches, and analyses. Such copyrights and patents are subject to a royalty-free, non-exclusive, and irrevocable AHRQ license to reproduce, publish, use or disseminate for any purpose consistent with AHRQ's statutory responsibilities and to authorize others to do so for any purpose consistent with AHRQ's statutory responsibilities. In accordance with its legislative dissemination mandate, AHRQ purposes may include, subject to statutory confidentiality protections, making project materials, databases, results, and algorithms available for verification or replication by other researchers. In addition, subject to AHRQ budget constraints, final products may be made available to the health care community and the public by AHRQ or its agents if such distribution would significantly increase access to a product and thereby produce substantial or valuable public health benefits. Ordinarily, to accomplish distribution, AHRQ publicizes research findings but relies on grantees to publish research results in peer-reviewed journals and to market grant-supported products. AHRQ requests that grantees notify the Office of Communications (OC) when an AHRQ-funded research article has been accepted for publication in a peer-reviewed journal. Researchers should submit manuscripts that have been accepted for publication in a peer-reviewed journal to JournalPublishing@ahrq.hhs.gov at least four to six weeks in advance of the journal's expected publication date.
Regulations applicable to AHRQ grantees concerning intangible rights and copyright can be found at 45 CFR 75.322.
1. Criteria
The mission of AHRQ is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used.
AHRQ's priority areas of focus are available at https://www.ahrq.gov/funding/policies/foaguidance/index.html
As part of this mission, applications submitted to AHRQ to support health services research are evaluated for scientific and technical merit through the AHRQ peer review system.
Overall Impact
Reviewers will provide an overall impact score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following review criteria and additional review criteria (as applicable for the project proposed).
Scored Review Criteria
Reviewers will consider each of the review criteria below in the determination of scientific merit, and give a separate score for each. An application does not need to be strong in all categories to be judged likely to have major scientific impact. For example, a project that by its nature is not innovative may be essential to advance a field.
Does the project address an important problem or a critical barrier to progress in the field? Is the prior research that serves as the key support for the proposed project rigorous? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive care transitions?
Investigator(s)
Are the PD(s)/PI(s), collaborators, and other researchers well suited to the project? If Investigators are in the early stages of independent careers, do they have appropriate experience and training? If established, have they demonstrated an ongoing record of accomplishments that have advanced their field(s)?
If the project is collaborative or multi-PD/PI, do the investigators have complementary and integrated expertise; are their leadership approach, governance and organizational structure appropriate for the project?
Is a single PD/PI, or are the multiple PD(s)/PI(s) combined, devoting at least 20% minimum full-time effort (i.e. at least 8 hours per week) in each given year of the project?
Are letters of support included for collaborating stakeholder organizations?
Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation, or interventions proposed?
Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Have the investigators included plans to address weaknesses in the rigor of prior research that serves as the key support for the proposed project? Have the investigators presented strategies to ensure a robust and unbiased approach, as appropriate for the work proposed? Are potential problems, alternative strategies, and benchmarks for success presented? If the project is in the early stages of development, will the strategy establish feasibility and will particularly risky aspects be managed? Have the investigators presented adequate plans to address relevant variables, such as sex, for studies human subjects?
If the project involves human subjects and/or clinical research, are the plans to address:
1) the protection of human subjects from research risks, and
2) inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion or exclusion of individuals of all ages (including children and older adults), justified in terms of the scientific goals and research strategy proposed?
Does the project include a detailed project timeline? Is there an evaluation section included in the grant application and does the applicant adequately measure interoperability, patient outcomes and adverse events? Is there a dissemination plan that includes innovative approaches to disseminating evidence-based research findings to audiences that may benefit from the knowledge in the final year of the project?
Will the scientific environment in which the work will be done contribute to the probability of success? Are the institutional support, equipment and other physical resources available to the investigators adequate for the project proposed? Will the project benefit from unique features of the scientific environment, subject populations, or collaborative arrangements? Is the scientific and organizational environment strong enough to support completion of the project as described and according to the timeline?
Additional Review Criteria
As applicable for the project proposed, reviewers will evaluate the following additional items while determining scientific and technical merit, and in providing an overall impact score, but will not give separate scores for these items.
How well does the proposed research plan align with AHRQ's mission and research priorities?
Does the approach focus on rigorously testing promising interoperable interventions that improve care transitions?
Is the usability of the intervention evaluated?
Does the approach measure interoperability, relevant patient outcomes and reductions in adverse events?
Is the intervention designed with sustainability and scalability in mind?
Is the dissemination plan well-described?
Protections for Human Subjects
For research that involves human subjects but does not involve one of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate the justification for involvement of human subjects and the proposed protections from research risk relating to their participation according to the following five review criteria: 1) risk to subjects, 2) adequacy of protection against risks, 3) potential benefits to the subjects and others, 4) importance of the knowledge to be gained, and 5) data and safety monitoring for clinical trials.
For research that involves human subjects and meets the criteria for one or more of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate: 1) the justification for the exemption, 2) human subjects involvement and characteristics, and 3) sources of materials. For additional information on review of the Human Subjects section, please refer to the Guidelines for the Review of Human Subjects.
Degree of Responsiveness
Reviewers will assess how well the application addresses the purpose and objectives of this FOA. How responsive is the application to the special eligibility criteria, including the project requirements, noted in the FOA?
Budget and Period of Support
The committee will evaluate whether the proposed budget is reasonable, and whether the requested period of support is appropriate in relation to the proposed research.
Inclusion of Priority Populations
Reviewers will assess the adequacy of plans to address the needs of both genders, racial and ethnic minorities (and subgroups). Reviewers will assess the adequacy of attention to AHRQ priority populations (see above discussion on Priority Populations in section IV.7 "Other Submission Requirements").
Resubmissions
For Resubmissions, the committee will evaluate the application as now presented, taking into consideration the responses to comments from the previous scientific review group and changes made to the project.
Additional Review Considerations
As applicable for the project proposed, reviewers will consider each of the following items, but will not give scores for these items, and should not consider them in providing an overall impact score.
2. Review and Selection Process
Applications that are complete and responsive to the FOA will be evaluated for scientific and technical merit by an appropriate Scientific Review Group convened in accordance with standard AHRQ peer review procedures that are described in 42 CFR Part 67, Subpart A. Incomplete and/or non-responsive applications or applications not following instructions given in this FOA will not be reviewed.
As part of the scientific peer review, all applications:
May undergo a selection process in which only those applications deemed to have the highest scientific and technical merit (generally the top half of applications under review) will be discussed and assigned an overall impact score.
Will receive a written critique.
Applications will compete for available funds with all other recommended applications submitted in response to this FOA.
The following will be considered in making funding decisions:
Scientific and technical merit of the proposed project as determined by scientific peer review.
Availability of funds.
Responsiveness to goals and objectives of the FOA.
Relevance and fit within AHRQ research priorities, as well as overall programmatic and geographic balance of the proposed project to program priorities.
3. Anticipated Announcement and Award Dates
After the peer review of the application is completed, the PD/PI will be able to access his or her Summary Statement (written critique) via the eRA Commons. Refer to Part 1 for dates for peer review, advisory council review, and earliest start date.
Information regarding the disposition of applications is available in the HHS Grants Policy Statement (see https://www.ahrq.gov/funding/policies/hhspolicy/index.html).
1. Award Notices
If the application is under consideration for funding, AHRQ will request "Just-In-Time" information from the applicant. Just-In-Time information generally consists of information on other support, any additional information necessary to address administrative and budgetary issues, and certification of IRB approval of the project's proposed use of human subjects. For details regarding IRB approval, applicants may refer to the "AHRQ Revised Policy for Institutional Review Board (IRB) Review of Human Subjects Protocols in Grant Applications" (https://grants.nih.gov/grants/guide/notice-files/not-hs-00-003.html).
