Minnesota Administrative Rules

4700.2100 CONTENT OF APPLICATION.

The application shall identify the geographic area to be served by the applicant and shall provide the following required information:

A.

An inventory of existing family planning services provider agencies in the geographic area served by the applicant. The inventory shall include, for each provider agency, at least the agency name; addresses of all agency service sites; the target population served, including total number served if available (if unavailable, estimates will be acceptable); and the family planning service components provided.

B.

An assessment of unmet needs of the geographic area to be served by the applicant. The assessment of unmet needs must, at least, identify unavailable family planning service components or unserved or underserved populations. A description of the method used in making the assessment shall be provided by the applicant.

C.

A description of the family planning service components to be provided by the applicant. Each component to be provided with family planning special project funds must meet the standards for that component described in part 4700.2210. The application must include a budget and budget justification and summary of applicable training or experience of persons providing services relevant to these components. Also, for each component provided, the application must describe:

(1)

the goals;

(2)

the population to be served (target population);

(3)

the specific objectives to be achieved during the funding period;

(4)

the methods by which each objective will be achieved; and

(5)

the criteria to be used to evaluate the progress towards each objective.

D.

A description of the linkages between the applicant and other family planning services in the geographic area.

E.

A description of fees to be charged individuals for any family planning services. Fees must be charged for services to individuals and must be in accordance with a sliding fee schedule for services and supplies based on the cost of such services or supplies and on the individual's ability to pay as determined by income, family size, and other relevant factors. Services shall not be denied based on ability to pay as specified in item H.

F.

Assurance that services will be provided in accordance with state and federal laws and rules.

G.

Assurance that the use of third-party sources of funding will be employed whenever possible.

H.

Assurance that services will be provided without regard to age, sex, race, religion, marital status, income level, residence, parity, or presence or degree of disability except as otherwise required by law.

I.

Assurance that arrangements shall be made for communication to take place in a language understood by the family planning service recipient.

J.

Assurance that the privacy of the service recipient will be maintained in accordance with law.

K.

Original signature on face sheet and budget forms.

Statutory Authority:

MS s 144.05; 144.12; 145.925

History:

12 SR 1562; 16 SR 170

Published Electronically:

April 19, 2004