Form 0285-Project Impac 0285-Project Impac Capital Improvement_Investment Project Impact

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

PROJECT IMPACT

FOR HRSA USE ONLY

Grantee Name

Grant Number

Application Tracking #

Project #

Project Type

Project Title

DIRECT IMPACT

Space Type	Square Feet Increased	Square Feet Improved
Administrative Space
Clinical Space
Other Please Describe: (Maximum 150 characters)
Total

Projected FTEs
Staff Type	FTEs Created	FTEs Retained
1. Health Center Administrative and Facility FTEs
a. Management and support staff
b. Fiscal and billing staff
c. IT staff
d. Facility staff
e. Patient support staff
2. Construction-related FTEs