Tab C - 2023 DSR Manual_02_ADA

Ryan White
HIV/AIDS Program Part F
Dental Services Report

Instruction Manual 2023
Release Date: December 13, 2022

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 Office of Management and Budget (OMB) control
number. The OMB control number for this project is 0915-0151, with an expiration date of 7/31/2023. Public
reporting burden for this collection of information is estimated to average 45 hours per response for Ryan White
HIV/AIDS Program (RWHAP) Part F Dental Reimbursement Program respondents and 35 hours per response for
RWHAP Part F Community-Based Dental Partnership Program respondents, 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 14N39,
Rockville, MD 20857.

HIV/AIDS Bureau
Division of Policy and Data
Health Resources and Services Administration
U.S. Department of Health and Human Services
5600 Fishers Lane, Room 9N164
Rockville, MD 20857

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Table of Contents
Icons Used in this Manual�������������������������������������������������������������������������������������������� 1
Reminders and Updates for 2023 Reporting���������������������������������������������������������������� 2
DSR Report Deadline������������������������������������������������������������������������������������������������������������������������������������������� 2

Overview of the RWHAP Dental Program�������������������������������������������������������������������� 3
Introduction�������������������������������������������������������������������������������������������������������������������������������������������������������� 3
Administration���������������������������������������������������������������������������������������������������������������������������������������������������� 3
DSR Technical Assistance������������������������������������������������������������������������������������������������������������������������������������ 4
Eligibility�������������������������������������������������������������������������������������������������������������������������������������������������������������� 4

Form Overview and Requirements������������������������������������������������������������������������������������5
General Requirements���������������������������������������������������������������������������������������������������������������������������������������� 5
Dental Reimbursement Program (DRP) Application Requirements�������������������������������������������������������������������� 5
Community-Based Dental Partnership Program (CBDPP) Data Reporting Requirements����������������������������������� 6
Dental Services Report Materials������������������������������������������������������������������������������������������������������������������������ 6

Registering for the Dental Services Report Web System����������������������������������������������� 7
DRP Registration Steps���������������������������������������������������������������������������������������������������������������������������������������� 7
CBDPP Registration Steps���������������������������������������������������������������������������������������������������������������������������������� 10

Accessing the Dental Services Report Web System�����������������������������������������������������12
Step 1���������������������������������������������������������������������������������������������������������������������������������������������������������������� 12
Step 2���������������������������������������������������������������������������������������������������������������������������������������������������������������� 12
Step 3���������������������������������������������������������������������������������������������������������������������������������������������������������������� 12

Navigating the Dental Services Report Website����������������������������������������������������������13
Navigation Bar��������������������������������������������������������������������������������������������������������������������������������������������������� 13

Dental Services Report Workflow�������������������������������������������������������������������������������15
Login����������������������������������������������������������������������������������������������������������������������������������������������������������������� 15
Access the Report��������������������������������������������������������������������������������������������������������������������������������������������� 15
Complete the Report���������������������������������������������������������������������������������������������������������������������������������������� 15
Submit the Report��������������������������������������������������������������������������������������������������������������������������������������������� 15
Print the Report������������������������������������������������������������������������������������������������������������������������������������������������ 16
Unsubmit the Report (if applicable)����������������������������������������������������������������������������������������������������������������� 16
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Dental Services Report Instructions����������������������������������������������������������������������������������� 17
Program Contacts��������������������������������������������������������������������������������������������������������������������������������������������� 17
Section 1: Patient Demographics and Oral Health Services������������������������������������������������������������������������������ 17
Section 2: Funding and Payment Coverage������������������������������������������������������������������������������������������������������� 25
Section 3: Staffing and Training������������������������������������������������������������������������������������������������������������������������� 27
Section 4 (DRP): Additional Dental Reimbursement Program Information������������������������������������������������������ 29
Section 4 (CBDPP): Additional Community-Based Dental Partnership Program Information��������������������������� 31

Managing User Profile����������������������������������������������������������������������������������������������� 34
Changing a Password���������������������������������������������������������������������������������������������������������������������������������������� 35
Changing MFA��������������������������������������������������������������������������������������������������������������������������������������������������� 35
Changing Contact Information�������������������������������������������������������������������������������������������������������������������������� 37

Frequently Asked Questions���������������������������������������������������������������������������������������38
Glossary�������������������������������������������������������������������������������������������������������������������� 40

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Icons Used in this Manual
The following icons are used throughout this manual to alert you to important and/
or useful information.

The note icon highlights information that you should know when
completing this section.

The tip icon points out recommendations and suggestions that can
make it easier to complete this section.

The question mark icon indicates common questions asked with
answers provided.

A star icon indicates important information pertaining to the
submission of the DSR.

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Reminders and Updates for 2023
Reporting
• The Dental Services Report (DSR) is completed in a web-based platform
accessible here.
• Agencies may now select multiple options for Institution/Program Type (see
page 8).
• The Dental Reimbursement Program (DRP) Notice of Funding Opportunity
(NOFO) release date is January 6, 2023.
• DRP Unreimbursed Costs: For DRP, the total unreimbursed costs of oral health
care provided to patients with HIV from July 1, 2021, through June 30, 2022,
entered in Section 4 Tab 2 must match the unreimbursed amount entered
in fields 18a and 18g of the SF-424. Failure to submit this information in
accordance with above instruction will result in an incomplete application
and HRSA will deem your application ineligible.

