Covered Entity Details

The system displays the entity's details, allowing the user to update the Employee Identification Number (EIN) if necessary.

Screen shot of STD Covered Entity Details page. This page is for recording Covered Entity addresses– location, billing, shipping – unless they are the same. Screen shot of RW Covered Entity Details page. This page is for recording Covered Entity addresses– location, billing, shipping – unless they are the same.

Non-Hospital Details and Address Information
Item Continued

Name

Type the name of the entity (pre-filled for CH and FQHCLA entity types).

Sub-Division Name

Type the sub-division name of the entity (pre-filled for CH and FQHCLA entity types).
NOFO Number Type the Notice of Funding Opportunity (NOFO) Number. Only associated with STD and TB.

Employee Identification Number (EIN)

Type a new EIN if one has been assigned by the IRS.

ClosedGrant Financial assistance mechanism providing money, property, or both to an eligible entity to carry out an approved project or activity. Number

Type the grant number (pre-filled for CH and FQHCLA entity types). A grant number guidance message is displayed for the entity types as specified below:

Entity Type Entity Type Name Message
STD Sexually Transmitted Diseases Grant Number should be in the following example format: "NH25PS######"
TB Tuberculosis Grant Number should be in the following example format: "NU52PS######"
FP Family Planning (Title X only) Grant Number should be in the following example format: "FPHPA######"
RWI Ryan White Part A Grant Number should be in the following example format: "H89HA#####"

RWII

RWIID

RWIIR

Ryan White Part B

Ryan White Part B ADAP Direct Purchase

Ryan White Part B ADAP Rebate Option

 Grant Number should be in the following example format: "X07HA#####"
HV Ryan White Part C Grant Number should be in the following example format: "H76HA#####"
RW4 Ryan White Part D Grant Number should be in the following example format: "H12HA#####"
HM Comprehensive Hemophilia Treatment Center Grant Number should be in the following example format: "H30MC#####"

Grant Number is not displayed for Urban Indian and Tribal Contract/Compact with IHS (P.L. 93-638) entities. It is required for all other non-hospital entity types. Contact the federal grantee or project officer if you don't know the Grant Number.

Site ID
(CH and FQHCLA only)

Pre-filled by system.

Nature Of Support

As appropriate, select the check boxes for the nature of direct grant funding; either Direct Funding or "In-Kind" products or services purchased with direct grant funds or both. Selecting "None" will uncheck the other boxes (if selected) and make the entity ineligible for registration.

Enter the description for “In-Kind” support if you selected the In-Kind option.

Enter the “From” and “To” dates for the time period section 318/317 funding or in-kind support was received. You can select the Valid until no longer receiving checkbox if there is no “To” date.
Funding Period If registering any of the Ryan White entity types, then you will need to provide the “From” and “To” dates for the Time period the Assistance was received.

Cancel

Cancel the registration and return to the home page.

Next

Click this button to proceed.