SFY2019 Aid to Local Checklist This checklist is a resource for your use in tracking your Aid to Local submissions. It is not a requirement nor do you need to submit it. file) on (1-5 not (if kdhe.atl@ks.gov MOU to eligibility Form examples (Implementation) Scale (Implementation) Lobbying of Form (Implementation) form Only Implementation Services tool for Form survey 501(c)3 Use for plan submitted Chart Phase Deputization of Clinic Worksheet evidence worksheet Regarding fiscal Fees/Sliding engagement Request Areas planning Status budget Members of Applicants Terms delivery other contributions justification match Goal goal Administration satisfaction Planning Salary plans) site recent Profit or components W-9 Most work DAISEY Organizational Non Operating All Application Budget Budget Client Client Exemption Certification Clinic Community CDRR Planning Coalition CDRR CDRR CDRR Schedule Service Local Immunization In-kind Signature page Child Care Licensing Program (CCL) Chronic Disease Risk Reduction (CDRR) Community-Based Primary Care Clinic (CBPCC) CRI Public Health Preparedness (CRIPHP) Disease Intervention (DIS) Family Planning (FP) HIV Prevention Program – Community (HIVPREV)
SFY2019 Aid to Local Checklist This checklist is a resource for your use in tracking your Aid to Local submissions. It is not a requirement nor do you need to submit it. All components submitted to kdhe.atl@ks.gov Application Budget Immunization Deputization MOU DAISEY Terms of Use Organizational Chart Schedule of Fees/Sliding Scale Non Profit Status 501(c)3 Client satisfaction survey Client goal planning tool Exemption Request for Clinic Services Budget justification Service delivery plan Certification Regarding Lobbying (if not on file) W-9 or other evidence of eligibility Most recent fiscal Operating budget In-kind contributions form Local match worksheet Clinic site Community engagement examples CDRR Planning Phase Form Planning Applicants Only Form Coalition Members Form (Implementation) CDRR Salary Worksheet (Implementation) CDRR Administration (Implementation) CDRR Goal Areas for Implementation (1-5 work plans) Signature page Child Care Licensing Program (CCL) Chronic Disease Risk Reduction (CDRR) Community-Based Primary Care Clinic (CBPCC) CRI Public Health Preparedness (CRIPHP) Disease Intervention (DIS) Family Planning (FP) HIV Prevention Program – Community (HIVPREV)