Get Hrsa Form 6a

Filling out the Hrsa Form 6a online is a crucial step for health centers to provide information about their current board members. This guide offers clear instructions to ensure accurate and complete submission.

Follow the steps to successfully complete the Hrsa Form 6a online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Review any pre-populated information regarding board members if you are a competing continuation or competing supplement applicant. Update any details as necessary.
3. List all current board members. For each member, provide their current board office position, such as Chair or Treasurer, and their area of expertise, like finance or nursing. Ensure that non-voting members are not included.
4. Indicate whether each board member derives more than 10 percent of their income from the health care industry by marking the appropriate box.
5. Specify if the board member is a health center patient. A patient is defined as someone who has received a service within the last 24 months that generated a health center visit.
6. Indicate whether the board member lives or works in the service area by selecting the correct response.
7. If applicable, indicate if the board member represents a special population, such as individuals experiencing homelessness or migratory workers, and specify the population.
8. Count and provide the total number of board members who are patients categorized by gender, ethnicity, and race. This information is necessary for compliance purposes.
9. If your organization is a public entity, confirm whether the listed members represent a co-applicant board. Ensure that any necessary co-applicant agreement is attached.
10. Once you have completed all sections, save your changes. You can then download, print, or share the form as needed.

Complete the Hrsa Form 6a online today to ensure your application is submitted accurately and promptly.