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Forms, publications and instructional material related to the DMHAS community services contracting program are made available on this website for your easy reference and download. If you encounter any difficulty with your selections, or have additional questions, please contact the DMHAS Bureau of Contract Administration at (609) 544-5241.

• Cash Advance Policy - Administrative Bulletin
• Cash Flow Worksheet Advance Payment Request
• Advance Payment Request Narrative
• DHS Contract Manuals (CRM & CPIM)
• Standard Language Document (April 2026) (contract "boilerplate" agreement) & Contracted State Agency Agreement
• DMHAS Business Associate Agreement (BAA)
• DMHAS Business Associate Agreement / Qualified Service Organization Agreement (BAA / QSO)
• Reports of Expenditure (ROE) Quarters and Reporting Schedule
• Standardized Board Resolution Form (P1.06)
• Executive Order 129 Certification: Source Disclosure Certification Form
• Labor Agreement Attestation Form
• Certification of Non-Involvement in Russia-Belarus (Jan-2024)

(No longer applicable for non-profit agencies - February 2008)

• Chapter 51 information

• Employee Information Report - AA302
• AA302 Instructions

• Agreement Form
• Instructions

• Cost-Based Provider Agency Administrative Information Form
• Cultural Competency Plan
• Payment Voucher for Cost Reimbursement Payment Contracts
• Schedule 1a Site Specific Information 
• Schedules D, G, I, K, H
• Source Disclosure
• Board Resolution
• Certification of Non-Involvement in Russia Belarus
• DMHAS Business Associate Agreement (BAA)
• Standard Language Document (April 2026) (contract "boilerplate" agreement)
• Labor Agreement Attestation Form
•  

Annex B - Budget Matrix:

• Budget Matrix Software Applications
• User Manual
• Budget Schedules
• Budget Modification Signature Page
• Budget Categories Before/After Summary
• Program Elements Before/After Summary
• Cost-Based Provider Agency Administrative Information Form
• Contract Information Form
• Annex A Forms / QCMR Forms & Documentation
• Program and Unit of Service Definitions
• Cluster Form
• Report of Expenditures (ROE) Summary Form
• Annex C - Supporting Information (Revised 04-01-21)
• Annex C - Permanent File Checklist  (Revised 07-23-2024)

Required Contract Documents

• Addendum to DHS SLD for Mental Health Fee for Service (MH FFS)
• Annex B-2
• FFS Rate Chart (Eff 06/01/25)
• DHS DMHAS MH FFS Non-Hospital Agency Administrative Information Form, FY27/28 (Revised 04/01/24)
• DHS DMHAS MH FFS Hospital Agency Administrative Information Form, FY27/28 (Revised 04/01/24)

Annex A's

•   (Revised 05/17/19)
•  (Effective 07/01/22)
•  (Effective 07/01/24)
•  (Effective 07/01/22)
•  (Effective 07/01/22)
•  (Effective 07/01/22)
•  (Effective 07/01/22)
•   (Revised 05/17/19)
• (Revised 05/17/19)

Required Contract Documents

• Addendum to DHS SLD for Mental Health Fee for Service (MH FFS) (Revised 04/01/2022)
• Annex B-2  (Revised 04/01/24)
• FFS Rates Chart (Eff 06/01/25)
• DHS DMHAS MH FFS Non-Hospital Agency Administrative Information Form, FY25/26 (Revised 04/01/24)
• DHS DMHAS MH FFS Hospital Agency Administrative Information Form, FY25/26 (Revised 04/01/24)

Annex A's

• Community Residences for Adults with Mental Illness Annex A  (Revised 05/17/19)
• Community Support Services (CSS) FFS Annex A (Effective 07/01/22)
• Integrated Case Management (ICMS) Annex A    (Effective 07/01/24)
• Outpatient Annex A (Effective 07/01/22)
• Partial Care Annex A (Effective 07/01/22)
• Partial Hospitalization Annex A (Effective 07/01/22)
• Programs for Assertive Community Treatment (PACT) Annex A   (Effective 07/01/22)
• Supported Education (SEd) Annex A  (Revised 05/17/19)
• Supported Employment (SE) Annex A (Revised 05/17/19)