Provider Application Process
Public or private non-profit organizations are eligible to apply for funding through the Ryan White HIV Services Program. Non-profit service providers must be able to document proof of non-profit status through appropriate documentation (i.e., a Letter of Determination issued by the Internal Revenue Service stating non-profit status). If a service provider does not wish to enter into a long-term contractual agreement for service provision, other options, such as a memorandum of understanding or business associates agreement may be discussed with the Ryan White HIV Services Program Director.
See the current Ryan White HIV Services Program providers here.
Application Materials for Service Provision (for agencies and organizations not currently funded through the RWSP)
This is the second year of the 3-year awards, with the possibility of renewal for an additional year based on compliance and performance. Subsequent year funding will require submission of grant specific program details.
- The following 4 documents are required to be completed for application for Part A/MAI funds for 2020-2021: Part A/MAI Request for Professional Services 2020-2021; Attachment A-Cost per unit template (this is an example and is not mandatory); Attachment B-Request Service Form; Attachment C-Budget Forms. The following 2 documents are for reference in completing the Request for Professional Services: PCN 16-02 HRSA Service Definitions; CAREWare Data Requirements (HRSA dot grid).
There will be an informational meeting on January 7, 2020 from 10am - 11:30am: 6th Floor Conference Room, Marion County Public Health Department, 3838 N. Rural St., Indianapolis, IN 46205.
Resources/Documents for Current Providers
- Ryan White HIV Services Program Calendar 2020-2021
- RWSP Medical Case Management and Non-Medical Case Management Manual Version 2: September 2019
- RWSP Client Enrollment and Re-Entry Application Form
- RWSP Client Attestation and Recertification Form
- RWSP Referral for Core and Support Services Form
- RWSP Client Notification of Change Form
- RSWP Client Employer Insurance Verification Form
- RWSP Client No Income Tax Return Form