25E Form 8 - edits

The Health Center Program Application Forms

Form 8 - edits

Form 8: Health Center Agreements

OMB: 0915-0285

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration Form 8: HEALTH CENTER AGREEMENTS

FOR HRSA USE ONLY

Grant Number

Application Tracking Number



Note: If a Health Center Program award recipient wishes to enter into an agreement/arrangement post-award that will either (1) result in another organization carrying out a substantial portion of the approved scope of project or (2) impact the governing board’s composition, authorities, functions, or responsibilities, a Prior Approval request must be submitted in EHB and approved by HRSA before the agreement/arrangement can be formalized and implemented.

PART I Health Center Agreements

1. Does your organization have a parent, affiliate, or subsidiary organization?

[_]Yes [_] No

  1. Do you currently have, or plan to utilize

a) Contract(s) with another organization to perform substantive programmatic work within the proposed scope of project? For the purposes of the Health Center Program, contracting for substantive programmatic work applies to contracting with a single entity for the majority of health care providers.


Or


b) Subawards to carry out a portion of the proposed scope of project. The purpose of a subaward is to carry out a portion of the and creates a Federal assistance relationship with the subrecipient.Federal award HYPERLINK "https://bphc.hrsa.gov/programrequirements/compliancemanual/glossary.html" \l "federal-award" \t "contentframe"






























42 U.S.C. 254b HYPERLINK "http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim" [email protected] HYPERLINK "https://sharepoint.hrsa.gov/sites/bphc/oppd/ED1/OMB%20Forms%20Approval%202020/[email protected]"



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleForm 8: Health Center Agreements
SubjectForm 8: Health Center Agreements
AuthorHRSA
File Modified0000-00-00
File Created2021-01-14

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