Part D Allocation and Expenditure forms

Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)

12/31/2007

Instructions for Preparing:
Part D Grant Program Allocations Report
Part D Grant Program Expenditures Report
PUBLIC BURDEN STATEMENT: 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 number. The OMB control number for this project is 0915-xxxx. Public
reporting burden for this collection of information is estimated to be 7 hours per response. These estimates include the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments to HRSA Reports Clearance Officer, Health Resources and Services
Administration, Room 10-33, 5600 Fishers Lane, Rockville, MD. 20857.

INTRODUCTION
Grantees that received a fiscal year Part D award under the Ryan White HIV/AIDS Treatment
Modernization Act must submit two reports to HRSA describing 1) how these funds were allocated and 2)
how these funds were spent.1 Grantees must submit an electronic copy of each report using the MS Excel
templates provided no later than the due dates shown below:
1) Part D Grant Program Allocations Report – due 60 days after the grant is awarded.
2) Part D Grant Program Expenditures Report – due 90 days after budget period ends.

GETTING STARTED
1) Log into the HRSA Electronic Handbook (EHB): Log into the EHB to locate the report that is due.
2) File formats: Both report templates were created with Excel-XP, but can be opened using an earlier

version of Excel.
3) Open, rename and save the files: Open the file you wish to work on and save it using a name that

consists of your grant number, the fiscal year, and the report name (e.g. H12HA00025 FY08
Allocations Report.xls or H12HA00025 FY08 Expenditures Report.xls). This will enable HRSA to
distinguish and track your report submissions.
a. After you open the file, click on File on your toolbar and select Save As.
b. When the dialogue box opens, click on the drop-down button next to Save In and choose the
directory location and file folder where you want to store your file. If possible, choose a location on
a secure network that is automatically and routinely backed up.
c. Point and click in the File Name box to create a new name for your file, and when you are finished
click Save.
4) Familiarize yourself with the worksheets: The workbook contains one worksheet that will be printed

as one page.
The “Freeze Frame” function is turned on in your worksheet. This means the column headings will
remain visible on the screen as you move down each column entering data. When you need to go
1

Please see the Conditions of Award attached to your Notice of Grant Award.

Instructions for Part D Allocations Report and Part D Expenditure Report

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Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)

12/31/2007

back to the top of the worksheet at any time, click on the up/down arrows on the right side of your
screen; or, use the up/down arrows on your keyboard. To move back and forth across the columns,
click on the right or left arrows at the bottom of your screen, or use the right/left arrows on your
keyboard.
When you open the file the first time, your cursor will most likely be at the top of the worksheet. If you
are not where you need to be, use the arrows to the right of your screen or on your keyboard to locate
the correct cell; then point and click in the cell. Once you begin entering data and save your file, the
next time you open it your cursor will be in the last place you were working when you saved the file.
5) Formatting, formulas, and data restrictions: Point and click or use the arrows on your keyboard to

move the cursor into the cell where you want to begin or continue entering data. Note the following:
a) The cells are already formatted for currency. For example, if you type in 100000 and hit the enter

b)
c)
d)
e)

key, it will appear as $100,000 on your screen. Use the decimal point only if the number is not a
whole dollar amount. Amounts are rounded to the nearest dollar.
Data cannot be entered in cells that contain formulas. Those cells will calculate percentages and
totals and cannot be changed.
Data cannot be entered in blocked-out cells. Data can only be entered in cells that are empty.
Percentages will be generated as you enter amounts in each column, but will be inaccurate until
ALL amounts are entered.
Do NOT leave any blank cells. If no funds were allocated to a service/activity, then enter zero (0).

ENTERING DATA
1) Allocations Report
a) In Section A, enter the name of the grantee, the grant number, the preparer’s name, the preparer’s
b)
c)

d)
e)

phone number, and the preparer’s email address.
In Section B, enter the amount of your total Part D grant award.
In Section C, in the column titled AMOUNT, enter the amount of the total award that was allocated
to each category listed in the first column. For definitions of service categories, see Appendix A.
Do not include funds from prior fiscal years. Those funds (referred to as “Carryover”) should only
be recorded in the Expenditures Report.
The amount for Grantee Administration should not exceed 10% of the total award.
It is important that you allocate the entire Part D award. The amount listed on Line 5 should match
your total Part D award for the fiscal year on which you are reporting.

2) Expenditures Report
a) In Section A, enter the name of the grantee, the grant number, the preparer’s name, the preparer’s

phone number, and the preparer’s email address.
b) In Section B, enter the amount of your total Part D grant award.
c) In Section C, in the column titled AMOUNT, enter the amount of the total award that was spent on
each category listed in the first column. For definitions of service categories, see Appendix A.
d) In Section C, In the column titled PRIOR FY CARRYOVER, enter the amount of the approved
carryover funds from the prior fiscal year that were spent on each category listed in the first
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Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)

12/31/2007

column.
e) The amount for Grantee Administration should not exceed 10% of the total award.
f) Unlike in the Allocations Report, the amount listed on Line 5 (Total Expenditures) is not required to

match your total award. However, your carryover total should equal the amount of the requested
and approved carryover funds.

