As a grantee, you are required to submit reports according to the schedule specified in your grant. Find your program's reporting forms and guidance documents below.
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Grant Invoice Template and Submission Tool
| Template and Submission Tool |
|---|
| Grant Invoice Template - updated 5/3/24 |
| Grant Invoice Submission Tool - updated 1/03/22 |
Evaluation Training & Templates
Training & Event Data Collection
Prevention
National Outcome Measures (NOMs)
The National Outcome Measures (NOMs) are the federal Substance Abuse and Mental Health Services Administration's (SAMHSA) approach to performance measures. States are required to report on National Outcome Measures for both prevention and treatment programs as part of block grant requirements.
National Outcome Measures are broken down into sub-categories called “domains”. Vermont is collecting data from prevention grantees to report on the three domains in bold below. DSU grantees are required to collect the data throughout their grant period and submit it as part of their regular reporting activities for the grant.
- Domain 1: Reduced Morbidity – Abstinence from Drug or Alcohol Use
- Domain 2: Employment/Education
- Domain 3: Crime and Criminal justice
- Domain 4: Social Connectedness
- Domain 5: Access/Capacity
- Domain 6: Retention
- Domain 7: Cost Effectiveness
- Domain 8: Use of Evidence-based Practices and Strategies
| Guidance Document |
|---|
| NOMs Data Collection Form |
| Reporting Form |
|---|
| NOMs Reporting Form (SurveyGizmo) |
Law Enforcement Drug Disposal Project
| Reporting Forms |
|---|
| Budget Form |
| Budget Narrative |
| Expense Form |
| Monthly Metric Report |
Overdose Data to Action (OD2A) Grants
| Reporting Forms |
|---|
| Budget and Budget Narrative Template (optional, DSU-created) |
| Quarterly Reporting Template |
| Reporting Portal (Alchemer) |
|---|
| OD2A Grant Reporting |
Prevention Leads
| Guidance Documents |
|---|
| Workplan Template |
| Budget Template |
| Reporting Forms |
|---|
| VPLO Budget, Budget Narrative and Workplan |
| VPLO Quarterly Report |
Vaping Prevention Grant
| Guidance Documents |
|---|
| Workplan Template |
| Budget Template |
| Reporting Forms |
|---|
| Quarterly Report Form |
| Budget, Budget Narrative, and Workplan |
Regional Prevention Partnerships
| Reporting Forms |
|---|
| RPP Budget Form |
| RPP Quarterly Report |
| RPP Workplan Template |
| RPP Budget Narrative |
| Guidance Documents |
|---|
| RPP Evaluation Plan Template |
| "Developing evaluation plans" training (video) |
| "Developing evaluation plans" training presentation (PDF) |
Regional Prevention Partnership County Profiles available on the Data & Reports page.
Intervention
Public Inebriate Program
Treatment
All Treatment Providers
| Reporting Forms |
|---|
| Critical Incident Form |
| Block Grant Quarterly Reporting Form - FY24 |
| Monthly Wait Times and Service Requests Summary Form - FY24 |
| Guidance Documents |
|---|
| Medicaid Rate Sheet |
| Substance Abuse Treatment Information System Manual – For Legacy Systems |
| Substance Abuse Treatment Information System Manual – For EHR Extracts (2019) |
| Contingency management |
|---|
| Note: The recordings of parts 1 and 2 include audio only. Open the PDF to view the presentation slides. |
| "Contingency Management Approaches" Training: Part 1 (video) |
| "Contingency Management Approaches" Training: Part 2 (video) |
| "Contingency Management Approaches" Training (PDF) |
Drug Court
| Reporting Forms |
|---|
| Quarterly Reporting Form - FY24 |
Recovery
Recovery Housing Programs
| Reporting Forms |
|---|
| Recovery Housing FY24 |
Recovery Services
Contact Us
Substance Use Programs (DSU)
Vermont Department of Health
280 State Street
Waterbury, VT 05671-8340
802-651-1550
[email protected]
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