American Rescue Plan Act Emergency Rural Health Care Grant Program

IC List for 0575-0200

American Rural Health Care (ARHC) Grant Program

The following Non-Form information is collected and accounted for under this collection package for Track I and Track II:

Summary Page & Table of Contents 

Applicants will prepare a brief summary page and table of contents to easily identify the funding track requested, summary of application request, and page numbers of supplemental documentation. The Summary Page and Table of Contents will be prepared by 1,092 respondents at .167 hours per response.

Evidence of Legal Existence and Authority. 

The applicant must submit certified copies of organization documents and a certified list of directors and officers as evidence of the applicant’s legal existence and authority for the proposed project. The organizational documents can be charters, bylaws, or articles of incorporation. RHS uses the information to determine if the applicant has the proper authority to enter into a binding agreement to use grant funds. RHS also uses the information to ensure ties to the local rural community for non-profit applicants. Evidence of Legal Existence and Authority will be submitted and certified by1,092 respondents at 15 minutes per response.

Narrative - Project Proposal, Track I 

Applicants will provide a written budget narrative that accounts for how the grant request was calculated, the time period for which assistance is requested, and the use of funds. The written narrative will also include a description of how the funds requested will meet the intent of the statute. Track 1 Narrative will be prepared by 1,000 respondents at 20 minutes per response.

 

Narrative - Project Proposal, Track II

Applicants will provide a written budget narrative that accounts for how the grant request was calculated, the time period of assistance, and the use of funds.  The applicants will also submit a consortium agreement that outlines the experience, responsibilities, and expectations of an existing (or planned) consortium to carry out the grant activities. Applicants will also submit a workplan with goals, activities, outcomes, and time period for the grant. Finally, applicants will present an evaluation plan for measuring outcomes and sustainability. Track II Narrative will be prepared by 92 respondents at 120 hours per response.

Environmental Information in response to 7 CFR 1970 

Applicants must submit documentation regarding the potential for environmental impact with the grant funding.  An Environmental response will be submitted by 1,092, respondents at 5 hours response.

Preliminary Architectural Feasibility Report or Engineering Documentation 

Applicants requesting funds for construction must submit associated architectural and engineering reports to justify the grant funding requested. A report/documentation will be submitted by 279 respondents at 10 hours per response.

Matching Funds Certification & Documentation

Matching funds are required for all of the grants provided under this program.  Applicants must provide a description and certification regarding the source of eligible matching funds.  This information will be prepared by 1,092 respondents at 1 hour per response. 

 

Audits/Financial Statements 

Applicants must submit audits or financial statements to validate the grant funds requested and to ensure the sound operations of awardees.  Audits/Financial statements will be submitted by1,092 respondents at 7 hours per response. 

 

CPA Certifications Regarding Funds Requested 

Applicants requesting funds for lost health care revenue and for staffing needs, must submit a CPA certification to ensure compliance with program requirements.  Certifications will be submitted by 500 respondents at 4 hours per response.

Intergovernmental Review Comments 

Applicants must seek comments from their local planning district commission, as applicable. Comments will be sought by 1,092 applicants at 15 minutes per response.

Documentation of Assistance Provided to Rural Development Employees  

Applicants must identify and report any known relationship or association with a RUS employee such as close personal association, immediate family, close relatives, or business associates. This includes any assistance provided to employees. Documentation will be provided by 1,092 respondents at 15 minutes per response.

Indirect Cost Rate Agreement. 

The applicant’s indirect cost rate agreement with a recognizant Federal Agency must be submitted if their proposed budget includes indirect costs. An agreement will be completed and submitted by 819 respondents at 1 hour per response.

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