Service area competition technical assistance Manual

Form 6B: Request for Waiver of Governance Requirements
Request for Waiver of Governance Requirements will be not applicable for current grantees
receiving CHC (section 330(e)) funding
The only grantees eligible to request a waiver for lack of patient majority board composition
are:
Migrant Health Centers
Homeless Health Centers
Public Housing Primary Care
Current grantees of the Community Health Center (CHC) program or those applying for
CHC funding are not eligible for waivers. Waivers are available for current grantees, but a
new waiver must be requested. Failure to meet the 51 percent patient majority must be
explained.
Form 9: Need for Assistance (NFA) Worksheet
The Need for Assistance Worksheet has been revised to include more current indicators.
Core Barriers and Health Indicators have been modified, added, or removed to include the
most relevant and current indicators of need for which data are available.
Form 9 includes 3 sections:
1) Core Barriers include:
a. Percent under 200% of the Federal Poverty Level
b. Percent Uninsured
c. Population to one FTE Primary Care Physician
d. Distance or Travel time to Nearest Primary Care Provider accepting Medicaid
and Uninsured Patients
See Data Reporting Guidelines Table in the application or the Data Resource Guide.
2) Core Health Indicators
3) Other Health and Access Indicators.
For sections 2 and 3, data required should be the most current and available sub-state data.
Please limit response to one per barrier or indicator.
Although an applicant may have multiple proposed sites, there should be one NFA
worksheet per application.
All responses must be consistent with the format in the worksheet template found at
http://www.hrsa.gov/grants/apply/assistance/SAC/form9.docx.
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