The purpose of filling out this form is to provide the Vermont Department of Health, Division of Substance Use Programs the information and documentation needed to issue grants.
Required Documentation:
In order to complete this survey, you will need to have the following internal control documents prepared to submit unless the documentation has already been submitted to the Division of Substance Use Programs and has not changed since the last submission:
- Organizational chart, and if applicable, Board chart
- Policies and procedures related to time reporting
- Policies and procedures related to purchasing
- Policies and procedures related to accounts payable
- Policies and procedures related to account receivable
- Policies and procedures related to conflict of interest
- Organization’s salary/indirect cost allocation plan, if applicable
The following documentation is required in order to submit the survey:
- Organization’s last single audit, if applicable
- Organization’s W-9 - must be hand-signed and dated within the last 3 months. Current State guidelines do not permit electronically signed W-9s.
- Insurance Certificate - Policies must be currently active. You can request a list of the insurance requirements from ahs.vdhdsuprovidersummary@vermont.gov.
- Indirect Rate Letter - only if you have a federally negotiated indirect rate
***After you finish the 1st page of this form, you'll have the option to hit "Save and Continue". This button will be located at the top right of each page (after the 1st page). If you choose to save and continue, it will ask for your email. The email you provide will receive an "edit link", which allows you to return to the form and continue where you left off. You can do this as many times as needed to complete the form. ***