DSR Report Deadline
• Community-Based Dental Partnership Programs (CBDPPs) must submit data
no later than March 10, 2023.
• DRPs must submit data no later than March 10, 2023.

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Overview of the RWHAP Dental
Program
Introduction
The Ryan White HIV/AIDS Program (RWHAP), first authorized by the U.S. Congress in
1990, is administered by the U.S. Department of Health and Human Services (HHS),
Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB). As
part of the RWHAP, Section 2692(b) of Title XXVI of the Public Health Service Act
authorizes the Secretary of Health and Human Services to make grants through the
Dental Reimbursement Program (DRP) to accredited predoctoral dental, postdoctoral
dental, and dental hygiene education programs to help cover the unreimbursed costs
of providing oral health services to patients with HIV. Each eligible dental education
program may submit an annual application that documents its unreimbursed costs of
providing oral health care to patients with HIV during the prior year. The Secretary
distributes the available funds among all eligible applicants, taking into account the
unreimbursed costs incurred by each institution, the total of all costs incurred by all
eligible applicants, and the amount of funds available.
Section 2692(b) also authorizes the Secretary to make grants to accredited predoctoral
dental, postdoctoral dental, and dental hygiene education programs to support
partnerships between dental education programs and community-based oral health
providers. The Community-Based Dental Partnership Program (CBDPP) focuses on
the provision of care and the training of additional oral health providers through
collaborative community-based partnerships to increase access to oral health care for
people with HIV. The CBDPP grants are awarded for project periods up to five years. Each
recipient must collect, manage, and report annual program data that will document key
service delivery and educational components of the funded programs.

Administration
The DRP and CBDPP are administered by the Division of Community HIV/ AIDS
Programs (DCHAP) within the HRSA HAB.

CBDPP questions should be directed to:
Recipient’s Project Officer

DRP questions should be directed to:
Catishia Mosley, MSPH
Public Health Advisor
Division of Community HIV/AIDS Programs
Email: [email protected]

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DSR Technical Assistance
Ryan White HIV/AIDS Program Data Support and Technical
Assistance
If you need technical assistance or have reporting questions, contact Ryan White
Data Support via telephone or email.
Days and hours of operation: Monday – Friday, 10 a.m. – 6:30 p.m. ET
Phone number: 1-888-640-9356
Email: [email protected]
Please note that Ryan White Data Support is closed on all observed federal holidays.

Grants.gov Technical Assistance
If you need technical assistance with the SF-424 submission, contact Grants.gov.
Days and hours of operation: 24 hours a day 7 days a week excluding federal holidays
Phone number: 1-800-518-4726
Email: [email protected]
Create a Ticket Here

Eligibility
To be eligible for DRP and CBDPP funding, the applicant must be an institution with
a predoctoral dental, postdoctoral dental, or dental hygiene education program that
is accredited by the Commission on Dental Accreditation of the American Dental
Association. DRP applicants must have documented unreimbursed costs of oral
health care provided to people with HIV.

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Form Overview and Requirements
The DSR is used by two programs under the Ryan White HIV/ AIDS Treatment
Extension Act of 2009: the DRP and the CBDPP. The DSR is designed to collect data
from accredited pre- and postdoctoral dental education programs and dental hygiene
education programs regarding oral health services provided to people with HIV.
DRP institutions applying for dental reimbursement funding must submit a completed
report annually to receive assistance with their unreimbursed costs of care incurred
in providing direct oral health services. CBDPP grant recipients use this report to
submit annual program data, which is a reporting requirement of the grant award.

General Requirements
DRP applicants and CBDPP recipients must complete the following components of
the DSR:
• Program Contacts
• Section 1: Patient demographics and oral health services
• Section 2: Funding and payment coverage
• Section 3: Staffing and training

Dental Reimbursement Program (DRP)
Application Requirements
All applicants for DRP funding will use this report to submit information for the period
July 1 through June 30 of the previous year (e.g., applications due in Spring 2023
report on services and training provided from July 1, 2021, to June 30, 2022).
In addition to the General Requirements (page 5), DRP applicants also must
complete Section 4 (DRP): Additional Dental Reimbursement Program Information
(page 29), which includes items regarding use of funding, unreimbursed costs,
and narratives. The narrative responses describe various aspects of the applicant’s
program and help portray the scope of oral health care provided to patients with HIV.

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Use the DSR website to complete and submit your report. The DRP submission has
two submission components:
• An application package and unreimbursed cost to Grants.gov.
• Your DSR data via the DSR Website.
Paper submissions will generally not be accepted. In extreme cases, you may request
a formal waiver of the requirement to submit electronically.
DRP DSR and Grants.gov submissions received after the due
date, are incomplete, or are from institutions that do not have
an accredited dental or dental hygiene education program will
not be accepted for consideration for funding.

Community-Based Dental Partnership
Program (CBDPP) Data Reporting
Requirements
All CBDPP recipients will use this report to submit annual program data for the period
of January 1 through December 31 of the prior year.
In addition to the General Requirements (page 5), CBDPP recipients must also
complete Section 4 (CBDPP): Additional Community-Based Dental Partnership
Program Information (page 31), which includes items about the target populations
and member organizations of the CBDPP.
Use the DSR Website to complete and submit your report.

