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 |
|
|
|
|
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|
|
|
|
- - |
h. Medical Case Management (incl. Treatment Adherence Services) |
|
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|
|
|
|
|
|
- - |
i. Medical Nutrition Therapy |
|
|
|
|
|
|
|
|
|
- - |
j. Mental Health Services |
|
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|
|
|
|
|
|
|
- - |
k. Oral Health Care |
|
|
|
|
|
|
|
|
|
- - |
l. Outpatient /Ambulatory Health Services |
|
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|
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|
- - |
m. Substance Abuse Outpatient Care |
|
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|
|
- - |
1. Core Medical Services Total |
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|
- - |
Support Services |
||||||||||
a. Child Care Services |
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b. Emergency Financial Assistance |
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c. Food Bank/Home-Delivered Meals |
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|
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d. Health Education/Risk Reduction |
|
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e. Housing |
|
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f. Linguistics Services |
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g. Medical Transportation |
|
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|
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h. Non-Medical Case Management Services |
|
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i. Other Professional Services |
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j. Outreach Services |
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|
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k. Psychosocial Support Services |
|
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|
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l. Referral for Health Care and Support Services |
|
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m. Rehabilitation Services |
|
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|
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n. Respite Care |
|
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o. Substance Abuse Services - residential |
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2. Support Services Total |
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|
|
|
3. Total |
|
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|
|
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|
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 |
|
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|
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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]
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Rawimas Laohavanich (Wi) |
File Modified | 0000-00-00 |
File Created | 2021-05-31 |