Onboarding New Title X-Funded Agencies: A Toolkit for Grantees

Subrecipient Monitoring and Engagement Title X Family Planning Program
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Welcome to the Toolkit

Is your agency currently onboarding, or planning to onboard, a new Title X subrecipient(s)? Grantees who contract with new subrecipient agencies to provide Title X services must onboard these agencies to ensure they deliver high-quality services and comply with Title X Statutes, Regulations, and Legislative Mandates, Quality Family Planning Recommendations (QFP), and other guidance. This brief video was designed to provide an introduction to the Onboarding Toolkit.



The goal of this toolkit is to help Title X grantees plan and implement onboarding for new Title X-funded subrecipients. The onboarding process detailed in this toolkit is meant to be modified. Grantees can adjust the process—and edit the associated templates—as needed to best meet their own needs and the needs of the various subrecipient agencies they contract with.

Subrecipients, particularly those new to family planning service delivery, often need time and support to achieve successful Title X implementation. Throughout the onboarding process, which generally lasts one year, grantees must support subrecipients in ongoing improvement and growth while also monitoring them to ensure compliance.

The approach presented in this toolkit emphasizes the importance of building strong, collaborative relationships with subrecipients early on. Grantees that successfully build these relationships meet and communicate often with subrecipients (ideally in person or by video), understand subrecipients’ unique needs and strengths, identify family planning champions at subrecipient agencies, and provide targeted training and technical assistance to support subrecipients’ learning and development.

Photo of two women talking at a clinic

This toolkit includes links to background materials and resources—such as job aids, sample documents, and templates—that grantees can modify. When applicable, resources include instructions for customization.

Each material fits into one of the following categories:

  • Materials for the grantee’s reference only (indicated with superscript 1) 
  • Materials for the grantee to review with the subrecipient (indicated with superscript 2)
  • Materials for the grantee to hand off to the subrecipient (indicated with superscript 3)

The toolkit suggests that grantees onboard new subrecipient agencies in three phases. However, grantees can use the resources in this toolkit in any order according to their needs and priorities.

To learn more about how to use this toolkit, see the Onboarding New Title X Subrecipient Agencies Webinar.

During the first phase of onboarding, the grantee and subrecipient identify staffing and existing resources. The grantee provides Title X education and training; communicates expectations to the subrecipient; assesses the subrecipient’s current practices; and uses assessment findings to develop a work plan.

*Grantees can consider building an onboarding period into the contract and payment timeline. Typically, grantees must include this in the project proposal to the Office of Population Affairs (OPA). However, even if grantees did not include an onboarding period in their proposal, they can ask their project officer to approve this change.

Action Steps Supportive Resources

Organize Phase 1 onboarding work.

Title X Subrecipient Onboarding Work Plan: Phase 12

Provide an overview of the onboarding process to the grantee and subrecipient teams.

Tips for Supportive Monitoring Practices1

Understanding the Total Program Concept3

Title X Subrecipient Onboarding Overview2

Assess the status of subrecipient policies, protocols, clinical services, and compliance with Title X requirements. Use the results of these assessments to inform policy development and the content and depth of training and technical assistance the grantee will provide to the subrecipient in subsequent steps.

Title X Subrecipient Policy Assessment and Onboarding Checklist Job Aid2

Title X Subrecipient Administrative Assessment and Onboarding Checklist Job Aid2

Title X Subrecipient Clinical Assessment and Onboarding Checklist Job Aid2

Title X Subrecipient Fiscal Assessment and Onboarding Checklist Job Aid2

Provide the subrecipient with education and training to address gaps identified in the assessment above. Include training and technical assistance on Title X Statutes, Regulations, and Legislative Mandates,3 and QFP.3

If the subrecipient is not already enrolled in the 340B Drug Pricing Program, provide resources and encourage them to start the enrollment process as soon as possible.

340B Drug Pricing Program: Frequently Asked Questions3

Apexus Sample Policy and Procedure Manual for Family Planning3

Support the subrecipient in adhering to reporting and documentation requirements including Title X Family Planning Annual Report Forms (FPAR) and Instructions.3

Title X Subrecipient Administrative Assessment and Onboarding Checklist Job Aid2

Support the subrecipient in providing required staff training. The Reproductive Health National Training Center and National Clinical Training Center for Family Planning are funded by OPA to provide training for the Title X network.

Federal Title X Training Requirements Summary3

During the second phase of onboarding, the grantee provides training and technical assistance; supports the subrecipient in finalizing policies, procedures, and clinical protocols; and works collaboratively to help the subrecipient provide quality family planning services in compliance with Title X requirements. To enhance collaboration, the grantee should avoid using punitive language with the subrecipient and present any concerns as opportunities for improvement.

Action Steps Supportive Resources

Organize Phase 2 onboarding work.

Title X Subrecipient Onboarding Work Plan: Phase 22

Support the subrecipient in understanding and implementing Title X-compliant policies, procedures, and clinical protocols as well as in grantee policies.

Putting the QFP into Practice Series Toolkit3

Title X Policy Templates3

Understanding the Total Program Concept2

Challenges to Patient Confidentiality - Potential Breaches Outside the Health Center Infographic3

Integrating Title X with Primary Care: Developing and Implementing Compliant Sliding Fee Discount Schedules Job Aid3

Provide technical assistance to support the subrecipient in readying their electronic health record (EHR) for alignment with Title X- specific documentation requirements and FPAR data submission.

Support the subrecipient in ensuring that Information & Education (I&E) materials and Community Participation, Education, and Program Promotion (CPEP) plans are in place and meet requirements.

Community Participation, Education, and Project Promotion Plan: Objectives, Activities, and Worksheet3

Evaluate the subrecipient’s compliance with Title X requirements and grantee policies.

Contraceptive Counseling and Education Checklist1

Defining Family Income for Title X Charges, Billing, and Collections Job Aid3

Collecting Copays and Applying Sliding Fee Scales: A Job Aid for Front Desk Staff3

Financial Management Toolkit3

During the third and final phase of onboarding, the grantee works with the subrecipient to ensure the subrecipient is set up to comply with Title X requirements and provide quality family planning services. In other words, they close out any outstanding items from Phases 1 and 2. To keep the process moving, the grantee should promptly review data submissions, fiscal reports, and any other documents shared by the subrecipient, and provide timely feedback and technical assistance. Before this phase is over, the grantee should establish and communicate a plan for ongoing communication, monitoring, quality improvement activities, and support.

Action Steps Supportive Resources

Organize Phase 3 onboarding work.

Title X Subrecipient Onboarding Work Plan: Phase 32

Complete outstanding Phase 1 and Phase 2 work plan tasks.

Work with the subrecipient to develop a plan for ongoing support and monitoring. Include Title X program and reproductive health updates and information on training opportunities.

Initiate an on-going quality improvement (QI) process. Evaluate the subrecipients’ strengths and areas that need improvement for conducting QI activities.

Quality Improvement Agency Self-Assessments2