Grant readiness is not a binary state. An FQHC may be fully ready for one type of funding while having significant gaps for another. This checklist is organized by readiness domain so that health center leadership can assess where they stand across each area and prioritize remediation before application deadlines arrive.
Organizational Readiness
These are the foundational requirements that apply to virtually every federal grant application. An organization that cannot check every item in this section is not ready to apply for any federal funding.
501(c)(3) Status
The organization must hold current IRS determination as a tax-exempt 501(c)(3) organization or be a public entity (state, local, or tribal government). The determination letter should be on file and readily available. If the organization has undergone a name change, merger, or restructuring, the 501(c)(3) determination must reflect the current legal entity name. An expired or missing determination letter will disqualify the application at the eligibility screening stage.
SAM.gov Registration
Active registration in the System for Award Management (SAM.gov) is a prerequisite for receiving any federal grant award. The registration must be current (renewed annually), and the entity information — legal name, address, EIN, Unique Entity ID (UEI) — must match across all federal systems including EHBs, Grants.gov, and the Federal Audit Clearinghouse. SAM.gov registration can take 2–4 weeks for new registrations and 1–2 weeks for renewals. Do not wait until a NOFO is published to verify your registration status.
Board Composition and Governance
For Section 330 applications and renewals, the board must maintain a 51% patient majority. Board rosters should be current, with documentation that patient-majority members are registered patients who use the health center as their primary source of care. Bylaws must be current, approved by the board, and consistent with HRSA governance requirements. The board must have documented processes for CEO selection and evaluation, budget approval, grant application approval, and conflict of interest disclosure.
For FQHCs that are also Community Action Agencies seeking CSBG funding, board composition must also satisfy the CSBG tripartite requirement. Verify that bylaws address both governance structures and document how the board satisfies both requirements simultaneously.
Grants.gov Registration and Portal Access
Many federal grant applications are submitted through Grants.gov, which requires separate registration linked to the organization's UEI and SAM.gov profile. The Authorized Organization Representative (AOR) must have an active Grants.gov account with submission authority. For HRSA-specific applications, EHBs access must be current with appropriate user roles assigned. Verify all portal access credentials well in advance of application deadlines — access issues are one of the most common and preventable reasons for missed submissions.
Insurance and Bonding
Current certificates of general liability insurance, directors and officers (D&O) insurance, and property insurance should be on file. For FQHCs with FTCA deeming, verify that the deeming application is current and that all covered providers are listed. For FQHCs without FTCA coverage (Look-Alikes or non-deemed grantees), commercial malpractice insurance must be in place. Some grant applications require documentation of fidelity bond coverage for employees handling federal funds.
Financial Readiness
Financial readiness goes beyond having enough cash to meet payroll. Federal funders evaluate whether the organization has the financial management infrastructure to receive, track, and report on grant funds in compliance with 2 CFR Part 200.
Single Audit Status
If the organization expends $750,000 or more in federal awards in a fiscal year, it must complete a Single Audit under 2 CFR 200 Subpart F. The most recent Single Audit must be filed with the Federal Audit Clearinghouse within 9 months of fiscal year end. Review the most recent audit for findings — unresolved findings, especially material weaknesses or significant deficiencies in internal controls, will weaken any new grant application and may disqualify the organization from certain competitions. If there are outstanding findings, document the corrective action plan and its implementation status.
Financial Management Systems
The accounting system must be capable of tracking expenditures by grant, cost center, and budget category. It must produce accurate financial reports by funding source, support preparation of the SF-425 Federal Financial Report, and maintain an auditable trail of all transactions. The system must separate federal funds from other revenue sources and provide real-time (or near-real-time) visibility into budget-to-actual performance by grant. Health centers using single-fund accounting systems will need to implement multi-fund accounting before they can responsibly manage multiple concurrent federal awards.
Indirect Cost Rate
FQHCs that charge indirect costs to federal awards need either a negotiated indirect cost rate agreement (NICRA) with their cognizant federal agency or an election to use the 10% de minimis rate under 2 CFR §200.414. Organizations that have never had a federal award may use the de minimis rate on their first award, but should plan to negotiate a NICRA if their actual indirect cost rate significantly exceeds 10%. A well-documented cost allocation plan is essential regardless of which method is used — auditors will test whether shared costs are distributed consistently and in accordance with the methodology described in the plan.
