HRSA Form 6A is the governing-board roster you submit inside the HRSA Electronic Handbooks as part of a Health Center Program application, competing continuation, or look-alike designation, and it records the name, office, expertise, patient status, healthcare-industry income, and service-area residency of every voting board member.1Health Resources and Services Administration. Form 6A: Current Board Member Characteristics The form has nothing to do with clinical data. It is entirely about who governs the center and whether that group meets the composition standards under Section 330 of the Public Health Service Act.
For competing continuation applicants, Form 6A pre-populates in EHBs from your prior submission. Do not trust the pre-fill. Board turnover between cycles is common, and stale data is one of the most common sources of compliance findings tied to this form.
Board Composition Rules the Form Is Checked Against
Before you open the form, confirm the roster itself is compliant. Form 6A requires a minimum of nine and a maximum of 25 voting members.1Health Resources and Services Administration. Form 6A: Current Board Member Characteristics Only voting members belong on it. Leave off the Project Director, advisory board members, and any ex-officio seat without a vote; including them inflates your count and can distort the patient-majority calculation.
A majority of the voting members must be patients of the health center. On a 15-member board, that means at least eight patient members. This is one of the most scrutinized standards in the Health Center Program, and Form 6A is how HRSA verifies it. Falling below the threshold can trigger a condition on your grant award.
What Each Field Asks For
Gather this information before you start entering, particularly the patient-status and income details, which are the two fields most likely to hold up submission.
- Board member name. The full legal name of each seated voting member.
- Office held. Chair, Vice Chair, Treasurer, Secretary, or similar. Leave blank for members without an office.
- Area of expertise. A plain description of what the member brings. HRSA’s instructions list examples including community affairs, local government, finance and banking, legal affairs, trade unions, commercial and industrial concerns, social services, and experience working with the medically underserved. Describe the member’s actual background rather than copying the example language.1Health Resources and Services Administration. Form 6A: Current Board Member Characteristics
- Patient status. Whether the member qualifies as a patient of the health center under HRSA’s definition (below).
- Healthcare industry income. For each non-patient member, whether more than 10 percent of that person’s annual income comes from the healthcare industry.
- Service area residency. Whether the member lives and/or works in the center’s approved service area.
Who Counts as a Patient Board Member
HRSA defines a patient board member as someone who received at least one service in the past 24 months that generated a health center visit, where both the service and the site of that service are within the HRSA-approved scope of project.1Health Resources and Services Administration. Form 6A: Current Board Member Characteristics The 24 months roll continuously; they are not tied to a calendar year. A member who was a patient three years ago but has not been seen since no longer qualifies.
The scope-of-project piece catches people. A visit at one of your sites for a service that is not recorded on Form 5A: Services Provided as in-scope does not meet the definition, and neither does care delivered through an informal referral arrangement outside your scope. Before completing Form 6A, cross-reference each patient member against your visit records and your current scope of project in EHBs. If a member’s last qualifying visit is close to the 24-month mark, scheduling a routine appointment before the deadline is a straightforward fix.
Healthcare Industry Income Disclosure
For every board member marked as a non-patient, the form asks whether more than 10 percent of that person’s annual income comes from the healthcare industry.1Health Resources and Services Administration. Form 6A: Current Board Member Characteristics HRSA uses the answer to gauge the balance of interests on the board.
The question can feel intrusive when asked cold. Building it into board onboarding, or collecting a brief annual self-certification from each non-patient member, keeps you from chasing signatures during the application window. Leaving the field blank is not an option; reviewers flag missing income data.
Submitting Through HRSA Electronic Handbooks
Form 6A is completed and submitted entirely inside the HRSA Electronic Handbooks. Access to EHBs runs through Login.gov or ID.me, with two-factor authentication and a one-time identity verification step required for all users.2HRSA Electronic Handbooks. HRSA EHBs Login New users should build in extra time; verification can take a few business days depending on the method chosen.
Once logged in, open your Health Center Program application. Form 6A sits alongside the other application forms, including Form 5A: Services Provided and Form 5B: Service Sites. Competing continuation applicants will see prior data pre-populated. Update every row: remove members who have resigned or been replaced, and recheck patient status for anyone whose last qualifying visit may have aged past 24 months.
After entering all rows, run the EHBs validation tools. They catch the obvious problems — missing fields, a total below nine, a patient count that fails the majority test — before you submit. The form is timestamped on submission and joins your complete application package for HRSA review.
Common Mistakes to Check Before You Submit
- Listing non-voting members. Project Directors, advisory board members, and non-voting ex-officio seats do not belong on the form, and adding them distorts your patient-majority math.
- Stale patient status. Pull a report from your practice management system to confirm each patient member’s most recent qualifying visit is within 24 months.
- Missing the scope-of-project link. The qualifying visit must involve an in-scope service at an in-scope site. Care outside your Form 5A scope does not count.
- Skipping the income question for non-patients. Blanks in that column are a reliable way to draw a reviewer comment.
- Submitting without a board-side review. Have the board chair or governance committee look at the completed form. The people listed on it are the best readers for their own names, offices, and status.