B-3 TC Part B X07 Expenditures Report 4_9_2021_tracked changes.

FYXX RWHAP Part B & MAI Expenditures Report

	Prior Year Carryover	Award Amount	Total Avail. Funds
1. RWHAP Part B Base Award
2. RWHAP Part B ADAP Earmark Award
3. RWHAP Part B ADAP Supplemental Award	This should not be blacked out as ADAP supplemental can be carried over.
4. Total RWHAP Part B Base + ADAP + ADAP Supplemental Funds
5. RWHAP Part B Emerging Communities Award	This should not be blacked out as EC can be carried over.
7. Total RWHAP Part B Funds
8. RWHAP Part B MAI Award
9. Total RWHAP Part B + MAI Funds

1. Base Award

2. ADAP Earmark + ADAP Supplemental

3. Emerging Communities Award

4. Total Prior Year Carryover

5. Total (including carryover)

Carryover

Award

Percent

Carryover

Award

Percent

Carryover

Award

Percent

Amount

Percent

Amount

Percent

1. RWHAP Part B AIDS Drug Assistance Program Subtotal

Should not be blacked out

a. ADAP Services

Should not be blacked out

b. Health Insurance to Provide Medications

Should not be blacked out

c. ADAP Access/Adherence/Monitoring Services

Should not be blacked out

2. RWHAP Part B Health Insurance Premium & Cost Sharing Assistance

Should not be blacked out

3. RWHAP Part B Home and Community-based Health Services

Should not be blacked out

4. RWHAP Part B HIV Care Consortia

Should not be blocked as carry over f dollars can be used for consortia services

Should not be blacked out

Should not be blocked out

4a. RWHAP Part B HIV Care Consortia Administration

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

5. RWHAP Part B State Direct Services

Should not be blocked out

6. RWHAP Part B Clinical Quality Management

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

- -

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

7. RWHAP Part B Recipient Planning & Evaluation Activities

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

- -

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

8. Recipient Administration

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

- -

Should be blacked out as carryover funds cannot be used for admin, planning & evaluation or CQM

9. Column Totals

Should not be blocked out.

10.Total RWHAP Part B Expenditures (excluding carryover)

validation: Total Prior year Carryover Expenditure should be <= Prior Year Carryover award amount??? Yes

- Need to confirm logic. Correct

OMB Number 0915-0318

Expiration date 09/30/2023

	1. Consortia		2. Direct Services		3. Emerging Communities		4. Prior Year Carryover		5. Total (including carryover)
	Award	Percent	Award	Percent	Award	Percent	Amount	Percent	Amount	Percent
Core Medical Services
a. AIDS Drug Assistance Program (ADAP) Treatments			Should be blocked out	Should be blocked out	Should be blocked out	Should be blocked out	Should be blocked out	Should be blocked out		- -
b. AIDS Pharmaceutical Assistance (LPAP)										- -
c. Early Intervention Services										- -
d. Health Insurance Premium & Cost Sharing Assistance					Should be blacked out as c captured above in column 3. Row 2	Should be blacked out as captured above in column 3 row 2	Should be blacked out as captured above	Should be blacked out as captured above		- -
e. Home and Community-based Health Services					Should be blacked out as captured above	Should be blacked out as captured above	Should be blacked out as captured above	Should be blacked out as captured above		- -
f. Home Health Care										- -
g. Hospice										- -
h. Medical Case Management (incl. Treatment Adherence Services)										- -
i. Medical Nutrition Therapy										- -
j. Mental Health Services										- -
k. Oral Health Care										- -
l. Outpatient /Ambulatory Health Services										- -
m. Substance Abuse Outpatient Care										- -
1. Core Medical Services Total										- -
Support Services
a. Child Care Services
b. Emergency Financial Assistance
c. Food Bank/Home-Delivered Meals
d. Health Education/Risk Reduction
e. Housing
f. Linguistics Services
g. Medical Transportation
h. Non-Medical Case Management Services
i. Other Professional Services
j. Outreach Services
k. Psychosocial Support Services
l. Referral for Health Care and Support Services
m. Rehabilitation Services
n. Respite Care
o. Substance Abuse Services - residential
2. Support Services Total
3. Total

MAI AWARD
	PRIOR FY CARRYOVER		REPORTING YEAR AWARD		TOTAL
	Amount	Percent	Amount	Percent	Amount	Percent
1. Education to increase minority participation in ADAP
2. Outreach to increase minority participation in ADAP
3. Clinical Quality Management	Should be blacked out as cannot use carryover for CQM	Should be blacked out as cannot use carryover for CQM
4. Recipient Planning & Evaluation Activities	Should be blacked out as cannot use carryover for planning and evaluation	Should be blacked out as cannot use carryover for planning and evaluation
5. Recipient Administration	Should be blacked out as cannot use carryover for administration	Should be blacked out as cannot use carryover for administration
6. Total MAI Expenditures

Public Burden Statement: The purpose of this data collection system is to collect allocations/expenditures information regarding Ryan White HIV/AIDS Program (RWHAP) Parts A, B, C, D grant funding. HAB will use these data to show the impact of RWHAP funding on the care and treatment of people with HIV in the United States. 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 information collection is 0915-0318 and it is valid until 09/30/2023. This information collection is mandatory (through increased Authority under the Public Health Service Act, Section 311(c) (42 USC 243(c)) and title XXVI (42 U.S.C. §§ 300ff-11 et seq.). 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]