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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.

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 - 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 - 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 2010-2011 DOC, 71 KB 09/09/09 Yes
Agreement Addendum Template Fiscal Year 2009-2010 DOC, 67 KB 09/19/08 Yes
Agreement Addendum Guidelines DOC, 70 KB 09/09/09 No
CA-AA-BE Timeline Chart DOC, 37 KB 09/09/09 No
CA/AA/BE/FA Training Questions for SFY 2010-2011 DOC, 58 KB 09/09/09 No
Consolidated Agreement Fiscal Year 2009-2010 PDF, 134 KB   02/13/09 No

Consolidated Agreement, Agreement Addendum, and Budgetary Estimate Processing Procedures

PDF, 183 KB 09/09/09 No
LHD Legal Names List DOC, 64 KB 01/18/08 No
Quality Assurance Checklist DOC, 47 KB 09/09/09 Yes
CASH ADVANCE
Form Name Format, Size Last Modified Required
Cash Advance DOC, 36 KB 03/18/09 Yes
Cash Advance Request DOC, 80 KB 03/02/09 Yes
Cash Advance Request Requirements DOC, 27 KB 01/10/01 No
CODE CHANGE
Form Name Format, Size Last Modified Required
Code Change Letter DOC, 228 KB 10/05/09 Yes
Code Change Request Instructions DOC, 40 KB 10/06/09 No
CONTRACT
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 103 KB 09/25/09 Yes
DOC, 100 KB 07/07/09 No
Contract Budget and Narrative Requirements DOC, 25 KB 12/14/06 Yes
Contract Determination Questionnaire XLS, 53 KB 10/05/09 Yes
DOC, 24 KB 07/01/04 No
Contract Justification Memorandum Grant (HT -- Please see note in red above.) DOC, 113 KB 07/16/09 Yes
DOC, 325 KB 08/29/08 No
Contract Justification Memorandum Guidelines DOC, 63 KB 07/16/09 No
Contract Profile Sheet DOC, 65 KB 10/05/09 Yes
Indirect Costs DOC, 31 KB 01/28/03 No
IT Checklist Detail and Summary DOC, 86 KB 10/28/08 Yes
DOC, 35 KB 11/02/04 No
New Contract Checklist DOC, 31 KB 07/07/09 Yes
Performance-Based Contract Scope Outline XLS, 16 KB 11/02/04 No
Performance Criteria Checklist DOC, 32 KB 07/01/05 No
Scope of Work (Form 3300) Fiscal Year 2009-2010 DOC, 43 KB 07/07/09 Yes
CONTRACT AMENDMENT
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 103 KB 09/25/09 Yes
DOC, 109 KB 07/07/09 No
Contract Amendment Checklist DOC, 35 KB 10/05/09 Yes
Contract Amendment Profile Sheet DOC, 55 KB 10/05/09 Yes
Contract Budget and Narrative Requirements DOC, 25 KB 12/14/06 Yes
IT Checklist Detail and Summary DOC, 86 KB 10/28/08 Yes
DOC, 35 KB 11/02/04 No
Justification Memorandum Amendment (HT -- Please see note in red above.) DOC, 68 KB 10/05/09 Yes
DOC, 325 KB 08/29/08 No
Justification Memorandum Amendment Guidelines DOC, 42 KB 07/16/09 No
Performance Based Contract Scope Outline XLS, 16 KB 11/02/04 No
Scope of Work Amendment Fiscal Year 2009-2010 DOC, 43 KB 07/07/09 Yes
DIRECT PAY REQUEST
Form Name Format, Size Last Modified Required
Direct Pay Request DOC, 287 KB 03/02/09 No
DUAL EMPLOYMENT
Form Name Format, Size Last Modified Required
CP-30 Dual Employment Certification Form PDF, 148 KB 08/11/95 Yes
EXPENDITURE REPORTS -- CURRENT AND LATE
Form Name Format, Size Last Modified Required
ARRA Contract Expenditure Report XLS, 42 KB 09/25/09 Yes
Contract Expenditure Report XLS, 39 KB 10/10/08 Yes
H1N1 Contract Expenditure Report XLS, 42 KB 09/16/09    Yes
Late CER Payment Request DOC, 83 KB 03/02/09 No
