| FYXX Ryan White HIV/AIDS Program (RWHAP) Part B (X07) | |||||||||||
| RWHAP Budget Year Award Information | |||||||||||
| 1. RWHAP Part B Base Award | |||||||||||
| 2. RWHAP Part B ADAP Earmark Award | |||||||||||
| 3. RWHAP Part B ADAP Supplemental Award | |||||||||||
| 4. Total RWHAP Part B ADAP Earmark + ADAP Supplemental Funds | $0 | ||||||||||
| 5. RWHAP Part B Emerging Communities Award | |||||||||||
| 6. Total RWHAP Part B Funds | $0 | ||||||||||
| 7. RWHAP Part B MAI Funds | |||||||||||
| 8. Total RWHAP Part B + MAI Funds | $0 | ||||||||||
| Current FY RWHAP Part B Allocations by Program Component | 1. Base Award | 2. ADAP Earmark + ADAP Supplemental Award | 3. Emerging Communities (EC) Award | 4. Total | |||||||
| Amount | Percent | Amount | Percent | Amount | Percent | Amount | Percent | ||||
| 1. Part B AIDS Drug Assistance Program Subtotal | $0 | - - | $0 | - - | $0 | - - | $0 | - - | |||
| a. ADAP Services | - - | - - | - - | $0 | - - | ||||||
| b. Health Insurance to Provide Medications | - - | - - | - - | $0 | - - | ||||||
| c. ADAP Access/Adherence/Monitoring Services | - - | - - | - - | $0 | - - | ||||||
| 2. Part B Health Insurance Premium & Cost Sharing Assistance for Low Income Individuals | |||||||||||
| 3. Part B Home and Community-based Health Services | |||||||||||
| 4a. Part B HIV Care Consortia / EC HIV Care Consortia | $0 | - - | - - | $0 | - - | ||||||
| 4b. Part B HIV Care Consortia Administration / EC HIV Care Consortia Administration | - - | - - | $0 | ||||||||
| 4c. Part B HIV Care Consortia Planning & Evaluation / EC HIV Care Consortia Planning & Evaluation | - - | - - | $0 | ||||||||
| 4d. Part B HIV Care Consortia CQM / EC HIV Care Consortia CQM | - - | - - | $0 | ||||||||
| 5. Part B Emerging Community Services | $0 | - - | $0 | - - | |||||||
| 6. Part B State Direct Services | $0 | - - | $0 | - - | |||||||
| 7. Part B Clinical Quality Management | - - | - - | - - | $0 | |||||||
| 8. Part B Recipient Planning & Evaluation Activities | - - | - - | - - | $0 | |||||||
| 9. Recipient Administration | - - | - - | - - | $0 | |||||||
| 10. Column Subtotals | $0 | - - | $0 | - - | $0 | - - | $0 | ||||
| Current FY RWHAP Breakdown for Consortia, State Direct Services and Emerging Communities Section | 1. Consortia | 2. Direct Services | 3. Emerging Communities | 4. Total | |||||||
| Amount | Percent | Amount | Percent | Amount | Percent | Amount | Percent | ||||
| 1. Core Medical Services Allocation Subtotal | $0 | - - | $0 | - - | $0 | - - | $0 | - - | |||
| a. AIDS Drug Assistance Program (ADAP) Treatments | - - | $0 | - - | ||||||||
| b. AIDS Pharmaceutical Assistance (LPAP) | - - | - - | - - | $0 | - - | ||||||
| c. Early Intervention Services (EIS) | - - | - - | - - | $0 | - - | ||||||
| d. Health Insurance Premium & Cost Sharing Assistance for Low Income Individuals | - - | - - | - - | $0 | - - | ||||||
| e. Home and Community-based Health Services | - - | - - | - - | $0 | - - | ||||||
| f. Home Health Care | - - | - - | - - | $0 | - - | ||||||
| g. Hospice Services | - - | - - | - - | $0 | - - | ||||||
| h. Medical Case Management (including Treatment Adherence Services) | - - | - - | - - | $0 | - - | ||||||
| i. Medical Nutrition Therapy | - - | - - | - - | $0 | - - | ||||||
| j. Mental Health Services | - - | - - | - - | $0 | - - | ||||||
| k. Oral Health Care | - - | - - | - - | $0 | - - | ||||||
| l. Outpatient /Ambulatory Health Services | - - | - - | - - | $0 | - - | ||||||
| m. Substance Abuse Outpatient Care | - - | - - | - - | $0 | - - | ||||||
| 2. Support Services Allocation Subtotal | $0 | - - | $0 | - - | $0 | - - | $0 | - - | |||
| a. Child Care Services | - - | - - | - - | $0 | - - | ||||||
| b. Emergency Financial Assistance | - - | - - | - - | $0 | - - | ||||||
| c. Food Bank/Home Delivered Meals | - - | - - | - - | $0 | - - | ||||||
| d. Health Education/Risk Reduction | - - | - - | - - | $0 | - - | ||||||
| e. Housing | - - | - - | - - | $0 | - - | ||||||
| f. Linguistics Services | - - | - - | - - | $0 | - - | ||||||
| g. Medical Transportation | - - | - - | - - | $0 | - - | ||||||
| h. Non-Medical Case Management Services | - - | - - | - - | $0 | - - | ||||||
| i. Other Professional Services | - - | - - | - - | $0 | - - | ||||||
| j. Outreach Services | - - | - - | - - | $0 | - - | ||||||
| k. Psychosocial Support Services | - - | - - | - - | $0 | - - | ||||||
