HRSA Form 6A 2019-2026 free printable template

Form 6A: Current Board Member Characteristics OMB No.: 09150285. Expiration Date: 1/31/2020DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration RSA USE ONLY Grant Number Application

How to fill out HRSA Form 6A

How to fill out HRSA Form 6A

1. Obtain the HRSA Form 6A from the HRSA website or your organization’s HR department.
2. Read the instructions carefully to understand the purpose of the form.
3. Fill out the header section with your organization's name and Federal TIN.
4. Complete the demographic information section accurately for all relevant staff.
5. Provide information on the positions and roles of staff members.
6. Complete the performance measures section, detailing how your organization meets HRSA requirements.
7. Review the budget section and ensure all figures are accurate.
8. Double-check all entries for completeness and accuracy.
9. Sign and date the form where required.
10. Submit the form according to the guidelines specified by HRSA.

Who needs HRSA Form 6A?

1. Organizations and health centers receiving HRSA funding or assistance.
2. Entities aiming to apply for HRSA grants or cooperative agreements.
3. Healthcare providers needing to document staff roles and qualifications for HRSA compliance.

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What is HRSA Form 6A?

HRSA Form 6A is a standardized form used by Health Resources and Services Administration (HRSA) to collect information about a healthcare provider's services, patient demographics, and service utilization. It is primarily used for reporting purposes in federally funded health programs.

Who is required to file HRSA Form 6A?

Organizations that receive federal funding from HRSA, such as Community Health Centers, are required to file HRSA Form 6A. This includes health centers that are looking to demonstrate compliance with HRSA requirements and facilitate funding allocation.

How to fill out HRSA Form 6A?

To fill out HRSA Form 6A, organizations should gather relevant data on patient demographics, services offered, and other required information. The form typically includes sections to input numerical data, narratives, and specific patient care metrics. Entities should ensure accuracy and completeness, aligning with HRSA guidelines.

What is the purpose of HRSA Form 6A?

The purpose of HRSA Form 6A is to provide HRSA with essential data to assess service delivery, allocate funds, and monitor compliance with federal standards for health centers. It helps evaluate the effectiveness and reach of healthcare services provided.

What information must be reported on HRSA Form 6A?

HRSA Form 6A requires reporting on various information, including patient demographics (such as age, gender, race/ethnicity), types of services provided, the number of visits, and data regarding health outcomes. It also asks for details on uninsured and underinsured patient populations served.