If all administrative and programmatic issues are resolved, a formal notification in the form of a Notice of Award (NoA) will be provided to the applicant organization for successful applications. The NoA signed by the AHRQ grants management officer is the authorizing document and will be sent via email to the e-mail address designated by the recipient organization during the eRA Commons registration process.
Awardees must comply with any funding restrictions described in Section IV.6. Funding Restrictions.
Selection of an application for award is not an authorization to begin performance. Any costs incurred before receipt of the NoA are at the recipient's risk. These costs may be reimbursed only to the extent considered allowable pre-award costs.
Any application awarded in response to this FOA will be subject to the DUNS, SAM Registration, and Transparency Act requirements as noted on the AHRQ web site at https://www.ahrq.gov/funding/grant-mgmt/index.html.
2. Administrative and National Policy Requirements
All AHRQ grant and cooperative agreement awards are subject to OMB's Uniform Grant Guidance, HHS's "Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards," (http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75), and the HHS Grants Policy Statement (see http://www.ahrq.gov/funding/policies/hhspolicy/index.html), and the terms and conditions set forth in the Notice of Award. As necessary, additional Terms and Conditions will be incorporated into the award statement.
All applicants will be subject to a term and condition that applies the terms of 48 CFR section 3.908 to the award, and requires that grantees inform their employees in writing of employee whistleblower rights and protections under 41U.S.C. 4712 in the predominant native language of the workforce.
Recipients of federal financial assistance (FFA) from HHS must administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html and http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html.
Recipients of FFA must ensure that their programs are accessible to persons with limited English proficiency. HHS provides guidance to recipients of FFA on meeting their legal obligation to take reasonable steps to provide meaningful access to their programs by persons with limited English proficiency. Please see https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html and https://www.lep.gov. For further guidance on providing culturally and linguistically appropriate services, recipients should review the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care at https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53.
Recipients of FFA also have specific legal obligations for serving qualified individuals with disabilities. Please see http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html.
HHS funded health and education programs must be administered in an environment free of sexual harassment. Please see https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html; https://www2.ed.gov/about/offices/list/ocr/docs/shguide.html; and https://www.eeoc.gov/eeoc/publications/upload/fs-sex.pdf.
Recipients of FFA must also administer their programs in compliance with applicable federal religious nondiscrimination laws and applicable federal conscience protection and associated anti-discrimination laws. Collectively, these laws prohibit exclusion, adverse treatment, coercion, or other discrimination against persons or entities on the basis of their consciences, religious beliefs, or moral convictions. Please see https://www.hhs.gov/conscience/conscience-protections/index.html and https://www.hhs.gov/conscience/religious-freedom/index.html
In accordance with the statutory provisions contained in Section 872 of the Duncan Hunter National Defense Authorization Act of Fiscal Year 2009 (Public Law 110-417), AHRQ awards will be subject to the Federal Awardee Performance and Integrity Information System (FAPIIS) requirements. FAPIIS requires Federal award making officials to review and consider information about an applicant in the designated integrity and performance system (currently FAPIIS) prior to making an award. An applicant, at its option, may review information in the designated integrity and performance systems accessible through FAPIIS and comment on any information about itself that a Federal agency previously entered and is currently in FAPIIS. The Federal awarding agency will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgement about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR Part 75.205 "Federal awarding agency review of risk posed by applicants." This provision will apply to all AHRQ grants and cooperative agreements except fellowships.
3. Reporting
When multiple years are involved, awardees will be required to submit the Research Performance Progress Report (RPPR) annually unless specified otherwise in the terms of the award.
For details regarding annual progress report submission, refer to https://www.ahrq.gov/funding/grant-mgmt/noncomp.html. If instructions on the AHRQ website are different from the RPPR Instructions, follow the instructions on the AHRQ website. Annual progress reports are due 3 months before the anniversary of the award.
In addition to the annual progress report, recipients may be required to submit interim progress reports to AHRQ. If applicable, detailed instructions on additional reporting requirements will be provided with the grant award.
Grantees are required to submit expenditure data on the Federal Financial Report (FFR; SF 425) annually.
Expenditure data is to be reported on the Federal Financial Report (FFR; SF 425). AHRQ requires annual financial expenditure reports for ALL grant programs as described in the HHS Grants Policy Statement (https://www.ahrq.gov/funding/policies/hhspolicy/index.html). AHRQ implementation of the FFR retains a financial reporting period that coincides with the budget period of a particular project. However, the due date for annual FFRs is 90 days after the end of the calendar quarter in which the budget period ends. For example, if the budget period ends 4/30/2018, the annual FFR is due 9/30/2018 (90 days after the end of the calendar quarter of 6/30/2018). https://www.ahrq.gov/funding/grant-mgmt/index.html#FinancialRep
A final Progress Report, final Federal Financial Report, and Final Invention Statement are required when an award ends. All final reports are due within 90 days of the project period end date. For further details regarding grant closeout requirements, refer https://www.ahrq.gov/funding/grant-mgmt/closeout.html.
The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for awardees of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later. All awardees of applicable AHRQ grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at www.fsrs.gov on all subawards over $25,000. See the HHS Grants Policy Statement (https://www.ahrq.gov/funding/policies/hhspolicy/index.html) for additional information on this reporting requirement.
In accordance with the regulatory requirements provided at 45 CFR 75.113 and Appendix XII to 45 CFR Part 75, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts from all Federal awarding agencies with a cumulative total value greater than $10,000,000 for any period of time during the period of performance of a Federal award, must report and maintain the currency of information reported in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period. The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently FAPIIS). This is a statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313). As required by section 3010 of Public Law 111-212, all information posted in the designated integrity and performance system on or after April 15, 2011, except past performance reviews required for Federal procurement contracts, will be publicly available. Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75 – Award Term and Conditions for Recipient Integrity and Performance Matters.
We encourage inquiries concerning this funding opportunity and welcome the opportunity to answer questions from potential applicants.
Application Submission Contacts
eRA Service Desk (Questions regarding ASSIST, eRA Commons, application errors and warnings, documenting system problems that threaten submission by the due date, and post-submission issues)
Finding Help Online: http://grants.nih.gov/support/ (preferred method of contact)
Telephone: 301-402-7469 or 866-504-9552 (Toll Free)
Grants.gov Customer Support (Questions regarding Grants.gov registration and Workspace)
Contact Center Telephone: 800-518-4726
Email: support@grants.gov
General Grants Information (Questions regarding application processes and AHRQ grant resources)
Email: GMI@ahrq.hhs.gov
Scientific/Research Contact(s)
Direct your questions about general FOA issues, including information on the inclusion of priority populations to:
CDR Derrick L. Wyatt
Center for Evidence and Practice Improvement (CEPI)
Division of Health Information Technology
Email: DigitalHealthcareResearch@ahrq.hhs.gov (preferred method of contact)
Peer Review Contact(s)
Direct your questions about peer review issues of grant application made in response to this FOA to:
Boris Aponte
Office of Extramural Research, Education and Priority Populations
Division of Scientific Review
Email: Boris.Aponte@AHRQ.hhs.gov
Financial/Grants Management Contact(s)
Direct your questions regarding fiscal matters to:
Steven Young
Office of Management Services
E-mail: steven.young@ahrq.hhs.gov
Recently issued AHRQ policy notices may affect your application submission. A full list of policy notices published by AHRQ is provided in the NIH Guide for Grants and Contracts. Notices can also be found at AHRQ Grants Policy Notices. All awards are subject to the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement.
Authority and Regulations
This program is described in the Assistance Listings (formerly called the Catalog of Federal Domestic Assistance) at http://www.cfda.gov/ and is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Awards are made under the authority of 42 USC 299 et seq., and in accordance with 45 CFR Part 75 and other referenced applicable statutes and regulations.
Awards are made under the authority of 42 USC 299 et seq., and in accordance with 45 CFR Part 75 and other referenced applicable statutes and regulations. All awards are subject to the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement. The HHS Grants Policy Statement can be found at http://www.ahrq.gov/fund/hhspolicy.htm.


