Service Delivery Forms
Contracting & Procurement Forms
| Number | Name | Purpose |
|---|---|---|
| 1513 | Disclosure of Ownership and Control Interest StatementWord Document | Documents ownership and financial interest information. |
| 2030 | Budget for Purchase of Services ContractsExcel Spreadsheet | Budget for Cost Reimbursement contracts. |
| 2030 CLIVE | Budget for Title IV-E County ContractExcel Spreadsheet | Budget for Title IV-E Legal services contracts. |
| 2030 CLIVE-IR | Budget for Title IV-E CountyExcel Spreadsheet | Budget for Title IV-E Legal services with parental representation contracts. |
| 2030 CWIVE | Budget for Title IV-E County ContractExcel Spreadsheet | Budget for Title IV-E Child Welfare services contracts. |
| 2031 | Signature Authority DesignationWord Document | Signature authority designation. |
| 2044MOU | DFPS Memorandum of Understanding Routing FormWord Document | Proper routing and signature authority of MOUs. |
| 2282G | DFPS Grant Contract TemplateWord Document | DFPS template for grant contracts. |
| 2282V | DFPS Vendor Contract TemplateWord Document | 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 SubcontractorsPDF Document | Release of information regarding criminal history or DFPS abuse and neglect history. |
| 2971C | Request for Criminal History and DFPS History CheckPDF Document | Application for requesting criminal history and DFPS abuse or neglect history. |
| 4514MOU | Memorandum of Understanding (MOU)Word Document | DFPS template to draft MOU. |
| 4530 | DFPS Cybersecurity Training CertificationPDF Document | Certifies completion of training required for access to DFPS systems and databases. |
| 4734 | Federal Funding Accountability and Transparency Act (FFATA) CertificationsPDF Document | 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 CertificationsWord Document | 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 ConditionsWord Document | Required Special Conditions for DFPS vendor Child Specific Contracts. |
| 5622G | DFPS Grant Supplemental and Special ConditionsWord Document | Required attachment for DFPS grant contracts. |
| 5622RCC-CPA | RCC Supplemental, Special, and Programmatic Conditions for CPA Word Document | Required Special Conditions for RCC CPA contracts. |
| RCC Performance Measures for CPAWord Document | Required performance measures for RCC CPA contracts. | |
| 5622RCC-GRO | RCC Supplemental, Special, and Programmatic Conditions for GRO Word Document | Required Special Conditions for RCC GRO contracts. |
| RCC Performance Measures for GROWord Document | Required performance measures for RCC GRO contracts. | |
| 5622RCC-IPTP | RCC Supplemental, Special, and Programmatic Conditions for IPTP Word Document | Required Special Conditions for RCC IPTP contracts. |
| RCC Performance Measures for IPTPWord Document | Required performance measures for RCC IPTP contracts. | |
| 5622V | DFPS Vendor Supplemental and Special ConditionsWord Document | Required Special Conditions for DFPS vendor client service contracts. |
| 5622VRG | Regional Contracts Supplemental and Special ConditionsWord Document | Required Special Conditions for DFPS regional client service contracts. |
| 5622VPADPAL | Post Adoption & PAL Contracts Supplemental and Special ConditionsWord Document | Required Special Conditions for DFPS PAD & PAL client service contracts. |
| 5645CBC | DFPS Special Attachment for Single Source Continuum ContractsWord Document | Required attachment, to DFPS Contract Templates for DFPS Single Source Continuum Contracts in addition to the 5622. |
| 5645G | DFPS Grant Uniform Terms and ConditionsPDF Document | Uniform Terms and Conditions for grant contracts. (*Updated in response to Governor’s Executive Order 48 (issued 11/19/2024). Information on this order and reason for the changes can be found at the Office of the Texas Governor website.External Link) |
| 5645V | DFPS Vendor Uniform Terms and ConditionsPDF Document | Uniform Terms and Conditions for vendor contracts. (*Updated in response to Governor’s Executive Order 48 (issued 11/19/2024). Information on this order and reason for the changes can be found at the Office of the Texas Governor website.External Link) |
| 5645INT | DFPS Interagency and Interlocal Uniform Terms and Conditions PDF Document | Uniform Terms and Conditions for Interagency and Interlocal contracts. |
| 74-157 | Payee Change RequestPDF Document | Change existing information for one payee number. |
| 74-176 | Direct Deposit AuthorizationPDF Document | For vendor to receive direct deposit. |
| 9007CR | Internal Control Structure Questionnaire and Instructions (ICSQ) for Cost Reimbursement ContractsWord Document | Contractor's disclosure of internal controls to safeguard assets. Instructions included. |
| 9007ICC | Internal Control Certification (ICC)Word Document | 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 $24,999Word Document | Contractor's disclosure of internal controls. Instructions included. |
| 9007CIVE | Internal Control Structure Questionnaire (ICSQ) for Title IV-E County > $25,000Word Document | Contractor's disclosure of internal controls. Instructions included. |
| 9007CPG | Internal Control Structure Questionnaire (ICSQ) for Community and Parent GroupsWord Document | Contractor's disclosure of internal controls. Instructions included. |
| 9007FFS | Internal Control Structure Questionnaire (ICSQ) for Fee for Service ContractsWord Document | Contractor's disclosure of internal controls. Instructions included. |
| 9007Claims | Internal Control Structure Questionnaire (ICSQ) for Claims ProcessingWord Document | Contractor's disclosure of internal controls. Instructions included. |
| 9007RCC | Internal Control Structure Questionnaire (RCC)Word Document | Contractor's disclosure of internal controls. Instructions included. |
| 9025a | Related Party Leases/Rental Worksheet PDF Document | Form used by Residential Child-Care Contracts to determine and manage Contractor Related party leases/rental agreement(s). |
| 9105 | Risk Analysis Questionnaire (RAQ)PDF Document | Questionnaire for provider to assist staff with the completion of the Risk Assessment Instrument (RAI). |
| PCS-102RCC | PCS Background ChecksExcel Spreadsheet | Residential Child Care Background Checks only. |
| AP-152 | Application for Texas Identification Number/Additional Mailing AddressPDF Document | Application for identification number. |
