Form 1 Increased demand for services

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

INCREASED DEMAND FOR SERVICES:

USE OF FUNDS

FOR HRSA USE ONLY

Application Tracking Number

Grant Number

Grantee Information
Grantee Name
Grantee City			Grantee State
Budget Information
Requested Amount (from SF424 box# 15A)			Maximum Eligible Amount
1. Need
How will you address the need for health services in the community and target population(s), including the needs of special populations (migrant and seasonal farm workers, people experiencing homelessness, and/or residents of public housing) and the uninsured? (Explain within 2000 characters)
2. Project Types
How do you plan to use IDS funds? (Check all that apply)
[_] Increase health center staffing (i.e., full-time equivalents) [_] Extend hours of operations [_] Expand existing services [_] Other If ‘Other’, please specify:
3. Description
How will you implement the IDS project(s) in a manner that is appropriate and responsive to the identified community and target population health care needs? Include a description of the types of services impacted as well as strategies/methods for expanding access to primary care services and increasing capacity. (Explain within 2000 characters)
4. Impact
How will the proposed IDS project(s) impact the needs for health services in the community and target population as well as the uninsured? (Explain within 2000 characters)
5. IDS Projections
Total New Patients (Unduplicated)
Total New Uninsured Patients
Total Retained Jobs