Official Site of The State of New Jersey
| Type of Form | Subject | Title of Document | Description | Policy Reference/ Statute/Regulation |
| Standard Contract Documents | Attestation to Contractor Requirements for Reporting | |||
| Standard Contract Documents | Attestation Regarding Claimed Exemptions | |||
| Standard Contract Documents | General Contract and Agency Information | DCF Annex A Section 1 | Should be completed and signed by the managing agency (host agency) of your program. The questions and information asked in this section pertain to your host agency NOT your specific program. | CPIM-P3.52 |
| Standard Contract Documents | Core Agency Personnal Information | Section 1.3 | CPIM-P3.52 | |
| Standard Contract Documents | Program Information | Section 2 Instructions | CPIM-P3.52 | |
| Standard Contract Documents | Program Description | Section 2.2 | CPIM-P3.52 | |
| Standard Contract Documents | Performance Outcomes | Section 2.3 | CPIM-P3.52 | |
| Standard Contract Documents | Program Personnel Information | Section 2.4 | CPIM-P3.52 | |
| Standard Contract Documents | Level of Service | Section 2.5 | CPIM-P3.52 | |
| Standard Contract Documents | Level of Service Report | LOS Report | CON-I-A-9-9.02.2007 | |
| Standard Contract Documents | Budget Template for Submission with Requests for Proposals | Proposed Budget Form for NJ DCF | ||
| Standard Contract Documents | Budget Template for Contracts with 1-6 Programs | Annex B (1-6 Programs) | CRM Section 5 | |
| Standard Contract Documents | Budget Template for Expanded Version for Contracts with 7 or more programs | Annex B (7+ Programs) | CRM Section 5 | |
| Standard Contract Documents | Annex B Tutorial | Viewing Tutorial recommended before completing and submitting the electronic Annex B | ||
| Standard Contract Documents | Fee for Service Fixed Rate Information Summary | |||
| Standard Contract Documents | Boiler Plates/Standard Terms and Conditions | Standard Language Document for Social Service Training Contracts | CPIM-P2.01 | |
| Standard Contract Documents | DCF Department Agreement with Another State Entity | |||
| Standard Contract Documents | Individual Provider Entity | |||
| Standard Contract Documents | Attestation Form to be Completed by Providers Covered by Policy Law 2021c.1 | |||
| Standard Contract Documents | Notice of Standard Contract Requirements | |||
| Standard Contract Documents | Certification on Non-Involvement Prohibited Activities in Russia or Belarus | |||
| Standard Contract Documents | Regarding Debarment, Suspension, Ineligibilty and Voluntary Exclusion Lower Tier Covered Transactions | Certification Debarment | CPIM-PG07-2-2007 | |
| Standard Contract Documents | Contract Modification Form | CPIM-P1.10 | ||
| Standard Contract Documents | Disclosure Certification for Lobbyist Activities | CPIM-P4.03 | ||
| Standard Contract Documents | HIPAA 200-B | HIPAA Business Associate Agreement | CPIM-P1.15 | |
| Standard Contract Documents | Provider identifies sources when a matching donation is required from the provider | Private/Public Donor Agreement | CPIM-P6.01 | |
| Standard Contract Documents | DCF Batch Interface Uploads | W-9/Questionnaire | ||
| Adolescent Services Forms | Project Myself Outcomes 2.3 | |||
| Adolescent Services Forms | Youth Housing Outcomes 2.3 | |||
| CP&P Forms | Visitation Programs | Supervised Visitation Outcomes, Section 2.3 | ||
| CP&P Forms | Visitation Programs | Therapuetic Visitation Outcomes, Section 2.3 | ||
| CP&P Forms | Visitation Programs | Observation Checklist - no score | ||
| CP&P Forms | Visitation Programs | Observation Checklist - with scoring | ||
| CP&P Forms | NJ Court Appointed Special Advocates (CASA) | Service Outcomes, Section 2.3 | ||
| CP&P Forms | LifeSet | LifeSet – Region 1 | ||
| CP&P Forms | LifeSet | LifeSet – Region 2 | ||
| CP&P Forms | LifeSet | LifeSet – Region 3 | ||
| CP&P Forms | LifeSet | LifeSet – Region 4 | ||
