Contracting Forms

 

This area includes miscellaneous forms that are referenced in FCADV contracts and agreements with providers.

 

Budget Adjustment/Amendment Form DVS (Excel)

This form shall be used to notify the FCADV Contract Manager when changes are made to the approved operating budget.

 

Budget Adjustment/Amendment Form Rural (Excel)

This form shall be used to notify the FCADV Contract Manager when changes are made to the approved operating budget. The form shall be used by certified domestic violence centers working on the Rural Project

 

Budget Adjustment/Amendment Form L&C (Excel)

This form shall be used to notify the FCADV Contract Manager when changes are made to the approved operating budget. The form shall be used by certified domestic violence centers working on the L&C Project

 

Budget Adjustment/Amendment Form STOP

This form shall be used to notify the FCADV Contract Manager when changes are made to the approved operating budget. This form shall be used by centers and other service providers funded under STOP. (VS, Courts, Law Enforcement, Prosecution)

 

Incident Reporting Procedures – QAOP 700-002 (PDF)

The Incident Reporting guidelines establishes procedures and guidelines for identifying and reporting information related to incidents that may be defined as major or critical.

 

General Incident Reporting Form (Word)

This is the official form in which incidents that occur on center property as described in the FCADV Incident Reporting Procedure shall be documented. Reports shall be submitted within 24 hours from the time of incident or upon being made aware of such incident.

 

Death Reporting Form (Word)

This is the official form in which any death that occurs on center property as described in the FCADV Incident Reporting Procedure shall be documented. Death on center property requires immediate notification to FCADV.

 

TANF Eligibility Determination Form in English (PDF)                                             

A portion of funding for certified domestic violence centers comes from Temporary Assistance for Needy Families (TANF). Centers are required to complete a TANF Eligibility Determination Form for each participant served. The completed form shall be maintained in the participant's file. The form is updated on a yearly basis based on the Federal Poverty Guidelines.

 

TANF Eligibility Determination Form in Spanish (PDF)                                            

A portion of funding for certified domestic violence centers comes from Temporary Assistance for Needy Families (TANF). Centers are required to complete a TANF Eligibility Determination Form for each participant served. The completed form shall be maintained in the participant's file. The form is updated on a yearly basis based on the Federal Poverty Guidelines.

 

TANF Eligibility Determination Form in Creole (PDF)

A portion of funding for certified domestic violence centers comes from Temporary Assistance for Needy Families (TANF). Centers are required to complete a TANF Eligibility Determination Form for each participant served. The completed form shall be maintained in the participant's file. The form is updated on a yearly basis based on the Federal Poverty Guidelines.

 

IRR Form  (Word)

This is the official form to be used when requesting to purchase Information Technology Resources. Written approval shall be obtained from the FCADV Contract Manager prior to making a purchase using the Information Resource Request (IRR) Form.

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