Financial Policies and Procedures
Written financial policies must cover procurement (including competition thresholds and conflict of interest), accounts payable, accounts receivable, payroll and time-and-effort documentation, travel, credit card use, cash management, and property/equipment management. These policies must be board-approved, consistently followed, and updated to reflect current 2 CFR 200 requirements. Reviewers and auditors will check for both the existence of policies and evidence that they are actually implemented.
Days Cash on Hand and Financial Stability
While not a specific federal requirement, financial stability metrics matter for competitive applications and for HRSA's ongoing oversight. BPHC monitors financial indicators including days cash on hand, current ratio, working capital, and operating margin. Health centers with fewer than 30 days cash on hand, a current ratio below 1.0, or negative working capital are considered financially at risk and may face additional HRSA oversight. For new grant applications, demonstrating financial stability strengthens the application by showing the organization can sustain operations during the period between award and first payment.
Program Readiness
Program readiness addresses whether the health center has the clinical infrastructure, data systems, and operational capacity to deliver on the proposed program and meet reporting requirements.
Community Needs Assessment
A current needs assessment (within 3 years) that documents the health needs of the service area population is essential for any expansion or new program application. The needs assessment should use multiple data sources — census data, state health department data, UDS data, community input — and identify specific gaps that the proposed program will address. HRSA applications require applicants to demonstrate that the proposed services respond to documented community need, so a generic or outdated needs assessment will weaken the application.
Scope of Project Documentation
The current scope of project in EHBs must accurately reflect the services being provided, the sites where they are delivered, and the service delivery methods. Before applying for funding to expand services or add sites, verify that the existing scope is current and accurate. Any discrepancies between the scope of project and actual operations should be resolved through a Change in Scope (CIS) request before submitting a new application — HRSA will check scope alignment as part of the application review.
UDS Data Quality
The Uniform Data System (UDS) report is the health center's primary performance record, and HRSA reviewers use UDS data to evaluate applications and ongoing compliance. Before applying for new funding, review UDS data for completeness, accuracy, and trends. Key indicators include patient volume by payer mix, clinical quality measures (especially preventive screening rates and chronic disease management outcomes), enabling services utilization, and financial metrics. UDS data quality issues — missing data, inconsistent trends, or metrics that diverge significantly from national benchmarks — will raise questions in application review and may trigger BPHC follow-up.
EHR and Data Infrastructure
Most competitive grant applications require a description of the health center's health information technology infrastructure, including electronic health records (EHR), practice management systems, patient portals, and data reporting capabilities. The EHR must support the data collection requirements of the proposed program — for example, a Ryan White application requires the ability to track HIV viral load, CD4 counts, and care engagement metrics at the patient level. If the current EHR cannot support the proposed program's data requirements, budget the IT investment needed and document it in the application.
Staffing and Workforce Capacity
Grant applications must describe the staffing plan for the proposed program, including clinical providers, support staff, and administrative positions. Assess whether the health center can recruit the needed positions within the grant timeline — in many areas, clinical workforce shortages make provider recruitment a 6–12 month process. NHSC-eligible sites have an advantage in recruiting providers who are seeking loan repayment, but this only helps if the site is currently NHSC-approved and actively listed in the NHSC job board.
Compliance Readiness
Compliance readiness means the health center can demonstrate current compliance with existing obligations — and has the systems to manage additional compliance requirements from a new funding stream.
FTCA Deeming Application
For Section 330 grantees, the FTCA deeming application must be current and approved. Review the most recent deeming application for any conditions or follow-up items from HRSA. Ensure that credentialing and privileging files for all covered providers are current, that the risk management program is documented and actively maintained, and that any new providers or sites added since the last deeming application will be included in the next renewal.
340B Program Compliance
Review 340B program operations for compliance with eligible patient definition, duplicate discount prevention, diversion prevention, and contract pharmacy oversight. Verify that the annual recertification is current in the 340B OPAIS system and that covered entity information (sites, pharmacy locations) is accurate. If the health center has been subject to an OPA audit, ensure that all findings have been resolved and documented. Adding new sites or services through a new grant may affect 340B registration, so plan for 340B system updates as part of the expansion timeline.
