Self-Directed Workforce Quarterly Report Form

Required Key

- Required Field

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

Reporting Period

Self Directed Workforce Report

Direct Care Workers (including Nursing Assistants)

Ethnicity of employees

Race of Employees

DCW Job Opening Titles
Specify job titles for DCW job openings

Expenditure Report: Additional Compensation Spending

Direct care workers (including Nursing Assistants)


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 acknolwedges 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 shall return to EOHHS any program funds not expended by the Program end date of Mar 31, 2023.