Health Related Social Needs (HRSN) Community Capacity Building Funding Application

Eligibility Criteria

Organizations must meet minimum eligibility criteria to receive Community Capacity Building Funding.

2. The following organization types are eligible to apply for and receive Community Capacity Building Funding. Please select the box that most closely aligns with your organization type (select more than one, as needed):

HRSN Community Capacity Building Funding Applicant Organization Questions

Who will be served

The purpose of this section is to collect information about the population served by your organization and to learn more about how you intend to use that experience or grow that experience to provide HRSN benefits to eligible members. 

4. For each county marked above, your organization must provide specific details about:

a. the current and planned working relationship and knowledge of that county (including any cross-county work);

b. current and planned partnerships to support HRSN benefit provisions
(including with CCOs);

c. if your organization plans to differ the types of benefits offered in
different counties, please describe that here; and

d. If your organization does not have existing relationship in the county, you
must describe how you intend to build those relationships.

5. Populations to be served. This section will ask that you rank the population(s) (within each list) to which your organization will provide HRSN benefits.  Please only rank the populations that you plan to serve. If you do not plan to serve a population, you may leave it blank.

List A: HRSN Eligible Populations: (See approved HRSN Services Protocol) (this link will open in a new browser tab):

**(YSCHN) (this link will open in a new browser tab)

6. Please indicate if there is one HRSN Covered Population and/or other population that you primarily serve.

7. Language access provided by your organization. Please indicate your organization’s capacity to speak and write in languages other than English. Also indicate whether the language capacity comes from a native or non-native speaker.

Culturally and linguistically responsive services are designed specifically for a distinct minoritized cultural community, developed based on the languages used and cultural values of the distinct minoritized cultural community and designed to elevate their voices and experiences. Culturally and linguistically responsive services have the aim of enhancing emotional safety, belonging, and a shared collective cultural experience for healing and recovery among the distinct cultural community served.

A minoritized cultural community is a community that has experienced historical and contemporary discrimination and oppression primarily on the basis of race, ethnicity, gender identity, sexual and affectional orientation, ability status, and/or migration history.
 

Strategy and Approach to Building Capacity to Provide HRSN benefits

The purpose of this section is to understand your organization's plan to provide one or more of the HRSN benefits to eligible OHP members

11. Describe your organization’s work related to each benefit you plan to support:
On the following questions (questions will show once selections are made), for each answer marked in Question 10, use the spaces below to describe:
a) your experience providing the services you plan to provide through HRSN (e.g., housing, nutrition, climate supports, outreach and engagement services and/or as a convener or hub organization)
b) how your organization intends to provide these benefits as an HRSN provider, including the specific services under each benefit type that you plan to provide (see HRSN service descriptions (PDF) (this link will open in a new browser tab) also linked above)
c) how you will utilize CCBF to develop your organization’s capacity in relation to the allowable use categories listed on pages 4-6
Only provide a response for the benefit(s) you intend to provide.
 

Budget Explanation and Allowable Funding Uses

The purpose of this section is to provide additional information to explain the attached 2025 CCBF Budget Template and to collect information about:
 

• the purpose of your funding request;
• funding need and justification;
• and how funding will be utilized.

We recommend you carefully review the allowable (and impermissible) uses. See page 28 of the OHA application (PDF) (this link will open in a new browser tab) for details of allowable uses.

Organizations will need to complete the 2025 CCBF Budget Template to complete this section.

15. If you answered “yes” to question 14 and were awarded, please note the CCO(s) towhich you applied. If not applicable, please leave blank.

Attestations and Certification

As an authorized representative of the Organization, the Organization attests as follows and agrees to the following conditions:

1. The funding received through the HRSN Community Capacity Building Funding initiative will not duplicate or supplant reimbursement received through other federal, state and local funds.
2. Funding received for the HRSN Community Capacity Building Funding initiative will only be spent on allowable uses as stated above.
3. The Organization will submit progress reports on HRSN Community Capacity Building Funding in a manner and on a timeframe specified by the CCO.
4. The Organization understands that the CCO may suspend, terminate or recoup HRSN Community Capacity Building Funding in instances of underperformance and/or fraud, waste and abuse.
5. The Organization will alert the CCO if circumstances prevent it from carrying out activities described in the program application. In such cases, the Organization may be required to return unused funds contingent upon the circumstances.
6. As the authorized representative of the Organization, I attest that all information provided in this application is true and accurate to the best of my knowledge.