In this fourth and last special article on grantsmanship [1–3], we discuss the strategies to write competitive “Significance,” “Innovation,” and “Impact” sections, when required. Several sponsors request these, and it is important that their elements are written strategically, as they often account for a large portion of the review criteria. We will also present specific components that are needed for applicants to the National Institute of Health (NIH) from Europe. The NIH is the leading funder of biomedical research in the United States; at present, 495 awards are given to “foreign” institutions, and even more funding is provided when the foreign institution is listed as a subaward, or an individual is listed as a consultant.