| CP&P Forms | Child Protection Substance Abuse Initiative (CPSAI) | Required Staffing and Performance Deliverables for CPSAI | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Peer Recovery Support Services (Revised November 22, 2017, Effective December 1, 2017) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Halfway House Substance Use Disorder Treatment, Mothers With Children Program (effective June 2020) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Halfway House Substance use Disorder Treatment, Mothers and Children, Straight and Narrow Continuum of Care, Subcontract with Eva's Village (effective June 2020) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Inpatient Withdrawal Management Substance Use Disorder Treatment (effective March 9, 2018) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Intensive Outpatient Substance Use Disorder Treatment, Fathers and Children (effective March 9, 2018) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Intensive Outpatient Substance Use Disorder Treatment, Mothers and Children (effective March 9, 2018) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Long-Term Residential Substance Use Disorder Treatment, Mothers and Children (effective March 9, 2018) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Long-Term Residential Substance use Disorder Treatment, Mothers and Children, Straight and Narrow Continuum of Care (effective March 9, 2018) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Outpatient Substance Use Disorder Treatment (effective March 9, 2018) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Outpatient Substance Use Disorder Treatment, Spanish (effective March 9, 2018) | ||
| CP&P Forms | Adult Substance Use Treatment | Annex A - Short-Term Residential Substance Use Disorder Treatment (effective March 9, 2018) | ||
| CP&P Forms | Regional Diagnostic and Treatment Center (RDTC) | RDTC Required Performance and Staffing Deliverables | ||
| CSOC Forms | Out of Home Reports | Program Staffing Summary Report | ||
| CSOC Forms | Out of Home Reports | Treatment Home Reporting Form | ||
| CSOC Forms | Out of Home Reports | Program Implementation Status Update Report | ||
| CSOC Forms | Additional Information | Partial Care/Hospitalization Outcomes, Section 2.3 | ||
| CSOC Forms | Additional Information | CSOC Out of Home Treatment (OOH) Minimum Staffing Requirements FAQ’s | ||
| DOW Contract Forms | Section 2 of the Annex A | Annex A 2.4 Consolidated Staffing Summary | This section asks questions ONLY about your specific program. Some of the questions have been pre-filled for you. Please complete/answer the remaining areas with grey shading. | |
| DOW Contract Forms | Section 2 of the Annex A | Instructions for the Annex A 2.4 Consolidated Staffing Summary | This section asks questions ONLY about your specific program. Some of the questions have been pre-filled for you. Please complete/answer the remaining areas with grey shading. | |
| DOW Contract Forms | Displaced Homemaker Programs | DH Homaker Programs - Annex A-Section 2 | ||
| DOW Contract Forms | Domestic Violence Programs | DV Direct Service Programs Description, Section 2.2 | ||
| DOW Contract Forms | Domestic Violence Programs | RES, DV Direct Services Required Performance and Staffing Deliverables | ||
| DOW Contract Forms | Domestic Violence Programs | DV Housing First Program Required Performance and Staffing Deliverables | ||
| DOW Contract Forms | Domestic Violence Programs | DV Liaisons Required Performance and Staffing Deliverables | ||
| DOW Contract Forms | Domestic Violence Programs | PALS (Peace: A Learned Solution) Outcomes, Section 2.3 | ||
| DOW Contract Forms | Domestic Violence Programs | TF-CBT for Child Victims of DV Required Performance and Staffing Deliverables | ||
| DOW Contract Forms | Sexual Violence Programs | Sexual Violence Direct Services Required Staffing and Program Deliverables Form | ||
| DOW Contract Forms | Sexual Violence Programs | Primary Prevention of Sexual Violence Required Performance and Staffing Deliverables | ||
| DOW Contract Forms | Sexual Violence Programs | Statement of Assurance | ||
| FCP Contract Forms | Adolescent Pregnancy Prevention Initiative | Program Description, Section, 2.2 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Adolescent Pregnancy Prevention Initiative | Performance Outcomes, Section 2.3 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Adolescent Pregnancy Prevention Initiative | Level of Services, Section 2.5 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | EnlightenMENT | EnlightenMENT Required Performance and Staffing Deliverables | ||
