Adult Day Workforce Quarterly Report Form

- Required Field

Please only leave a field blank if you do not collect the data in that field.

I hereby attest that, to the best of my knowledge and belief, that the above information is accurate and complete.

My agency has maintained personnel records to support this attestation and acknowledges that such personnel records may be subject to audit by EOHHS. In the event that EOHHS determines that Program funds have been used for ineligible expenses, my agency may be required to repay such funds to EOHHS. My agency is aware that ALL enhanced HCBS funds must be expended no later than September 30, 2023.