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How to Apply for HPSA
Designation
There is not a standard application form
to apply for a HPSA designation, but there is a process.
| Contact Your State Primary Care Office
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- We encourage you to apply through your Primary
Care Office, which has the expertise and data
and access to the on-line application system, which
accelerates the review process. The PCO is the primary
contact for OSD in developing and reviewing designation
requests and updates.
- If you wish to submit directly, make sure the
PCO has not already submitted a designation request
for your service area. Request the PCO's assistance
in helping prepare and review your designation request.
| Prepare Your Designation Request |
Your request should be in the form of a letter addressed
to:
Andy Jordan, MSPH, Director
Office of Shortage Designation
Health Resources and Services Administration
Parklawn Building , Room 8C-26
5600 Fishers Lane
Rockville, MD 20857
Make sure your letter contains reasons for the designation
request and data for the service area, as required
by the HPSA Designation Criteria
& Guidelines, including:
- Total population
- Number of providers and total FTEs
- Percent of the population at 100% and 200% of
the Federal Poverty Level
- Infant mortality rate
- Low birth weight rate
- Miles and minutes to the nearest source of non-designated
care
- Map of the area to the contiguous areas
- Statement explaining the inability of the contiguous
areas to provide care
| Submit Your Designation Request |
Send one copy of the letter to the HRSA Shortage
Designation Branch and at the same time, send a copy
to the State Primary Care Office shortage designation
contact.
The State Primary Care Office will provide copies
of the request to and ask for comments from:
- Governor's Office
- State Primary Care Association
- Health Systems Agency (where active)
- Appropriate State Professional Association (s)
- State Mental Health Authority (mental health designation
requests)
- State Dental Officer (dental designation requests)
All agencies/organizations are given 30 days to comment
on the request.
If necessary, HRSA will contact you for more information.
Once comments have been received, and the comment
period expired, HRSA will complete evaluation of the
request and determine whether the criteria for designation
have been satisfied.
| Every effort is made to complete action on each
designation request within 90 days of the date
of receipt by HRSA, depending on current caseload.
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Page last updated: May 19, 2008
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