| FCP Contract Forms | Evidence Based Home Visitation - Healthy Families - TANF Initiative for Parents | HFA Required Staffing and Program Deliverable | ||
| FCP Contract Forms | Evidence Based Home Visitation - Home Instruction for Parents of Preschool Youngsters | Annex A 2.2 HIPPY Update October 2023 | ||
| FCP Contract Forms | Evidence Based Home Visitation - Home Instruction for Parents of Preschool Youngsters | Annex A 2.3 Update July 2023 | ||
| FCP Contract Forms | Evidence Based Home Visitation -Nurse Family Partnership | Nurse Family Partnership Required Staffing | ||
| FCP Contract Forms | Evidence Based Home Visitation -Parents as Teachers | PAT Required Performance and Staffing Deliverables | ||
| FCP Contract Forms | Evidence Based Home Visitation -Parents as Teachers | PCANJ HFA & PAT Training and Technical Assistance Deliverables | ||
| FCP Contract Forms | Family Friendly Centers | FFC Program Description, Section 2.2 | ||
| FCP Contract Forms | Family Friendly Centers | FFC Service Outcomes, Section 2.3 | ||
| FCP Contract Forms | Family Friendly Centers | FFC Level of Service, Section 2.5 | ||
| FCP Contract Forms | Family Preservation Services (FPS) | Required Performance and Staffing Deliverables | ||
| FCP Contract Forms | Family Preservation Services (FPS) | Follow-up Protocol | ||
| FCP Contract Forms | Family Preservation Services (FPS) | Follow-up Report | ||
| FCP Contract Forms | Family Preservation Services (FPS) | FPS Practice Standards | ||
| FCP Contract Forms | Family Success Centers | FSC Required Performance and Staffing Deliverables | ||
| FCP Contract Forms | Family Success Centers | FSC Strategic Plan | ||
| FCP Contract Forms | Keeping Families Together | KFT Required Performance and Staffing Deliverables | ||
| FCP Contract Forms | Kinship Navigator Program (KNP) | KNP Required Performance and Staffing Deliverable | ||
| FCP Contract Forms | Life Skills | Service Outcomes, Section 2.3 | ||
| FCP Contract Forms | New Jersey Statewide Student Support Services (NJ4S) | NJ4S Annex A - July 1, 2024 | ||
| FCP Contract Forms | Parent Linking Program | Program Description, Section 2.2 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Parent Linking Program | Service Outcomes, Section 2.3 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Parent Linking Program | Level of Service, Section 2.5 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Parent Linking Program | Sustainability Cheat Sheet | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Parent Linking Program | Exhibit B - Young Fathers Healthy Teen Network | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Prevention of Juenile Delinquency | Program Description 2.2 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Prevention of Juenile Delinquency | Level of Service, Section 2.5 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | Prevention of Juenile Delinquency | Performance Outcomes | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | School Based health Centers | Program Description, Section 2.2 | ||
| FCP Contract Forms | School Based health Centers | Level of Service, Section 2.5 | ||
| FCP Contract Forms | School Based health Centers | Performance Outcomes | ||
| FCP Contract Forms | School Based Youth Services - Elementary | Program Description (K-8) Section 2.2 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | School Based Youth Services - Middle School and High School | Program Description (MS and HS) Section 2.2 | Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2. Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type. | |
| FCP Contract Forms | SPAN Parent Advocacy Network | SPAN Deliverables | ||
| FCP Contract Forms | Supportive Visitation Services | SVS Required Performance and Staffing Deliverables | ||
| Sandy Related Forms and Information | Guidance Memorandum on SSBG Funded Equipment Purchases, Equipment Retention, Property Management Standards and Equipment Disposition | In response to Superstorm Sandy, the federal government awarded the State of New Jersey federal funds to assist with its recovery efforts. | ||
