Description | Forms and Documents | Monthly Reporting Forms | Resources
Helpful Website Links

Monthly Client Service Report Changes
Updates to the template have occurred due to changes in the data collection of services. Effective Aug 1, 2010 (for the Jul reporting data) all providers will be required to use the new templates to record their data. You can find a list of changes to the template here: template_changes_20100616.pdf If you have any questions, please contact your DCDHS Data Entry Staff.

Description

To help our vendors, providers, and staff gain quick and easy access to necessary documentation and forms that are required by state and law.

Forms and Documents

• IRS W-9 Form
• Special Needs Payroll - Substitute W-9 Form
• Payroll Action Sheet
• Budget, Personnel, and Expense Schedules
• Client Registration Form (600 Form)
• Client Number Request Form
• State of Wisconsin Medicaid Waiver Agreement
• Best Practice Revenue and Expense Schedule
• Dane County Equal Benefits Certification
• Living Wage Certification:
  • DCDHS Living Wage Certification for Sole Proprietorships
  • DCDHS Living Wage Certification for Corporations
  • Dane County Living Wage - Exemption

Monthly Reporting Forms

• Monthly Client Services Report - Instructions Manual (a.k.a. 610 Form)
• Monthly Client Services Report - Non-AODA
• Monthly Client Services Report - AODA
• Monthly Hospital/Institutional Lapse - Developmental Disability
• Monthly Hospital/Institutional Lapse - Long Term Support
• Monthly Participant/Staff Summary (711 Form)
• 711 Form Instructions

Resources

• Sample Cost Allocation Plan
• Senior Nutrition Program Best Practices Manual
• Provider Contract University (PCU) Brochure
• Sample Equal Employment Opportunity - Affirmative Action Policy
• Sample How To File An Employment Or Service Delivery Complaint

Helpful Website Links

State and Federal links:

• State of Wisconsin Provider Agency Audit Guide
• State of Wisconsin Allowable Cost Manual and related Federal Office of Management and Budget (OMB) circulars
• State of Wisconsin Contract Administration Resources including Financial Management Handbook and Contract Administrators Toolbox
• Federal OMB Circular A-133 Audits of States, Local Governments, and Non-Profit Organizations

• Department of Homeland Security Business Emergency Plan

Non-profit links:

• National Council of Nonprofit Associations
• Society for Nonprofit Organizations

Last Revised: June 21, 2010