Attachment A - Application Form is the form that applicants complete for the COVID-19 Health Disparities in Rural Areas of West Virginia funding opportunity, issued by the West Virginia Department of Health and Human Resources (DHHR), Bureau for Public Health. It is one of the application forms listed on the Bureau's funding page, where it is paired with a Project Narrative Worksheet and a Budget Worksheet. On this page you can fill out the form online on FillingPDF and download or print the completed PDF. The agency's funding page lists this opportunity as closed on 11/18/2021, and the original PDF is published by the agency.
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What is Attachment A?
Attachment A - Application Form is the one-page form that applicants complete for the COVID-19 Health Disparities in Rural Areas of West Virginia funding opportunity, issued by the West Virginia Department of Health and Human Resources (DHHR), Bureau for Public Health (BPH).
The form identifies the applicant and the proposed project. It asks for the project title, the applicant organization, a contact person, the organization's address, a daytime telephone number, fax and email. It then asks for the regions to be served, listed by county together with Rural Urban Community Area (RUCA) codes, with room for five counties. The remaining entries are the grant amount requested, the WV Oasis # and the Duns #, and a brief description of the project in no more than one or two paragraphs.
The form also states the terms of review. Failure to provide complete and accurate information may be considered grounds for disqualification. The Bureau reserves the right to request additional information from any applicant, and it may accept or reject any or all proposals, in whole or in part.
The BPH funding page lists this opportunity next to two other 2021 opportunities: Addressing COVID-19 Health Disparities Among Racial and Ethnic Minorities in WV, and COVID-19 Vaccination Equity & Prioritizing Populations Disproportionately Affected by COVID-19. Each lists an Application Form, a Project Narrative Worksheet and a Budget Worksheet as required forms. This version carries the Rural Health Disparities title in its footer.
Who needs to file Attachment A?
Organizations applying for funding under the COVID-19 Health Disparities in Rural Areas of West Virginia opportunity from the West Virginia Bureau for Public Health complete this form. The form is built around an "Applicant Organization" and a "Contact Person", so it is filled out on behalf of the organization that proposes the project.
The form asks each applicant to:
- name the project and describe it in one or two paragraphs;
- list the counties the project will serve, with the RUCA code or codes for each;
- state the grant amount requested;
- give the organization's WV Oasis # and Duns #.
It is an attachment to a larger application. The form tells applicants to attach a Project Narrative Form, a Budget Worksheet and supporting documentation, so it is not a complete application by itself.
The BPH funding page lists this opportunity as closed on 11/18/2021 and shows no current funding announcements. Anyone looking for open funding should check that page, because the other two 2021 opportunities it lists are also marked closed.
When to file Attachment A
The form states that applications were due by November 18, 2021, by 5:00 p.m. ET. The Bureau for Public Health's funding page lists the 2021 Addressing COVID-19 Health Disparities in Rural Areas of WV opportunity as closed on 11/18/2021 and says there are no current funding announcements.
The form is submitted with the rest of the application package, because it asks you to attach the Project Narrative Form, the Budget Worksheet and supporting documentation. It sets no separate date of its own. If the Bureau announces a new funding opportunity, check that announcement for its own deadline before using this form.
Documents you need
- Project Narrative Form: the form tells applicants to attach it to the application. The BPH funding page calls it the Project Narrative Worksheet.
- Budget Worksheet: the form lists it among the items to attach, and the BPH funding page names it as a required form.
- Supporting Documentation (Letters of Support): the form lists letters of support among the items to attach.
- Other supplemental information you wish to include, such as graphs and charts: optional, added at the applicant's choice.
How to fill out Attachment A
Enter the project title
In Project Title, write the name of the project you propose for the COVID-19 Health Disparities in Rural Areas of West Virginia opportunity.
Name the applicant organization
Enter the organization's name in Applicant Organization and the person to contact about the application in Contact Person.
Complete the organization address
Fill in the address of the organization, then City, State and Zip.
Add telephone, fax and email
Enter a daytime number in Telephone (Day), then Fax and Email for the contact person.
List regions and RUCA codes
For each county the project will serve, enter the county name and its RUCA Code(s). The form has five county lines.
Enter amount and identification numbers
Enter the Grant Amount Requested, your WV Oasis # and your Duns #.
Describe the project briefly
In the description box, summarize the project in no more than one or two paragraphs.
Gather the required attachments
Prepare the Project Narrative Form, Budget Worksheet, supporting documentation (letters of support), and any supplemental information you wish to include, such as graphs or charts.
Review and download the completed PDF
Check that every entry is complete and accurate, since the form warns that incomplete or inaccurate information may lead to disqualification. Download or print the completed PDF from FillingPDF and assemble the package described under How to submit.
How to submit Attachment A
Attachment A prints no mailing address, email address or online portal, so the form itself names no submission channel. It is sent as part of the application package, with these items attached: a Project Narrative Form, a Budget Worksheet, supporting documentation (letters of support), and any other supplemental information you wish to include, such as graphs or charts.
The Bureau for Public Health's funding page, https://dhhr.wv.gov/bph/funding/Pages/Funding.aspx, lists the Application Form, Project Narrative Worksheet and Budget Worksheet as the required forms for this opportunity. It marks the opportunity as closed on 11/18/2021 and shows no current funding announcements. Check that page for any new announcement and its submission instructions before you prepare a package.
FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Leaving fields blank or entering inaccurate information; the form says incomplete or inaccurate information may be considered grounds for disqualification.
- Sending the form without the Project Narrative Form, Budget Worksheet or supporting documentation (letters of support) that it tells you to attach.
- Writing a project description longer than the one or two paragraphs the form allows.
- Listing counties without the RUCA code or codes that the form asks for next to each county.
- Leaving out the WV Oasis # or the Duns #, which the form requests from the applicant organization.
- Submitting after the printed deadline of November 18, 2021, 5:00 p.m. ET.
- Using this form for another funding opportunity; its footer is titled for Rural Health Disparities, and the BPH page lists separate opportunities.
Frequently asked questions
What is the Attachment A application form for rural COVID-19 health disparities?
It is the one-page Application Form that the West Virginia Bureau for Public Health used for the COVID-19 Health Disparities in Rural Areas of West Virginia funding opportunity. It collects the project title, applicant details, counties and RUCA codes, grant amount requested and a short project description.
Is the Attachment A application form still open?
No. The form prints a deadline of November 18, 2021, 5:00 p.m. ET, and the Bureau for Public Health's funding page lists the opportunity as closed on 11/18/2021, with no current funding announcements. Check that page for any new announcement.
What do I need to attach to the application form?
The form says to attach a Project Narrative Form, a Budget Worksheet, supporting documentation (letters of support), and any other supplemental information you wish to include, such as graphs or charts. The funding page lists the narrative as the Project Narrative Worksheet.
What information does the form ask for about the regions served?
It asks for the counties the project will serve, with the RUCA (Rural Urban Community Area) code or codes for each. There are five county lines on the form, each with a field for the county and one for its RUCA code(s).
Where do I send the completed Attachment A?
The form prints no address, email or portal. It is part of an application package with the narrative, budget and supporting documents. For submission details, check the Bureau for Public Health's funding page at dhhr.wv.gov/bph/funding/Pages/Funding.aspx.
What happens if my application information is incomplete?
The form says that failure to provide complete and accurate information may be considered grounds for disqualification. It also says the Bureau may request additional information from any applicant and may accept or reject any or all proposals, in whole or in part.
Can I fill out this application form online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not affiliated with the West Virginia DHHR, and it does not submit the form; you send it through the agency's channels.
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