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DPH Contracts Unit
Forms
Forms
This page provides a convenient way for Division of Public Health employees to access needed Contracts Unit materials. Each "package" below contains the forms, instructions, and documents you need to begin and complete the various contracts submission processes. The forms have been modified from those found on the DHHS Center of Excellence website to include DPH specifications. The forms found on the DHHS Center of Excellence can be used; however, additional information will then be required by the Contracts Unit to complete and process the contract package.

All forms required for submission from a package are indicated in the "Required" column by either a "Yes" or "No" value. In addition, any required form includes "(req)" in its file name. However, there may be other forms you want to include for your particular contract. Please refer to the checklist in each contract package for more detailed instructions.

For clarification or if you have questions, please contact the appropriate person from the Staff Directory.

PLEASE NOTE: Items marked with "(HT)" have instructions included as "Hidden text" to assist users with developing appropriate responses. Hidden text can be viewed by depressing the "Show/Hide" -- "¶" -- button on the "Standard" MS Word toolbar. Hidden text will appear in red, underscored with a broken line, and will only be visible on the document while viewing it on the monitor -- unless you have the option enabled to print hidden text. (To disable the option which allows hidden text to print, in MS Word go to Tools/Options/Print and un-check “Hidden text”.) Remember, since the hidden text will not appear in print, please include a form of the questions in red in your response.

To view the files listed below, the free viewers for Word and Excel may be helpful if you don't have Word and/or Excel installed on your machine.

  • Excel 2003 Viewer for Windows (link opens in new window) - Open, view, and print Excel workbooks, even if you don't have Excel installed. You can also copy data from Excel Viewer 2003 to another program. However, you cannot edit data, save a workbook, or create a new workbook.
  • Word Viewer 2003 for Windows or Macintosh (link opens in new window) - Open, view, print, and copy document contents to another program. However, you cannot edit an open document, save a document, or create a new document.
Contract Package Forms

Expand All Packages | Collapse All Packages

AGREEMENT ADDENDUM
Form Name Format, Size Last Modified Required
Agreement Addendum Template Fiscal Year 2007 - 2008 DOC, 38 KB 11/05/07 Yes
Agreement Addendum Template Fiscal Year 2008 - 2009 DOC, 64 KB 09/27/07 Yes
Agreement Addendum Guidelines DOC, 63 KB 08/27/07 No
Consolidated Agreement Fiscal Year 2007-2008 DOC, 96 KB 10/10/07 No
Consolidated Agreement Fiscal Year 2008-2009 PDF, 112 KB   4/28/08 No

Consolidated Agreement, Agreement Addendum, and Budgetary Estimate Processing Procedures