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text:
Barnaby's Newsletter Archive
Subscribe to Barnaby's Newsletter You are subscribed to Barnaby's newsletter
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Hello and welcome to my Nuzzel newsletter! Barnaby (Maker of high quality software.)
Kustomer raises $60M for its omnichannel-based CRM platform
TechCrunch – Ingrid Lunden – Dec 3, 2019, 10:29 PM
Image Credits: Warchi / Getty Images Kustomer, a CRM startup that's taking on the likes of Zendesk, Salesforce, and many other bigger and older providers, has closed yet another round of funding — no less than its third fundraise of the year…
A letter from Larry and Sergey
Google – Larry Page and Sergey Brin – Dec 3, 2019, 1:30 PM
Our very first founders' letter in our 2004 S-1 began: "Google is not a conventional company. We do not intend to become one. Throughout Google's evolution as a privately held company, we have managed Google differently. We have also…
The Case for Services in Enterprise Software Startups
Andreessen Horowitz – Martin Casado – Mar 12, 2018, 5:00 PM
One of the truisms of software business strategy is that services is bad business; heck, we've also said it. The reason, put bluntly, is that it's a business with low margins and is not as scalable. So in the early days of bringing to market a…
How McKinsey Helped the Trump Administration Detain and Deport Immigrants
ProPublica – Ian MacDougall – Dec 3, 2019, 2:00 PM
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they're published. This article is co-published with The New York Times. Just days after he took office in 2017, President…
Warped worldview of Jeremy Corbyn's foreign policy
The Times – Daniel Finkelstein – Dec 3, 2019
'TOP SECRET 12 March 1948. To the British ambassador to the United States. Please inform Mr Bevin that in accordance with your aide-memoire of 11 March, we are prepared to proceed at once in the joint discussions on the establishment of an…
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text:
Q: PHP round() function does not round the number It looks like PHP round() does not behave as expected. Look at the following code:
log_rec("BEFORE ROUNDING","x", $x);
$x = round($x, 3);
log_rec("AFTER ROUNDING","x", $x);

