Report Templates consists of the required documents that must be submitted throughout the SHIP grant cycle to the Federal Office of Rural Health Policy (FORHP).
|FY 2021 SHIP Hospital Application||SHIP coordinators may select SHIP Hospital Application A (short form) or SHIP Hospital Application B template for their hospitals to at the start of the new fiscal year and return it to their SHIP Coordinator. SHIP Coordinators need to keep all hospital applications on file.|
|FY 2020 Work Plan
|This is attachment #1 in the NCC Instructions. Use the FY 2020 Work Plan document to fill in activities, completion date, responsible staff and entity, progress/process measures and outcome/impact pertaining to the goals and objectives made during the FY 2020 budget period (June 1, 2020– May 31, 2021).||
|FY 2020 SHIP Activities Progress File||This is attachment #2 in the NCC Instructions. During the FY 2020 budget period, state SHIP Coordinators should include each hospital, the FY 2020 investment/activity, and progress (complete, incomplete, or in progress), any change in investment/activity, and the impact/change or measure related to that activity.|
|FY 2021 Work Plan||
This is attachment #3 in the NCC Instructions. Use the FY 2021 Work Plan document to fill in activities, completion date, responsible staff and entity, progress/process measures and outcome/impact pertaining to the goals and objectives for the upcoming budget period FY 2021 (June 1, 2021– May 31, 2022). The FY 2021 Work Plan should include any adaptions or updated progress/process measures for the upcoming year based upon FY 20 results.
|FY 2021 SHIP Hospital Funding Spreadsheet||This is attachment #4 in the NCC instructions. This spreadsheet is used to collect detailed information on all eligible hospitals for the upcoming FY 2021 budget period (June 1, 2021– May 31, 2022). FORHP will use this information to determine the award amount for each hospital for the upcoming FY 2021 budget period.|
|FY 2019 Annual Report Template||
This is the attachment to upload to EHB for the FY 2019 Annual Report by 9/30/2020. The reporting period is 06/01/2019 - 05/31/2020. It represents the following:
|FY 2019 SHIP Annual Report Template|