| Sandy Related Forms and Information | Sample Equipment Log | In response to Superstorm Sandy, the federal government awarded the State of New Jersey federal funds to assist with its recovery efforts. | ||
| Sandy Related Forms and Information | Budget Modification Form | In response to Superstorm Sandy, the federal government awarded the State of New Jersey federal funds to assist with its recovery efforts. | ||
| Sandy Related Forms and Information | Example Budget Modification Form | In response to Superstorm Sandy, the federal government awarded the State of New Jersey federal funds to assist with its recovery efforts. | ||
| Sandy Related Forms and Information | Payroll Cost Guidance Memo | In response to Superstorm Sandy, the federal government awarded the State of New Jersey federal funds to assist with its recovery efforts. | ||
| Sandy Related Forms and Information | Payroll Timesheet Template | In response to Superstorm Sandy, the federal government awarded the State of New Jersey federal funds to assist with its recovery efforts. | ||
| Archived Forms | Annex A - Intensive Outpatient Treatment, Fathers With Children Program | |||
| Archived Forms | Annex A - Intensive Outpatient Treatment, Mothers With Children Program | |||
| Archived Forms | Annex A - Intensive Outpatient Methadone Treatment, Fathers With Children Program | |||
| Archived Forms | Annex A - Intensive Outpatient Methadone Treatment, Mothers With Children Program | |||
| Other Forms | RIDER For Purchases Funded by Federal Funds | |||
| Other Forms | Family Violence Prevention and Services Act Formula Grantees States, Tribes, and DV Coalitions | |||
| Other Forms | Family Violence Prevention and Services Act State Administrators and Tribes |
More Information
Click HERE to learn more about services and programs offered by Family and Community Partnerships.
Click on the links below for Annex A documents and related contract information.
Please note that the following applies for the APPI, SBYSP, PLP and PJD programs:
- Providers contracted to provide one type of program in multiple sites (for example: New Brunswick Board of Education provides SBYSP services in five schools) should complete one Annex A and list each site in the boxes provided in Section 2.2.
- Providers that have more than one program component (for example, SBYSP and APPI) must complete one Section 1 and separate Sections 2.2, 2.3, 2.4 and 2.5 for each program type.
Click HERE to learn more about services and programs offered by the Division on Women.
Click on the links below for Annex A and other program specific reports.
ANNEX A Instructions for Providers
SECTION 1 OF THE ANNEX A: http://www.nj.gov/dcf/providers/contracting/forms/
Should be completed and signed by the managing agency (host agency) of your program. The questions and information asked in this section pertain to your host agency NOT your specific program.
SECTION 2 OF THE ANNEX A:
This section asks questions ONLY about your specific program. Some of the questions have been pre-filled for you. Please complete/answer the remaining areas with grey shading.
Please visit the NJ Department of Treasury's website to find additional forms that may be required to be submitted with some contracts. Names of these forms can be found on the Required Contract Documents Checklist below.
Click HERE to learn more about services and programs offered by the Children's System of Care (formerly DCBHS).
Various program specific Annex A documents and related contract information are accessible below. Check back soon for additional information as we are continuously updating this page.
Note that some programs are regulated by the DCF Office of Licensing. Manuals and requirements for these programs can be accessed HERE.
Click HERE to learn more about services and programs offered by the Child Protection and Permanency.
Various program specific addenda to the Annex A are accessible below. Check back soon for additional information as we are continuously updating this page.
Note that some programs are regulated by the Office of Licensing. Manuals and requirements for these programs can be accessed HERE.