Dental Services Report Materials
To obtain guidance materials, go to the HRSA HIV/AIDS Bureau website. Resources
are also available for download via the Resources option in the Navigation Bar (page
13) of the DSR Website.

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Registering for the Dental
Services Report Web System
DRP Registration Steps
Step 1
Navigate to the DSR Website.

Step 2
Click the link to fill out the DSR Registration Form Link (Figure 1).
Figure 1. DSR Registration Form Link

Step 3
You will be taken to the registration page (Figure 2). You must indicate if your
organization is a CBDPP grantee by selecting “yes” or “no.” If you are only applying
for the Dental Reimbursement Program, select “no.” If you are a CBDPP recipient,
select “yes” and follow the CBDPP Registration Steps (page 10).

Step 4
• Organization’s name. Enter your organization’s name. A pre-populated list of
organizations will appear. If your organization’s name appears in the populated
list, go to Step 4a. If it does not appear in the list, go to Step 4b.

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Step 4a
• Click your organization’s name from the populated list. Your Organization
Information will automatically populate. Continue to Step 5.

Step 4b
Complete the following fields:
• Institution/Program Type (Select all that apply)
▪ Accredited predoctoral dental education program – School of Dentistry
▪ Accredited postdoctoral dental education program – School of Dentistry,
Hospital, Health Center, or Other
▪ Accredited dental hygiene education program

New in 2023, agencies may now select all instutition/program
type that apply. If you require assistance with this, contact Ryan
White HIV/AIDS Program Data Support and Technical Assistance
(page 4).
• Organization Address
• Institution/Program Website Address

Step 5
Complete the User Information section by completing the following components:
• Email Address
• First and Last Name
• User Address
• Contact Information

Step 6
Click “Submit Request.” You will receive an email stating your request has been
submitted. All registration requests are reviewed by Ryan White Data Support. If
approved, you will receive an email with a link to continue setting up your account.
The link is only active for 24 hours. If 24 hours have elapsed, you can have a new
email sent to finish setting up your account by using the Forgot Password link on the
login page.

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Figure 2. DRP Registration Form

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CBDPP Registration Steps
Step 1
Navigate to the DSR Website.

Step 2
Click the link to fill out the DSR Registration Form Link (Figure 3).
Figure 3. DSR Registration Form Link

Step 3
You will be taken to the “Register for a user account” page (Figure 4). Indicate if your
organization is a CBDPP grantee by selecting “yes” or “no.” CBDPP recipients may still
complete the DRP application even if “yes” is selected. If “no” is selected, return to
the DRP Registration Steps (page 7).

Step 4
Complete the Organization Information section by completing the following
components:
• Organization’s name. Begin entering your organization’s name. A list of options
should populate. Select your organization from the list. If you do not see your
organization populate, contact the DSR Technical Assistance (page 4).

Step 5
Complete the User Information section by completing the following components:
• Email Address
• First and Last Name
• User Address
• Contact Information

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Step 6
Click “Submit Request.” You will receive an email stating your request has been
submitted. All registration requests are reviewed by Ryan White Data Support. If
approved, you will receive an email with a link to continue setting up your account. The
link is only active for 24 hours. If 24 hours have elapsed, you can have a new email sent
to finish setting up your account by using the Forgot Password link on the login page.
Figure 4. CBDPP Registration Form

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Accessing the Dental Services
Report Web System
Step 1
Navigate to the DSR Website.

Steps for registering for the DSR website can be found here:
Registering for the Dental Services Report Web System (page 7).

Step 2
On the login page, you will enter your email and password and click “Log in.”
Forgot Password? Use the Forgot Password link on the Login
page and enter your email address when prompted to receive a
password reset email.

Step 3
If this is your first time logging in, you will be prompted to set up an Authentication
Phone Number. See What is Multi-Factor Authentication? (page 38) for more details
on how to manage your authentication settings. Depending on the authentication
method chosen, you will do one of three things:
1. If you select the “text message” option, you will input your telephone number
and press “Save.” You will then receive a six-digit authentication code via text to
enter into the code field. Click “Save.”
2. If you select the “voice call” option, you will input your telephone number and
press “Save.” You will then receive an automated voice call to your telephone.
You will enter the spoken six-digit authentication code into the field and then
click “Save.”
3. If you select the “Google Authenticator” option, you will be prompted to open
the Google Authenticator app on your smartphone device. You may either scan
the QR code on the screen using the Google app or manually enter the provided
code. Once you click “Save,” you will be prompted to enter the current six-digit
authentication code the app displays for the DSR Website. Click “Save.”
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Navigating the Dental Services
Report Website
Navigation Bar
There are five sections of the system that are accessed by the navigation bar at the
top of the page. These sections are described below.
Figure 5. DSR Site Navigation Bar

Why don’t I see “Admin” on my navigation bar?
Only one user for each organization will have the OrgAdmin user
role. More information about the organization admin role can be
found in the Admin (Organization Admin User Only). If you need
assistance changing your organization’s OrgAdmin, contact Ryan
White HIV/AIDS Program Data Support Technical Assistance.

