Healthy Start Expenditure Document Form (EDF) Instructions

Helping Families. Supporting Communities. Empowering Individuals.

Bureau of Maternal and Child Health


For FY14, Healthy Start provider agencies must use the Healthy Start Summary Expenditure Documentation Form (EDF) to provide reporting of the 20% of the total grant allocated to Outreach and Client transportation.

The Healthy Start EDF is used to report up to 20% of the total grant amount for Outreach and Client Transportation services that support building and maintaining active cases; and, assisting clients with transportation requirements for Consortium attendance and accessing services to which they are referred. A maximum of 15% of the total award can be used for outreach and 5% for Client Transportation.

It is possible to earn the entire grant during the FY from monthly payments for Active Cases. For agencies that have already spent down the grant on direct service, the provider will no longer be expected to submit an EDF. If a Provider has met the allowable limit for Outreach and Client Transportation, the Provider will no longer be expected to document costs that will not be reimbursed.

The EDF may be photocopied or a reasonable electronic duplication developed. However, the electronic format is in Excel so that calculations will automatically occur as expenses are entered. The amounts reported must be the total expenditures. The instructions below will assist you in completing the EDF:

  • Person Completing Form - Contact person (Mandatory)
  • Phone & Ext - List the phone number and extension for a contact person who will be able to answer questions concerning the submitted expenditure form. (Mandatory)
  • Email Address - Provide the email address of the contact person
  • Components -The components under Healthy Start include: Outreach - Services to locate and enroll high-risk pregnant women within the assigned community areas; and, services to promote awareness of Healthy Start in order to persuade referral sources to refer potential eligible women. Client Transportation - Services to Healthy Start clients to assist with transportation requirements for Consortium attendance and to access services to which they are referred.
  • Outreach and Transportation must contribute to the goals and objectives of the Provider's Healthy Start program. Client Transportation represents costs specific to the provision of client-related transportation, including but not limited, to bus cards, cab fare, train fare, use of an agency-owned vehicle, etc.
  • Monthly caseload must be entered in the space provided.
  • Authorized Agency Official - This form must be signed and dated by an authorized official of the provider agency. (Mandatory)

Submission of EDF

EDFs are due to DHS by the 15th of each month, for costs incurred the prior month. One copy of the EDF is submitted to the contact person specified in Exhibit C of the Healthy Start contract. A copy of the EDF must also be sent to the Healthy Start Program Administrator via email to: