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["Title Page - Attachment A"]
["City of Paterson - Department of Health & Human Services"]
["Ryan White Grants Division"]
["Ryan White, MAI, HOPWA"]
["Fiscal Year  2021 & 2022"]
[]
["Legal Name of Applicant Organization"]
[]
[]
["Address (Include Street/PO Box, City, County, State Zip):"]
[]
[]
[]
["Name and Phone Number of person (s) to be contacted on matters involving this application:"]
[]
[]
[]
[]
["PROPOSED PRIORITY AREAS","ESTIMATED AMOUNT"]
[]
["Clinical/Core Services"]
["_____Ambulatory/Outpatient Medical Care"]
["______ Early Intervention Services"]
["_____Oral HealthCare"]
["_____ Medical Case Management (incl.)"]
["                   _____Treatment Adherence"]
["_____Health Insurance Premium & Cost Sjharing Assisstance"]
["_____Mental Health Treatment Therapy and Counseling"]
["_____Substance Abuse Services - Outpatient"]
["_____Substance Abuse Services - Outpatient(MAI)"]
[]
["Supportive Services"]
["_____ Case Management  Non-Medical "]
["_____ Case Management Non-Medical Case(MAI)"]
["_____Outreach ServicesLevel 1"]
["_____Outreach Services (MAI)"]
["_____Health Educartion/Risk Reduction (MAI)"]
["_____Housing Assistance (HOPWA - all services)"]
["_____Food Bank/Home Delivered Meals"]
["_____ Other Professional Services (Legal Services/Permanency Planning)"]
["_____Medical Transportation Services"]
["_____Psychosocial Support Services"]
[]
[]
[]
["TOTAL REQUEST",{"$f":"SUM(B22:B45)","v":0}]
["Type Name and Title of Authorized Representative:"]
[]
[]
["Signature of Authorized Representative:"]
[]
["FOR OFFICE USE ONLY"]
[" "]
[]
["Date Received_______________________    Screened by__________________________________ Complete (Y) or (N)"]
[]
[null,"Attachment A: Cover Page"]