Certificate Of Eligibility - Division Of Policy And Shortage Designation Bureau Of Health Workforce, Health Resources Services Administration

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Division of Policy and Shortage Designation
Bureau of Health Workforce
Health Resources Services Administration
Certificate of Eligibility
Certificate of Eligibility
This
is to request a Rural Health Clinic (RHC) certification as an Automatic
Health Professional Shortage Area (HPSA) to the Division of Policy and Shortage Designation. For
further assistance please e-mail us at SDB@hrsa.gov (Attention: Tracey Martin and Kristen
Jackson) or contact Tracey Martin at (301) 594 -4462 or Kristen Jackson at (301) 594-4519.
Additional Documents for Certification
Please provide the following required information in addition to this Certificate of Eligibility:
• RHC Certification Letter from the Centers for Medicare and Medicaid Services (CMS)
• Sliding Fee Scale (SFS) for the RHC site applying for Automatic HPSA
NOTE: Certificates of Eligibility that do not include the required
information will not be processed
.

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