Form 8: Health Center AgreementsHealth Center Agreements • July 3rd, 2019
Contract Type FiledJuly 3rd, 2019DEPARTMENT OF HEALTH AND HUMAN SERVICESHealth Resources and Services Administration Form 8: HEALTH CENTER AGREEMENTS FOR HRSA USE ONLY LAL Number Application Tracking Number Note: When a look-alike wishes to establish an agreement/arrangement in the future that will either (1) result in another organization carrying out a substantial portion of the approved scope of project or (2) impact the governing board’s composition, authorities, functions, or responsibilities, a Prior Approval request must be submitted in HRSA EHB and approved by HRSA before the agreement/arrangement can be formalized andimplemented. PART I Health Center Agreements 1. Does your organization have a parent, affiliate, or subsidiary organization? [_]Yes [_] No 2. Do you have, or propose to make as part of this application any contract with another organization to carry out a substantial portion of the proposed scope of project? Contracts for a substantial portion of the award include contracting for the majority