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Get Hrsa Form 6a
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How to fill out the HRSA Form 6A online
This guide provides clear and comprehensive instructions on how to fill out the HRSA Form 6A online, which is essential for documenting current board member characteristics. By following these steps, users can ensure that they accurately complete the form, meeting all necessary requirements.
Follow the steps to effectively complete the HRSA Form 6A online.
- Click the ‘Get Form’ button to download the HRSA Form 6A and open it in your preferred editor.
- Review the pre-populated list of board members and make any necessary updates to their information.
- For each board member, enter their office position held, providing specifics such as Chair or Treasurer.
- Indicate each board member's gender by selecting from the available options: Male, Female, or Unreported/Declined to Report.
- Choose the ethnicity for each board member from the options provided: Hispanic or Latino, Non-Hispanic or Latino, or Unreported/Declined to Report.
- Select the race of each board member from the following categories: Native Hawaiian, Other Pacific Islanders, Asian, Black/African American, American Indian/Alaska Native, White, More Than One Race, or Unreported/Declined to Report.
- Specify the area of expertise for each board member, aligning with their professional background.
- Determine if more than 10 percent of any board member's income comes from the health industry and record accordingly.
- Indicate if each board member is a patient of the health center, based on the defined criteria.
- Confirm whether each board member lives or works in the service area and note this information.
- Identify if any board member represents a special population and specify if applicable.
- Complete the section on patient board member classification, entering the number of patient board members where required.
- If applicable, answer whether the listed board members represent a co-applicant board and ensure required attachments are included.
- Once all sections are completed, save changes, and opt to download, print, or share the form as needed.
Start filling out your HRSA Form 6A online today to ensure compliance and accurate documentation.
Eligibility for the provider relief fund typically includes health care providers who bill Medicare, Medicaid, or Children’s Health Insurance Program. Specific conditions may apply, so reviewing the HRSA Form 6A for application requirements is essential. This funding serves to support providers impacted by the COVID-19 pandemic.
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