Providers
Client Data Collection and Reporting
Monthly Participant/Staff Summary (a.k.a. 711 form)
Some service programs may be required to complete a 711 form rather than a 600/610 form. The specific form used is based on what SPC code is identified for the specific service provided. The State has determined which SPCs require a 711 form and which require a 600/610 form. The County Contract Manager will communicate which reporting process is required for each program through its annual contracts. Note that the Contract Manager may require a 600/610 form despite the program being one that has a 711 form-appropriate SPC code.
The 711 Form may be used only for these types of services.
| SPC Code |
Description |
Reporting Units |
| 107 |
Specialized Transportation & Escort Trips |
One-Way Trip |
| 403 |
Recreation & Alternative Activities |
Staff Hours |
| 408 |
Community Prevention |
Staff Hours |
| 501 |
Crisis Intervention |
Staff Hours |
| 601 |
Outreach |
Staff Hours |
| 602 |
Information & Referral |
Contacts |
| 603 |
Intake Assessment |
Contacts |
| 605 |
Advocacy & Defense Resources |
Staff Hours |
| 606 |
Health Screening & Accessibility |
Staff Hours |
| 701 |
Training & Development |
Staff Hours |
| 702 |
Agency / Systems Management |
Staff Hours |
- Monthly Participant/Staff Summary Form (711 Form)
- Monthly Participant/Staff Summary Form Instructions
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If you have questions about this report, please call your designated data entry contact.
03/23/2011