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
- How to Become a Provider: Part A/MAI Request for Professional Services 2019-2020. Please note: This RPS applies to agencies and organizations interested in applying for funding for Ryan White Part A/MAI service delivery. Additional attachments to the RPS include the Cost Per Unit Template, HRSA Service Definitions, and the RSR Dot Grid.
Resources/Documents for Current Providers
- Ryan White HIV Services Program Calendar 2019-2020
- RWSP Client Enrollment Form
- RWSP Client Attestation Form
- RWSP Client Recertification Form
- RWSP Client Pending Referral for Core and Supportive Services Form
- RWSP Client Referral for Core and Supportive Services Form
- RWSP Universal External Referral Plan of Care Form
- RWSP Client Notification of Change Form
- RSWP Client Employer Insurance Verification Form
- RWSP Client No Income Tax Return Form