[Code of Federal Regulations]
[Title 42, Volume 1]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR64a.105]

[Page 376-379]
 
                         TITLE 42--PUBLIC HEALTH
 
    CHAPTER I--PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN 
                                SERVICES
 
PART 64a--OBLIGATED SERVICE FOR MENTAL HEALTH TRAINEESHIPS--Table of Contents
 
Sec. 64a.105  What are the conditions of obligated service?

    In order to receive a clinical traineeship an individual must comply 
with the following conditions:
    (a) Written assurance. Prior to the award of a clinical traineeship, 
the individual must sign a written assurance (in such form and manner as 
the Secretary prescribes) that he or she will satisfy the requirements 
of this section.
    (b) Commencement and crediting of service. (1) An individual must 
start the obligated service within twenty-four

[[Page 377]]

months after termination of the clinical traineeship and carry out the 
service on a continuous basis unless, as specified in paragraph (e) of 
this section, the individual has requested and had approved, 
respectively, an extension of the time for beginning the service, or a 
break in service.
    (2) Following termination of the traineeship, the individual must 
annually provide (in such form and manner as the Secretary prescribes) a 
written report describing those previous years' activities which are 
related to service that fulfills the payback obligation. The Secretary 
will review this report and credit all service performed in those 
categories specified in paragraph (d) of this section toward the 
individual's payback obligation, except any service which is performed:
    (i) Before termination of the individual's clinical traineeship; and
    (ii) As part of any activity, such as course work, preparation of a 
dissertation or thesis, or practicum, which is needed to complete the 
training for which the individual received the traineeship.
    (c) Duration of obligation. The period of service payback must equal 
the period of support under the clinical traineeship on a month for 
month basis.
    (d) Performance of the obligated service--(1) General requirements. 
The obligated service must consist of the provision of service for which 
the individual was trained (in the training program for which the 
clinical traineeship was received) and must be performed on a full-time 
basis (not less than 30 hours per week averaged over the obligated 
service period).
    (2) Preferred service. Except as provided under paragraph (d)(3) of 
this section, the individual must provide the obligated service in:
    (i) A public inpatient mental institution;
    (ii) Any entity which is receiving or has received a grant under the 
Mental Health Systems Act or the Community Mental Health Centers Act;
    (iii) A psychiatric manpower shortage area designated by the 
Secretary under section 332 of the Public Health Service Act and 42 CFR 
part 5;
    (iv) Any public or private nonprofit entity or in any nursing home 
(whether public, private nonprofit, or for profit) in which 50 percent 
or more of those served are within one or more of the following groups: 
Racial or ethnic minorities (American Indian or Alaskan Native, Asian or 
Pacific Islander, Black, Hispanic), chronically mentally ill, mentally 
retarded, criminal or delinquent populations, rape victims, physically 
handicapped, abusers of alcohol, or persons addicted to drugs or other 
substances, children and adolescents, the elderly, poverty populations, 
migrants, members of the armed forces (or veterans if seen in a Federal 
facility), residents of areas other than those defined as urbanized by 
the Department of Commerce, or any other special populations, such as 
groups of refugees or disaster victims, which are specifically 
designated by the Secretary for this purpose.
    (3) Alternate service. If the individual obtains the written 
approval of the Secretary, the individual may fulfill his or her 
obligation by:
    (i) Serving in any public or private nonprofit entity or in any 
nursing home (whether public, private nonprofit, or for profit) in which 
not less than 25 percent of those served are within one or more of the 
underserved population groups listed in paragraph (d)(2)(iv) of this 
section. The individual must demonstrate a service commitment of more 
than 50 percent of his or her time to the targeted populations.
    (ii) Teaching, conducting research, or conducting evaluation 
directed at improving alcohol, drug abuse or mental health services to 
one or more of the priority population groups listed in paragraph 
(d)(2)(iv) of this section, or working in a position which fosters the 
closer collaboration of health and alcohol, drug abuse or mental health 
services.
    (iii) Providing in a public or private nonprofit entity 
consultation, training and education, liaison, community support or 
other professional services for which the individual was trained when 
the individual's work is directed toward improving alcohol, drug abuse 
or mental health services to the priority populations listed in 
paragraph (d)(2)(iv) of this section.

