Contract Policy and Information Manual(CPIM)

Glossary of Terms

The following terms when capitalized in the Manual shall have the
meaning as stated. Additional terms, as needed, will be defined in
the policy circulars. Furthermore, when a term in this glossary has a
different meaning in a particular circular, the term will be defined
for a limited application in that circular.

Accrual Basis of Accounting: the accounting method in which Revenue

is reported in the period in which it is earned, regardless of when
it is collected, and expenses are reported in the period in which
they are incurred, regardless of when they are paid.

Acquiring Organization: the business entity that acquires,

affiliates, consolidates, merges, etc. with a Provider Agency.

Acquisition: the takeover of one corporation by another, if both

parties retain their legal existence after the transaction.

Acquisition Cost: the net invoice unit price of an item of Equipment,

including the cost of any modifications, attachments, accessories
or auxiliary apparatus necessary to make it usable for the purpose
for which it was acquired. Ancillary charges, such as taxes, duty,
protective in-transit insurance, freight and installation shall be
included in or excluded from the Acquisition Cost in accordance
with the Provider Agency's regular written accounting practices.

Action: Notice of an impending remedy, including Termination of the

Contract. The action may be implemented during the current Contract
or a subsequent Contract as appropriate.

Actual Units of Service: the number of service units delivered by the

Provider Agency for the reporting period.

Additional Insured: an endorsement to an insurance policy extending

the coverage to the State of New Jersey, Department of Human
Services and its Departmental Component against loss in accordance
with the terms of the policy. Designating the State of New Jersey,
Department of Human Services and its Departmental Component as an
additional insured permits the Department to pay the premium should
the insured fail to do so.

Affiliation: the association of two or more entities for the

advancement of a specific goal or purpose.

Agreement: The Standard Language Document, the Individual Provider

Agreement, the Annex(es), any additional appendices or attachments
(including any approved assignments, subcontracts or modifications)
and all supporting documents

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Allocability: a cost is allocable if it is assignable or chargeable
to a particular cost objective - such as a contract, project,
product, service, process, or other major activity - in accordance
with the relative benefits received or some other equitable
relationship.

Annex B Budget: the Attachments to the Contract Standard Language

Document and Standardized Agreement containing Financial
information.

Annex(es): the attachment(s) to the Contract Standard Language

Document and Standardized Agreements containing programmatic and
financial information.

Applicable Credits: those receipts or reduction of expenditures which

operate to offset or reduce expense items allowable to the Contract
as direct or indirect costs.

Applicant: the person, agency or entity responding to an RFP.

Approval: written permission from the Departmental Component’s Ethic

Liaison Officer to attend and/or participate in an Event; to accept
and honorarium or fee; and/or to accept Direct or Indirect Benefits
in connection with attendance.

Award: includes State grants, State aid, and federal and State
financial assistance in the form of grants, loans, loan guarantees,
property, capital funding agreements, interest subsidies,
insurance, food commodities and other assistance.

Broad Form: liability coverage that provides insurance for multiple

types of perils. A Broad Form policy provides all risks coverage in
one policy except for listed exclusions.

Budget Category: one of the major groupings of cost identified in the

Contract Budget Annex B form.

Budget Period: a period congruent with the Contract when services are
delivered. Generally, a budget will cover a 12-month period which
coincides with the Provider Agency's fiscal year.

Budgeted Units of Service: the projected level at which the Provider

Agency will deliver Contract services. The Budgeted Units of
Service are specified in the Annex B and/or Annex B-2.

Cash Basis of Accounting: the accounting method in which Revenue is

reported in the period in which it is received and expenses are
reported in the period in which they are paid.

Client Fees (also Fees): the monetary assessment which, according to

Departmental policies, may be charged to certain recipients of
specific social services. Any allowable Client Fees to be charged
and the amount projected to be collected by the Provider Agency in
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 connection with the delivery of Contract services are specified in
the Contract Annex (es).

