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How to fill out PHS 416-1

01
Obtain a copy of the PHS 416-1 form from the official website or your local health department.
02
Read the instructions carefully to understand the areas that need to be filled out.
03
Start with the applicant's personal information, including name, address, and contact details.
04
Provide information regarding the organization if applicable, including the organization name and address.
05
Complete the section that asks for details of the project or program.
06
Fill out the funding information, including the amount requested and any matching funds.
07
Review and check all provided information for accuracy.
08
Sign and date the form where indicated.

Who needs PHS 416-1?

01
Individuals or organizations seeking funding for health-related projects or programs from the Public Health Service.
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PHS 416-1 is a form used by public health organizations to report information regarding health programs and services.
Entities receiving Health Resources and Services Administration (HRSA) funding or certain public health organizations are required to file PHS 416-1.
To fill out PHS 416-1, applicants must provide accurate information on program operations, services provided, and demographic data as specified in the instructions accompanying the form.
The purpose of PHS 416-1 is to collect standardized data on health programs to ensure compliance with federal requirements and to evaluate program effectiveness.
PHS 416-1 requires reporting on program objectives, target populations, services provided, staffing, and outcome measures.
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