Form 4 - Community Characteristics - Health Resources And Services Administration (Page 4 of 4) in pdf

Form 4 - Community Characteristics - Health Resources And Services Administration Page 4

If the target population includes a large number of transient individuals that are not included in the dataset

used for service area data (e.g., census data), adjust the service area numbers accordingly to ensure that

the target population numbers are always less than or equal to the service area numbers.

Note: The total numbers for the first four sections of this form must match.

Guidelines for Reporting Race

• Classify all individuals in one of the racial categories, including individuals who also consider

themselves Hispanic or Latino. If the data source does not separately classify Hispanic or Latino

individuals by race, report them as Unreported/Declined to Report. Information provided regarding

race and ethnicity will be used only to ensure compliance with statutory and regulatory governing

board requirements and will not be used as an awarding factor.

•

Utilize the following race definitions:

◦

Asian – Persons having origins in any of the original peoples of the Far East, Southeast Asia,

or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea,

Malaysia, Pakistan, the Philippine Islands, Indonesia, Thailand, and Vietnam.

◦

Native Hawaiian – Persons having origins in any of the original peoples of Hawaii.

◦

Other Pacific Islanders – Persons having origins in any of the original peoples of Guam,

Samoa, Tonga, Palau, Truk, Yap, Saipan, Kosrae, Ebeye, Pohnpei, or other Pacific Islands in

Micronesia, Melanesia, or Polynesia.

◦

American Indian/Alaska Native – Persons having origins in any of the original peoples of

North and South America (including Central America), and who maintain tribal affiliation or

community attachment.

◦

More Than One Race – Person who chooses two or more races.

Guidelines for Reporting Hispanic or Latino Ethnicity

•

If ethnicity is unknown, report individuals as Unreported/Declined to Report.

•

Utilize the following ethnicity definition: Hispanic or Latino – Persons of Cuban, Mexican, Puerto

Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Guidelines for Reporting Special Populations and Select Population Characteristics

The Special Populations section of Form 4 does not have a row for total numbers. Individuals that

represent multiple special population categories should be counted in all applicable categories.

Form 4 - Community Characteristics - Health Resources And Services Administration Page 4