where log_rec() is simply a function of mine to write a record in a log file,
and $x value is initially set to 3.339999999999999857891452847979962825775146484375.
I expect $x to be 3.34 after rounding.
Here is the result in log file:
▶"BEFORE ROUNDING"■"x"■3.339999999999999857891452847979962825775146484375■
▶"AFTER ROUNDING"■"x"■3.339999999999999857891452847979962825775146484375■

No change. What am I doing wrong? I am using PHP 7.4.26.
NOTE: I need to round the number, that is, to obtain another float number. So, number_format() is not a solution.
UPDATE
I decided to use a different approach, that is to use
log_rec("BEFORE ROUNDING","x", $x);
$x= intval(100 * $x)/100;
log_rec("AFTER ROUNDING","x", $x);

I expected now
▶"BEFORE ROUNDING"■"x"■3.339999999999999857891452847979962825775146484375■
▶"AFTER ROUNDING"■"x"■3.34■

but I still get
▶"BEFORE ROUNDING"■"x"■3.339999999999999857891452847979962825775146484375■
▶"AFTER ROUNDING"■"x"■3.339999999999999857891452847979962825775146484375■

Now I am totally confused. This is a sequence of three well defined instructions. No other code should create some collateral effect.
Any idea?
PS: WHERE THE NUMBER COMES FROM?
Someone asked where that big number comes from.
From a JSON file. What is strange is that that number in JSON is 3.334, but after json_decode() something strange happens: if I use var_dump() I get 3.334 but if I use print_r() I get that big number.