Home:
Click “Home” to return to the DSR landing page. Announcements pertaining to the
submission and Ryan White Data Support’s contact information can be found on
this page.

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Reports:
My Organization Info: Your organization’s information, including organization name,
institution/program type, grant number, address, and program website are listed here.
These fields are only editable by the organization’s Admin
(OrgAdmin). If you’re in need of assistance with editing this
information, contact Ryan White HIV/AIDS Program Data Support
and Technical Assistance (page 4) or your OrgAdmin.
Dental Reimbursement Program: Click here to access the DRP Report. The website will
default to the current reporting period. Past submission periods will be accessible in
Read Only format using the Submission Period dropdown menu.
Community-Based Dental Partnership Program: CBDPP recipients will click here to
access the CBDPP Report. The website will default to the current reporting period. Past
submission periods will be accessible in Read Only format using the Submission Period
dropdown menu.
Only CBDPP recipients will have access to the CBDPP Report. If
you’re in need of assistance accessing your report, contact Ryan
White HIV/AIDS Program Data Support and Technical Assistance
(page 4).

Resources:
Ryan White Data Support and HRSA HAB will post DSR resources here, such as this
Instruction Manual and PDF versions of the forms.

Admin (Organization Admin User Only):
Each organization has one organization Admin (OrgAdmin) user. If you’re unsure of who
this individual is within your organization, contact DSR Technical Assistance (page 4).
Manage Registration Requests: The OrgAdmin can approve or reject new user
registration requests here.
Manage Users: The OrgAdmin can modify who is the assigned OrgAdmin for the
organization, review other organization users, and deactivate user accounts for their
organizations.

Your Email Address:
My Profile: From the My Profile page, you can change your password, change your
multi-factor authentication type, and update your contact information.
Log off: Use this link to log out of the DSR website.
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Dental Services Report Workflow
Login
Login to the DSR Website.

Access the Report
Access the DRP or CBDPP Report via the Reports tab dropdown menu at the top of
the page.

Complete the Report
Once in the report, complete each section. This includes Program Contacts and
Sections 1-4. Additional instruction can be found here: Dental Services Report
Instructions (page 17).

Each section must be completed sequentially in its entirety
and error free before the section can be successfully saved. We
suggest using the blank PDF to collect data prior to entering data
in the DSR website.

Submit the Report
Once each section has been successfully saved, click “Submit.” You will be asked to
verify that the information submitted is accurate and you are authorized to submit
this report. Once you click “Verify,” you may still view each section of the report, but
the information will no longer be editable. Your report will advance to “Submitted”
status as indicated in Figure 6 (page 16).
Prior to submission, you may generate a filled in PDF of the data
entered in the DSR website. This may be used to verify data
internally prior to submitting the report. However, your submission
is not complete until the report is in “Submitted” status.

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Figure 6. Submission Status Table

Prior to submission, you may generate a filled in PDF of the data entered
in the DSR website. This may be used to verify data internally prior to
submitting the report. However, you submission is not complete until the
report is in “Submitted” status.

Print the Report
Once submitted, you may click “Print” to access a completed PDF version of your
report and save it for your records. This PDF may take up to a minute to generate.

Unsubmit the Report (if applicable)
If you’ve identified an issue with your report and it’s within the reporting period, you
may request to “Unsubmit” your report. Each request is reviewed by Ryan White Data
Support. If approved, you will receive an email when your report has been returned
to “Working” status. Return to the report to correct and resubmit the data.

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Dental Services Report Instructions
All programs must complete the General Requirements (page 5).
Each section must be completed sequentially in its entirety
and error free before the section can be successfully saved. We
suggest using the blank PDF to collect data prior to entering data
in the DSR website.

Program Contacts
Primary Contact: Indicate the name and contact information for the person most
closely connected to the provision of services covered by this report, typically the
dentist or dental hygienist managing the program. This person will be notified
of funding and will be considered the primary contact for all dental program
communications. Include the contact person’s email address, as this has become a
primary method of correspondence.
Alternate Program Contact: Provide an alternate name and contact information for
a person connected to the provision of services if the primary contact is unavailable.

Section 1: Patient Demographics and Oral
Health Services
Tab One:
Unduplicated Patient Count: Indicate the number of all unduplicated patients with
HIV who received at least one oral health service from your program’s students,
residents, faculty, or dental staff during the period covered by this report, regardless
of where these services were provided. For CBDPP recipients, this number should
include all individuals with HIV seen during this period whose services were exclusively
or partially paid for by RWHAP. Include patients who are not continuing to receive
services from your clinic because they moved; transferred to another institution,
program, or provider; or died.
This must be an actual count of patients with HIV. You may not use estimates of any kind.

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New Patients: Of the number of patients reported in the unduplicated patient count,
indicate how many patients were seen by your program for the first time during the
period covered by this report. Patients who were seen in a prior period, even if after
an absence from your clinic, should not be counted as new patients.
The number of new patients reported must be less than or equal
to the total unduplicated patients.
HIV/AIDS Status: Of the number of unduplicated patients, indicate the number by
HIV/AIDS status as of the first visit in the period covered by this report.
• HIV-positive, not AIDS
• HIV-positive, AIDS status unknown
• CDC-defined AIDS
The sum of all HIV/AIDS status categories must equal the total
number of unduplicated patients.

