8000, Required Documents and Reports

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Revision 25-3; Effective Oct. 29, 2025

Required Form or Report 1: Monthly Voucher Packet

  • Description: Includes Form B-13X, Form 4116, and Form Data Management
  • Submission Date: By the last business day of the month following the month when expenses were incurred or services provided. Final voucher due within 45 calendar days after the grant term ends.
  • Accepted Method of Submission: Email
  • Submit Copy to: fcs_finance@hhs.texas.gov
  • Original Signature Required: No
  • Number of Copies: One
  • Instructions: Enter Cost Reimbursement monthly expenses per budget category, copays and donations, which is program income, non-HHSC funding and data collection.
  • Note: The Monthly Voucher Packet templates are sent to grantees by their contract manager. Vouchers must be submitted each month even if there are no expenditures. Vouchers must still be submitted each month for actual expenditures of the program even if the grant limit has been reached.

Required Form or Report 2: Financial Status Report (FSR) Form 269A

  • Description: Quarterly report that includes all expenditures, program income and non-HHSC funding for the defining three months with amounts received from HHSC.
  • Submission Date: Reports are due as follows: Quarter 1: September through November; Quarter 2: December through February; Quarter 3: March through May; Quarter 4: June through August. Submit 30 calendar days after the end of each quarter. The final quarterly FSR is due 45 days after the end of the grant term. The final quarter report includes all final charges and expenses associated with the program grant. Mark it as Final.
  • Accepted Method of Submission: Email
  • Submit Copy to: fcs_finance@hhs.texas.gov
  • Original Signature Required: No
  • Number of Copies: One

Required Form or Report 3: Fee-for-Service Report

  • Description: Fee-for-Service, file furnished voucher through Texas Medicaid and Healthcare Partnership (TMHP) TexMedConnect/Compass 21
  • Submission Date: Claims Filing Deadline: Within 95 calendar days from date of service or date of third-party insurance EOB form. Within 45 calendar days after the end of the grant term.
  • Accepted Method of Submission: TMHP/Compass 21
  • Submit Copy to: Not applicable
  • Original Signature Required: No
  • Number of Copies: Not applicable
  • Instructions: Claims must continue to be submitted to TMHP TexMedConnect/Compass 21 even if the grant award amount has been reached.
  • Note: Appeals must be submitted within 120 calendar days of denial during the grant term. All appeals must be submitted and finalized within 45 calendar days after the end of the grant term.

Required Form or Report 4: Financial Reconciliation Report (FRR)

  • Submission Date: No later than 60 calendar days after the end of the grant term.
  • Accepted Method of Submission: Email
  • Submit Copy to: fcs_finance@hhs.texas.gov
  • Original Signature Required: No
  • Number of Copies: Not applicable
  • Instructions: The FRR is required only if the grantee has only a fee-for-service component without a cost reimbursement component.

Required Form or Report 5: Promotion and Outreach Annual Plan

  • Description: This plan should outline the grantee’s goals to inform the public of the program’s purpose and available services, enhance community understanding of its objectives, disseminate basic family planning and women’s health care knowledge, enlist community support and recruit potential clients for FPP.
  • Submission Date: The contractor completes the report within 45 calendar days of the start of the grant period and keeps it on file for monitoring purposes.
  • Accepted Method of Submission: Plans must be kept on file for monitoring requirements, but do not need to be submitted to HHSC.
  • Submit Copy to: Not applicable
  • Original Signature Required: No
  • Number of copies: Not applicable
  • Instructions: Complete plan annually by due date outlined.

Required Survey 6: Promotion and Outreach Biannual Survey

  • Description: This survey will be sent via email to designated FPP signature authorities biannually. Grantees are required to complete the survey within 30 days.
  • Submission Date: The report is due within 30 days of receipt.
  • Original Signature Required: No
  • Number of Copies: Not applicable

Instructions: Submit completed surveys biannually by the due date outlined.

Required Form or Report 7: Quarterly Performance Measures Report

  • Description: This report will assess the grantee’s activities and services to determine if they continue to be effective throughout the year.
  • Submission Date: The report is due within 30 days of the end of each state fiscal quarter. a
  • Accepted Method of Submission: Email
  • Standard Naming Convention: FYXX.QX.FPP.Performance Measures.AgencyName.xlsx
  • Submit Copy to: famplan@hhs.texas.gov
  • Original Signature Required: No.
  • Number of Copies: Not applicable

Instructions: Submit completed reports quarterly by due date outlined.

Required Form or Report 8: Quarterly Patient Navigator Report, if applicable

  • Description: Grantees with FPP-funded patient navigator(s) will be expected to submit the following measures in the patient navigator quarterly report:
    1. Total number of active funded patient navigator(s);
    2. Total number of unduplicated people screened for any program offered at the clinic location by any staff person. Note: This is not limited to HHSC programs;
    3. Total number of unduplicated people screened and served by the funded patient navigator(s);
    4. Total number of unduplicated people screened and served by the funded patient navigator(s) lost to follow-up or refusal of services;
    5. Total number of unduplicated people served by the funded patient navigator(s) who are successfully navigated to Medicaid, HTW, FPP, PHC and BCCS; and
    6. Total number of Non-Medical Service Needs identified by patient navigator(s).
  • Submission Date: The report is due within 30 calendar days after the end of each quarter.
  • Accepted Method of Submission: Email
  • Standard Naming Convention: FYXX.QX.FPP.PN.AgencyName.xlsx
  • Submit Copy to: famplan@hhs.texas.gov
  • Original Signature Required: No.
  • Number of Copies: Not applicable
  • Instructions: Submit completed reports quarterly by due date outlined

Required Survey 9: Clinic Locator Survey

  • Description: This survey will be sent via email to designated FPP signature authorities annually. Grantees are required to complete the survey within 10 days. This survey will assess the grantee’s patient navigation activities and services to determine if they continue to be effective throughout the year.
  • Submission Date: The report is due within 10 days of request.
  • Original Signature Required: No.
  • Number of Copies: Not applicable
  • Instructions: Submit completed reports annually

Required Form or Report 10: Mental Health and Substance Use Screening Report

  • Description: This report will assess the grantee’s mental health screening activities throughout the year.
  • Submission Date: The report is due within 30 days of the end of each state fiscal quarter.
  • Accepted Method of Submission: Email
  • Standard Naming Convention: FYXX.QX.FPP.MentalHealthSUD.AgencyName.xlsx
  • Submit Copy to: famplan@hhs.texas.gov
  • Original Signature Required: No.
  • Number of Copies: Not applicable

Instructions: Submit completed reports quarterly by due date outlined.