FY 2021 SAC/SAC-AA Application Eligibility Summary

ELIGIBILITY REQUIREMENT DOCUMENTATION
1. Domestic public or nonprofit private entity, such as a tribal, domestic faith-based, or community-based organization
  • Attachment 11: Evidence of Nonprofit or Public Center Status
2. Propose to operate a health center that makes all required primary health care services available and accessible in the service area without regard for ability to pay
  • Project Narrative: Response section
3. Propose to make General Primary Medical Care available directly (Column I) or through formal written contractual agreements in which the health center pays for the service (Column II)
  • Form 5A: Services Provided
4. Propose continuity of services in an announced service area
  • See a-d below
  1. Patients: Project to serve at least 75% of the Patient Target, as identified in the SAAT, for the proposed service area in calendar year 2022 (January 1 – December 31, 2022)
  • Form 1A: General Information Worksheet
  1. Services: Project patients for each Service Type (e.g., Medical, Mental Health, Enabling) listed for the service area in the SAAT
  • Form 1A: General Information Worksheet
  1. Service Area (New or Competing Supplement Applicants): Enter a combination of SAAT Service Area Zip Codes for service delivery sites where zip code patient percentages total at least 75 percent of the current patients served*

    *or enter all SAAT Service Area Zip Codes for the proposed service area, if the sum of all zip code patient percentages is less than 75 percent of the current patients served

  • Form 5B: Service Sites
  1. Populations: Propose to serve all listed population types (i.e., CHC, MHC, HCH, PHPC) and maintain the current funding distribution from the SAAT
  • SF-424A: Budget Information Form
5. New or Competing Supplement Applicants: Propose at least one new full-time (operational 40+ hours per week) permanent, fixed-building site (MHC-only projects may propose a full-time seasonal service delivery site)
  • Form 5B: Service Sites – verifiable physical site address must be included
6. Provide access to services for all individuals in the service area and target population
  • Project Narrative: Response section
7. New or Competing Supplement Public Housing Primary Care Applicants: Demonstrate consultation with residents of public housing in the preparation of the SAC application
  • Project Narrative: Governance section
Other - Request annual funding that does not exceed the ceiling amount for the service area (Total Funding available in the SAAT)
  • SF-424: Application for Federal Assistance
  • Other application components, as applicable (e.g., Bylaws, Budget Narrative, Form 8 and its attachments)
Other – Submit all documents indicated as “required for completeness”
  • Project Narrative
  • Attachment 6: Co-Applicant Agreement (New Public Center Applicants that have a Co-Applicant Board)
  • Attachment 11: Evidence of Nonprofit or Public Center Status
Other – Propose to perform a substantive role in the project
  • SF-424: Application for Federal Assistance
  • Other application components, as applicable (e.g., Bylaws, Budget Narrative, Form 8 and its attachments)
Other - Submit the application by the posted deadlines in Grants.gov and EHBs
  • Refer to Section IV.4 of the NOFO

Note: The total size of all uploaded files may not exceed the equivalent of 160 pages when printed by HRSA.

 

Date Last Reviewed:  June 2020