Common use of Financial Assistance Award Clause in Contracts

Financial Assistance Award. 2. Oregon Health Authority Public Health Division Expenditure and Revenue Report (for all Programs). 3. Explanation of the Financial Assistance Award. FINANCIAL ASSISTANCE AWARD OREGON HEALTH AUTHORITY PUBLIC HEALTH DIVISION EXPENDITURE AND REVENUE REPORT EMAIL TO: XXX-XXX.XxxxxxXxxXxxxxx@xxxxxx.xxxxx.xx.xx Agency: [Enter your agency name] Program: [Enter the Program Element Number / Sub Element and Title] Fiscal Year: July 1, [start year] to June 30, [end year] BREAKDOWN BY FISCAL YEAR QUARTER REVENUE Q1: Jul, Aug, Sep Q2: Oct, Nov, Dec Q3: Jan, Feb, Mar Q4: Apr, May, Jun Fiscal Year To Date A. PROGRAM INCOME/REVENUE Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue

Financial Assistance Award. 2. Oregon Health Authority Public Health Division Expenditure and Revenue Report (for all Programs). 3. Explanation of the Financial Assistance Award. FINANCIAL ASSISTANCE AWARD (FY25) Oregon Health Authority Public Health Division Expenditure and Revenue Report (for all Programs) OREGON HEALTH AUTHORITY PUBLIC HEALTH DIVISION EXPENDITURE AND REVENUE REPORT EMAIL TO: XXX-XXX.XxxxxxXxxXxxxxx@xxxxxx.xxxxx.xx.xx Agency: [Enter your agency name] Program: [Enter the Program Element Number / Sub Element and Title] Fiscal Year: July 1, [start year] to June 30, [end year] BREAKDOWN BY FISCAL YEAR QUARTER REVENUE Q1: Jul, Aug, Sep Q2: Oct, Nov, Dec Q3: Jan, Feb, Mar Q4: Apr, May, Jun Fiscal Year To Date A. PROGRAM INCOME/REVENUE Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue

Financial Assistance Award. 2. Oregon Health Authority Public Health Division Expenditure and Revenue Report (for all Programs). 3. Explanation of the Financial Assistance Award. FINANCIAL ASSISTANCE AWARD (FY23) OHA - 2021-2023 INTERGOVERNMENTAL AGREEMENT - FOR THE FINANCING OF PUBLIC HEALTH SERVICES OREGON HEALTH AUTHORITY PUBLIC HEALTH DIVISION EXPENDITURE AND REVENUE REPORT EMAIL TO: XXX-XXX.XxxxxxXxxXxxxxx@xxxxxx.xxxxx.xx.xx Agency: [Enter your agency name] Program: [Enter the Program Element Number / Sub Element and Title] Fiscal Year: July 1, [start year] to June 30, [end year] BREAKDOWN BY FISCAL YEAR QUARTER REVENUE Q1: Jul, Aug, Sep Q2: Oct, Nov, Dec Q3: Jan, Feb, Mar Q4: Apr, May, Jun Fiscal Year To Date A. PROGRAM INCOME/REVENUE Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue

Financial Assistance Award. 2. Oregon Health Authority Public Health Division Expenditure and Revenue Report (for all Programs). 3. Explanation of the Financial Assistance Award. FINANCIAL ASSISTANCE AWARD OREGON HEALTH AUTHORITY PUBLIC HEALTH DIVISION EXPENDITURE AND REVENUE REPORT EMAIL TO: XXX-XXX.XxxxxxXxxXxxxxx@xxxxxx.xxxxx.xx.xx XXX-XXX.Xxxxxx&XxxXxxxxx@xxxxx.xx.xx Agency: [Enter your agency name] Program: [Enter the Program Element Number / Sub Element and Title] Fiscal Year: July 1, [start year] to June 30, [end year] BREAKDOWN BY FISCAL YEAR QUARTER REVENUE Q1: Jul, Aug, Sep Q2: Oct, Nov, Dec Q3: Jan, Feb, Mar Q4: Apr, May, Jun Fiscal Year To Date A. PROGRAM INCOME/REVENUE Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA Revenue Non-OHA/PHD Revenue LPHA RevenueRevenue 1. Revenue from Fees ------------- ------------- ------------- ------------- ------------- $ -