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[" FY 2008 Part B & MAI Allocations Report  OMB No. 0915-xxxx Expiration Date: "]
[]
["Detailed instructions for completing and submitting this report can be \nfound in the Electronic Handbooks and download from the web:\nhttps://grants.hrsa.gov/webexternal/Login.asp",null,null,null,"Section B:  FY 2008 Award Information"]
[{"$nulls":4},"1. Part B Base Award"]
[{"$nulls":4},"2. Part B ADAP Earmark Award"]
[{"$nulls":4},"3. Part B Supplemental Award"]
["Section A: Identifying Information",null,null,null,"4. Total Part B ADAP + Supplemental Award",null,null,null,0]
["~ Enter Name of Grantee Here ~",null,null,null,"5. Part B Emerging Communities Award"]
["~ Enter Preparer's Name Here ~",null,null,null,"6. Total Part B Award",null,null,null,0]
["~ Enter Preparer's Phone Number Here ~",null,null,null,"7. Part B MAI Award"]
["~ Enter Preparer's Email Address Here ~",null,null,null,"8. Total Part B + MAI Award",null,null,null,0]
[]
["Section C: Part B Allocations by Program Component","1. Base Award",null," 2. ADAP Earmark + Supplemental Award",null,"3. Emerging Communities Award",null,"4. Total "]
[]
[null,"Amount","Percentage","Amount","Percentage","Amount","Percentage","Amount","Percentage"]
["1. Part B AIDS Drug Assistance Program Subtotal",0,"- -",0,"- -",0,"- -",0,"- -"]
["a. ADAP Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["b. Health Insurance to Provide Medications",null,"- -",null,"- -",null,"- -",0,"- -"]
["c. ADAP Access/Adherence/Monitoring Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["2. Part B Health Insurance Premium & Cost Sharing Assistance ",null,"- -",null,null,null,"- -",0,"- -"]
["3. Part B Home and Community-based Health Services",null,"- -",null,null,null,"- -",0,"- -"]
["4. Part B HIV Care Consortia Services (Provide detail in Section D, Column 1) 1 ",0,"- -",null,null,null,"- -",0,"- -"]
["5. Part B State Direct Services (Provide detail in Section D, Column 2)1",0,"- -",null,null,null,"- -",0,"- -"]
["6. Part B Clinical Quality Management2 ",null,"- -",null,"- -",null,"- -",0,"- -"]
["7. Part B Grantee Planning & Evaluation Activities3",null,"- -",null,"- -",null,"- -",0,"- -"]
["8. Grantee Administration 3",null,"- -",null,"- -",null,"- -",0,"- -"]
["9. Column Totals ",0,"- -",0,"- -",0,"- -",0,"- -"]
["10.Total Part B Allocations4",0]
[]
["Section D: Breakdown for Consortia, State Direct  Services and Emerging Communities","1. Consortia5",null,"2. Direct Services",null,"3. Emerging Communities 6",null,"4. Total"]
[null,"Amount","Percentage","Amount","Percentage","Amount","Percentage","Amount","Percentage"]
["1. Core Medical Services Sub-total7",0,"- -",0,"- -",0,"- -",0,"- -"]
["a. Outpatient /Ambulatory Health Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["b. AIDS Drug Assistance Program (ADAP) Treatments",null,"- -",null,"- -",null,"- -",0,"- -"]
["c. AIDS Pharmaceutical Assistance (local)",null,"- -",null,"- -",null,"- -",0,"- -"]
["d. Oral Health Care",null,"- -",null,"- -",null,"- -",0,"- -"]
["e. Early Intervention Services ",null,"- -",null,"- -",null,"- -",0,"- -"]
["f. Health Insurance Premium & Cost Sharing Assistance ",null,"- -",null,"- -",null,"- -",0,"- -"]
["g. Home Health Care ",null,"- -",null,"- -",null,"- -",0,"- -"]
["h. Home and Community-based Health Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["i. Hospice Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["j. Mental Health Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["k. Medical Nutrition Therapy",null,"- -",null,"- -",null,"- -",0,"- -"]
["l. Medical Case Management (including Treatment Adherence)",null,"- -",null,"- -",null,"- -",0,"- -"]
["m. Substance Abuse Services–outpatient",null,"- -",null,"- -",null,"- -",0,"- -"]
["2. Support Services Sub-total",0,"- -",0,"- -",0,"- -",0,"- -"]
["a. Case Management (non-Medical) ",null,"- -",null,"- -",null,"- -",0,"- -"]
["b. Child Care Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["c. Emergency Financial Assistance",null,"- -",null,"- -",null,"- -",0,"- -"]
["d. Food Bank/Home-Delivered Meals",null,"- -",null,"- -",null,"- -",0,"- -"]
["e. Health Education/Risk Reduction",null,"- -",null,"- -",null,"- -",0,"- -"]
["f. Housing Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["g. Legal Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["h. Linguistics Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["i. Medical Transportation Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["j. Outreach Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["k. Psychosocial Support Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["l. Referral for Health Care/Supportive Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["m. Rehabilitation Services",null,"- -",null,"- -",null,"- -",0,"- -"]
["n. Respite Care",null,"- -",null,"- -",null,"- -",0,"- -"]
["o. Substance Abuse Residential Services ",null,"- -",null,"- -",null,"- -",0,"- -"]
["p. Treatment Adherence Counseling",null,"- -",null,"- -",null,"- -",0,"- -"]
["3.  Total",0,"- -",0,"- -",0,"- -",0,"- -"]
[]
[null,"MAI Award"]
["Section E: MAI Allocations by Program Component","Amount","Percentage"]
["1.  Education to increase minority participation in ADAP",null,"- -",null,"FOR OFFICE USE ONLY:"]
["2.  Outreach to increase minority participation in ADAP",null,"- -",null,"o Grantee received waiver for 75% core medical services requirement."]
["3.  Clinical Quality Management 2",null,"- -"]
["4.  Grantee Planning & Evaluation Activities 3",null,"- -"]
["5.  Grantee Administration 3",null,"- -"]
["6. Total MAI Allocations5",0,0]
["(1) In the Base Award column ONLY, this cell will automatically calculate based on the detail you provide in Section D."]
["(2) May not exceed 5% of the Part B award, or 3 million, whichever amount is smaller."]
["(3) May not exceed 10% of the Part B award for either Planning & Evaluation or Grantee Admin.  Additionally, the combined costs for these two categories may not exceed 15% of the Part B award."]
["(4) This amount must equal the combined total of the Part B Base, ADAP, ADAP Supplemental, and Emerging Communities awards."]
["(5) All services in this column are considered Supprt Services."]
["(6) In the Emerging Communities Column ONLY, the Total Allocations should equal the combined total of Rows 4 + 5 in Section C, Column 3."]

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[" FY 2008 Part B & MAI Allocations Report"]
["Automatic Calculation of Part B Core Medical & Support Services Allocations"]
[]
["~ Enter Name of Grantee Here ~"]
[]
["NOTE: This table is for reference only and is provided for grantees to automatically calculate their total Core Medical Service allocations/percentages across all Part B service dollars.  The figures below reflect the amounts entered in the Allocations Report (turquoise tab)."]
[]
[" Core Medical Services Allocations ","Amount","Percentage\n(Amount / Total Service Allocations)"]
["ADAP (H14)",0,"- -"]
["Home-and Community-based Health Services (H19)",0,"- -"]
["Health Insurance Premium & Cost Sharing Assistance (H18)",0,"- -"]
["State-Direct Services: Core Medical Services (D30)",0,"- -"]
["Emerging Communities: Core Medical Services (F30)",0,"- -"]
["Total Core Medical Services Allocations",0,"- -"]
[]
["Support Services Allocations","Amount","Percent"]
["Consortia Services (H20) ",0,"- -"]
["State-Direct Services: Support Services (D44)",0,"- -"]
["Emerging Communities: Support Services (F44)",0,"- -"]
["MAI Allocations for Education + Outreach Services (B66 + B67)",0,"- -"]
["Total Support Services Allocations",0,"- -"]
[]
["Total Part B Services Allocations ",0]