| l. Referral for Health Care and Support Services | - - | - - | - - | $0 | - - | ||||||
| m. Rehabilitation Services | - - | - - | - - | $0 | - - | ||||||
| n. Respite Care | - - | - - | - - | $0 | - - | ||||||
| o. Substance Abuse Services (residential) | - - | - - | - - | $0 | - - | ||||||
| 3. Services Allocations Total | $0 | - - | $0 | - - | $0 | - - | $0 | - - | |||
| MAI Award | |||||||||||
| Current FY RWHAP MAI Allocations by Program Component | Amount | Percent | |||||||||
| 1. Education to increase minority participation in ADAP | - - | ||||||||||
| 2. Outreach to increase minority participation in ADAP | - - | ||||||||||
| 3. Clinical Quality Management | |||||||||||
| 4. Recipient Planning & Evaluation Activities | |||||||||||
| 5. Recipient Administration | |||||||||||
| 6. MAI Allocations Total | $0 | ||||||||||
| FOR OFFICE USE ONLY: | |||||||||||
| o Recipient received waiver for 75% core medical services requirement. | |||||||||||
| Public Burden Statement: The purpose of this data collection system is to collect aggregate data on the number of new and existing clients, and clients who have been out of care treated with EHE initiative funding. HAB will use these data to show the impact of the increased funding on reducing new HIV infections, identifying new HIV infections, engaging clients in care and treatment. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0318 and it is valid until XX/XX/202X. This information collection is mandatory (through increased Authority under the Public Health Service Act, Section 311(c) (42 USC 243(c)) and title XXVI (42 U.S.C. §§ 300ff-11 et seq.). Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov | |||||||||||
| LEGISLATIVE REQUIREMENTS CHECKLIST | |||||||||||
| CORE MEDICAL SERVICES | Amount | Percent (Amount / Total Service Allocation) |
|||||||||
| ADAP (H16) | $0 | - - | |||||||||
| State-Direct Services: Core Medical Services (D35) | $0 | - - | |||||||||
| Emerging Communities: Core Medical Services (F35) | $0 | - - | |||||||||
| Total Core Medical Service Allocations | $0 | 0% | |||||||||
| Support Service Allocations | Amount | Percent | |||||||||
| Consortia Services (B22) | $0 | - - | |||||||||
| Consortia EC Services (F22) | $0 | - - | |||||||||
| State-Direct Services: Support Services (D49) | $0 | - - | |||||||||
| Emerging Communities: Support Services (F49) | $0 | - - | |||||||||
| MAI Allocations for Education + Outreach Services (B69 + B70) | $- | - - | |||||||||
| Total Support Services Allocations | $0 | 0% | |||||||||
| Total Service Allocations | $0 | ||||||||||
| CLINICAL QUALITY MANAGEMENT | |||||||||||
| Total Clinical Quality Management allocations must be 5% of the total X07 award or $3 million (whichever is smaller.) | $0 | (Capped Amount) | |||||||||
| To the right in red, is the maximum (Capped Amount) that may be allocated to Clinical Quality Management (the lesser of E11* .05 or $3 million) as well as the amount of Current Fiscal Year dollars allocated (CQM Allocations) on Clinical Quality Management (H25+H28+B71). Please check to make sure the Allocations do not exceed the Capped Amount. | $0 | (CQM Allocations) | |||||||||
| PLANNING AND EVALAUTION / RECIPIENT ADMINISTRATION | |||||||||||
| Total Part B X07 Planning and Evaluation allocations and total Recipient Administration allocations must each be 10% of less than the total X07 award. Planning and Evaluation and Recipient Administration do not necessarily need to be 10% of each funding stream as long as the combined total of each is 10% or less of the total X07 award. In addition, Planning and Evaluation and Recipients Administration allocations combined must not exceed 15% of the total X07 award. | $0 | #DIV/0! | (Planning & Evaluation) | ||||||||
| $0 | #DIV/0! | (Recipient Administration) | |||||||||
| To the right in red, is the percentage of Planning and Evaluation allocations divided by the total X07 award (H24 + H29 + B72) / E11 and Recipient Administration allocation divided by the total X07 award (H23 + H30 + B73) /E11. Please check to make sure these percentage are not greater than 10%. also shown is the percentage of the combined Planning and Evaluation and Recipient Administration allocations divided by the Total X07 Award (H23 + H24 + H29 + H30 + B72 + B73) / E11. | $0 | #DIV/0! | (Planning & Evaluation + Recipient Administration) | ||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |