Post Award Contract Documents (Completed by Contractee)

POST AWARD CONTRACT DOCUMENTS (COMPLETED BY CONTRACTEE)

1.Budget Revision and Instructions (DAS-57)

2.Report of Contract Expenditures and Instructions (DAS-20a)

3.Contract Progress Report (DAS-45)

4.Report of Expenditures and Request for Reimbursement for Construction Contracts and Certification

NEW JERSEY DEPARTMENT OF HUMAN SERVICES

BUDGET REVISIONS REQUEST (DAS-57)

Instructions

DAS-57

JULY 04

Please refer to Subpart M of the Terms and Conditions for Administration of Contracts for additional instructions for the use of this form.

DAS-57

JULY 04

Reporting Agency and Address

Enter the name and complete mailing address, including the zip code.

Project Title

Enter the title of the Project.

Budget Period

Refer to the Notice of Contract Award or the latest Approved Contract Modification for this information; the Budget Period is the period of time for which a project is funded.

Contract Number

Enter the Contract Number as shown on the signed Notice of Contract Award.

Account Number(s)

Enter the account number or numbers which appear in the Notice of Contract Award.

Revision Number

Requests should be numbered consecutively for each Contract.

Budget Categories and Approved Budget

Enter the amounts by budget category as approved in the Notice of Contract Award, Attachment B or the amounts in the most recent budget request approved by the Department of Human Services.

Requested Changes

Enter the amounts, plus or minus, of the requested changes. On a separate sheet provide complete justifications for all the requested changes. Decreases should be explained in the same detail as increases.

Revised Budget

The Approved Budget column plus or minus the Requested Changes equals the Revised Budget.

Signatures

The budget revision must be signed by the Chief Financial Officer of the agency receiving this Contract.

Approval

A Budget Revision Request shall require the approval of the Contracting Agency’s Program Management Officer and Contract Management Officer. A budget revision will not be considered as valid unless both signatures are on the copy returned to your agency.

DAS-57

JULY 04

New Jersey Department of Human ServicesBUDGET REVISION REQUEST

Attach justification for each category revision on a separate sheet

*Use Plus (+) or Minus (-) signs to indicate additions and subtractions.

DAS-57

JULY 04

NEW JERSEY DEPARTMENT OF HUMAN SERVICES

BUDGET REVISION REQUEST (DAS-57)

Budget /Cost Categories and Elements of Cost

DAS-57

JULY 04

Personnel Cost

Salaries and Wages

Fringe Benefits

Consultant / Professional Services Cost

Accounting and Auditing Services

Any other non-employee related professional services for which a formal

consultant agreement is required

Bookkeeping Services

Office Expense and Related Cost

Advertising for Recruitment and Procurement

Bonding Cost

Data Processing supplies and services

Office Equipment maintenance which are normal maintenance costs compared to

capital improvements

Payroll Services

Postage

Printing and Office Supplies

Telephone

Program Expense and Related Cost(1)

Educational Supplies and Equipment Maintenance

Food for Patients

Kitchen Supplies and Maintenance of Equipment

Medical or Laboratory Supplies or Contract Services (other than consultants)

Medical Supplies and Equipment Maintenance Supplies

Patient Personal care items

Recreation Supplies and Services

Vocational Supplies and Equipment Maintenance

Staff Training and Education Cost

All costs relating to training and continuing education of agency staff

Travel, Conferences and Meetings

Conference and meeting costs

Costs of meals or refreshments served at meetings with volunteers

Employee travel reimbursement

Insurance for Agency Vehicles

Maintenance cost for agency owned vehicles

Reimbursement to volunteers

Equipment and Other Capital Expenditures

Purchase of capital assets including renovations costs

Facility Cost

Depreciation or Use Allowance

Household supplies and Security Services

Insurance and property taxes

Lease or rent payments

License Fees

Maintenance of Building and Grounds

Utilities

Water and Sewer

Sub-Contracts

DAS-57

JULY 04

DAS-57

JULY 04

NOTE: Please refer to the appropriate cost principles for the exact definitions of these cost elements.

(1) Definitions and Cost elements to be included with the applications.

DAS-57

JULY 04

NEW JERSEY DEPARTMENT OF HUMAN SERVICES

INSTRUCTIONS FOR PREPARING THE REPORT OF CONTRACT EXPENDITURES (DAS-20A)

DAS-20a

JULY 04

The Report of Contract Expenditures must be submitted to the New Jersey Department of Human ServicesContracting Agency no later than ten (10) working days immediately following the end of each reporting period. Please refer to Attachment A of the Contract Award and to the Terms & Conditions for Administration of Contracts (Manual) for additional general instructions for the use of this form.

DAS-20a

JULY 04

DAS-20a

JULY 04

Reporting Agency and Address

Enter the name and complete mailing address, including the zip code.

Contract Title

Enter the title of the Contract Award. Refer to item 4 of the Notice of Contract Award Document (GAD).

Contract Number

See item 3 of the GAD.

Contractee Account/Fund Number

Enter your account number, fund number or other identifying numbers which have been assigned to this Contract.

New Jersey Department of Human Services Account Number

Enter the account number or numbers which appear in the Notice of Contract Award Document.

Reporting Period

Enter the month, day and year of the beginning and ending dates of the period for which this report is prepared.

