Supporting Information

Evaluation Metrics

For the HCP that meets each criterion:

• Round 1 Application Number (GRA00XXXX) for previous applicants or documentation demonstrating submission, e.g., an e-mailed confirmation
• Full Site Name and Physical Address, including county information, for rural, low-income, Critical Access Hospital (CAH), and Tribal area providers and for “hardest hit” providers
• Supporting documentation is needed for certain “Other” Tribal affiliations
• Healthcare Provider Shortage Area (HPSA) ID or Score for HPSA providers
• Federally-Qualified Health Center (FQHC) ID, Bureau of Primary Health Care Health Center Management Information System ID (BHCMISID), or Uniform Data System (UDS) number for FHQCs, FQHC Look-Alikes, and Disproportionate Share Hospitals

Purpose and Intent

• Whether the applicant will treat COVID-19 patients directly
• Whether the applicant will treat patients without COVID-19 symptoms

Funding Request

For all requested funding items:

• Category
• Description
• Quantity, if applicable
• Cost on applicable basis
  • One-Time
  • Monthly
  • Per Unit

Applicants must provide supporting cost documentation (e.g., an invoice or a vendor quote) for all eligible services and devices for which funding is requested.