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text:
Iowa caucus early results show Pete Buttigieg leading
Pete Buttigieg is leading the field in the first vote of the 2020 US presidential election, based on the initial reports of the Iowa caucus.
With 62 per cent precincts reporting, Buttigieg had 26.9 per cent of state delegate equivalents, Vermont Sen. Bernie Sanders had 25.1 per cent, Massachusetts Sen. Elizabeth Warren followed with 18.3 per cent and former Vice President Joe Biden had 15.6 per cent.
The partial results are a major boost for Buttigieg, whose hopes of winning the Democratic nomination are dependent on how he fares in the first two states, as well as Sanders, who outpaced Warren as the preference of progressives.
They were an alarming failure for Biden, whose campaign fell short of the 15 per cent viability threshold in some precincts. The national front-runner in most polls, whose campaign was built on the argument he is the party's most electable contender, is on course to limp into the New Hampshire primary with a clear loss.
Prior to the initial release, the chairman of the state Democratic Party, Troy Price, apologised for the delay in the caucus results of the Iowa, saying there was a problem with the "back end" in reporting the data, but ensuring that the data itself was accurate.
"The reporting of the results and circumstances surrounding the 2020 Iowa Democratic Party caucuses were unacceptable. As chair of the party, I apologise deeply for this," Price said.
"The bottom line is that we hit a stumbling block on the back end of the reporting of the data, but the one thing I want you to know, we know this data is accurate," Price said.
The final outcome of the Iowa Democratic caucuses remains unknown, with the state party continuing to delay the reporting of the results after a night of confusion and chaos rocked the critical first-in-the-nation 2020 contest.
Hours after caucusing began in Iowa on Monday, local officials raised concerns about the vote reporting, raising difficulties in using the new app to report their results and complaining about long hold times to report results by phone.
READ: How Ryan Reynolds Became Hollywood's Most Likeable (And Bankable) Star
On Tuesday, the candidates had already moved on to New Hampshire, the next state on the 2020 calendar -- as they tried to spin the lack of results in favour of their own campaigns.
In Iowa, meanwhile, state Democrats were sorting through the wreckage of an embarrassing night while working to report the first official results.
Price said in a statement Tuesday morning that the plan is to release results "as soon as possible today" and said an investigation found the "underlying data" collected by the new app was sound.
"As part of our investigation, we determined with certainty that the underlying data collected via the app was sound. While the app was recording data accurately, it was reporting out only partial data. We have determined that this was due to a coding issue in the reporting system. This issue was identified and fixed. The application's reporting issue did not impact the ability of precinct chairs to report data accurately," Price said.
"While our plan is to release results as soon as possible today, our ultimate goal is to ensure that the integrity and accuracy of the process continues to be upheld," Price added.
A Democratic source told CNN that the issue seemed to lie with a major coding error in the app that was discovered once data started flowing into the Iowa Democratic Party. Party officials began to see discrepancies in the three data streams: how voters had first aligned with candidates at their caucus sites; the final alignments after those short of 15 per cent support were eliminated at each site; and the state delegate equivalents won at each site.
The source said that it took time for party officials to identify the issue, and noted that there was not a problem with the raw data that was being put in by individual precincts.
READ: Body found in bushfire-destroyed home on NSW south coast
The Iowa Democratic Party is holding another conference call Tuesday morning with representatives of the Democratic presidential campaigns. The last the campaigns heard from the Iowa Democratic Party came during a contentious telephone conference call shortly after midnight. Campaigns were told that the state party had results from about 35 per cent of precincts, but it was unclear whether those would have to be recounted.
Problems with the app apparently surfaced last week.
Polk County Democratic Chairman Sean Bagniewski told CNN that tests of the app last week did not go entirely smoothly. Last Thursday, Bagniewski advised precinct chairs who couldn't get the app to work to call in their results to the Iowa Democratic Party.
He said early Tuesday morning that he had boxes of results filed away at Polk County Democratic headquarters, but that some of his precinct chairs had still not been able to report them because of app errors and long hold times on the phone with the state party -- with some calls being dropped.
Former Vice President Joe Biden's campaign has been most aggressive in challenging the legitimacy of the results in Iowa due to the long delays. In a letter to the state party Monday night before the first phone call with campaigns, Biden's general counsel Dana Remus wrote that "the campaigns deserve full explanations and relevant information regarding the methods of quality control you are employing, and an opportunity to respond, before any official results are released."
Kate Bedingfield, Biden's communications director, told CNN's John Berman on Tuesday morning, "We have real concerns about the integrity of the process, and I think there were some significant failures in the process last night that should give voters concern."
READ: Kobe Bryant pilot may have become disoriented in fog
"If you have a process where you can't be confident that the results that are being reported are reflective of the votes that people cast last night in the process, that's a real concern," Bedingfield said.
Howard Dean, the former Vermont governor and one-time presidential candidate, criticised Bedingfield's comments.
Other Democratic presidential candidates have attempted to put their own spin on the delay.
Former South Bend, Indiana, Mayor Pete Buttigieg declared victory while speaking to supporters on Monday night: "By all indications, we are going on to New Hampshire victorious."
In an interview with CNN the next morning, Buttigieg cited his campaign's internal data from the caucuses.
"It sounds to me like the vice president didn't do as well as he hoped. And I think to question the legitimacy of the count is wrong. I know Iowa well. Those people do not cheat," Dean said
Biden addressed supporters Monday night and said, "Our indication's it's going to be close, we're going to walk out of here with our share of delegates. We don't know exactly what it is yet, but we feel good about where we are. And look, so it's on in New Hampshire, Nevada, South Carolina, and well beyond, we're in this for the long haul."
Minnesota Sen. Amy Klobuchar was first to appear publicly and speak to supporters. She told the crowd, "We know there's delays, but we know one thing: We are punching above our weight."
Vermont Sen. Bernie Sanders said Monday night to supporters, "When those results are announced, I have a good feeling we're going to be doing very, very well here in Iowa." Sanders' campaign, like Buttigieg's, also pointed to internal campaign data to spin the caucuses in his favour.
Massachusetts Sen. Elizabeth Warren said Monday night, "Tonight, we are one step closer to winning the fight for the America we imagine is possible."
Source: 9News https://www.9news.com.au/world/iowa-caucus-results-pete-buttigieg-in-the-lead-usa-news/8ccb3863-9637-4984-b358-1edc5501b2ca


text:
Texas Supreme Court OKs Abortion Funding Restrictions
The Texas Supreme Court has held that the Texas Medicaid program's restrictions on funding for "medically necessary" abortions for poor women don't violate rights guaranteed to them by the state constitution. The court acknowledged that the state treats indigent women differently, thereby denying them equality, but said the plaintiffs failed to demonstrate that the funding scheme reflects a purpose to discriminate because of sex.
By Mary Alice Robbins | Updated on January 06, 2003


text:
Q: Performing basic math on an object project but value returns NaN I'm currently learning about JS objects and trying to perform basic subtraction on a property that is then outputted via a method. However, the object method returns value of NaN even though typeof tells me currentAge and currentYearare numbers. What am I doing wrong and How can I get my below method to output the correct number?

var today = new Date();
var year = today.getFullYear();

var Sam = {
  age: 27, //Number
  birthMonth: "March", //March
  currentYear: year, //number
  birthYear: this.currentYear - this.age,

