Service Delivery Forms
Contracting & Procurement Forms
| Number | Name | Purpose |
|---|---|---|
| 1513 | Disclosure of Ownership and Control Interest Statement | Documents ownership and financial interest information. |
| 2030 | Budget for Purchase of Services Contracts | Budget for Cost Reimbursement contracts. |
| 2030 CLIVE | Budget for Title IV-E County Contract | Budget for Title IV-E Legal services contracts. |
| 2030 CLIVE-IR | Budget for Title IV-E County | Budget for Title IV-E Legal services with parental representation contracts. |
| 2030 CWIVE | Budget for Title IV-E County Contract | Budget for Title IV-E Child Welfare services contracts. |
| 2031 | Signature Authority Designation | Signature authority designation. |
| 2044MOU | DFPS Memorandum of Understanding Routing Form | Proper routing and signature authority of MOUs. |
| 2282G | DFPS Grant Contract Template | DFPS template for grant contracts. |
| 2282V | DFPS Vendor Contract Template | DFPS template for vendor contracts. |
| 2970C | Disclosure and Consent to Release of Information Regarding Criminal or Abuse/Neglect History For Applicants, Employees or Volunteers of DFPS Contractors and Subcontractors | Release of information regarding criminal history or DFPS abuse and neglect history. |
| 2971C | Request for Criminal History and DFPS History Check | Application for requesting criminal history and DFPS abuse or neglect history. |
| 4514MOU | Memorandum of Understanding (MOU) | DFPS template to draft MOU. |
| 4530 | DFPS Cybersecurity Training Certification | Certifies completion of training required for access to DFPS systems and databases. |
| 4734 | Federal Funding Accountability and Transparency Act (FFATA) Certifications | The form is required for any DFPS subrecipient contracts and any other sub-awards granted under a federal cooperative agreement or grant. |
| 4735 | Out of State Contractor Certifications | Certifies compliance with business entities laws of the state where the contractor does business and that the contractor is not delinquent in state or federal taxes. |
| 5622CSC | RCC Child Specific Contract Special Conditions | Required Special Conditions for DFPS vendor Child Specific Contracts. |
| 5622G | DFPS Grant Supplemental and Special Conditions | Required attachment for DFPS grant contracts. |
| 5622RCC-CPA | RCC Supplemental, Special, and Programmatic Conditions for CPA | Required Special Conditions for RCC CPA contracts. |
| RCC Performance Measures for CPA | Required performance measures for RCC CPA contracts. | |
| 5622RCC-GRO | RCC Supplemental, Special, and Programmatic Conditions for GRO | Required Special Conditions for RCC GRO contracts. |
| RCC Performance Measures for GRO | Required performance measures for RCC GRO contracts. | |
| 5622RCC-IPTP | RCC Supplemental, Special, and Programmatic Conditions for IPTP | Required Special Conditions for RCC IPTP contracts. |
| RCC Performance Measures for IPTP | Required performance measures for RCC IPTP contracts. | |
| 5622V | DFPS Vendor Supplemental and Special Conditions | Required Special Conditions for DFPS vendor client service contracts. |
| 5622VRG | Regional Contracts Supplemental and Special Conditions | Required Special Conditions for DFPS regional client service contracts. |
| 5622VPADPAL | Post Adoption & PAL Contracts Supplemental and Special Conditions | Required Special Conditions for DFPS PAD & PAL client service contracts. |
| 5645CBC | DFPS Special Attachment for Single Source Continuum Contracts | Required attachment, to DFPS Contract Templates for DFPS Single Source Continuum Contracts in addition to the 5622. |
| 5645G | DFPS Grant Uniform Terms and Conditions | Uniform Terms and Conditions for grant contracts. |
| 5645V | DFPS Vendor Uniform Terms and Conditions | Uniform Terms and Conditions for vendor contracts. |
| 5645INT | DFPS Interagency and Interlocal Uniform Terms and Conditions | Uniform Terms and Conditions for Interagency and Interlocal contracts. |
| 74-157 | Payee Change Request | Change existing information for one payee number. |
| 74-176 | Direct Deposit Authorization | For vendor to receive direct deposit. |
| 9007CR | Internal Control Structure Questionnaire and Instructions (ICSQ) for Cost Reimbursement Contracts | Contractor's disclosure of internal controls to safeguard assets. Instructions included. |
| 9007ICC | Internal Control Certification (ICC) | For contractors to certify there have been no internal control changes. |
| 9007CIVE_S | Internal Control Structure Questionnaire (ICSQ) for Title IV-E County Between $10,000 and $24,999 | Contractor's disclosure of internal controls. Instructions included. |
| 9007CIVE | Internal Control Structure Questionnaire (ICSQ) for Title IV-E County > $25,000 | Contractor's disclosure of internal controls. Instructions included. |
| 9007CPG | Internal Control Structure Questionnaire (ICSQ) for Community and Parent Groups | Contractor's disclosure of internal controls. Instructions included. |
| 9007FFS | Internal Control Structure Questionnaire (ICSQ) for Fee for Service Contracts | Contractor's disclosure of internal controls. Instructions included. |
| 9007Claims | Internal Control Structure Questionnaire (ICSQ) for Claims Processing | Contractor's disclosure of internal controls. Instructions included. |
| 9007RCC | Internal Control Structure Questionnaire (RCC) | Contractor's disclosure of internal controls. Instructions included. |
| 9025a | Related Party Leases/Rental Worksheet | Form used by Residential Child-Care Contracts to determine and manage Contractor Related party leases/rental agreement(s). |
| 9105 | Risk Analysis Questionnaire (RAQ) | Questionnaire for provider to assist staff with the completion of the Risk Assessment Instrument (RAI). |
| PCS-102RCC | PCS Background Checks | Residential Child Care Background Checks only. |
| AP-152 | Application for Texas Identification Number/Additional Mailing Address | Application for identification number. |