The 1993 AIDS Surveillance Case Definition of the U.S. Centers
for Disease Control and Prevention
A diagnosis of AIDS is made whenever a person is living with HIV and:
• Has a CD4+ cell count below 200 cells per microliter,
• Their CD4+ cells account for less than 14 percent of all
lymphocytes, or
• They have been diagnosed with one or more AIDS-defining
illnesses.
Go to the CDC website for a complete list.

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Tab Two:
Gender: Of the number of unduplicated patients reported, indicate the number by
gender.
• Male
• Female
• Transgender male to female
• Transgender female to male
• Transgender other
• Unknown
The sum of all gender categories must equal the total number of
unduplicated patients reported.
Sex at Birth: Of the number of unduplicated patients reported, indicate the number
by the sex assigned to the client at birth.
• Males
• Females
Age: Of the number of unduplicated patients reported, indicate the number of
patients by their oldest ages at any time during the period covered by this report.
• <13
• 13-24
• 25-34
• 35-44
• 45-54
• 55-64
• 65 or older

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Income: Of the number of unduplicated patients reported, indicate the number of
patients by their annual household income relative to the federal poverty guidelines at
any time during the period covered by this report. (See the Federal Poverty Guidelines)
• Equal to or below the federal poverty line
• 101-200% of the federal poverty line
• 201-300% of the federal poverty line
• >300% of the federal poverty line
• Unknown/unreported
The sum of all Household Income categories must equal the total
number of unduplicated patients reported.
Race: Of the number of unduplicated patients reported, indicate the number by the
race categories shown. Patients who identify with more than one race or multi-race
should be counted in the “More than one race” category.
The following racial category descriptions, defined in October 1997, are required for
all federal reporting, as mandated by OMB.
Find more information here. HRSA mandated use of these categories as of January 2002.
• American Indian or Alaska Native is a person having origins in any of the
original peoples of North and South America (including Central America) and
who maintains tribal affiliation or community attachment.
• Asian is a person having origins in any of the original peoples of the Far East;
Southeast Asia; or the Indian subcontinent, including Cambodia, China, India,
Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
• Black or African American is a person having origins in any of the black racial
groups of Africa.
• Native Hawaiian or Other Pacific Islander is a person having origins in any of
the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
• White is a person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.
• More than one race is a person who identifies with more than one racial
category.
The sum of all race categories must not exceed the total number
of unduplicated patients reported. RWHAP dental programs
are expected to make every effort to obtain and report race
information based on each patient’s self-identification.

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Ethnicity: Of the number of unduplicated patients reported, indicate the number by
the ethnicity categories shown.
• Hispanic or Latino/a is a person of Mexican, Puerto Rican, Cuban, Central or
South American, or other Spanish culture or origin, regardless of race.
• Non-Hispanic or Latino/a
The sum of the ethnicity categories must not exceed the total
number of unduplicated patients reported. RWHAP dental
programs are expected to make every effort to obtain and report
ethnicity information, based on each patient’s self-identification.

Tab Three:
Pregnancy Status: Of the total number of patients with HIV whose sex at birth was
reported as female, indicate their pregnancy status during the period covered by
this report. Indicate their status as “pregnant,” when that is known, regardless of the
pregnancy outcome.
Also indicate the number who were known to not be pregnant, or who were unsure
of their pregnancy status.
• Pregnant
• Not pregnant
• Unsure if pregnant
• Unknown/unreported
If data are reported in the “unknown/unreported” category,
indicate why the data are not available. The sum of all
pregnancy categories must equal the total number of patients
whose sex at birth was female.

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Hispanic Subgroup: Of the number of Hispanic patients reported, indicate the
number by the ethnic subcategories shown.
• Mexican, Mexican American, Chicano/a
• Puerto Rican
• Cuban
• Other Hispanic, Latino/a or Spanish origin

The sum of the Hispanic ethnicity categories must not exceed
the total number of Hispanic patients reported. RWHAP dental
programs are expected to make every effort to obtain and report
ethnicity information based on each patient’s self-identification.
Native Hawaiian or Pacific Islander Subgroup: Of the number of Native Hawaiian
or other Pacific Islander patients reported, indicate the number by the racial
subcategories shown.
• Native Hawaiian
• Guamanian or Chamorro
• Samoan
• Other Pacific Islander
The sum of the Native Hawaiian or other Pacific Islander racial
categories must not exceed the total number of Native Hawaiian
or other Pacific Islander patients reported. RWHAP dental
programs are expected to make every effort to obtain and report
race information based on each patient’s self-identification.

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Asian Subgroup: Of the number of Asian patients reported, indicate the number by
the racial subcategories shown.
• Asian Indian
• Chinese
• Filipino
• Japanese
• Korean
• Vietnamese
• Other Asian
The sum of the Asian racial categories must not exceed the total
number of Asian patients reported. RWHAP dental programs
are expected to make every effort to obtain and report race
information based on each patient’s self-identification.

Tab Four:
Location: Of the number of unduplicated patients reported, show the number who
usually received their primary medical care in each of the locations listed.
• Provider or clinic co-located in the same physical facility or site where oral
health care is provided
• Provider or clinic in the same institution providing oral health care, but at a
different site
• Other medical provider or clinic not in the same institution providing oral
health care at a different site
• Unknown/unreported
The total number of patients reported here should be equal to
the number of unduplicated patients reported.

