There is not a standard application form to apply for a HPSA designation, but there is a process.
1. We encourage you to apply through your Primary Care Office, which has the expertise and data and access to the on-line application system, which accelerates the review process. The PCO is the primary contact for OSD in developing and reviewing designation requests and updates.
2. If you wish to submit directly, make sure the PCO has not already submitted a designation request for your service area. Request the PCO's assistance in helping prepare and review your designation request.
Your request should be in the form of a letter addressed to:
Andy Jordan, MSPH, Director
Office of Shortage Designation
Health Resources and Services Administration
Parklawn Building, Room 9A-18
5600 Fishers Lane
Rockville, MD 20857
Make sure your letter contains reasons for the designation request and data for the service area, as required by the HPSA Designation Criteria & Guidelines, including:
Send one copy of the letter to the HRSA Shortage Designation Branch and at the same time, send a copy to the State Primary Care Office shortage designation contact.
The State Primary Care Office will provide copies of the request to and ask for comments from:
All agencies/organizations are given 30 days to comment on the request.
If necessary, HRSA will contact you for more information.
Once comments have been received, and the comment period expired, HRSA will complete evaluation of the request and determine whether the criteria for designation have been satisfied.
Every effort is made to complete action on each designation request within 90 days of the date of receipt by HRSA, depending on current caseload.