Report Templates

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Author: 
Federal Office of Rural Health Policy (FORHP)

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).

Topic Description Report Templates
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 requests the following: 

  • Progress on the investment/activities for each hospital
  • Key outcomes on activities (if completed)
  • Amount of unobligated balance per hospital
  • Carryover amount and activity information (if applicable)
SHIP Grant Application Participating SHIP hospitals fill out the application form 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 2019 Work Plan

 

 This is attachment #1 in the NCC Instructions. Use the FY 2019 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 2019 budget period (June 1, 2019– May 31, 2020).
FY 2019 SHIP Activities Progress File This is attachment #2 in the NCC Instructions. During the FY 2019 budget period, state SHIP Coordinators should include each hospital, the FY 2019 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 2020 Work Plan

This is attachment #3 in the NCC Instructions. Use the FY 2020 Work Plan documetn 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 2020 (June 1, 2020– May 31, 2021). The FY 2020 Work Plan should include any adaptions or updated progress/process measures for the upcoming year based upon FY 19 results.
FY 2020 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 2020 budget period (June 1, 2020– May 31, 2021). FORHP will use this information to determine the award amount for each hospital for the upcoming FY 2020 budget period.
Quarterly Progress Report If there are incomplete projects and/or a substantial unobligated balance, grantee will provide to the HRSA Project Officer, via EHB, a FY20 SHIP Quarterly Progress Report on the progress of approved work plan activities, including detail on the expenditure of all grant funds during the quarter.  FY19 SHIP Quarterly Progress Report

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,009,121 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.