[[Page 378]]

    (e) Conditions for deferral or break in service, waiver, or 
cancellation. (1) Upon receipt of a written request showing good cause 
therefor by the individual having a payback obligation, the Secretary 
may:
    (i) Extend the period for beginning the obligated service (24 months 
after termination of the clinical traineeship), permit breaks in the 
required continuous service or extend the period for repayment under 
paragraph (g)(2) of this section, if it is determined that:
    (A) An extension or break in service is necessary for the completion 
of training;
    (B) Performance of the obligation must be delayed because a 
temporary disability makes present performance impossible; or
    (C) Performance of the obligation must be delayed because present 
performance would involve a substantial hardship and failure to extend 
the period would be against equity and good conscience.
    (ii) Waive, in whole or in part, the service payback and recovery 
requirements of this section if it is determined that fulfillment would 
be impossible because the individual is permanently and totally 
disabled.
    (iii) In making determinations under Sec. 64a.105(e)(1)(i)(C), the 
Secretary will take into consideration the following factors:
    (A) The individual's present financial resources and obligations;
    (B) The individual's estimated future financial resources and 
obligations;
    (C) The reasons for the individual's failure to complete the 
requirements within the prescribed period, such as problems of a 
personal nature;
    (D) The unavailability of employment opportunities appropriate to 
the individual's education and training; and
    (E) Any other extenuating circumstances.
    (2) Upon receipt of written notice giving evidence of a conflicting 
obligation under section 752 or 753 of the Act or of an election to 
fulfill an obligation under section 472 of the Act prior to an 
obligation under this section, the Secretary will extend the period for 
beginning service (24 months after termination of the clinical 
traineeship), permit breaks in the required continuous service or extend 
the period for repayment under paragraph (g)(1), as appropriate.
    (3) The service payback and recovery obligations of an individual 
will be cancelled upon the submission to the Secretary of a certificate 
of that individual's death or other evidence which the Secretary 
determines to be satisfactory.
    (f) Conflicting or multiple payback obligations. In any case where 
the individual has, in addition to a payback obligation incurred under 
this section, an obligation to perform service under section 752 or 753 
of the Act (because of receipt of a National Health Service Corps 
scholarship) or under section 472 of the Act (because of receipt of a 
National Research Service Award), or both, performance of the same 
activity may not be counted toward more than one of these obligations. 
In determining the order in which obligations must be fulfilled, 
obligations under section 752 or 753 take precedence over obligations 
incurred under this section. However, with respect to obligations under 
this section and 472, the individual may elect which obligation to 
fulfill first. Any individual who has an obligation under section 752 or 
753 or makes an election to fulfill an obligation under section 472 
prior to an obligation under this section, must give written notice to 
the Secretary as provided by paragraph (e)(3) of this section.
    (g) Recovery for failure to perform obligated service. (1) If an 
individual fails to begin or complete the obligated service in 
accordance with the requirements of paragraphs (a) through (f) of this 
section, that individual is obligated to repay the United States an 
amount equal to three times the cost of the award (including stipends 
and other trainee allowances) plus interest on that amount calculated 
for the total period since the trainee failed to perform the obligated 
service at the rate set by the Secretary of the Treasury for National 
Research Service Awards prevailing on the date on which the period of 
appointment begins, multiplied, in any case in which the service that 
was required has been performed in

[[Page 379]]

part, by the percentage which the length of service that was not 
performed is to the length of the service that was required to be 
performed. The amount will be determined under the following formula:
[GRAPHIC] [TIFF OMITTED] TC13NO91.004

where

A = the amount the United States is entitled to recover;
[thetas] = the cost of the clinical traineeship (including stipends and 
other trainee allowances);
m = the number of months since the trainee failed to perform obligated 
service;
i = the National Research Service Award rate on the date which the 
period of appointment begins divided by twelve;
t = the total number of months of the service obligation;
s = the number of months that have been served.

    (2) Unless the Secretary extends the repayment period as provided in 
paragraph (e) of this section, the individual shall pay to the United 
States the total amount which the United States is entitled to recover 
under paragraph (g)(1) of this section immediately upon the date that 
the individual fails to begin or complete the period of obligated 
service (including failing to comply with the applicable terms and 
conditions of an extension or break in service granted the individual) 
or upon the date that the individual indicates his or her intention not 
to fulfill the service obligation as determined by the Secretary. The 
amount is considered a debt owed to the United States, with interest 
accruing monthly upon the total debt as provided under paragraph (g)(1) 
of this section.

[46 FR 39979, Aug. 5, 1981, as amended at 52 FR 18359, May 15, 1987]