  // Method to say birth year
  sayBirthYear: function(){
    console.log("I was born in the year " + this.birthYear );
    //return NANS
  }
}

Sam.sayBirthYear(); // Outputs Birth year

A: The context this is not making reference to the current object Sam, but the enclosing context, in this case the window context.
An alternative is using a function, and create objects from it.  That way, the enclosing context would be the function:

var Sam = function () {
  var today = new Date();
  var year = today.getFullYear();

  this.age = 27;
  this.birthMonth = "March";
  this.currentYear = year;
  this.birthYear = this.currentYear - this.age;

  // Method to say birth year
  this.sayBirthYear = function() {
    console.log("I was born in the year " + this.birthYear );
  }
}

new Sam().sayBirthYear();

A: When this.currentYear - this.age executes this is not the object referenced by Sam. In fact that object hasn't even been created yet, and currentYear and age are not available as properties of any object at that point. You have a few options for achieving the behaviour you want.
You can add the birthYear property after the object is created like this:

var today = new Date();
var year = today.getFullYear();

var Sam = {
  age: 27,
  birthMonth: "March",
  currentYear: year,

  // Method to say birth year
  sayBirthYear: function(){
    console.log("I was born in the year " + this.birthYear );
  }
}

Sam.birthYear = Sam.currentYear - Sam.age;

Sam.sayBirthYear(); // Outputs Birth year

or you can do it during object creation like this:

var today = new Date( );
var year = today.getFullYear( );

var Sam = new function ( ) {
  this.age = 27;
  this.birthMonth = "March";
  this.currentYear = year;
  this.birthYear = this.currentYear - this.age;

  // Method to say birth year
  this.sayBirthYear = function ( ) {
    console.log( "I was born in the year " + this.birthYear );
  };
};

Sam.sayBirthYear( ); // Outputs Birth year

or you can make birthYear a getter like this:

var today = new Date();
var year = today.getFullYear();

var Sam = {
  age: 27,
  birthMonth: "March",
  currentYear: year,
  get birthYear() { return this.currentYear - this.age; },

  // Method to say birth year
  sayBirthYear: function(){
    console.log("I was born in the year " + this.birthYear );
  }
}

Sam.sayBirthYear(); // Outputs Birth year

A: In JavaScript, this is window by default :
john = { whoami: this }
john.whoami // window

You must put it into a function to be able to change its value :
function whoami () { return this; }
john = { whoami: whoami }
jack = { whoami: whoami }
whoami() // window
john.whoami() // john
jack.whoami() // jack
whoami.call(john) // john
whoami.call(jack) // jack


text:
Home » Republic's Higgins Mo. Sports Commission Softball Player of the Year
Republic's Higgins Mo. Sports Commission Softball Player of the Year
Published by notices on Thu, 07/11/2019 - 3:51pm
A recent graduate of Republic High School was named the 2018-19 Softball Player of the Year by the Missouri Sports Commission. Julia Higgins, who was a catcher for the Lady Tigers, was presented with the award during a ceremony at the University Plaza Hotel & Convention Center in Springfield on Monday, June 17.
"It was obviously very formal," Higgins said of the ceremony, "but we all had a really good time and it was so incredible to see all of the other talent from so many other sports and schools and everything they'd done too. You could tell that there was a kind of energy in the room with everyone waiting for the outcome of their area or sport."
Higgins said she didn't know she was going to receive the award until her name was announced.
"We had no idea who would get it when we went on stage," she said. "I was happy, and kind of relieved, because I think we were all pretty anxious about it, no matter who got it."
Asked about the decision to name her as Softball Player of the Year, Higgins said she only focused on doing her best when playing softball.
"All I did was go out every day and do everything I could for the program and my team," she said, "and apparently they thought what I was able to do for them was deserving of the award, but I still really only see what I did as going out and doing my job."
Wanting to be able to do her best, Higgins said she put extra effort into honing her abilities as a softball player.
"I've really tried to make what other people see as going the extra mile a part of my daily routine," she said. "Working out on my own a lot, staying positive all the time, and working to exceed expectations 100-percent of the time has really become a mindset for me because I really love see- ing the results of 'the extra mile.'"
An article on the Sports Commission website gave some of Higgins' statistics.
"Higgins turned in one of the more memorable seasons in state high school softball history," the article stated, "as she finished with 60 runs batted in, the second- most in a single-season in MSHSAA. She also hit 14 home runs, breaking the program's record by one, and also had 12 assists, all of which earned Hig- gins Class 4 All-State and All-Region honors as well as the Co-Player of the Year in the Central Ozark Conference." For her part, Higgins
credited her coaches, Lee Dishman and Allen Stolte, for her success as a softball player.
"I definitely have to thank my coaches for everything they've done for me since moving to Republic," she said. "Dishman and Stolte have both pushed me to be better
every day, and I wouldn't even be close to the ballplayer I am today without them. Dishman is not only the greatest coach I've ever had, but one of the best people I've ever had the honor of knowing, and he and his family have definitely made me better in every single way since we've known them. I can't thank them enough
for what they've done in my life."
Higgins graduated from Republic High School earlier this year and is going to attend Evangel Univer- sity in Springfield on a softball scholarship, an academic scholarship and several outside schol- arships. She plans to major in business and minor in pre-law.


