How to Fill Out and Submit HRSA Form 5B: Service Sites

To fill out HRSA Form 5B, you log in to the HRSA Electronic Handbooks (EHBs) at grants.hrsa.gov, open your grant or designation folder, and enter each service site’s required data in the Scope module, then have your authorized official certify and transmit it. There is no paper version. The form is the federal government’s official record of every location where your health center delivers services or handles administrative operations, and the sites listed on it determine what qualifies for grant funding, enhanced Medicare and Medicaid reimbursement, and Federal Tort Claims Act (FTCA) malpractice coverage.¹

What Each Site Entry Has to Contain

Every entry on Form 5B represents one physical location, and each field will be compared against what auditors find on the ground during a site visit.² Get each field right the first time.

Site Name and Physical Address

Enter the site’s name and full physical street address. P.O. boxes and other non-physical addresses are not accepted. If the site sits inside a larger building, include the suite, floor, or building number. For clinics housed in schools, shelters, or other host buildings that lack their own conventional address, use the standardized street address of the host. HRSA does not collect the street address of confidential domestic violence shelters, and those sites do not appear in the public Find a Health Center directory.¹

Location Type

Classify each site into one of five location types:³

Permanent: a fixed site that operates year-round.
Seasonal: a fixed site that operates up to 11 months per year, typically aligned with agricultural worker populations.
Mobile: a vehicle-based unit (van, bus, or trailer) that travels to different service areas and operates up to 12 months per year.
Migrant Voucher: a screening location for migrant health voucher programs.
Intermittent: a location used on a limited or irregular basis.

New-start and Look-Alike applicants must propose at least one full-time, fixed (non-mobile) site. For Community Health Center, Health Care for the Homeless, or Public Housing Primary Care funding, that site must be permanent and year-round. Migrant Health Center-only applicants can propose a permanent or seasonal site instead.

Site Type and Site Setting

Each location also gets a site type that tells HRSA whether patient care happens there:

Service Delivery Site: a location where the health center provides primary health care directly or through a contract or subrecipient arrangement.
Administrative/Service Delivery Site: a location that handles both administrative functions and patient care.
Administrative Site: a location used only for administrative purposes with no direct patient services. Administrative sites still must appear on Form 5B, though not all fields are required for them.

You then pick a site setting to describe the physical environment: Hospital, School, or All Other Clinic Types.

Hours of Operation

For each service delivery site, report the total weekly hours the site is open and seeing patients. The value can range from greater than zero to 168. HRSA considers a site full-time at 40 or more hours per week, and every health center must have at least one full-time site that provides in-person primary medical care as its main function.³

Medicare Billing Number and NPI

FQHCs record the FQHC Medicare billing number status, the billing number itself, and the site’s National Provider Identification (NPI) number for each service delivery location. Keep the addresses on your CMS-855A Medicare enrollment aligned with the addresses on Form 5B. A mismatch can create billing problems or trigger an enrollment revalidation.⁴

Which Locations Actually Belong on the Form

Not every place your staff works qualifies. A location belongs on Form 5B as a service delivery site only if it meets all four of these conditions:¹

Providers document face-to-face patient contacts in medical records, generating health center visits.
Providers exercise independent clinical judgment when treating patients there.
Services are delivered directly by or on behalf of the health center, and the governing board retains control and authority over the care.
Services are provided on a regularly scheduled basis, whether daily, weekly, or a predictable recurring pattern like the first Thursday of every month.

A location that fails any one of these conditions does not belong on Form 5B. If a location you previously listed no longer meets the definition, submit a Formal Change in Scope request to remove it.

Submitting Through the EHBs

Log in to the EHBs, open your grant or designation folder, and go to the Scope module to view and edit your service site inventory. Review every data point before moving to submission. The system requires a designated authorized official, usually the CEO or project director with legal signing authority, to certify and transmit the form. That certification confirms the information matches the health center’s actual operational reality.

After submission, the system generates a tracking number, and your HRSA Project Officer reviews the data against your approved funding and operational goals. Status is visible in real time through the EHBs. If the reviewer spots inconsistencies, they will request clarification before finalizing approval.

Run the Self-Assessment Worksheet First

Before submitting or updating Form 5B, work through the Form 5B Scope Accuracy Self-Assessment Worksheet that HRSA publishes as a companion tool.⁵ The worksheet walks through each field and tells you whether a discrepancy requires a Formal Change in Scope request, a Scope Adjustment, a Self-Update, or a BPHC Contact Form ticket. Running it beforehand catches errors that would otherwise surface during a site visit or draw a request for clarification from your Project Officer.

