Form 19 Implementation Plan (track changes)

The Health Center Program Application Forms

Implementation Plan (track changes)

Implementation Plan

OMB: 0915-0285

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NAP Implementation Plan


The Implementation Plan outlines the applicant’s planned activities required to bring the organization into operational readiness and compliance with all 19 Health Center Program requirements within 120 days of the Notice of Award (NoA). See Appendix C of the FOA for instructions. Applicants may choose focus areas based on the list below and in Appendix C or provide different focus areas and goals based on the action steps necessary to achieve the required operational and compliance status. Goals must be specific to the proposed NAPproject.

OMB No.: 0915-0285. Expiration Date: XX/XX/20XX

Goal

On separate rows, identify the goals for each focus area. Goals should describe measureable results.

Key Action Steps

Identify the action steps that must occur to accomplish each goal.

Person/Area Responsible

Identify who will be responsible and accountable for carrying out each action step.

Time Frame

Identify the expected time frames for carrying out each action step.

Comments

As desired, provide supplementary information.

Focus Area: Operational Service Delivery Program

Goal A1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal A2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal A3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Key Management Staff/Systems/Arrangements

Goal B1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal B2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal B3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Operational NAP Site(s) within 120 Days

Goal C1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal C2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal C3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Implementation of Sliding Fee Discount Program and Billing and Collections System

Goal D1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal D2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal D3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Quality Improvement/Quality Assurance (QI/QA) Program

Goal E1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal E2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal E3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Governing Board

Goal F1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal F2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal F3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Other

Goal G1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal G2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal G3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame



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 control number. The OMB control number for this project is 0915-0285. Public reporting burden for this collection of information is estimated to average 3 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 14N-39 Rockville, Maryland, 20857

File Typeapplication/msword
File TitleNAP Implementation Plan
SubjectNAP Implementation Plan
AuthorHRSA
Last Modified ByJoanne Galindo
File Modified2016-04-11
File Created2016-04-11
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