SFY 2024 One-Time Supplemental Payment for Adult BH Agencies

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

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Reporting Period

Adult Behavioral Health Workforce Report

Ethnicity of employees

Race of Employees

Expenditure Report

Spending Category Amount Spent in Reporting Period Notes/Explanations

Recruitment Activities

Recruitment Bonus

Retention Bonus

Administrative expenses (not to exceed 15%)


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 shall return to EOHHS any program funds not expended by the Program end date of December 1, 2024.