Any Agency submitting
a grant for any mental health or alcohol or other drug service must provide the
following information:
1. Name of grant/service program
2. Population group to be served by grant/service program
3. Total number of people to be served by grant/service program
4. Hours services will be offered
5. Goals/objectives of grant/service program
6. Program/service narrative
7. Outcome measures (must be measurable)
8. Proposed staffing pattern of program/service grant
9. System Collaboration Narrative:
In many cases, grants the Board will fund will be delivered by more than
one agency. Each agency should describe
the component of the grant/service program it will deliver. In addition, each agency must describe how it
will coordinate/collaborate its service delivery with that of each other agency
involved. Finally, there must be a
signed service agreement between agencies collaborating/coordinating the
implementation of a grant-type program/service.
10. Line item budget (use the grant line item budget form contained
in this section).
Other Conditions:
1. There will be annual budget reconciliation
on all grant-type contracts.
2. Any line items that will be exceeded by 10%
and $1,000 must be approved by the Board prior to the expenditure being made.
3. It is the intent (where possible) of the
Board to transfer some of these grant contracts to Purchase of Service or
performance contracts for the next fiscal year.
4. Grant-type funding may be dependent upon receiving requested grant monies from ODMH and/or ODADAS.
GRANT
MONTHLY LINE ITEM BUDGET EXPENDITURE REPORT
(BOARD FUNDS ONLY)
This form is to be used to request reimbursement of expenditures of Board funds ONLY for each grant awarded in the POS/Grant Contract. Submit one copy of this form monthly for each grant awarded. The form is due in the Board Office by the 5th working day of each month. To download spreadsheet go to: www.mhrbeo.com, Forms, Grant monthly Line Item Expenditure Report.
INSTRUCTIONS
AGENCY Agency name and State
assigned ID number.
REPORTING UNIT The number assigned to the grant in the
Board/Agency POS/Grant Contract (700 - 799)
GRANT NAME The name of the grant as submitted to
the Board in response to the Request for Proposals/Grants.
BILLING MONTH Month expenses were received.
BUDGET Final budget for the grant. Once this column is completed the 10% line item transfer policy is in effect.
CURRENT MONTH Enter all expenses incurred for the grant during the reporting month.
YEAR-TO-DATE Enter
year-to-date expenses incurred for the grant.
YTD % Calculate the YTD % of expenses incurred (i.e.
July would be calculated as the amount in the YTD column divided by 1/12th of
the budgeted expenses).
TOTAL EXPENSES Total each column and calculate the overall YTD
% based on the Budget and Year-to-Date column totals.
LESS POS/FEDERAL/STATE/3RD PARTY
BILLINGS
Enter the total amount of any units billed to and reimbursed by another payer source other than the Board (i.e. Medicaid).
BALANCE DUE FROM GRANT
Net
total expenses submitted for Board reimbursement (Total Expenses -
POS/Federal/State/3rd Party Billings).