Instructions for Completion of Report

How To Reach Us:  If you have questions about this progress report or final report, email us at We will aim to be in touch with you within two business days.

How To Complete This Report:  Complete each item of this online report form.  Do not leave any item blank.  To locate instructions for completion of each item, glide your cursor across the “?” next to each item. 

You must complete each item on a given page before you will be able to advance to the next page. You will not be able to submit the report before each item on each page is completed.

How To Save Your Work On This Report And Then Return To It Later:  You may register and set up a free account with FormSite--the software platform for this report-in order to save your prior work, and then return to the report later.  

To register, please CLICK HERE  to setup or return to your account for this form. The established account is only for this particular form. 

If you do not register with FormSite, you will not be able to save a partially completed report—in which case you will need to complete the report from start to finish during one work episode.

How To Download and Save Copy of Blank Report Form:  If you prefer to save a copy of this report to your computer, please click on: CLICK HERE. You can then download this report and save it on your computer.

How To Submit Report:  If you are unable to submit this report online, you can email it to or mail it to:  Health Care Quality Accounts Grant Program, Quality Initiatives Unit, Office of Health Care Quality, 7120 Samuel Morse Drive Second Floor, Columbia MD 21046

Entity Identification Number (EIN) of Recipient Organization: 🛈
Mailing Address of Recipient Organization: 🛈
Website Address of Applicant Organization: 🛈
(Page 1 / 3)