Form 3: Income Analysis - Bureau of Primary Health Care - HRSA - bphc hrsa 2026

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The document is Form 3: Income Analysis, used by the Health Resources and Services Administration (HRSA) to collect projected income data from health centers for patient services and other income sources. It outlines two main parts: Patient Service Revenue - Program Income, which details income from various payer categories (Medicaid, Medicare, etc.), and Other Income from federal, state, local sources. The form requires specific calculations and classifications of income based on patient insurance types and service revenues, ensuring accurate financial reporting for health center operations.

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How to use or fill out Form 3: Income Analysis - Bureau of Primary Health Care - HRSA - bphc hrsa

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Click ‘Get Form’ to open it in the editor.
Begin with Part 1: Patient Service Revenue. Enter the projected number of patients by primary medical insurance in Column (a). Ensure you classify them correctly based on their primary insurance.
In Column (b), input the total number of billable visits. This should reflect all reimbursable visits, excluding any non-billable services.
Calculate the income per visit for Column (c) by dividing the projected income in Column (d) by the number of billable visits in Column (b).
For Column (d), enter your projected income, ensuring it includes allowances for bad debt and is reflective of all patient services.
Complete Part 2: Other Income by detailing any additional federal, state, or local income sources that are not directly tied to patient services.
Finally, review your entries and utilize our platform's features to save and share your completed form seamlessly.

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Who funds HRSA?

HRSA receives its discretionary appropriation through the Labor, Health and Human Services, and Education appropriations act.

Who qualifies for HRSA?

These include low income populations, the uninsured, those with limited English proficiency, migrant and seasonal farmworkers, individuals and families experiencing homelessness, and those living in public housing.

Is HRSA a federal program?

Established in 1980, HRSA is the primary federal agency responsible for ensuring access to health care services for people who are uninsured, isolated, or medically vulnerable, including those living with HIV/AIDS, mothers and children, and those living in rural areas.

What annual reporting is required by HRSA?

As a condition of award, you must submit a Federal Financial Report (FFR) annually.

What does HRSA fall under?

The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services located in North Bethesda, Maryland. It is the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.

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What is the HRSA award determination?

Award Determination During this step, we use the grant reviewers recommendations to determine who will receive funding. We review the selected applications to ensure they comply with HRSA program requirements and your financial viability. We then make our final decisions on who receives funding.

What is HRSA BPHC?

The Bureau of Primary Health Care (BPHC) funds nearly 1,400 health centers. They provide affordable, accessible, and high-quality primary health care to underserved communities at over 15,500 sites.

What is the maintenance of effort for HRSA?

It stipulates that Maintenance of Effort (MOE) is required, meaning applicants must maintain non-federal assistance to support the programs longevity if approved. You can use non-federal sources, such as private, state, and local funding.

Form 3: Income Analysis - Bureau of Primary Health Care - HRSA - bphc hrsa 2026

Here's how it works

How to use or fill out Form 3: Income Analysis - Bureau of Primary Health Care - HRSA - bphc hrsa

Complete this form in 5 minutes or less

Got questions?

Who funds HRSA?

Who qualifies for HRSA?

Is HRSA a federal program?

What annual reporting is required by HRSA?

What does HRSA fall under?

Security and compliance

Complete this form in 5 minutes or less

People also ask

What is the HRSA award determination?

What is HRSA BPHC?

What is the maintenance of effort for HRSA?

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