1. Proposal arrives at NIH and is sent to appropriate study section.
2. Scientific review administrator appoints two study section members to serve as primary and secondary reviewers of the application.
3. Study section convenes. Primary and secondary reviewers present reports on proposal, followed by open discussion. Study section may vote to reject or defer action on application. Otherwise, panelists assign it a priority score.
4. Proposal proceeds to National Advisory Council (NAC) of appropriate institute. NAC--composed of about eight independent scientists and four people from the lay community--checks that proposal received a fair hearing from the study section and offers its own assessment based on proposal's relevance to institute's overall goals. NAC may not change priority scores, but it can recommend that proposals be funded out of order.
5. Institute staff makes final decision based on proposal's priority score and advice from study section and NAC.