text:
Current Affairs Quiz – July 29 & 30 2018
1. Who has been Appointed as CEO for HSBC India?
a) Surendra Rosha
b) Aravind Ramamoorthy
c) Arun Sathyan v
d) Karthik Kumar L
Answer a) Surendra Rosha. The Hongkong and Shanghai Banking Corporation (HSBC) has announced the appointment of IIM Ahmedabad alumnus Surendra Rosha as CEO for HSBC India, subject to regulatory approvals.
2. Who won last Grand Prix race before F1 summer break?
a) Kimi Räikkönen
b) Fernando Alonso
c) Sebastian Vettel
d) Lewis Hamilton
Answer d) Lewis Hamilton . Mercedes' British driver Lewis Hamilton won the last Grand Prix race before the Formula One's summer break in Hungary.
3. Who has become the first Indian to win gold in javelin throw at Commonwealth Games?
a) Dipika Patnak
b) Neeraj Chopra
c) Renuka M
d) Shabna Pandey
Answer b) Neeraj Chopra. Neeraj Chopra, who became the first Indian to win gold in javelin throw at Commonwealth Games in April this year, won gold at the Savo Games in Finland. The 20-year-old hurled the javelin to a distance of 85.69m to bag the gold medal.
4. Who has become the first Welshman to win the Tour de France cycling race in Paris?
a) Richie Porte
b) Greg Van Avermaet
c) Geraint Thomas
d) Chris Froome
Answer c) Geraint Thomas. Geraint Thomas became the first Welshman to win the Tour de France cycling race in Paris. The 32-year-old and his teammates enjoyed champagne while riding on their bikes during the 21st and final stage of the race in Paris.
5. Who is the current CM of Odisha?
a) Naveen Patnaik
b) Rajendra Narayan Singh Deo
c) Biju Patnaik
d) Biren Mitra
Answer a) Naveen Patnaik. Odisha Chief Minister Naveen Patnaik inaugurated the Rs 300 crore Rukura Medium Irrigation Dam project in Sundargarh district. This project will irrigate 5,800 hectares of the agricultural field.
6. Kapil Dev selected in Indian ___________ team for tournament in Japan.
a) Football
b) Golf
c) Volley Ball
Answer b) Golf. India's 1983 Cricket World Cup-winning captain Kapil Dev has been selected in the national golf team to take part in the 2018 Asia-Pacific Senior Amateur Championship, which will be held from October 17 to 19 in Japan.
7. Which country has organised the 'Sano Cricket Curry Festival'?
a) Sri Lanka
b) India
c) Bangladesh
d) Japan
Answer d) Japan. International cricket's governing body, ICC, organised the 'Sano Cricket Curry Festival' in the Japanese city of Sano to promote cricket in the nation.
8. Who won Russian Open Badminton Trophy?
a) H. S. Prannoy
b) B. Sai Praneeth
c) Sourabh Verma
d) Sameer Verma
Answer c) Sourabh Verma. Ace Indian shuttler Sourabh Verma won the Russian Open Badminton trophy at Vladivostok. Sourabh won the Chinese Taipei Masters in 2016 and finished runners-up at Bitburger Open the same year.
9. Who won second consecutive international gold at Yasar Dogu International?
a) Malika Shasha
b) Bajrang Punia
c) Sakshi Malik
d) Sandeep Tomar
Answer b) Bajrang Punia. Bajrang Punia won his second consecutive international gold and Sandeep Tomar won a silver medal at the Yasar Dogu International in Istanbul, Turkey. Indian wrestlers returned with 10 medals, including seven by women, from the ranking event.
10. International Army Games 2018 declared open in ___________.
a) Moscow
b) Kazan
c) Saint Petersburg
d) Sochi
Answer a) Moscow. The International Army Games 2018 at Patriot Park in Moscow region was declared open by Russian Defence Minister Sergei Shoigu.
11. Which union minister has launched National Viral Hepatitis Control Program?
a) JP Nadda
b) Smriti Irani
c) Rajnath Singh
d) Arun Jaitley
Answer a) JP Nadda . To eradicate viral hepatitis by the year of 2030, Union Minister J P Nadda launches National Viral Hepatitis Control Program. He released the Operational Guidelines for National Viral Hepatitis Control Program, National Laboratory Guidelines for Viral Hepatitis Testing and National Guidelines for Diagnosis and Management of Viral Hepatitis.
12. International Tiger Day is held annually on ___________.
a) 28 July
b) 29 July
c) 30 July
d) 31 July
Answer b) 29 July. International Tiger Day is held annually on 29 July. It is an annual celebration to raise awareness for tiger conservation. It was created in 2010 at the Saint Petersburg Tiger Summit.


text:
Blackjack Ketchum, Desperado () é um filme estadunidense de 1956, dirigido por Earl Bellamy, roteirizado por Luci Warde Jack Natteford, baseado no livro Kilkenny de Louis L'Amour, música de Mischa Baklenikoff.

Sinopse
Tentando seguir uma vida normal, um homem tem que assumir seu passado de pistoleiro, e defender uma cidade dos avanços de um barão de gado.

