First, please familiarize yourself with this multi-step application process. Click below to see forms, instructions and other helpful links:

Application Flow Chart - phase4-arp-application-visual.pdf (hrsa.gov)

Website to Apply - Future Payments | Official web site of the U.S. Health Resources & Services Administration (hrsa.gov)

Application Instructions - Application Instructions | Official web site of the U.S. Health Resources & Services Administration (hrsa.gov)

FAQ – PRF General Distribution and ARP Rural Questions | Official web site of the U.S. Health Resources & Services Administration (hrsa.gov)

Fact Sheet - Phase 4 Rural Fact Sheet DRAFT (hrsa.gov)

In order to complete the Operating Expense Section – The following expenses can be included per their website instructions. You will find this information in your December monthly reports. The report is called "Statement of Revenues and Expenses 12-Month Comparison."

Patient Care Operating Expenses:

• Salaries (12 month comparison report page 2)
• Supplies/Total Direct Production Cost (12 month comparison report page 3)
• Information Technology (12 month comparison report page 4)
• Administrative (12 month comparison report page 5)
• Deprecation (12 month comparison report page 4)
• Interest (12 month comparison report page 6)

• Quarter 3 – Add July, Aug & Sept
• Quarter 4 – Add Oct, Nov & Dec
• Quarter 1 – Add Jan, Feb & March

• You will need to have the 12 month comparison report for 2019 (located in your December monthly reports)
• You will need to have the 12 month comparison report for 2020 (located in your December monthly reports)
• You will need to have your 12 month comparison repot for 2021 (located in your Mach monthly reports)