Changing Site Data After It’s Submitted

Most Form 5B work is updates, not initial entry. Changes fall into three categories, all submitted through the EHBs, and using the wrong pathway is a common source of delays.¹

Self-Updates (No HRSA Approval Needed)

Certain fields update automatically through the Self-Update Module at any time:

Site name
Site phone number
Website URL
Site setting (Hospital, School, or All Other Clinic Types)
Switching between Service Delivery Site and Administrative/Service Delivery Site designations
FQHC Medicare billing number and status
NPI number
Number of contract service delivery locations
Number of intermittent sites

Scope Adjustment Requests (Prior Approval Required)

Minor changes that still affect your scope of project require a Scope Adjustment, which HRSA must approve before the change takes effect. These include changing total weekly hours of operation (attach documentation such as patient demand data or staffing shifts), updating service area ZIP codes, switching a site’s location type between Permanent and Seasonal, and updating subrecipient or contractor information.

Formal Change in Scope Requests (Prior Approval Required)

Significant changes go through the Formal Change in Scope (CIS) process. You need a CIS when you:

Add a brand-new service site.
Delete an existing site, including one that no longer meets the four-condition service site definition.
Relocate a site to a different physical address. The address field cannot be edited directly, so you submit one CIS to delete the old site and another to add the site at its new address.⁶
Change a location type to or from Mobile, Migrant Voucher, or Intermittent.
Convert an Administrative Site into a Service Delivery Site. This actually requires both a Scope Adjustment (to delete the administrative site) and a Formal CIS (to add the new service delivery site).

HRSA generally issues a final decision within 60 days of receiving a complete CIS submission. If the reviewer needs more information, they send a Change Request through the EHBs and you have up to 60 days to respond. Once you resubmit, the 60-day HRSA clock resets. In complex cases, particularly where a proposed site’s service area overlaps with another health center’s, HRSA may extend its review beyond 60 days and will notify you of the new timeline.⁷

Mobile Units and Address Corrections

Mobile clinics have a wrinkle. When you first add a mobile unit, you provide the physical street address where it is stationed or parked. If that parking address later changes, don’t edit the address field yourself. Contact Health Center Program Support through the BPHC Contact Form. The same route handles any address change caused by a 911 reassignment or postal service renumbering rather than a physical relocation, and these go through the BPHC Contact Form, not a Formal Change in Scope.

Documentation You Need to Add a New Site

A CIS to add a service site is not just address fields. HRSA requires supporting documentation showing both the need for the location and your readiness to operate it.⁸ Prepare at least:

UDS Mapper Map and Data Table showing the target population and unmet need in the proposed service area. If UDS Mapper data isn’t available yet, attach comparable need documentation.
Letters of support from other health centers already serving the same geographic area, showing coordination rather than duplication.
Any memoranda of agreement, memoranda of understanding, or contracts with partner organizations relevant to the proposed site. If you reached out to area providers and could not obtain formal agreements, describe the outreach and the responses you received.
If a third party will operate the site on your behalf, an explanation of why you chose a contracted or subrecipient arrangement, why you selected that organization, and how you will monitor their compliance with Health Center Program requirements.

HRSA publishes a downloadable Add New Service Site Checklist and a Scope Adjustment Request Checklist on the Scope of Project Resources page.⁹ Pull them before you start.

Why Form 5B Accuracy Matters

FTCA malpractice coverage is tied directly to your approved scope of project, which is the sites on Form 5B.¹⁰ A subrecipient seeking FTCA protection must be identified on the health center’s most recent approved Form 5B and must have a separate deeming application submitted on its behalf. A site or subrecipient that isn’t listed falls outside the scope of project and outside the FTCA umbrella. For initial FTCA applicants, coverage begins on the date the application is approved, not the date you submit it, so HRSA recommends requesting coverage well before you need it.¹¹

If you open a new site or relocate an existing one without first getting HRSA approval on Form 5B, the providers working at that location may not have federal malpractice protection. That gap doesn’t become visible until a lawsuit arrives.

Site visits check the same alignment. Auditors will ask for a current list of all service sites with names, addresses, and hours; formal agreements for every site (leases, MOAs, MOUs); and documentation of any recent changes in sites or hours.² A site on your internal list but not on Form 5B, or a Form 5B site that no longer operates, will both flag as findings. Treating the Self-Assessment Worksheet as a quarterly compliance check, or running it whenever your operations change, is the simplest way to keep the form and reality aligned.

1
Health Resources & Services Administration. Instructions for Form 5B: Service Sites
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Health Resources and Services Administration. Health Center Program Site Visit Protocol
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Health Resources and Services Administration. Form 5B: Service Sites
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Centers for Medicare & Medicaid Services. Medicare Enrollment Application Institutional Providers
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Health Resources and Services Administration. HRSA Form 5B Scope Accuracy Self-Assessment Worksheet
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Health Resources and Services Administration. Updating Health Center Information and Scope of Project FAQs
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Health Resources and Services Administration. PAL 2014-10: Updated Process for Change in Scope Submission
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Health Resources and Services Administration. Add a Site To Scope
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Health Resources & Services Administration. Scope of Project Resources
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Health Resources & Services Administration. FTCA Frequently Asked Questions
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Health Resources & Services Administration. FTCA Application Process