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For Providers

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 all agencies and organizations seeking funds, regardless of current RWSP funding status)

Application Materials for Service Provision

The following 4 documents are required to be completed for application for Part A/MAI funds for 2022-2023:

Part A/MAI Request for Professional Services 2023-2024;
Attachment A-Cost per unit template

Attachment B-Requested Service Form

Attachment C-Budget Forms

Attachment D-Time and Effort Form for Subrecipients.

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).

The following documents provide information on Program Income and are useful reference materials for preparation of applications:

HRSA PCN 15-03, Program Income

HRSA PCN 15-04, Pharmaceutical Rebates

HRSA PCNs 15-03 and 15-04, Frequently Asked Questions

Program Income Guidance and FAQs for Ryan White Part B and Parts A/C/MAI, Update

Program Income Infographic

Imposition of Charges Infographic

Program Income Tracker Template IDOH-MCPHD

Program Income Spending Plan Template for Part B and Parts A/C/MAI

If you have questions regarding this Request for Professional Services, please contact:

Alisha Hooks, Project and Training Coordinator

Ryan White HIV Services Program
Marion County Public Health Department

Resources/Documents for Current Providers

Ryan White HIV Services Program Calendar 2023-2024

RWSP Medical Case Management and Non-Medical Case Management Manual Version 2: September 2019