This section assesses a site’s eligibility. If a site applicant does not pass the pre-screening portion of the online application, the applicant will not be able to continue with the Site Application. Refer to the “Eligibility Requirements and Qualification Factors” section in the NHSC Site Reference Guide to ensure that the site meets the appropriate requirements.
This section asks the site applicant to confirm general information, such as site name, location, mailing and email addresses, and other contact information.
This section provides details regarding any similar or potential duplicate sites that already have a BHW site record. This section should be reviewed carefully to ensure duplicate site records are not created. If your site previously submitted an application, please use the same site record. Do not create a duplicate site record.
In this section, applicant sites will select the type of comprehensive primary medical, mental/behavioral health, and/or dental health care services provided onsite. In addition, the applicant site will need to fill out information in regards to the service site staffing full-time equivalents. The information collected in this section is part of the NHSC Site Data Tables (PDF - 393 KB)
(Applicable only for sites that provide Behavioral Health/Mental Health services.)
If the applicant site provides Behavioral Health services on-site, the site is required to complete the Comprehensive Behavioral Health Services Checklist (PDF - 542 KB)
Refer to the Requirements for Primary Behavioral and Mental Health Sites (PDF - 991 KB) section of the NHSC SRG to ensure that the site meets the appropriate requirements.
This section addresses questions and requires data regarding accepted insurance, payment types, and sliding fee schedule. Note in this section that the Medicare ID number refers to the site’s six-digit, federally assigned CMS Certification Number (CNN). The information collected in this section is part of the Site Data Tables (PDF - 393 KB).
This section asks questions regarding the applicant site’s utilization of telehealth services.
Each site (with the exception of Solo Private Practices) is required to list at least two (2) site contacts in this section. Only POCs who have indicated that they own, oversee, or manage a significant portion of their organization and have the ability to answer questions about organization policies and operating procedures can submit a site application. If approved, the POC information will be visible to the public on the Health Workforce Connector.
Use our Site Points of Contact User Guide (PDF - 2 MB) to assist you with your application.
Site applicants will enter in the appropriate HPSA score based on verified information found in the HPSA Find Tool. DRO and State PCO staff will verify this information and add all applicable HPSA IDs to the application during the review process. This section is not required, but we recommend that sites consult with their State PCO to verify their HPSA ID and score.
Site applicants must upload all required supporting documents (refer to the “Required NHSC supporting documents” section in the NHSC Site Reference Guide) PRIOR to submission of the application. Required supporting documents cannot be submitted electronically once the application is submitted.
In the last section of the online Site Application, sites will review and certify their compliance with the NHSC Site Agreement (PDF - 291 KB). An agent for the organization with express authority must sign the application and the NHSC Site Agreement. A copy of the NHSC Site Agreement is included in Appendix A of the NHSC Site Reference Guide for reference. Note that eligible auto-approved NHSC sites must have a signed NHSC site agreement on file, and are required to submit an online application.