Operational Site Visit Documents Provided by HRSA

This resource complements the Site Visit Protocol (SVP), which is the primary tool for assessing compliance with Health Center Program requirements during Operational Site Visits (OSVs). Refer to the Health Center Program Compliance Manual as the principal resource to assist health centers in understanding and demonstrating compliance with Health Center Program requirements and the SVP for complete guidance on OSVs.

HRSA Staff will provide the most current versions of the following documents to the site visit team prior to the site visit. These documents, in addition to the documents the health center provides, will inform the site visit assessment.

  • Service Area Competition (SAC)/New Access Point (NAP)/Renewal of Designation (RD) Application(s). The application contains the following:
    • Form 1A: General Information Worksheet
    • Form 1C: Documents on File 
    • Form 2: Staffing Profile
    • Form 3: Income Analysis
    • Form 3A: Look-Alike Budget Information
    • Form 4: Community Characteristics
    • Form 5A: Services Provided
    • Form 5B: Service Sites
    • Form 5C: Other Activities/Locations
    • Form 6A: Current Board Member Characteristics
    • Form 6B: Request for Waiver of Board Member Requirements (if applicable)
    • Form 8: Health Center Agreements
    • Form 12: Organization Contacts
    • Clinical & Financial Performance Measures
    • Attachments (1–12)
      • Service Area Map and Table
      • Bylaws
      • Project Organizational Chart
      • Position Descriptions for Key Management Staff
      • Biographical Sketches for Key Management Staff
      • Co-Applicant Agreement for Public Centers
      • Summary of Contracts and Agreements
      • Collaboration Documentation
      • Sliding Fee Discount Schedule(s)
      • Budget Narrative
  • Budget Period Progress Report (BPR)/Annual Certification (AC) Report
  • Health center’s current Form 5A: Services Provided and current Form 5B: Service Sites from Electronic Handbooks (EHB)
  • Most recent prior OSV Report (only for historical context)
  • Information on any prior targeted technical assistance (TA) provided by HRSA within the last two project periods
  • Uniform Data System (UDS) Summary Report
  • UDS Health Center Trend Report
  • UDS Performance Comparison Report
  • Description(s) of any specific issues or unique characteristics of the health center, including but not limited to:
    • Background information on the health center
    • Unique characteristics (for example, large number of contracted or referral services, substantial numbers of special populations) 
    • List of current progressive action conditions
Date Last Reviewed:  May 2021