DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

FOR HRSA USE ONLY

Application Tracking Number

SAMPLE PROJECT WORK PLAN

Section A - Comprehensive Needs Assessment
Goal A1: Identifying major health issues for the populations to be served, unmet need, barriers to
care, etc.
Comment(s
Data
Person /
)
Expected
Evaluation and Area
Objective(s)
Key Action Step(s)
Measurement(s Responsible (Maximum
Outcome(s)
500
)
(s)
characters)
A1.1 Develop
1. Identify
1. Participate in
1. The number
1. Planning
protocol and
appropriate tools to
the comprehensive of planning
Grant
measures for
use for the needs
needs assessment meetings.
committee
implementing
assessment.
elements meeting
2. Determination 2. CEO
needs assessment
2. Establish
with area
made regarding
3. Board of
within two months
Subcommittee of the stakeholders.
approach.
Directors
of grant award.
planning staff to
2. Create tangible
3. The number of 4.
A.1.2 Establish a
oversee needs
targeted
meetings
Consultant
team of
assessment.
assessment
attended.
knowledgeable
3. Define roles of
protocols and tools 4. Number of
planning staff to
planning staff and for for identified
persons at each
oversee
the project.
populations in
meeting.
undertaking of
collaboration with
5. Progress
needs assessment
other health
against
within one month of
centers.
established
grant award.
3. Conduct at
timeline for
A.1.3. Complete
least one
completion of

needs assessment
coordinating
for targeted service
meeting every
area within 4
month.
months of award.
4. Completed
A2.3 Secure
needs assessment.
consultant to assist
with needs
assessment.
Goal A2 : Applying for MUA/MUA Designation
Objective(s)
A2.1 Obtain
MUA/MUP
designation for
census tracts within
target service area
without a
designation by
(DATE).
A2.2 Identify areas
with current
MUA/MUP
designations in
targeted service
area by (DATE).
A2.3 Secure
consultant to assist
with designations.
Section B Service

Key Action Step(s)

1. Identify tracts that
qualify for MUA/MUP
in targeted service
area.
2. Apply for
MUA/MUP
designation and
secure list of census
tracts that already
have MUA/MUP
designation in
targeted service
area.

Delivery

Expected
Outcome(s)
1. Implement
process for
MUA/MUP
designation for
undesignated
census tracts in
service area.
2. Census tracts
within targeted
service area have
MUA/MUP
designations.

assessment.

Data
Evaluation and
Measurement(s
)

Person /
Area
Responsible
(s)

1. Number of
successfully
Identified census
tracts with or
without
MUA/MUP
designation for
targeted service
area.
2. Number of
census tracts
that successfully
received
MUA/MUP
designation.

1. Needs
Assessment
subcommitte
e of Planning
Grant Staff.
2. CEO
3. Consultant

Comment(s
)
(Maximum
500
characters)

Goal B1: Developing and appropriate service delivery model based on the comprehensive needs
assessment
Person /
Comment(s)
Key Action
Expected
Data Evaluation and
Area
(Maximum
Objective(s)
Step(s)
Outcome(s)
Measurement(s)
Responsibl
500
e(s)
characters)
B1.1 Develop a
1. Assess current 1. Written
1. Finalized document
1. CEO
service delivery
capacity and
documentation of describing evaluation
2. CMO
model that is
willingness of
current
of service delivery
3. Human
appropriate
local health care
community
models submitted to
Resource
relative to the
providers to
model, capacity,
the Board of Directors.
Staff
results of the
provide services
and resources
2. A model and guide
4. Consultant
comprehensive
and possible
potentially
for developing specific
needs
collaborations.
available to the
recruitment and
assessment by
2. Based upon
target population. retention activities for
(DATE).
needs
2. Identified
the satellite.
B.1.2 Identify
assessment,
essential clinical
medical staffing
working
and support staff.
needs by (DATE). projections,
current inventory
of providers and
experience,
identify optimal
clinical and
support staff.
Goal B2: If special populations (e.g., migrant/seasonal agricultural workers, residents of public
housing, homeless persons, low-income school children) are included in the target population,
specifying activities related to the identification of the unique access problems and health care needs
of these populations.
Objective(s)
Key Action
Expected
Data Evaluation and
Person /
Comment(s)
Step(s)
Outcome(s)
Measurement(s)
Area
(Maximum

