Report Templates

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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
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 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 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.
Best Practice Workplan The template provides a workplan that includes goals, objectives, activities, staffing, timeline and evaluative measures. When developing a workplan, use the SHIP Best Practice Workplan-Table Blank Template.

SHIP Best Practice Workplan-Table

SHIP Best Practice Workplan- Table Blank Template
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 progress of approved work plan activities, including detail on expenditure of all grant funds during the quarter.  FY19 SHIP Quarterly Progress Report
Non-compete-continuation (NCC) performance narrative. A state SHIP best practice example of a Non-compete-continuation (NCC) performance narrative. NCC-Performance Narrative Best Practice

 

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, $1,205,000 (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.