RHITND_Demographics

RHITND_Demographics.pdf

Rural Health Community-Based Grant Programs Data Collection Tool

RHITND_Demographics

OMB: 0915-0354

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Rural HIT Network Development Program - Demographics | HRSA EHBs

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Monday 23rd July 2012 04:59:49 P.M. ET

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Rural HIT Network Development Program
Instructions:
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 valid OMB control number. The OMB control number for this project is 0915-0319. Public reporting burden for this collection
of information is estimated to be 3.77 hours per response, including the time for reviewing instructions, searching existing data sources, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane, Room Rockville,
Maryland, 20857.
For help on this page, please click the ORHP Instructions link under Support at the top right of the page.

Program Selection
Admin Home

H9CRH22851: Alaska State Hospital & Nursing Home Association

Report Status: Not Started

Collection Periods
Grant Number: H9CRH22851 | Grantee: Alaska State Hospital & Nursing Home Association

Role Assignment

Current Report Period: 9/1/2011 - 8/31/2012 | Report Due Date: 9/30/2012
PDF Version
09/01/2011 08/31/2012

Demographics
Access To Care | Population Demographics | Staffing/Workforce

Grantee Info
Grantee Infomation

Access To Care
Information collected in this table provides an aggregate count of the number of counties within the service area which may or may not be
the total population residing within the service area. Please [more]
Number of Counties
Denotes the number of counties served through the program. Please include entire, as well as partial counties served through the grant
program. If your project is serving only a fraction of a county, [more]
Number of counties served in program

Return to Top (Index)
Population Demographics
The Baseline Number 9/1/2011 column is the initial number when the grant was awarded and only applies to #2.

Network Service Population
Denotes the number of people in your service population (not necessarily the number of people who availed your services). For example, the number
of persons impacted by the services rendered by network partners.

Baseline Number (prior to 9/1/2011)

End of budget year Number

Number of people in the service population

Number in service population by ethnicity
Number of people served through program by ethnicity (Hispanic or Latino/Not Hispanic or Latino). Hispanic or Latino origin includes
Mexican, Mexican American, Chicano, Puerto Rican, Cuban and other Hispanic, [more]
Hispanic or Latino
Not Hispanic or Latino
Unknown
Total: 0

Number in service population by race
American Indian/Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
White
More than one race
Unknown

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Total: 0

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Staffing/Workforce
Please provide the number of Full-Time Equivalents (FTEs) for clinical and non-clinical staff recruited in the project and the total number
of staff FTEs that are shared between two or more Network partners. [more]

Number of new clinical staff recruited to work on the project

Full-Time

Part-Time (>=50%)

Part-Time (<50%)

Clinician/Practitioner Consultants
Physician
Dentist
Podiatrist
Optometrist
Chiropractor
Nurse Practitioner
Physician Assistant
Certified nurse midwife
Other
Total:

Number of new non-clinical staff recruited to work on the project

Full-Time

Part-Time (>=50%)

Part-Time (<50%)

Technical/Software Support
Project Manager
Trainers
Health IT Specialist
Other
Total:

Number of staff recruited to work on the project

Full-Time

Part-Time (>=50%)

Part-Time (<50%)

Paid by Grant
Number of staff with HIT-training obtained through HRSA grant funds.
(HIT training is defined as courses specifically related to planning, selecting, implementing, and managing electronic health records and
other health information technology, including TA provided by [more]

Number of staff positions shared between two or more Network Partners.
FTEs
Part-time
Total: 0

Type of HIT Training
Please select at least one.
Seminars
College-level courses
Self-taught
Webinar
Federally-sponsored training
Association meeting
Other
None
Return to Top (Index)

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File Titlehttp://localhost/ORHP/dataentry/granteeform.aspx?formid=33&&con
AuthorSZhou
File Modified2012-07-23
File Created2012-07-23

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