Get Application For Technical Assistance For Community Health Needs ...

This guide will assist you in completing the Application For Technical Assistance For Community Health Needs. Understanding each section of the form is essential for a successful submission, particularly for those in rural counties seeking technical assistance with community health needs assessments.

Follow the steps to complete your application accurately.

1. Click ‘Get Form’ button to obtain the form and open it for editing. Ensure that you have the correct platform ready to fill out the form electronically.
2. Begin by filling in the applicant information section. You will need to provide basic details such as your county name, state, and population. Make sure these are accurate to avoid any discrepancies.
3. Indicate whether your county has a hospital. If applicable, provide additional details about the number of hospitals, their ownership, management, and total bed capacity.
4. Provide information about nursing homes in your county. Specifically, indicate if there is a nursing home and the number of beds available.
5. Fill in the details regarding the lead county official for the project. This includes their name, title, and department. Ensure that this person is a point of contact for the application.
6. Complete the contact information fields for both the lead county official and any other project contacts, including their phone numbers and emails.
7. Prepare a separate document to respond to the project description prompts. Ensure that you provide comprehensive yet concise answers to each question, staying within the four-page limit.
8. After filling out all required fields and preparing the necessary additional documentation, review your application thoroughly for accuracy.
9. Once confirmed that all information is correct, provide the required electronic signatures from both a member of the County Board of Commissioners/Supervisors and the hospital CEO.
10. Submit your completed application by the specified deadline to avoid disqualification. Ensure to keep a copy of the submission for your records.
11. You can save your changes, download the completed application, print it for physical submission, or share it as needed.

Complete your application for technical assistance online to enhance your community's health needs assessment efforts.