ORHPC General Grant Forms

The forms below are general forms used for many of our grants.

If you do not see what you are looking for, please contact health.orhpc@state.mn.us, or 651–201–3838.

Index:
General forms
Budget modification forms
Expenditure reports
Other reports

General

• ORHPC Grant Guide, August 2022 (PDF)
• Applicant Conflict of Interest Disclosure (PDF)
• Due Diligence (PDF)
• MDH Grant Agreement - Sample (PDF)

Budget modification forms

• Grant Budget Modification Worksheet - basic (no indirect, no match) (Excel)
• Grant Budget Modification Worksheet - with indirect and match (Excel)
• Grant Budget Modification Worksheet - with indirect (Excel)
• HCBS Budget Adjustment Template (Excel)

Expenditure reports

• ARP SHIP Grantee's Expenditure Report (Excel), November 2021
• HCBS Employee Scholarship Grantee's Expenditure Report (Excel), updated July 2023
• MHCCCE Individual Expenditure Report has been moved to MHCCCE Individual Loan Information
• Mental Health Grants for Health Care Professionals Participant Report (Excel) June 2023
• Standard Grantee Expenditure Report, with match (Excel), updated July 2023
• Standard Grantee Expenditure Report, without match (Excel), updated July 2023

Other reports

• FY23 HCBS Qualified Education Loan Form (Excel)
• FY23 HCBS Payment Verification Form (Excel)
• Mental Health Grant for Health Care Professionals Participant Report (Excel) updated July 2023

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