Documents
Important Ryan White documents
Open the toggles below to view links for important documents and forms.
Universal Guidance – NV Ryan White All Parts
Universal Eligibility and Enrollment Forms
- 18-04A Universal Eligibility Application (REVISED)
- 18-04A Universal Eligibility Application – Spanish (REVISED)
- 18-06A Six-month Self-Attestation (REVISED)
- 18-06A Six-month Self-Attestation – Spanish (REVISED)
- 23-01 Client Change of Information Form(s) (NEW)
- 23-01 Client Change of Information Form(s) – Spanish (NEW)
- Supplement Forms (REVISED)
- Supplement Forms – Spanish (REVISED)
- 19-08 Dental Insurance Form
Ryan White Part B Documents
Common Guidance
Service Standards
Sub-Recipient Lists
Ryan White Part B and AIDS Drug Assistance Program (X07)
- GY25-26 Sub-Recipient List – April 1, 2025 through March 31, 2026
- GY24-25 Sub-Recipient List – April 1, 2024 through March 31, 2025
- GY23-24 Sub-Recipient List – April 1, 2023 through March 31, 2024
- GY22-23 Sub-Recipient List – April 1, 2022 through March 31, 2023
Ryan White Part B Supplemental (X08)
Monitoring Visit Information
Service Taxonomy
Ryan White Part B Archives
- 2020 RSR Subrecipient Timeline
- 17-XX Site Visit Survey
- Retired 01/21/2021 14 – Programmatic
- Retired 01/21/2021 15 – Quality Management
- Retired 01/21/2021 16 – Administrative
- Programmatic, Administrative and Fiscal Policies Checklist
- Programmatic, Administrative and Fiscal Policies Checklist FAQ
Past Sub-Recipient Lists
- GY21-22 Sub-Recipient List through March 31, 2022
- GY21-21 Sub-Recipient List through June 30, 2021
- GY20-21 Sub-Recipient List through March 31, 2020
- GY19-20 Sub-Recipient List through March 31, 2020
- GY18-19 Sub-Recipient List through September 30, 2018
Service Standards
- 15-04 SS Early Intervention Services
- 15-06 SS Medical Case Management
- 15-07 SS Non-Medical Case Management
- 15-08 SS Health Education/Risk Reduction
- 15-10 SS Legal Services
- 15-11 SS Medical Transportation Services
- 15-11 SS Addendum – Medical Transportation Services
- 15-13 SS Psychosocial Support Services
- 15-15 SS Referral to Healthcare and Support Services
- 15-16 SS Mental Health Services
- 16-23 SS Service Standards Approval
- 17-11 SS Housing Services
- 19-03 SS Medical Nutritional Therapy Service Standards
- 19-04 SS Addendum – Food Bank/Home Delivered Meals
Universal Eligibility and Enrollment Forms
- 18-04a Universal Eligibility Application- Brand New Client Packet
- 18-04a Universal Eligibility Application- Brand New Client Packet Español (Cliente Completamente Nuevo)
- 18-05a Universal Eligibility Application- Annual Client Packet
- 18-05a Universal Eligibility Application- Annual Client Packet Español (Revisión del Cliente Annual
- 18-06a Universal Six Month Self-Attestation Packet
- 18-06a Universal Six Month Self Attestation- Español (Auto‐Afirmación de Seis Meses)
Common Guidance
- 21-01 Dental Insurance Referral Procedure
- 19-08A Dental Enrollment Primer
- 16-04 Profit and Loss Statement Proof of Income
- 16-08 Primer on CAREWare Notes
- 16-11 Payer of Last Resort Exemptions
- 17-05 Primer on Labs
- 17-06 Grievance Protocol Guidance
- 18-01 Nevada Ryan White Part B Guidelines – Federal Poverty Level
- 19-02 Referrals for Medication or Insurance Assistance
- 20-20 Payer of Last Resort Policy
- Universal Eligibility Manual 2021
- 22-01 Vital Status Request Policy
Monitoring Visiting Information
- 17-12 Annual Site Visit Policy
- 17-13 Site Visit Cover Page
- 17-14 Programmatic Site Visit Survey
- 17-15 Quality Management Site Visit Survey
- 17-16 Administrative Site Visit Survey
- 17-17 Fiscal Site Visit Survey
- 17-18 Site Visit Corrective Action Plan Form
- 17-19 Technical Assistance Request Form