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Service Type: Indicate the total number of visits made by patients for each type of
service provided during the period covered by this report. This question is intended to
determine the scope and relative frequency of oral health services provided for your
patients, not the number of individual treatment procedures performed. Therefore,
report numbers of visits, not patients or procedures. If your program provided
several services to a patient during a single clinic visit, count each service type as
a separate visit. For example, if during a patient’s clinic visit, you took radiographs,
performed two quadrants of root planning, and provided root canal therapy for two
molars, count these as three visits — one visit each in the diagnostic, periodontic,
and endodontic service categories.
If the type of service provided is not listed, specify it in the “Other” category.
• Diagnostic
• Preventive
• Oral health education/health promotion
• Nutrition counseling
• Tobacco prevention/cessation
• Oral medicine/oral pathology
• Restorative
• Periodontic
• Prosthodontic
• Oral and maxillofacial surgery
• Endodontic
• Anesthesia/sedation/nitrous oxide analgesia/palliative care
• Emergency services
• Other (specify below)

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Section 2: Funding and Payment Coverage
Tab One:
Ryan White HIV/AIDS Program Funding: Indicate whether the parent institution of the
program received any other RWHAP funding during the period covered by this report
(i.e., monies received from RWHAP Parts A–D, Special Projects of National Significance,
or AIDS Education and Training Centers) to provide any HIV-related services, not only
oral health services or training. Indicate the total amount the parent institution of the
program received from each funding type listed (rounded to the nearest dollar). If no
additional funding was received, enter “0” in the corresponding field.
• Part A
• Part B
• Part C
• Part D
• Part F Special Projects of National Significance (SPNS)
• Part F AIDS Education and Training Centers (AETCs)
Third-Party Payor Coverage: Of the number of unduplicated patients reported,
indicate how many received oral health care with no or partial third-party payor
coverage and the number whose third-party payor coverage status was unknown.
• NO third-party payor coverage
• PARTIAL third-party payor coverage
• UNKNOWN third-party payor coverage status

The total number of patients reported here should be equal to
the total unduplicated patients reported.

Only report direct reimbursements from third-party payors
(public and private) as payment for services provided. For the
purposes of this report, funding from RWHAP or other grants
is considered program income or revenue and should not be
reported in Third-Party Payor Coverage or Number of Patients
and Payments Received.

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Tab Two:
Number of Patients and Payments Received: Indicate the number of patients with
HIV whose oral health care was partially covered by each of the listed payment
sources and the amounts of payments received (rounded to the nearest dollar)
from those sources, including patients who self-pay. For the purposes of this report,
count a patient if at any time during the period covered by this report, payment was
received for at least one visit or service.
Report patients whose oral health care was covered by more than one payment
source under all categories of payment source from which payment was received.
For example, report a patient whose care was supported by Medicare and private
insurance twice in this table. If a payment source is not included, specify it in the
“Other” category (Figure 7).

If a value is entered in the “Patients with HIV column,” the
“Payment Received ($)” column may not be blank.
Figure 7. DSR Funding and Payment Coverage Table

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Section 3: Staffing and Training
Staffing and Training: For the period covered by this report, indicate the total number
of students, residents, and other nonstudent dental providers who were enrolled in
or rotated through your program, and the total number of those students, residents,
and other dental providers who received training in providing services to patients with
HIV. Also indicate the total number of hours of your training curriculum dedicated to
issues related to HIV and oral health management, and the total number of hours
that all students, residents, and other dental providers spent providing direct clinical
services for patients with HIV. Include any optional narrative description of your HIV
training program to provide further clarification (Figure 8).
Data validations triggered for this table are based on the
institution/program type(s) selected. To review your agency’s
selections, please review the “My Organization Info” on the
Reports (page 14) navigation bar. If you need assistance,
contact Ryan White HIV/AIDS Program Data Support and
Technical Assistance (page 4).

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Figure 8. DSR Staffing and Training Table

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Section 4 (DRP): Additional Dental
Reimbursement Program Information
This section is only completed by agencies submitting the DRP DSR.

Tab One:
Use of Funding: Check each way you will use DRP funds (check all that apply). If a use
is not listed, specify it in the “Other” category.
• Direct patient services (e.g., provider/faculty salaries)
• Patient education or outreach
• Curriculum development
• Student education/training
• Staff education/training
• Clinic staff salary/support
• Equipment/instruments/supplies/materials
• Pharmaceuticals or dental medicaments
• General operations
• Other (specify)

Tab Two:
Unreimbursed Costs: Indicate the total unreimbursed costs (rounded to the nearest
dollar) of oral health care provided to patients with HIV during the period covered
by this report. Institutions/programs should review their charts and financial records
to calculate the total actual unreimbursed costs of services provided. If you cannot
calculate actual costs, use your institution’s usual fees as a surrogate for the services
provided (before any discount or sliding-fee schedule is applied).
Calculation Methods: Provide a concise description of the methods used to calculate
the reported Unreimbursed Costs.
The total unreimbursed costs of oral health care provided to
patients with HIV from July 1, 2021, through June 30, 2022,
entered must match the unreimbursed amount entered in 18a
and 18g of the SF-424.

