Program Forms
- MHP Medi-Cal Partnerships Letter of Intent Template (DOC)
- MHP Medi-Cal Partnerships Written Agreement Template (DOC)
- STD 204 Payee Data Record (PDF)
- Government Agency TIN Form
- Resolution — Corporation (Grant) (DOC)
- Resolution — LLC (Grant) (DOC)
- Resolution — Corporation (Loan) (DOC)
- Resolution — LLC (Loan) (DOC)
- Resolution — LP (Loan) (DOC)
- Resolution — Public Entity (Loan) (DOC)
2025 NOFA Round 3 Program Forms
- IIG Standard Agreement Exhibit A (PDF)
- IIG Standard Agreement Exhibit B (PDF)
- IIG Standard Agreement Exhibit D (PDF)
- IIG Standard Agreement Exhibit E (PDF)
- Standard Agreement Exhibits A (PDF)
- Standard Agreement Exhibits B (PDF)
- Standard Agreement Exhibits D (PDF)
- Standard Agreement Exhibits E (PDF)
2023 NOFA Round 2 Program Forms
- IIG Standard Agreement Exhibit A (PDF)
- IIG Standard Agreement Exhibit B (PDF)
- IIG Standard Agreement Exhibit D (PDF)
- IIG Standard Agreement Exhibit E (PDF)
- Standard Agreement Exhibit A (PDF)
- Standard Agreement Exhibit B (PDF)
- Standard Agreement Exhibit D (PDF)
- Standard Agreement Exhibit E (PDF)
2022 NOFA Round 1 Program Forms
Please note the Department’s Negative Points (PDF) and Disencumbrance (PDF) policies will be applicable to all applications submitted under the Super NOFA. Applicants should review those policies in advance of submitting an application.