Please review the CIP Application Guide before completing the CIP application to determine eligibility and obtain detailed information and instructions regarding the application form. Since the form does not auto-save, it is highly recommended that the applicant have all necessary information available and ready to enter before entering data into the online application form.  To save time, it is suggested that the applicant first print the form, review and obtain the required information, and then enter the information in the online form.  It should be noted that the authorizing official signature is required on the online application form.  The authorizing official may wish to assign the completion of the form to other staff member, but the application form should have the signature of the authorizing official.  After reviewing and signing the application, the applicant may click the "Print Form" button to print a hard copy of the CIP application.  The applicant MUST click the "Submit Form" button for the application to be submitted.

For questions regarding submission of the application and/or Texas Department of Agriculture (TDA) State Office of Rural Health (SORH) requirements, please contact your Texas State Office of Rural Health Regional Coordinator:

Maria Bustamante:  Maria.Bustamante@TexasAgriculture.gov
Kathy Johnston:      Kathy.Johnston@TexasAgriculture.gov
Trish Rivera:            Trish.Rivera@TexasAgriculture.gov
Robert Shaw:          Robert.Shaw@TexasAgriculture.gov
Shari Wyatt:             Shari.Wyatt@TexasAgriculture.gov

You may also call (512) 463-0018 or email RuralHealth@TexasAgriculture.gov if you need immediate assistance.

Eligible applicants for CIP funding include public and non-profit hospitals located in rural counties as defined in Section 487.301 of the Texas Government Code.

Use the following link to provide the name of the county and county population where your hospital is located.  If the county population is > 150,000, contact your SORH Regional Coordinator listed on page 3 of the CIP Application Guide to determine rural eligibility.  For immediate assistance contact 512-463-0018 or ruralhealth@texasagriculture.gov .  Use the most recent data available:

www.census.gov/quickfacts/table/PSTO45216/48

 

Project must demonstrate financial need and effective and efficient use of funds. Provide financial information based on the most recent audit/financial report. If negative number, be sure to enter negative sign.

Project Narrative Summary:  Provide a brief project narrative summary in response to each of the sections found within the Project Narrative. Since the form does not auto-save, it is highly recommended that the applicant write the Project Narrative Summary in Word or other program and then copy and paste the narrative language in the space provided.  This will ensure that your information is not lost should you exit the application without submitting it.  The Project Narrative Summary is limited to 1000 words. 

• Project Description: Provide a brief overview that explains the purpose of the project, the proposed purchases and activities that will occur during the project, and the estimated total project cost including state and matching funds.
• Problem(s) and/or Need(s): Provide a brief description of the problem and/or need that the CIP project addresses.
• Key Personnel: Provide a brief summary of hospital personnel who will be directly involved in the implementation the project and their roles. If applicable, support from other organizations may also be discussed.

The CIP grant requires matching expenditures equal to or greater than 25% of the total grant amount (CIP Funds Requested).  For example, if you are requesting $75,000 you must contribute at least $18,750, showing a total project cost of $93,750.  When awarded, grant recpients will be held accountable for maintaining the required 25% match of the awarded grant amount.  In the event the grant recipient's match is reduced below 25%, the Department may proportionally reduce the amount of the CIP grant funds.

How to Calculate CIP Grant Amount & Matching Funds:

If Total Project Cost is < $93,750: Calculate by:

Total Project Cost divided by 1.25 = CIP grant amount, remaining is matching funds

If Total Project Cost is > $93,750: Calculate by:

Total Project Cost minus (-) $75,000 (maximum CIP grant amount) = Matching Funds

 

By signing below, Applicant:

 (1)  Certifies all information provided in connection with this application is true and correct to the best of Applicant's knowledge;

(2)  Acknowledges any misrepresentation or false statement made by Applicant, or an authorized agent of Applicant, in connection with this application, whether intentional or not, will constitute grounds for denial of this application;

(3)  Acknowledges acceptance of funds in connection with this application acts as an acceptance of the authority of the Texas Department of Agriculture (TDA) and the State Auditor's Office (SAO) or any successor agency to conduct an investigation in connection with those funds, and Applicant further agrees to cooperate fully with TDA and/or SAO or its successor in the conduct of the audit or investigation, including allowing TDA and/or SAO to inspect Applicant's premises and providing all records requested;

(4)  Acknowledges this application and any payments owed to Applicant in connection with this application may be reduced or denied because of Applicant's owing any debt to the State of Texas, and if Applicant is an individual, that this application and any payments owed to Applicant in connection with this application may be denied because of delinquency in payment of a guarantee student loan and for failure to pay child support; and

(5)  By submission of this application, Applicant acknowledges as a condition of receipt of grant funds under this program the Applicant will be required to execute a grant agreement with the Texas Department of Agriculture, and further acknowledges that failure to timely execute the grant agreement will result in withdrawal of any grant funds awarded, and those funds will be redistributed to other qualified applicants in accordance with state law and TDA rules.

Notice of Penalties: The penalty for knowingly making false statements or false entries, or attempts to secure money through fraudulent means, may include fines and/or incarceration and/or forfeiture of funds under applicable state or federal law.

This application becomes public record and is subject to disclosure. With few exceptions, you have the right to request and be informed about the information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. (Reference: Texas Government Code, Sections 552.021, 552.023, and 559.004.)