B2.1. Recruit
staff that
specialize in
providing health
services for
MSFW
populations by
(DATE).
Goal B3: Facility
Objective(s)
B3.1 Identify
potential sites
that will meet
the health care
needs of the
target
population by
(DATE).

1. Identify
specific focus
areas for
recruiting staff to
work with MSFW
population.

1. Recruitment of
staff with
expertise in
serving the MSFW
population.

1. Recruitment of staff
persons with expertise
in serving the MSFW
population.

Responsibl
e(s)
1. CEO
2. CMO
3. CFO

500
characters)

Person /
Area
Responsibl
e(s)
1. CEO
2. CMO
3. CFO

Comment(s)
(Maximum
500
characters)

planning and location selection.

Key Action
Step(s)

Expected
Outcome(s)

Data Evaluation and

Measurement(s)

1. Based upon
1. Identify ideal
1. Number of locations
the needs
locations (based
identified for possible
assessment and
upon travel
location of health
the current
patterns and
center.
inventory of
population
providers identify concentrations,
the optimal
etc.).
location, facility
configuration and
related square
footage, exam
rooms, etc.
Section C - Securing Financial, Professional and Technical Assistance

Goal C1: Recruiting and retaining key management and other qualified staff.
Person /
Key Action
Expected
Data Evaluation and
Area
Objective(s)
Step(s)
Outcome(s)
Measurement(s)
Responsibl
e(s)
C1.1 Identify
1. Identify
1. Hired
1. Number of filled
1. CEO
staffing needs
strategy for
Management staff positions for key
2. Human
for future health recruiting
for future health
management staff.
Resource
center by
management
center.
Staff
(DATE).
staff.
3. Board of
2. Recruit
Directors
management
staff.

Comment(s)
(Maximum
500
characters)

Goal C2: Providing technical assistance and acquiring consultant activities as appropriate.

Objective(s)

Key Action Step(s)

Expected
Outcome(s)

Data Evaluation
and
Measurement(s)

Person /
Area
Responsibl
e(s)

Comment(
s)
(Maximum
500
character
s)

C2.1 Hire
consultant to
provide training for
staff on Section
330 requirements
by (DATE).
C2.2 Train staff on
section 330
requirements by
(DATE)

1. Identify
1. Key staff is
1. Successful hiring 1. CMO
consultants that
adequately trained of consultant.
2. Human
provide section 330
to comply with
2. Completion rate
Resources
training for
section 330
of staff
staff
community health
requirements.
participation
3.
centers.
documented in
Consultant
2. Establish contract
training log.
with identified
consultant.
3. Train staff on
section 330
compliance for
community health
centers.
Goal C3: Financial, management, and administrative considerations to the organization related to
future operation of the health center.
Comment(
Person /
s)
Data Evaluation
Expected
Area
(Maximum
Objective(s)
Key Action Step(s)
and
Outcome(s)
Responsibl
500
Measurement(s)
e(s)
character
s)
C3.1 Pursue
1. Identify available
1. Identified
1. Number of
1. CEO
funding
state and local
potential funding
identified funding
2.
opportunities from
funding resources for resources for
opportunities
Development
federal, state, local future health center.
future health
available for the
Director
resources to
2. Apply for available center.
establishment and
support service
funding.
2. Funding for the
operation of future
delivery plan by
establishment and health center.
(DATE).
long-term
2. Number of
operation of future funding proposals
health center.
submitted.