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Tab Three:
Your narrative responses will inform HRSA of your program’s unique characteristics
and strengths in providing comprehensive oral health care for patients with HIV.
Your responses will also enable HRSA to more fully understand the environment in
which oral health care is provided to patients with HIV and to gauge the extent of
collaboration among the various RWHAP-supported programs.
Site Descriptions: Concisely describe the sites where your predoctoral dental/
postdoctoral dental/ dental hygiene education program provides oral health services
to patients with HIV. In identifying these sites, describe whether students and
residents provide direct patient care in community-based facilities and whether such
facilities are organizational components of your institution or separate organizations.
Working Relationships with Ryan White HIV/AIDS Programs: Describe working
relationships that your predoctoral dental/postdoctoral dental/ dental hygiene
education program has established with RWHAPs, including RWHAP Part A HIV
planning councils and RWHAP Part B HIV consortia. Describe how your program has
been working to maximize coordination, integration, and effective linkages among
local RWHAP-funded programs.
Special Strengths or Unique Capabilities: Concisely describe any special strengths or
unique capabilities of your predoctoral dental/postdoctoral dental/dental hygiene
education program with respect to providing oral health care for patients with HIV
(e.g., facilities, hours of operation, support services, or staff skills or expertise).
Include evening and weekend clinic hours, onsite participation in clinical trials,
provider or staff diversity, special patient education programs, the availability of
childcare services, language translation services, transportation services, or other
special strengths.

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Section 4 (CBDPP): Additional CommunityBased Dental Partnership Program
Information
This section is only completed by agencies submitting the
CBDPP DSR.

Target Populations: Indicate which populations of people with HIV were prioritized
to receive outreach or services from your program during the period covered by this
report (check all that apply).
• Urban populations
• Suburban populations
• Rural populations
• Migrant or seasonal workers
• Youth experiencing homelessness
• Gay, lesbian, bisexual, transgender, gender non-conforming youth
• Gay, lesbian, bisexual, transgender, gender non-conforming adult
• People experiencing homelessness
• People who are justice involved
• People with substance use disorders
• Other (specify)
HRSA RWHAP recipients and subrecipients may provide HRSA
RWHAP core medical services and support services to people
with HIV incarcerated in federal and state prison systems on a
transitional basis only. HRSA RWHAP recipients and subrecipients
may also provide HRSA RWHAP core medical services and
support services to people with HIV incarcerated in other
correctional systems on a short-term and/or transitional basis.
Please see HRSA HAB Policy Clarification Notice 18-02 The
Use of Ryan White HIV/AIDS Program Funds for Core Medical
Services and Support Services for People Living with HIV Who Are
Incarcerated and Justice Involved for further clarification on the
provision of HRSA RWHAP services to people with HIV who are
justice-involved.

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Member Organizations: List your CBDPP member organizations’ names and
addresses and each partner’s primary contact person. Also indicate if each partner
receives CBDPP funds by selecting “yes” or “no,” and briefly describe each partner’s
role, function, or contribution to the partnership (e.g., special staff skills, capacity
to provide services or train providers, experience managing grants, expertise in
community outreach or dental case management, capacity to provide transportation
or child care services).
To add the organization, click “Add Member Organization” as shown in Figure 9
(page 32).
Figure 9. Add Member Organization

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A new window will open with fields pertaining to the member organization you’re adding.
Complete the required fields, including a brief description of the partner’s role or function
and click “Save” as shown in Figure 10 (page 33).
Figure 10. Member Organization Details

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Managing User Profile
You can manage your contact information, password, and Multi-Factor Autentication
(MFA) settings through the My Profile page (Figure 11). This page is accessible via
your email address in the Navigation Bar (page 13).
Figure 11. My Profile Page

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Changing a Password
You may change your password by selecting the “Change Password” button on the
My Profile page. This will bring up the change password page. To change a password,
you must provide your original password and your desired new password in the
provided fields and click “Change Password.”
User passwords must contain at least fifteen characters and include at least one
uppercase letter (A-Z), one lowercase letter (a-z), one digit (0-9), and one non-letter
or digit character (e.g., !, @, #, $, %, ^, &, etc.).
*You may not reuse previously used passwords.
*You may not change your password more than once every 24 hours for security
reasons.

Changing MFA
The MFA telephone number and method can be changed by clicking on the “Change
Authentication” button on the My Profile page. This will bring up the Change MultiFactor Authentication page (Figure 12).
Depending on the authentication method chosen, you will do one of three things:
1. If you selected the “text message” option, you will input your telephone
number and press “Save.” You will then receive a six-digit authentication
code sent via text to enter into the code field and will then click “Save.”
Figure 12. Change MFA to Text Message

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2. If you selected the “voice call” option, you will input your telephone number
and press “Save.” You will then receive an automated voice call to your
telephone. You will enter the spoken six-digit authentication code into the
field and then click “Save.”
3. If you selected the “Google Authenticator” option, you will be prompted
to open the Google Authenticator app on your smart telephone device
(Figure 13). You may either scan the QR code on the screen using the google
app or manually enter the provided code. Once you click “Save,” you will be
prompted to enter the current six-digit authentication code the app displays
for the DSR Website and click “Save.”
Figure 13. Change MFA to Google Authenticator App

*If the process is not completed by submitting a valid MFA code, the MFA setting will
not be changed.

