Forms, publications and instructional material related to the DMHAS community services contracting program are made available on this website for your easy reference and download. If you encounter any difficulty with your selections, or have additional questions, please contact the DMHAS Bureau of Contract Administration at (609) 544-5241.

• Cash Advance Policy - Administrative Bulletin
• Cash Flow Worksheet Advance Payment Request
• Advance Payment Request Narrative
• DHS Contract Manuals (CRM & CPIM)
• Standard Language Document (April 2021) (contract "boilerplate" agreement) & Contracted State Agency Agreement
• DMHAS Business Associate Agreement (BAA)
• DMHAS Business Associate Agreement / Qualified Service Organization Agreement (BAA / QSO)
• Standardized Board Resolution Form (P1.06)
• Executive Order 129 Certification: Source Disclosure Certification Form
• Labor Agreement Attestation Form
• Certification of Non-Involvement in Russia-Belarus (Jan-2024)

(No longer applicable for non-profit agencies - February 2008)

• Chapter 51 information

• Filing Information
• Registration

• Employee Information Report - AA302
• AA302 Instructions

• Agreement Form
• Instructions

• More information and sign up-???

• Payment Voucher for Cost Reimbursement Payment Contracts
• CIMS Log-in
• Contract Application
• Cost-Based Provider Agency Administrative Information Form

Annex B - Budget Matrix:

• Budget Matrix Software Applications
• User Manual
• Budget Schedules
• Budget Modification Signature Page
• Budget Categories Before/After Summary
• Program Elements Before/After Summary
• Cost-Based Provider Agency Administrative Information Form
• Contract Information Form
• Annex A Forms QCMR Forms & Documentation
• Program and Unit of Service Definitions
• Cluster Form
• Report of Expenditures (ROE) Summary Form
• Annex C - Supporting Information (Revised 04-01-21)
• Annex C - Permanent File Checklist (Revised 07-23-2024)

Required Contract Documents

• Addendum to DHS SLD for Mental Health Fee for Service (MH FFS) (Revised 04/01/2022)
• Annex B-2  (Revised 04/01/19)
• FFS Rates Chart (Revised 06/21/22)
• DHS DMHAS MH FFS Non-Hospital Agency Administrative Information Form, FY23 (Revised 04/01/22)
• DHS DMHAS MH FFS Hospital Agency Administrative Information Form, FY23 (Revised 04/01/22)

Annex A's

• Community Residences for Adults with Mental Illness Annex A  (Revised 05/17/19)
• Community Support Services (CSS) FFS Annex A (Effective 07/01/22)
• Integrated Case Management (ICMS) Annex A    (Effective 07/01/22)
• Outpatient Annex A (Effective 07/01/22)
• Partial Care Annex A (Effective 07/01/22)
• Partial Hospitalization Annex A (Effective 07/01/22)
• Programs for Assertive Community Treatment (PACT) Annex A   (Effective 07/01/22)
• Supported Education (SEd) Annex A  (Revised 05/17/19)
• Supported Employment (SE) Annex A (Revised 05/17/19)