PDF, 101 KB 10/31/07 No
Glossary of Terms for Agreement Addendum DOC, 49 KB 10/25/07 No
LHD Legal Names List DOC, 64 KB 01/18/08 No
Parking Lot Questions DOC, 42 KB 11/01/07 No
Quality Assurance Checklist DOC, 44 KB 09/28/07 Yes
CASH ADVANCE
Form Name Format, Size Last Modified Required
Cash Advance DOC, 26 KB 12/12/06 Yes
Cash Advance Request DOC, 80 KB 06/10/08 No
Cash Advance Request Requirements DOC, 27 KB 01/10/01 No
CODE CHANGE
Form Name Format, Size Last Modified Required
Code Change Letter DOC, 191 KB 01/04/08 No
Code Change Procedure DOC, 30 KB 11/28/06 No
CONTRACT
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 88 KB 10/05/07 Yes
DOC, 81 KB 10/15/07 No
Contract Budget and Narrative Requirements DOC, 25 KB 12/14/06 Yes
Contract Determination Questionnaire XLS, 34 KB 09/14/07 Yes
DOC, 24 KB 07/01/04 No
Indirect Costs DOC, 31 KB 01/28/03 No
IT Checklist Detail and Summary DOC, 83 KB 12/07/07 Yes
DOC, 35 KB 11/02/04 No
Justification Memorandum (HT -- Please see note in red above.) DOC, 100 KB 01/24/08 Yes
DOC, 28 KB 09/11/06 No
Justification Memorandum Guidelines DOC, 61 KB 10/05/07 No
(Authorization) Letter to Sign Contracts DOC, 26 KB 12/20/07 Yes
(Authorization) Letter to Sign Expenditure Reports DOC, 26 KB 12/20/07 Yes
New Contract Checklist DOC, 33 KB 12/07/07 Yes
Performance-Based Contract Scope Outline XLS, 16 KB 11/02/04 No
Performance Criteria Checklist DOC, 32 KB 07/01/05 No
Performance Measures Chart DOC, 42 KB 11/15/07 Yes
Profile Sheet DOC, 53 KB 12/07/07 Yes
Scope of Work (Form 3300) DOC, 35 KB 11/28/07 Yes
CONTRACT AMENDMENT
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 88 KB 10/05/07 Yes
DOC, 90 KB 10/15/07 No
Contract Amendment Checklist DOC, 34 KB 12/07/07 Yes
Contract Budget and Narrative Requirements DOC, 25 KB 12/14/06 Yes
IT Checklist Detail and Summary DOC, 83 KB 12/07/07 Yes
DOC, 35 KB 11/02/04 No
Justification Memorandum Amendment (HT -- Please see note in red above.) DOC, 54 KB 10/02/07 Yes
DOC, 28 KB 09/11/06 No
Justification Memorandum Amendment Guidelines DOC, 32 KB 10/05/07 No
Performance Based Contract Scope Outline XLS, 16 KB 11/02/04 No
Performance Measures Chart DOC, 42 KB 11/15/07 Yes
Profile Sheet Amendment DOC, 40 KB 09/28/07 Yes
Scope of Work Amendment DOC, 38 KB 11/28/07 Yes
CONTRACT ATTACHMENTS
Form Name Format, Size Last Modified Required
State Grant Certification -- No Overdue Tax Debts DOC, 31 KB 12/07 Yes
Notarized Conflict of Interest Policy DOC, 64 KB 09/25/07 Yes
DIRECT PAY REQUEST
Form Name Format, Size Last Modified Required
Direct Pay Request DOC, 286 KB 10/17/07 No
EXPENDITURE REPORTS -- CURRENT AND LATE
Form Name Format, Size Last Modified Required
Contract Expenditure Report DOC, 45 KB 08/02/05 Yes
Late CER Payment Request DOC, 82 KB 10/25/07 No
INTRA-DEPARTMENTAL MEMORANDUM OF AGREEMENT (IMOA)
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 88 KB 10/05/07 Yes
DOC, 61 KB 10/15/07 No
Intra-Departmental Memorandum of Agreement Template DOC, 35 KB 11/20/07 Yes
Justification Memorandum (HT -- Please see note in red above.) DOC, 100 KB 01/24/08 Yes
Justification Memorandum Guidelines DOC, 60 KB 10/05/07 No
MEMORANDUM OF AGREEMENT (MOA)
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 88 KB 10/05/07 Yes
DOC, 61 KB 10/15/07 No
Justification Memorandum (HT -- Please see note in red above.) DOC, 100 KB 01/24/08 Yes
DOC, 22 KB 03/16/05 No
Justification Memorandum Guidelines DOC, 60 KB 10/05/07 No
MOA Template DOC, 33 KB 12/12/06 Yes
MOA Checklist DOC, 25 KB 11/30/05 Yes
PERSONAL SERVICES CONTRACT
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 88 KB 10/05/07 Yes
DOC, 61 KB 10/15/07 No
Employment Relationship Questionnaire DOC, 137 KB 07/01/05 Yes
IT Checklist Detail and Summary DOC, 83 KB 12/07/07 Yes
DOC, 35 KB 11/02/04 No
Justification Memorandum (HT -- Please see note in red above.) DOC, 100 KB 01/24/08 Yes
DOC, 22 KB 09/11/06 No
Justification Memorandum Guidelines DOC, 60 KB 10/05/07 No
PSC Attachments DOC, 29 KB 05/30/08 Yes
PSC Checklist DOC, 27 KB 12/11/06 Yes
PSC Profile Sheet DOC, 40 KB 03/20/06 Yes
PERSONAL SERVICES CONTRACT AMENDMENT
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 88 KB 10/05/07 Yes
DOC, 90 KB 10/15/07 No
IT Checklist Detail and Summary DOC, 83 KB 12/07/07 Yes
DOC, 35 KB 11/02/04 No
Justification Memorandum Amendment (HT -- Please see note in red above.) DOC, 54 KB 10/02/07 Yes
DOC, 28 KB 09/11/06 No
Justification Memorandum Amendment Guidelines DOC, 32 KB 10/05/07 No
PSC Amendment Checklist DOC, 24 KB 08/23/05 Yes
PSC Profile Sheet Amendment DOC, 45 KB 04/12/07 Yes
REQUEST FOR APPLICATIONS (RFA)
Form Name Format, Size Last Modified Required
Application Face Sheet DOC, 38 KB 10/24/07 No
IT Checklist Detail and Summary DOC, 79 KB 12/07/07 Yes
DOC, 35 KB 11/02/04 No
Notice of Funding Availability Reporting Form DOC, 83 KB 03/08/06 Yes
RFA Proposal Format Guide DOC, 47 KB 10/24/07 No
RFA Approval Form DOC, 35 KB 01/16/07 Yes
DOC, 22 KB 07/01/04 No
RFA Checklist DOC, 26 KB 01/10/08 Yes
RFA Justification Memorandum (HT -- Please see note in red above.) DOC, 95 KB 10/04/07 Yes
RFA Template DOC, 166 KB 12/20/07 Yes
REQUEST FOR PROPOSALS (RFP)
Form Name Format, Size Last Modified Required
IT Checklist Detail and Summary DOC, 79 KB 12/07/07 Yes
DOC, 35 KB 11/02/04 No
Justification Memorandum (HT -- Please see note in red above.) DOC, 100 KB 01/24/08 Yes