Elenco
 Howard Duff ....... Tom "Blackjack" Ketchum
 Victor Jory .......  	 Jared Tetlow
 Maggie Mahoney ....... Nita Riordan
 Angela Stevens ....... Laurie Webster
 David Orrick ....... Bob Early
 William Tannen ....... Dee Havalik
 Ken Christy ....... Sheriff Macy
 Martin Garralaga ....... Jaime Brigo
 Robert Roark ....... Ben Tetlow
 Don C. Harvey ....... Mac Gill
 Pat O'Malley ....... Doc Blaine
 Jack Littlefield ....... Burl Tetlow
 Sydney Mason .......  Matt Riordan

Bibliografia
 HIRSCHHORN, Clive – The Columbia story – 1989 – Pyramid Books
 MALTIN, Leonard –  Leonard Maltin's Movie Guide 1987 – Penguin
 QUINLAN, David – Illustracted Directory of Film Stars – 1986 – B.T. Batsford Ltd.

Ligações externas

  (Página visitada em 30 de junho de 2010)

Filmes dos Estados Unidos de 1956
Filmes de faroeste dos Estados Unidos
Filmes de faroeste da década de 1950
Filmes em língua inglesa
Filmes baseados em obras de Louis L'Amour
Filmes em preto e branco
Filmes baseados em romances

redpajama_set_name: RedPajamaWikipedia


While past presidents have clashed with attorneys general – which in one case led to a resignation – a president has never directly fired one.
President Trump's attacks on his Jeff Sessions left many in Washington wondering whether Trump would fire his attorney general.
As the investigation into possible collusion between Trump associates and Russians seeking to influence the election by hacking Democrats continues to dog his term, Trump said he would not have nominated Sessions in the first place had he known Sessions would step aside.
For his part, Sessions insists that he's staying put. He said Thursday that he would serve in his position for "as long as that is appropriate."
Can the president fire his attorney general?
Yes. Just as the president appoints the attorney general, subject to Senate approval, he can also dismiss the attorney general.
But that doesn't mean they should. Firing an attorney general would almost certainly come with tremendous political blowback and accusations of interference with law enforcement matters.
Has one ever been fired before?
No. While past presidents have clashed with their top law enforcement officials – which in one case led to a resignation – a president has never directly fired his attorney general.
Trump made headlines when he dismissed acting Attorney General Sally Yates for directing the Justice Department not to defend the president's temporary travel ban. But that was the exception, not the rule. What's more, Yates was only in that temporary position for 10 days.
Have other presidents clashed with their attorneys general?
Yes. It's not just Trump.
One of the most controversial and consequential clashes occurred between President Nixon and Attorney General Elliot Richardson. After Richardson appointed a special prosecutor, Archibald Cox, to investigate the break-in of the Democratic National Committee's offices at the Watergate Hotel, Cox subpoenaed tapes of key White House conversations.
Instead of turning them over, Nixon ordered Richardson to fire Cox. Richardson refused, and resigned. So did his deputy. The Saturday Night Massacre, as it was called, was one of the key developments that led to Nixon's resignation.
What about in more recent administrations?
During the George W. Bush administration, there was a hospital room showdown between Attorney General John D. Ashcroft and top Bush aides. Andrew Card, Bush's chief of staff, and White House Counsel Albert Gonzales wanted Ashcroft to reauthorize Bush's domestic surveillance program, which the Justice Department had just determined was illegal. Ashcroft was laying in bed in an intensive care unitafter his gallbladder was removed.
Then FBI director Robert Mueller – who is now, incidentally, the special counsel investigating Russia's meddling in the 2016 election – and then-Deputy Attorney General James Comey raced with sirens blaring to the hospital to get there before the White House aides. They succeeded, and Ashcroft refused to sign the papers that Gonzales and Card brought with them.
The dispute was later resolved, Comey told Congress years later, when Bush overruled Gonzales and Card. He agreed to make changes to the surveillance program. But that was after Ashcroft, Comey and Mueller said they were prepared to resign.
Is it just Republicans who have problems with attorneys general?
Janet Reno, the second-longest serving attorney general in history, was President Bill Clinton's third choice for the job and was never a confidante. Reno tried to maintain her independence from the White House as she was thrust into a nearly unending series of tests, from the government's deadly raid on the Branch Davidian compound near Waco, Texas, and the first World Trade Center attack investigation to the bombing of the Oklahoma City federal building, and the international custody battle for a Cuban boy named Elian Gonzalez.
Republicans were infuriated when Reno rejected a recommendation to appoint a special counsel to look at the campaign fundraising activities of Vice President Al Gore, the 2000 Democratic presidential nominee. But Reno did authorize an independent investigation of a failed Clinton land deal in Arkansas. That led to an investigation into Clinton's relationship with White House intern Monica Lewinsky. As a result, Hillary Clinton never forgave Reno, according to The Washington Post.
But who really didn't like his attorney general?
The antipathy between Lyndon Johnson and his attorney general Robert Kennedy was "perhaps the greatest blood feud of American politics in the twentieth century," historian Robert Caro has written.
The dislike began, and grew, years before Kennedy served under Johnson after the assassination of John F. Kennedy. According to a Garry Wills review of Caro's book, it started with their very first meeting, in the Senate cafeteria in 1953. Kennedy refused to rise or even look at Johnson. But Johnson forced Kennedy to shake hands. Their real feud began, according to author Jeff Shesol, when Kennedy ran his brother's 1960 presidential campaign. Johnson was John F. Kennedy's main competitor.
Johnson, after he became president, couldn't fire Bobby Kennedy as attorney general. But he was overjoyed when Kennedy left the administration nine months later to run for the Senate.