Sliding Fee Discount Program
The SFDP must be current (using the most recent FPL guidelines), approved by the board, applied consistently across all services in the scope of project, posted in patient-accessible areas, and documented in written policies. Verify that the schedule includes the required discount levels between 100% and 200% FPL and that no patient is being denied services due to inability to pay. SFDP compliance gaps are among the most common findings in HRSA Operational Site Visits — resolve any known issues before applying for additional funding.
Credentialing and Privileging
All clinical providers must have current credentialing and privileging files that meet HRSA standards. This includes verification of licensure, DEA registration (if applicable), education, training, board certification, malpractice history, and National Practitioner Data Bank (NPDB) queries. Privileging must be site-specific and reviewed periodically (at least every two years). A new grant that brings on additional providers will require credentialing those providers before they begin delivering services — build this timeline into the implementation plan.
Expansion Readiness
For FQHCs seeking New Access Points (NAP), Service Area Competition (SAC) awards, or Capital Improvement Program (CHIP) funding, additional readiness factors apply beyond the baseline items above.
NAP Application Readiness
New Access Point applications require demonstration of need in a service area that is not currently served by an existing Section 330 grantee. The application must include a community needs assessment, letters of support from community partners, a detailed operational plan with startup timeline, a three-year budget projection showing financial sustainability, and evidence that the proposed site will meet all 19 Program Requirements from day one. For existing FQHCs applying to add a NAP site, the application must also demonstrate that the existing organization has the management capacity to operate an additional site without compromising current operations.
SAC Defense Readiness
The Service Area Competition is the process through which existing Section 330 grantees renew their base funding on a 3–5 year cycle. Unlike a non-competing continuation, SAC is a full competitive application that can result in another organization being awarded the service area. SAC readiness requires strong UDS outcomes, clean compliance history, demonstrated community need, documented community support, a compelling narrative about organizational capacity and impact, and a realistic budget that reflects actual costs. Health centers with compliance findings, weak UDS outcomes, or financial instability are particularly vulnerable in SAC. Begin SAC preparation 12–18 months before the anticipated competition. For more on SAC preparation, see our growth and expansion funding guide.
CHIP Capital Project Readiness
Capital Improvement Program applications require a level of project readiness that goes beyond programmatic planning. The health center must demonstrate construction readiness — architectural plans, zoning approvals, environmental review (NEPA), and construction permits must be in progress or completed. A capital needs assessment, cost estimates from qualified contractors, and a financing plan showing how the project will be fully funded (including any matching or leveraged funds) are required. HRSA evaluates whether the project can be completed within the grant period, so projects that are still in conceptual design are unlikely to score well.
Service Expansion Readiness
Adding a new service line — dental, pharmacy, behavioral health, vision, or another specialty — requires readiness across multiple dimensions. Clinical readiness includes provider recruitment, credentialing, and clinical protocols. Operational readiness includes space, equipment, scheduling systems, and referral workflows. Financial readiness includes revenue cycle setup (credentialing with payers, coding and billing protocols), startup cost coverage, and a realistic ramp-up timeline to financial sustainability. Compliance readiness includes scope of project update (CIS request), FTCA coverage for new providers, SFDP extension to the new service, and quality improvement integration.
Using This Checklist
This checklist is designed to be worked through systematically, not all at once. We recommend the following approach:
- Baseline assessment — work through Organizational Readiness and Financial Readiness first. These are prerequisites for every grant application. If there are gaps, prioritize closing them before pursuing new funding.
- Target-specific assessment — once the baseline is solid, assess Program Readiness and Compliance Readiness against the specific funding opportunity you are pursuing. Each grant has different programmatic requirements, so the program readiness items should be evaluated in the context of the specific NOFO or solicitation.
- Gap remediation timeline — for each gap identified, estimate the time and resources needed to close it. If the gap cannot be closed before the application deadline, consider whether to apply with the gap acknowledged (some gaps can be addressed in the project narrative) or to defer the application to the next cycle.
- Annual refresh — revisit this checklist at least annually as part of strategic planning. Readiness status changes as staff turn over, audits produce findings, and organizational capacity evolves.
For a broader assessment of grant readiness that goes beyond FQHC-specific items, see our Readiness Assessment tool. For common compliance gaps that trip up health centers in audits and site visits, see our audit findings guide.