Goal C4: Developing plans for attaining and maintaining long-term viability (i.e., future requirements
for space, securing other financial support).
Comment(
Person /
s)
Data Evaluation
Expected
Area
(Maximum
Objective(s)
Key Action Step(s)
and
Outcome(s)
Responsibl
500
Measurement(s)
e(s)
character
s)
C4.1 Identify
1. Based on needs
1. Identify facility,
1. Rate of projected 1. CMO
projected patient
assessment,
staff, and financial patient growth and 2. CFO
growth over next 5 calculate projected
resources needed
identified financial
years by (DATE).
patient growth for
to provide health
needs for the first 4
C.4.2. Develop
targeted service
services for the
years of operation.
patient payor mix
area.
target population
calculations based
over next 4 years.
on needs
assessment.
Section D - Developing Community Involvement/Participation
Goal D1: Developing linkages/building partnerships with other providers in the community including
any federally qualified health centers, health departments, local hospitals, and rural health clinics.
Comment(
Person /
s)
Data Evaluation
Expected
Area
(Maximum
Objective(s)
Key Action Step(s)
and
Outcome(s)
Responsibl
500
Measurement(s)
e(s)
characters
)
D1.1 Develop
1. Identify local
1. Establish local
1. Number of local
1. CEO
linkages/building
providers in service
provider support
providers that are
2. Board of
partnerships with
area.
for future health
in support of the
Directors
at least 3 other
2. Schedule
center.
future health
providers in the
meetings with local
2. Establish
center.
target area based
providers to gain
linkages with other

on the needs
assessment by
(DATE).

input on planning
activities for future
health center.

area providers.

Goal D2: Developing a Governing Board that aligns with section 330 statutory and regulatory
requirements.
Comment(
Person /
s)
Data Evaluation
Expected
Area
(Maximum
Objective(s)
Key Action Step(s)
and
Outcome(s)
Responsibl
500
Measurement(s)
e(s)
characters
)
D2.1 Recruit
1. Develop strategy
1. Established
1. Number of
1. Planning
representatives
to recruit for
Governance Board Governance Board
Committee
who live and work
governing board
for future health
candidates that
2.
in targeted service membership.
center.
have agreed to
Community
area to serve on
2. Identify potential
serve on the Board. Outreach
Governing Board
candidates (focus
staff
for future health
groups, interviews,
center by (DATE).
interested parties).
3. Invite candidates
to join governance
board.
Goal D3: Developing community support.
Comment(
Person /
s)
Data Evaluation
Expected
Area
(Maximum
Objective(s)
Key Action Step(s)
and
Outcome(s)
Responsibl
500
Measurement(s)
e(s)
characters
)
D3.1 Attend at
1. Identify
1. Assessment of
1. The number of
1. Planning
least 4 community
community events to community
events attended to Committee
events and
attend.
support for
gain support.
2.

administer 100
surveys to assess
community support
for establishment
of future health
center by (DATE).

2. Develop and test

establishment of
2. Percent of
survey instrument.
future health
survey participants
3. Identify survey
center.
in support of future
participation
health center.
strategy.
4. Administer 100
surveys at 4 or more
community events.
Section E - Establishing Collaborative Working Relationships With Other Area

Community
Outreach
Staff
3. Board of
Directors
4. CEO

Goal E1: Developing linkages/building partnerships with other providers in the community including
any federally qualified health centers, health departments, local hospitals, and rural health clinics.
Comment(
Person /
s)
Data Evaluation
Expected
Area
(Maximum
Objective(s)
Key Action Step(s)
and
Outcome(s)
Responsibl
500
Measurement(s)
e(s)
character
s)
E1.1 1. Obtain at
1. Identify local
1. Identify
1. Number of
1.CEO
least 5 letters of
health providers to
potential partners. secured letters of
2. CMO
support from
target for letters of
2. Obtain letters of support.
3.
health care
support.
support for the
Community
providers in the
2. Meet with
establishment of
Outreach
service area for the Executive Officers to future health
staff
establishment of
discuss collaboration center.
future health
and request letters
center by (DATE).
of support.