Form 44 Project Work Plan - clean

The Health Center Program Application Forms

Project Work Plan - clean

Project Work Plan

OMB: 0915-0285

Document [docx]
Download: docx | pdf

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







DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

PROJECT WORK PLAN

FOR HRSA USE ONLY

Application Tracking Number

Grant Number




Goal

For PCAs and HCCNs: All goals and objectives are required

For NTTAPs: All goals and objectives relevant to the selected NTTAP type are required.



Objective

Each goal includes predefined objectives that are required and may not be edited.


Baseline Data

Baseline data for some measures is prepopulated, and for some measures data must be entered by the applicant.


Numerator



Denominator



Baseline Value



Baseline Narrative

Provide a narrative description of baseline data informed by recent needs assessments and aligned with described key factors that impact performance.


Baseline Data Source

Provide source of baseline data when supplied by applicant.


Objective Target

Provide a numerical value to be achieved by the end of the project period for each required objective.


For Progress Reports Only: Current Data

Current data for some measures is pre-populated, and for some measures data must be entered by the applicant for each required objective.


For Progress Reports Only: Current Numerator



For Progress Reports Only: Current Denominator



For Progress Reports Only: Current Data Progress Toward Objective Target Value

System calculated percentage progress based on current data compared to baseline and objective target data.


Objective Impact Narrative

Describe the overall impact the planned activities are predicted to have on the objective by the end of the project period. Reference data sources used to determine the expected impact.


For Progress Reports Only: Objective Impact Narrative Progress

Describe progress toward achieving the predicted overall impact. Reference data sources used to determine the impact progress.


Key Factors

(maximum 500 characters)

Identify the factors that will contribute to and restrict progress on achieving the objectives.  Cite supporting data sources, (e.g., needs assessments, focus groups). 




PCAs and NTTAPs/NTTAPs: Formal Training and Technical Assistance (T/TA) Session Target

Provide the number of formal T/TA sessions planned (e.g., structured T/TA sessions with specific objectives and outcomes) through the end of the project period in order to meet this objective target.


For PCA/NTTAP Progress Reports Only: T/TA Session Target Progress

Provide numeric and narrative progress toward achieving the T/TA session target.


PCAs and NTTAPs/NTTAPs: Participation Target

Provide the number of health center representatives that will participate in the formal T/TA sessions through the end of the project period in order to meet this objective.


For PCA/NTTAP Progress Reports Only: Participation Target Progress

Provide numeric and narrative progress toward achieving the participation target.


For PCAs and NTTAPs: Additional Process Measure(s) Target(s)

Provide goal targets for 1-2 additional process measure(s) to align with HRSA metrics.


For PCA/NTTAP Progress Reports Only: Additional Process Measure(s) Progress

Provide numeric and narrative progress toward achieving the additional process measure(s).


Activity Audience

(NTTAPs only)

For NTTAPs: Select one predefined Activity Audience for each proposed Activity: Learning Collaborative or National Audience.


Activity Name (maximum 200 characters)

Provide a unique name for each activity that can be used to quickly distinguish between similar activities.



Activity

(maximum 7,500 characters)

For PCAs: Propose 2-5 activities for each objective.


For NTTAPs: Propose at least 1 activity for each Activity Audience under each objective.


For HCCNs: Propose 2-3 activities for each objective.



Person/Group Responsible (maximum 1,000 characters)

Identify the person(s)/position(s) that will be responsible and accountable for carrying out each Activity.


For PCAs and NTTAPs: Timeline (maximum 1,000 characters)

Provide a timeline for carrying out each Activity.


For HCCNs: Start Date

Provide a targeted start date for each activity.


For HCCNs: End Date

Provide a targeted end date for each activity.


Expected Activity Outcome (maximum 7,500 characters)

Identify the principal outcome for each Activity.




Comments (maximum 7,500 characters)

Update/provide supplementary information related to entries in the project work plan, as desired. Not required; this field can be left blank.

For Progress Reports Only: Activity Progress (maximum 5,000 characters)

Provide a progress description for each activity.









Public Burden Statement: Health centers (section 330 grant funded and Federally Qualified Health Center look-alikes) deliver comprehensive, high quality, cost-effective primary health care to patients regardless of their ability to pay. The Health Center Program application forms provide essential information to HRSA staff and objective review committee panels for application evaluation; funding recommendation and approval; designation; and monitoring. The OMB control number for this information collection is 0915-0285 and it is valid until XX/XX/XXXX. This information collection is mandatory under the Health Center Program authorized by section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b). Public reporting burden for this collection of information is estimated to average 4 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 14N136B, Rockville, Maryland, 20857 or [email protected].


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleWord version
AuthorRujuta Waknis
File Modified0000-00-00
File Created2021-01-14

© 2024 OMB.report | Privacy Policy