Budget Period

Refer to the Notice of Contract Award Document, item 7, or the latest Approved Notice of Contract Modification for this information. The Budget Period is the period of time for which a project is funded.

Basis of Report

Mark the appropriate box. Refer to Subpart R, Section 18.3 of the Manual.

For reports prepared on a cash basis, expenditures are the sum of actual cash disbursements for goods and services and the amount of cash advances/and payments made to subContractees and contractors.

For reports prepared on the accrual basis, expenditures are the sum of actual cash disbursements and the net increase (or decrease) in the amounts owed by the Contractee for goods and other property received and for services performed by employees, contractors and other payers.

Report Number

Reports should be numbered consecutively within the budget period.

Revision of Report Number

Complete this section only if a revised report of Contract expenditures is being submitted.

Final

Mark this box if the final report of Contract expenditures is being submitted. Final reports are due no later than sixty days after the completion of budget period. All Cash balances shall be returned to the New Jersey Department of Human Services within ten days after submission of this final report.

Budget Categories and Approved Budget

The budget categories have been pre-printed. The Approved Budget amounts should be taken from Attachment B of the GAD. Do not reflect changes to budgeted funds that are requested and have not been approved by the New Jersey Department of Human Services.

Period Expenditures – Whole Dollars

Enter the expenditures by budget category which relates to the reporting period. If program income funds have been approved to be expended during the Contract period, the expenditure of those funds should be included with Contract funds.

Cumulative Expenditures – Whole Dollars

Enter the cumulative expenditures by budget cate- gory from the beginning of the budget period to the end of the budget period. These figures should be computed by adding the current reporting period expenditures to the prior cumulative expenditures.

Total Direct Cost

The total of all budget categories should be en-tered here. If program income funds have been approved to be expended in the budget during this Contract period, they should be reported as expenditures and included in this total.

Indirect Cost

Apply the approved rate to the appropriate base. All indirect cost rates must be approved in the Contract prior to claiming this cost on the Report of the Contract Expenditures.

Total Cost

Total Direct Cost plus applied indirect cost is the total cost.

Less: Program Income

If expenditures of program income funds are reported in the budget categories, the amount program income funds received during the reporting period should be deducted from total direct cost. Program income should be reported on the cash basis, i.e. when funds have been received. Please refer to Subpart K of the manual for definitions and application of program income.

Net: Total Direct Cost

Total cost less applied program income is the net total cost.

Status of Funds

Please complete this section if your Contract has been funded under the Advanced Payment Schedule Method. Indicate total cash received to date less the total cash disbursed to date to calculate the actual cash balance as of the end of the reporting period. This section will be used by the Contracts Management Officer to monitor cash versus expenditures and if necessary, to adjust future scheduled advance payments.

Certification

Complete the certification before submitting the report to the Contracts Management Officer.

DAS-20a

JULY 04

New Jersey Department of Human ServicesREPORT OF CONTRACT EXPENDITURES

DAS-20a

JULY 04

Budget /Cost Categories and Elements of Cost

DAS-20a

JULY 04

Personnel Cost

Salaries and Wages

Fringe Benefits

Consultant / Professional Services Cost

Accounting and Auditing Services

Any other non-employee related professional services for which a formal \

consultant agreement is required

Bookkeeping Services

Office Expense and Related Cost

Advertising for Recruitment and Procurement

Bonding Cost

Data Processing supplies and services

Office Equipment maintenance which are normal maintenance costs compared to

capital improvements

Payroll Services

Postage

Printing and Office Supplies

Telephone

Program Expense and Related Cost(1)

Educational Supplies and Equipment Maintenance

Food for Patients

Kitchen Supplies and Maintenance of Equipment

Medical or Laboratory Supplies or Contract Services (other than consultants)

Medical Supplies and Equipment Maintenance Supplies

Patient Personal care items

Recreation Supplies and Services

Vocational Supplies and Equipment Maintenance

Staff Training and Education Cost

All costs relating to training and continuing education of agency staff

Travel, Conferences and Meetings

Conference and meeting costs

Costs of meals or refreshments served at meetings with volunteers

Employee travel reimbursement

Insurance for Agency Vehicles

Maintenance cost for agency owned vehicles

Reimbursement to volunteers

Equipment and Other Capital Expenditures

Purchase of capital assets including renovations costs

Facility Cost

Depreciation or Use Allowance

Household supplies and Security Services

Insurance and property taxes

Lease or rent payments

License Fees

Maintenance of Building and Grounds

Utilities

Water and Sewer

Sub-Contracts

DAS-20a

JULY 04

DAS-20a

JULY 04

NOTE: Please refer to the appropriate cost principles for the exact definitions of these cost elements.

(1) Definitions and Cost elements to be included with the applications.

New Jersey Department of Human ServicesCONTRACT PROGRESS REPORT

NOTE: Please type or print clearly. Report due 30 days after the end of each reporting period.

LIST BELOW EACH ACTIVITY REQUIRED TO MEET ABOVE STATED OBJECTIVE

ORIGINAL

DATE

PAGE OF PAGES

DAS-45

JULY 04

NEW JERSEY DEPARTMENT OF HUMAN SERVICES

REPORT OF EXPENDITURES AND

REQUEST FOR REIMBURSEMENT FOR CONSTRUCTION CONTRACTS

DAS-5

JULY 04