REVIEWING AND SAVING YOUR WORK
1) Preview your worksheets: Click on File and select Print Preview. Use the Zoom on your toolbar for a

close-up view. When finished, click “Close” to return to the worksheet.
2) Save your files: It is a good idea to set the defaults in Excel so that a backup will be created

automatically when you save the file with any new information. To do that, click on Tools on the toolbar
and choose Options from the drop-down menu. When the dialogue box opens, click on the General
tab and select the Always create backup check box. Click OK, and then click Save. We also suggest
saving your file periodically as you work, in case of an unexpected power or system failure. Finally,
make sure you save the file before you close it each time.

HOW TO SUBMIT THE REPORTS
Log into HRSA’s Electronic Handbook (EHB) and upload your report.
https://grants.hrsa.gov/webexternal/Login.asp

HOW THIS DATA IS USED
The allocation and expenditure information reported by Part D grantees is used by HRSA to prepare an
annual Report to Congress on the Use of Part D Funds as required, as well as to respond to inquiries from
the Congress, Department of Health and Human Services, grantees, the media and the public-at-large.

MORE INFORMATION
If you need additional assistance or have questions about the allocations and expenditures reporting
requirements, please contact your project officer.

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Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)

12/31/2007

APPENDIX A: SERVICE CATEGORY DEFINITIONS
1) Core Services
a) Outpatient/Ambulatory medical care (health services) is the provision of professional diagnostic

b)

c)

d)

e)

f)

g)

and therapeutic services rendered by a physician, physician's assistant, clinical nurse specialist, or
nurse practitioner in an outpatient setting. Settings include clinics, medical offices, and mobile
vans where clients generally do not stay overnight. Emergency room services are not outpatient
settings. Services includes diagnostic testing, early intervention and risk assessment, preventive
care and screening, practitioner examination, medical history taking, diagnosis and treatment of
common physical and mental conditions, prescribing and managing medication therapy, education
and counseling on health issues, well-baby care, continuing care and management of chronic
conditions, and referral to and provision of specialty care (includes all medical subspecialties).
Primary medical care for the treatment of HIV infection includes the provision of care that is
consistent with the Public Health Service’s guidelines. Such care must include access to
antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic
infections and combination antiretroviral therapies. NOTE: Early Intervention Services provided by
Ryan White Part C and Part D Programs should be included here under Outpatient/ Ambulatory
medical care.
NOTE: Includes all costs associated with the provision of this service, including travel.
AIDS Pharmaceutical Assistance (local) includes local pharmacy assistance programs
implemented by Part A or Part B Grantees to provide HIV/AIDS medications to clients. This
assistance can be funded with Part A grant funds and/or Part B base award funds. Local
pharmacy assistance programs are not funded with ADAP earmark funding.
Note: Part D grantees should include funds for pharmaceuticals in this category.
Oral health care includes diagnostic, preventive, and therapeutic services provided by general
dental practitioners, dental specialists, dental hygienists and auxiliaries, and other trained primary
care providers.
Home Health Care includes the provision of services in the home by licensed health care workers
such as nurses and the administration of intravenous and aerosolized treatment, parenteral
feeding, diagnostic testing, and other medical therapies.
Home and Community-based Health Services include skilled health services furnished to the
individual in the individual’s home based on a written plan of care established by a case
management team that includes appropriate health care professionals. Services include durable
medical equipment; home health aide services and personal care services in the home; day
treatment or other partial hospitalization services; home intravenous and aerosolized drug therapy
(including prescription drugs administered as part of such therapy); routine diagnostics testing
administered in the home; and appropriate mental health, developmental, and rehabilitation
services. Inpatient hospitals services, nursing home and other long term care facilities are NOT
included.
Hospice services include room, board, nursing care, counseling, physician services, and palliative
therapeutics provided to clients in the terminal stages of illness in a residential setting, including a
non-acute-care section of a hospital that has been designated and staffed to provide hospice
services for terminal clients.
Mental health services are psychological and psychiatric treatment and counseling services offered
to individuals with a diagnosed mental illness, conducted in a group or individual setting, and
provided by a mental health professional licensed or authorized within the State to render such
services. This typically includes psychiatrists, psychologists, and licensed clinical social workers.

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Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)

12/31/2007

h) Medical nutrition therapy is provided by a licensed registered dietitian outside of a primary care visit

i)

j)

and includes the provision of nutritional supplements. Medical nutrition therapy provided by
someone other than a licensed/registered dietitian should be recorded under psychosocial support
services.
Medical Case management services (including treatment adherence) are a range of clientcentered services that link clients with health care, psychosocial, and other services. The
coordination and follow-up of medical treatments is a component of medical case management.
These services ensure timely and coordinated access to medically appropriate levels of health and
support services and continuity of care, through ongoing assessment of the client’s and other key
family members’ needs and personal support systems. Medical case management includes the
provision of treatment adherence counseling to ensure readiness for, and adherence to, complex
HIV/AIDS treatments. Key activities include (1) initial assessment of service needs; (2)
development of a comprehensive, individualized service plan; (3) coordination of services required
to implement the plan; (4) client monitoring to assess the efficacy of the plan; and (5) periodic reevaluation and adaptation of the plan as necessary over the life of the client. It includes clientspecific advocacy and/or review of utilization of services. This includes all types of case
management including face-to-face, phone contact, and any other forms of communication.
Substance abuse services outpatient is the provision of medical or other treatment and/or
counseling to address substance abuse problems (i.e., alcohol and/or legal and illegal drugs) in an
outpatient setting, rendered by a physician or under the supervision of a physician, or by other
qualified personnel.

