HIV Prevention Portal: Forms

On this page:
Form Instructions and Due Dates
Progress Reports
Work Plans
Budget Forms
Invoice
HIV Testing
Data Collection Tools
Materials Review
Miscellaneous

Form Instructions and Due Dates:

1. Click on the form's link.
2. “Save” or “Save As” to your computer.
3. Email completed forms to health.hivprevention@state.mn.us

• HIV Prevention Programs Checklist, 2023-2024 (PDF)
  A printable list of due dates for all required documents.
• HIV Prevention Grant Manager Contact List (PDF)
  Use this list to locate contact information for your grant manager for all MDH-funded HIV prevention grants. All communications should be directed to your grant manager.

Progress Reports

• EIS HIV Testing Progress Report (Word)
• Syringe Services Program Progress Report (Word)
• PrEP Progress Report (Word)

Work Plans

• EIS HIV Testing Program Work Plan (Word)
• Syringe Services Program Work Plan (Word)
• PrEP Work Plan (Word)

Budget Forms

• Budget forms (Word)
  Includes budget justification and instructions, budget summary, and indirect cost questionnaire.

Invoice

• For a new invoice form template, please email request to health.hivprevention@state.mn.us.
• For Direct Deposit: Minnesota Supplier Portal (PDF)

HIV Testing

• Client Consent - Template (Word)
• Health Information Release - Template (Word)
• HIV/AIDS Confidential Case Report Forms
• HIV and HCV Testing Protocol (Word)
• OSHA BBP Exposure Control (Word)
• STD, HIV, and Hepatitis Risk Assessment (Optional template)

Data Collection Tools

• Outreach Data Collection Tool (Word)
• Condom Distribution Data Collection Tool (Word)
  • EvaluationWeb Condom Distribution Instructions (PDF)

Materials Review

• HIV-Related Educational Materials Review
  • HIV-Related Educational Materials Approval Request (Word)

Miscellaneous

• Quality Assurance Plan Components (Word)
• Incentives Policy Components (Word)