Templates, Samples, and Forms

Disparities Impact Statement (DIS) Guidance and Template

Posted 11/16/2022 (updated 3/27/2024)

The Disparities Impact Statement (DIS) template is a deliverable for this project that you will be required to complete.

The DIS template due dates are:

  • RCORP Psychostimulant Support Program: February 28, 2023 
  • RCORP Medication Assisted Treatment Access: March 30, 2023
  • RCORP Behavioral Health Care Support Program: March 31, 2023
  • RCORP Implementation IV Program: June 30, 2023 

There was a webinar discussing the DIS for all relevant cohorts on November 15, 2022. This webinar provided RCORP grantees with the tools to complete a disparities impact statement, to support efforts to address populations in rural communities that have historically suffered from poorer health outcomes and health inequities as a part of the prevention, treatment, and recovery of SUD/OUD. We strongly encourage you to review these documents or listen to the recording when it is posted to the RCORP- TA portal at a later date. Please be in contact with your Technical Expert Lead (TEL) with any questions. 

Resource Downloads

The Behavioral Health Disparities Impact Statement – At a Glance (103.89 KB)
Template: Behavioral Health Disparities Impact Statement (386.52 KB)

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