Provider Application Process
Public or private non-profit organizations are eligible to apply for funding through the Ryan White HIV Services Program. Non-profit service providers must be able to document proof of non-profit status through appropriate documentation (i.e., a Letter of Determination issued by the Internal Revenue Service stating non-profit status). If a service provider does not wish to enter into a long-term contractual agreement for service provision, other options, such as a memorandum of understanding or business associates agreement may be discussed with the Ryan White HIV Services Program Director.
See the current Ryan White HIV Services Program providers here.
Resources/Documents for Current Providers
- Ryan White HIV Services Program Calendar 2017-2018
- How to Become a Provider-Part A/MAI Request for Professional Services 2017-2018 Please note: This RPS applies only to agencies and organizations not currently funded for Ryan White Part A/MAI service delivery. Current Ryan White Part A/MAI providers are operating under a 3-year contract with established reporting requirements. Please contact the Ryan White HIV Services Program with any questions.
- RWSP Client Enrollment Form
- RWSP Client Attestation Form
- RWSP Client Recertification Form
- RWSP Client Pending Referral for Core and Supportive Services Form
- RWSP Client Referral for Core and Supportive Services Form
- RWSP Universal External Referral Plan of Care Form
- RWSP Client Notification of Change Form
- RSWP Client Employer Insurance Verification Form
- RWSP Client No Income Tax Return Form