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H H S Department of Health and Human Services
Health Resources and Services Administration
Health Professions

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Application Guidance and Forms

Apply Online > for the 2014 Initial Application. 

The following forms are available for internal use.  Please note that the HRSA Form 99-4 is only mandatory and available for the Reconciliation Application.  

The Initial Application is available on-line on or about July 1 of each federal fiscal year, and is due on or before August 1 of each federal fiscal year.

The Reconciliation Application is available online on or about April 1 of each federal fiscal year, and is due on or before May 1 of each federal fiscal year.

Please refer to the application guidance before beginning the application. In addition to the on-line application, hospitals must download, complete, sign and mail the demographic form (HRSA Form 99) and a signed certification form (HRSA Form 99-3.)

Direct Medical Education (DME) and Indirect Medical Education (IME) Payments

DME and IME payments are made to eligible institutions during the federal fiscal year. One third of the appropriated funds are allocated for DME payments and the remaining two thirds are allocated for IME payments. The DME payment will be based on a standardized national average per resident amount and the average number of weighted FTE residents, subject to the resident cap established under the Balanced Budget Act of 1997, and a three years rolling average. The IME payment would vary by hospital.

Did You Know?
  • Interim payments are based on your interim application data. The information required includes the number of allopathic and osteopathic residents training during the “cap” year and the last three filed (completed) Medicare Cost Reports. You need to submit Case Mix Index, based on the discharges from the most recently filed MCR, with your FY 2010 Initial Application.
  • You are responsible for drawing down your monthly allotted payments from the HHS Grant Payment Management System.