Self-Directed/Personal Choice Quarterly Reports

Quarterly reports must be submitted to EOHHS within two weeks following the end of each reporting period, and should include data as of the last day of the reporting quarter.

Mailing address for lead contact

Reporting Period

Workforce Report

Total # of Employed shuld equal the total of each of the following sections:

  • Years of Service
  • Ethnicity
  • Race of Employees

Personal Care Aides

Ethnicity of employees

Race of employees

Cumulative Grant Expenditure Report Summary

Grant Funds Spent Since January 1st, 2022

Total Grant Funding Received

% of grant funding spent since Jaunary 1, 2022

Cumulative Number of PCAs Supported

Total funds spent on additional compensation

Number of PCAs that have received additional compensation

Note highlight successed, challenges, and lessons learned

Attestation

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, payroll, and financial 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 April 30, 2023.

Name
Title