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Operational Plan

ICR 202610-0915-001 · OMB 0915-0285 · Object 174059500.

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleOperational Plan
Last Modified ByWriter
File Modified2026-09-29
File Created2026-10-22
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OMB No.: 0915-0285. Expiration Date: 6/30/2029

Operational Plan

The Operational Plan must be specific to the proposed project, with appropriate and reasonable time-framed goals and action steps necessary to:
    1. Begin operations at all proposed sites (as noted on Form 5B: Service Sites and described in the Project Narrative) within 120 days of the notice of award, with staff and systems in place to begin delivering primary care services to the proposed population(s). 
    2. Achieve compliance with all Health Center Program requirements detailed in the Compliance Manual.
    3. Provide all required and additional services as proposed on Form 5A: Services Provided for the number of hours per week indicated on Form 5B: Service Sites. If required services are provided by contract or referral, include action steps and timeframes for the execution of these formal arrangements.

You may choose focus areas and goals based on the list below, or develop your own, as appropriate.  Please note that the items listed below are not in order of importance or chronology. 

If you are currently operational and compliant with Health Center Program requirements, state your compliance status and highlight proposed changes in access to care, such as planned service expansion and outreach activities, new collaborations or partnerships, and any other changes that would occur as a result of the funding. Use the Compliance Manual and Site Visit Protocol to assess your compliance with Health Center Program requirements. 
	
Goal
On separate rows, identify the goals for each focus area.  Goals should describe measureable results.
Key Action Steps
Identify the action steps that must occur to accomplish each goal.
Person/Area Responsible
Identify who will be responsible and accountable for carrying out each action step.
Time Frame
Identify the expected time frames for carrying out each action step.
Comments
As desired, provide supplementary information.
Focus Area: Operational Service Delivery 
Goal  A1
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  A2
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  A3
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  A4
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  A5
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal A6
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Focus Area: Functioning Staff and Systems
Goal  B1
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  B2
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  B3
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  B4
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Focus Area: Implementation of Sliding Fee Discount Program
Goal  C1
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  C2
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  C3
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Focus Area: Quality Improvement/Quality Assurance (QI/QA) Program
Goal  D1
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  D2 
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  D3
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Focus Area: Governing Board 
Goal  E1
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  E2
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  E3
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal E4
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Focus Area: Other
Goal  F1
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  F2 
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame

Goal  F3
    1. Action Step
    1. Person Responsible
    1. Time Frame


    2. Action Step
    2. Person Responsible
    2. Time Frame


Public Burden Statement: Health centers (section 330 grant funded and Federally Qualified Health Center look-alikes) are patient-directed organizations that deliver affordable, accessible, quality, and cost-effective primary health care services to patients and adjust fees based on income and family size. 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. 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 0915-0285 and it is valid until XX/XX/202X. 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 2 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 Information Collection Clearance Officer, 5600 Fishers Lane, Room 13N82, Rockville, Maryland, 20857 or [email protected].  Please see https://www.hrsa.gov/about/508-resources for the HRSA digital accessibility statement.