<p>Minnesota Department of Health MIIC Regional Services RFP Proposed Annual Staffing Plan Template</p><p>Instructions Please use this document to provide additional detail on staffing plans to administer MIIC regional services. Submit with other required Proposal forms to MDH by 4:00 p.m., October 15, 2015. </p><p>Applicant Information Agency Name: Address: Contact: Title: Phone: Fax: Email: </p><p>Lead MIIC Regional Coordinator This staff person is responsible for interfacing with MDH regarding ongoing grant duties. Name: Title: Description of Qualifications, Experience, and/or Background as it Relates to the RFP and Eventual Grant Duties: </p><p>Staffing Plan Include all staff and contractors included in the Proposed Annual Budget Plan Template. Be sure all proposed regional entity duties are sufficiently covered in the staffing plan. Include references to Proposed Regional Entity Duties: </p><p>1 | P a g e Minnesota Department of Health MIIC Regional Services RFP</p><p>1. Provide active outreach and training to primary care clinics. 2. Administer AFIX. 3. Provide active outreach and training to local public health and community health boards. 4. Participate in the regional and state management of MIIC. 5. Work with MDH to enroll and support other partner organizations. 6. Conduct immunization recall to MA-eligible populations. 7. Meet quarterly and annual reporting and invoicing requirements. </p><p>Description of Planned Work as It Relates Staff Name, Title and Agency or If Staff, Brief Description of Qualifications, to Proposed Duties (reference duty Contractor Name FTE Experience, and/or Background number from above in description)</p><p>2 | P a g e Minnesota Department of Health MIIC Regional Services RFP</p><p>[Add additional rows if necessary.] </p><p>3 | P a g e</p>