№ files_lp_4_process_3_088641
Administrative compliance and assurance form outlining requirements, data reporting elements, and service area analysis criteria for federally funded health centers requesting a Change in Scope under the HRSA Health Center Program.
Document Title: Assurances and Questions for Change in Scope (CIS) Request
Document Type: Administrative form
Program: Health Center Program
Administering Agency: Health Resources and Services Administration (HRSA)
Oversight Bureau: Bureau of Primary Health Care (BPHC)
Related Federal Statute: Section 330 of the Public Health Service Act
OMB Control Number: 0915-0285
Expiration Date: XX/XX/20XX
Subject: Change in Scope request assurances, eligibility criteria, and service area analysis
Applicable Programs: 330(e) Community Health Center (CHC); 330(g) Migratory and Seasonal Agricultural Workers (MHC); 330(h) Health Care for the Homeless (HCH); 330(i) Public Housing Primary Care (PHPC)
Intended Users: Federally funded health centers and Health Center Program grantees or look-alikes
Required Attachments: UDS Mapper Map and Data Table
Optional Attachments: Supporting documentation demonstrating community need
Key Sections: Assurances; Target Population Selection; Patient Data; Section 330 Funding Reallocation; Maintenance of Approved Scope of Project; Service Area Analysis
Implementation Requirement: Change must be implemented and verified within 120 days after HRSA approval
Submission Condition: Proposed implementation date at least 60 days after submission to HRSA
Geographic Scope: United States health center service areas
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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