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Changing Contact Information
Contact information can be changed by clicking on the “Change Contact Info” button
on the My Profile page. This will bring up the Change Contact Info page (Figure 14).
Changes can be saved by clicking on the “Save” button or canceled by clicking the
“Back to My Profile” button.
Figure 14. Change Contact Info in the My Profile Page

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Frequently Asked Questions
Why won’t the section of my report that I just completed, save?
To successfully save, data must be entered in each tab of the section and the data must
be error free. Ensure you’ve navigated through each tab and all errors are resolved. If
you need assistance resolving errors in your report, contact DSR Technical Assistance
(page 4).
How do I print my report?
The print option is available once the report is in submitted status. Navigate to your
DRP or CBDPP Report via the navigation bar. Below the table of report sections, click
the “Print” button.
How do I make a change to my report?
If your report has not been submitted, follow the Dental Services Report Workflow
(page 15) steps to modify your report. If your report has been submitted, but a
change is necessary within the reporting period you may request your report be
unsubmitted. To unsubmit your report, access your CBDPP or DRP report via the
Navigation Bar (page 13). Under the report sections, click the “Unsubmit” button.
Each request is reviewed by Ryan White Data Support. If approved, you will receive
an email when your report has been returned to “Working” status.
What do I do if I forget my password?
Use the Forgot Password link on the login page and enter your email address when
prompted to receive a password reset email.
What is Multi-Factor Authentication?
Multi-Factor Authentication (MFA) provides multiple layers of security for accounts
logging into the system. Typically, MFA consists of “something you know” (a username
and password) and “something you have” (a personal telephone). When new users
first log into the system, they will enter their username and password. Users are
then required to enter a valid telephone number and select whether they would like
to verify their entry through a randomized number code sent via text message, an
automated voice call, or by using Google Authenticator.
The telephone number and authentication settings entered during a user’s first entry
to the system are stored for future authorizations. Every time a user attempts to
log into the system, they will be required to enter a verification code. Verification
codes are randomized upon each entry to the system, so users will receive a new
verification code for each login attempt.

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Are data on the DSR website secure?
In addition to the MFA, the system employs exhaustive security steps, in both software
and hardware, to protect data. Only authorized users have access to the system. All
communications between the user’s browser and the system are encrypted with
Secure Socket Layer (SSL). The site is configured to immediately switch to HTTPS, so all
communications, without exception, between the user and the system are encrypted.
Can other users access my organization’s data?
Only users associated with your organization may view the data for their organization
affiliation.
Can I share my login information with others?
Login information should not be shared with any other individual. Each user should
also employ a unique telephone number for MFA, and not share a telephone number
with other users for purposes of MFA.

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Glossary
Term

Definition

Eligible Applicant

A dental school, institution with a predoctoral or postdoctoral dental education
program, or a dental hygiene education program that have provided oral health care
for patients with HIV and been accredited by the Commission on Dental Accreditation.

Household Income

The sum of money received in the previous calendar year by all household members,
ages 15 years and older, including household members not related to the householder,
people living alone, and others in nonfamily households.

Patient with HIV

A person who has the human immunodeficiency virus; a person with documented
confirmation of her/his positive serostatus (e.g., a positive HIV test result; a letter
verifying that the person is receiving HIV-related care or services from a primary
medical care provider, case manager, or AIDS service organization; a viral load test
result; an AIDS Drug Assistance Program (ADAP) enrollment card); or a person who
self-identifies as being HIV-positive. Patient with HIV pertains to people receiving direct
healthcare services.

Period Covered by
This Report

The period for which you are reporting data. If you are applying for DRP funding,
this report should present data on services provided from July 1 through June 30 of
the prior year. If you are submitting an annual CBDPP data report, this report should
present data on services provided from January 1 through December 31 of the prior
year.

Ryan White HIV/
AIDS Program

The Ryan White HIV/AIDS Treatment Extension Act of 2009 — The federal legislation
created to address the health care and service needs of people with HIV disease and
their families in the United States and its territories.

Statewide
Coordinated
Statement of Need
(SCSN)

A statement of significant HIV-related issues specific to each state, which is a result of
coordination, integration, and effective links across the Ryan White HIV/AIDS Programs.
The Ryan White HIV/AIDS Treatment Extension Act of 2009 requires recipients to
conduct activities to enhance coordination across all Ryan White HIV/AIDS Programs,
including collaborative development of an SCSN.

Unduplicated
Number of Patients

Patients counted using a method by which a single individual is counted only once
during the period covered by this report, regardless of how many clinic visits were
made or procedures performed. For institutions that provided care at multiple sites, a
patient is counted only once, even if he or she received services at more than one site.

Unreimbursed Oral
Health Care Costs

The balance remaining after subtracting the total payment received from patients
with HIV or Medicaid or other third-party payors, plus grants and all other sources of
revenue to support oral health care for patients with HIV, from the total of actual costs
incurred by the applicant institution in providing oral health care to those patients. If
actual costs to provide services cannot be calculated, then the applicant institution’s
usual fees for those procedures (before any discount or sliding-fee schedule is applied)
should be used as a surrogate for actual costs.

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