2) Support Services
a) Case Management (non-Medical) includes the provision of advice and assistance in obtaining

b)

c)

d)

e)

medical, social, community, legal, financial, and other needed services. Non-medical case
management does not involve coordination and follow-up of medical treatments, as medical case
management does.
NOTE: Includes all costs associated with the provision of this service, including travel.
Child care services are the provision of care for the children of clients who are HIV-positive while
the clients attend medical or other appointments or Ryan White Program-related meetings, groups,
or training.
NOTE: This does not include child care while a client is at work.
Pediatric development assessment / early intervention services are the provision of professional
early interventions by physicians, developmental psychologists, educators and others in the
psychosocial and intellectual development of infants and children These services involve the
assessment of an infant’s or child’s developmental status and needs in relation to the involvement
with the educational system, including early assessment of educational intervention services. It
includes comprehensive assessment of infants and children, taking into account the effects of
chronic conditions associated with HIV, drug exposure, and other factors. Provision of information
about access to Head Start services, appropriate educational settings for HIV-affected clients, and
education/assistance to schools should also be reported in this category.
Emergency financial assistance is the provision of short-term payments to agencies or
establishment of voucher programs to assist with emergency expenses related to essential utilities,
housing, food (including groceries, food vouchers, and food stamps), and medication when other
resources are not available
Food bank/home-delivered meals include the provision of actual food or meals. It does not include
finances to purchase food or meals. The provision of essential household supplies such as

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Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)

f)

g)

h)
i)
j)

k)

l)

m)

n)

o)
p)

12/31/2007

hygiene items and household cleaning supplies should be included in this item. Includes vouchers
to purchase food.
Health education/risk reduction is the provision of services that educate clients with HIV about HIV
transmission and how to reduce the risk of HIV transmission. It includes the provision of
information; including information dissemination about medical and psychosocial support services
and counseling to help clients with HIV improve their health status.
Legal services are the provision of services to individuals with respect to powers of attorney, donot-resuscitate orders and interventions necessary to ensure access to eligible benefits, including
discrimination or breach of confidentiality litigation as it relates to services eligible for funding under
the Ryan White Program. It does not include any legal services that arrange for guardianship or
adoption of children after the death of their normal caregiver.
Linguistics services include the provision of interpretation and translation services.
Medical transportation services include conveyance services provided, directly or through voucher,
to a client so that he or she may access health care and support services.
Outreach services are programs that have as their principal purpose identification of people with
unknown HIV disease or those who know their status so that they may become aware of, and may
be enrolled in care and treatment services (i.e., case finding), not HIV counseling and testing nor
HIV prevention education. These services may target high-risk communities or individuals.
Outreach programs must be planned and delivered in coordination with local HIV prevention
outreach programs to avoid duplication of effort; be targeted to populations known through local
epidemiologic data to be at disproportionate risk for HIV infection; be conducted at times and in
places where there is a high probability that individuals with HIV infection will be reached; and be
designed with quantified program reporting that will accommodate local effectiveness evaluation.
Permanency planning is the provision of services to help clients or families make decisions about
placement and care of minor children after the parents/caregiver s are deceased ore are no longer
able to care for them.
Psychosocial support services are the provision of support and counseling activities, child abuse
and neglect counseling, HIV support groups, pastoral care, caregiver support, and bereavement
counseling. Includes nutrition counseling provided by a non-registered dietitian but excludes the
provision of nutritional supplements.
Referral for health care/supportive services is the act of directing a client to a service in person or
through telephone, written, or other type of communication. Referrals may be made within the nonmedical case management system by professional case managers, informally through support
staff, or as part of an outreach program.
Rehabilitation services are services provided by a licensed or authorized professional in
accordance with an individualized plan of care intended to improve or maintain a client’s quality of
life and optimal capacity for self-care. Services include physical and occupational therapy, speech
pathology, and low-vision training.
Respite care is the provision of community or home-based, non-medical assistance designed to
relieve the primary caregiver responsible for providing day-to-day care of a client with HIV/AIDS.
Treatment adherence counseling is the provision of counseling or special programs to ensure
readiness for, and adherence to, complex HIV/AIDS treatments by non-medical personnel outside
of the medical case management and clinical setting.

*Peer Positions should be budgeted and reported under the support services they provide (i.e. a peer
health liaison position would provide peer-based health education and should be reported under the Health
Education support service category.)
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