INTRA-DEPARTMENTAL MEMORANDUM OF AGREEMENT (IMOA)
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 103 KB 09/25/09 Yes
DOC, 100 KB 07/07/09 No
Contract Justification Memorandum Grant (HT -- Please see note in red above.) DOC, 113 KB 07/16/09 Yes
DOC, 325 KB 08/29/08 No
Contract Justification Memorandum Guidelines DOC, 63 KB 07/16/09 No
Intra-Departmental Memorandum of Agreement Template DOC, 35 KB 03/02/09 Yes
MEMORANDUM OF AGREEMENT (MOA)
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 103 KB 09/25/09 Yes
DOC, 100 KB 07/07/09 No
Contract Justification Memorandum Grant (HT -- Please see note in red above.) DOC, 113 KB 07/16/09 Yes
DOC, 325 KB 08/29/08 No
Contract Justification Memorandum Guidelines DOC, 63 KB 07/16/09 No
MOA Template DOC, 34 KB 03/02/09 Yes
MOA Checklist DOC, 25 KB 11/30/05 Yes
PERSONAL SERVICES CONTRACT
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 103 KB 09/25/09 Yes
DOC, 100 KB 07/07/09 No
Employment Relationship Questionnaire DOC, 140 KB 10/05/09 Yes
Contract Justification Memorandum Grant (HT -- Please see note in red above.) DOC, 113 KB 07/16/09 Yes
DOC, 325 KB 08/29/08 No
Contract Justification Memorandum Guidelines DOC, 63 KB 07/16/09 No
IT Checklist Detail and Summary DOC, 86 KB 10/28/08 Yes
DOC, 35 KB 11/02/04 No
PSC Attachments DOC, 32 KB 10/05/09 Yes
PSC Checklist DOC, 28 KB 10/24/08 Yes
PSC Policy DOC, 28 KB 06/10/09 No
PSC Profile Sheet DOC, 46 KB 10/05/09 Yes
PERSONAL SERVICES CONTRACT AMENDMENT
Form Name Format, Size Last Modified Required
Contract Approval Form DOC, 103 KB 09/25/09 Yes
DOC, 109 KB 07/07/09 No
IT Checklist Detail and Summary DOC, 86 KB 10/28/08 Yes
DOC, 35 KB 11/02/04 No
Justification Memorandum Amendment (HT -- Please see note in red above.) DOC, 68 KB 10/05/09 Yes
DOC, 325 KB 08/29/08 No
Justification Memorandum Amendment Guidelines DOC, 42 KB 07/16/09 No
PSC Amendment Attachments DOC, 32 KB 10/05/09 Yes
PSC Amendment Checklist DOC, 27 KB 10/24/08 Yes
PSC Amendment Profile Sheet DOC, 56 KB 10/05/09 Yes
REQUEST FOR APPLICATIONS (RFA)
Form Name Format, Size Last Modified Required
IT Checklist Detail and Summary DOC, 86 KB 10/28/08 Yes
DOC, 35 KB 11/02/04 No
Notice of Funding Availability Reporting Form DOC, 84 KB 10/20/08 Yes
RFA Approval Form DOC, 40 KB 07/07/09 Yes
DOC, 38 KB 07/07/09 No
RFA Checklist DOC, 27 KB 09/09/08 Yes
RFA Justification Memorandum (HT -- Please see note in red above.) DOC, 55 KB 08/29/08 Yes
RFA Awards Template DOC, 44 KB 10/05/09 Yes
RFA Template DOC, 221 KB 10/05/09 Yes
RFA Questions and Answers Template DOC, 41 KB 10/20/08 Yes
REQUEST FOR PROPOSALS (RFP)
Form Name Format, Size Last Modified Required
Contract Justification Memorandum Grant (HT -- Please see note in red above.) DOC, 113 KB 07/16/09 Yes
DOC, 325 KB 08/29/08 No
Contract Justification Memorandum Guidelines DOC, 63 KB 07/16/09 No
IT Checklist Detail and Summary DOC, 86 KB 10/28/08 Yes
DOC, 35 KB 11/02/04 No
RFP Approval Form DOC, 102 KB 07/07/09 Yes
DOC, 51 KB 07/07/09 No
RFP Checklist DOC, 24 KB 02/21/06 Yes
RFP Outline DOC, 25 KB 12/13/04 No
TRAINING
Form Name Format, Size Last Modified Required
Acronym List DOC, 74 KB 10/05/09 No

Questions and Answers from October 2008 Training Sessions

DOC, 45 KB 12/17/08 No

 

 

 

 

 

 

 

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