Closeout “preliminary”: the process, whereby the Departmental

Component reconciles the amount of funding paid to a Provider
Agency during the contract term against the final Report of
Expenditures (ROE) or the latest ROE submitted by the Provider
Agency to the Departmental Component, and also the “final” process
by which the Department of Human Services determines that all
applicable administrative actions and all required work of the
Contract, with the exception of the final audit, have been
completed by the Department and the Provider Agency.

Cluster: one or more service-related Programs designated by the

Departmental Component, and identified in the Contract.

Cognizant: a term used to designate audit responsibilities and is

generally used in conjunction with the awarding agency that
provides the predominant amount of federal and State funding.

Cognizant Division: the division or other designated component within

the Department of Human Services responsible for all fiscal
Contract administration functions when a Provider Agency contracts
with more than one Departmental Component.

Commercial Automobile Liability Insurance: coverage that provides

limits above the standard limits in the base policy and/or covers
areas of liability not covered in a standard policy.

Conditional Contract: a social service or training Contract between

the Department and the Provider Agency for less than one year
during which time special terms or conditions specified in the
Contract must be met by the Provider Agency.

Conflict of Interest (also Conflict): a conflict, or the appearance

of a conflict, between the private interests and the official
responsibilities of a person in a position of trust. Persons in a
position of trust include Provider Agency staff members, officers
and Governing Board Members.

Copyrighted Material: an exclusive, legal right to adapt, distribute,

reproduce, publish or sell any information funded and developed
under a Department Contract or subcontract.

Consistency: a Provider Agency's method of accounting must be uniform

from one period to another.

Consolidation: occurs when two or more corporations cease to exist,

and by the same process a new one is created, taking over the
assets and assuming the liabilities of those passing out of
existence.

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Consumer: an individual receiving services from or funded in whole or
in part by DHS (Department) or one of its departmental component.

Contract: one of the Department's social service or training

Contracts with a Provider Agency. Terms and conditions of the
Contract are included in the Standard Language Document, Annex
(es), appendices, and attachments and Contract Modifications
(including any approved assignments and subcontracts) and
supporting documents. The Contract constitutes the entire binding
agreement between the Department and the Provider Agency.

Contract Budget: the Department approved budget for Cost-Related

Contracts contained in the Annex B and Annex B-2, and prepared in
accordance with the Department's Contract Reimbursement Manual and
Contract Policy and Information Manual.

Contract Modification: the formal procedures entailing the

Department's written approval on the P1.10 Contract Modification
form (Attachment A) to allow certain programmatic and/or financial
changes in the Contract during the Contract term.

Contracted State Agency: the State organization or unit that enters

into a contractual arrangement with a Departmental Component of the
Department of Human Services.

Cost Analysis: the evaluation of cost data for the purpose of

establishing estimates of Contract costs to be incurred and then
determining costs to be reimbursed or prices to be paid. The Cost
Analysis method for determining Contract value is applicable to
Cost-Related Contracts.

Cost-Related Contract: a Contract for which the total value of the

Contract is determined by a detailed analysis of costs, i.e., "Cost
Analysis".

Cost Sharing: denotes Provider Agency participation in the cost of

Programs funded under Department Contracts. Provider Agencies are
able to participate in the cost of Programs from various sources of
restricted and unrestricted funds.

County Human Services Advisory Councils (CHSACs): councils appointed

by the government of each county to review county-level human
service activities and to serve as the primary vehicle for local
public input into New Jersey Department of Human Services’ decision
making. The activities of the County Human Services Advisory
Councils include, but are not limited to, the issuance, review and
comment on human service proposals; preparation of allocation
plans; review of existing purchase of service contracts; and
coordination and consolidation of the local human services delivery
systems.

Cumulative Increase: the combined effect of all budget changes within

a Budget Category.
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Days: calendar days.

Default: the Provider Agency has materially failed to fulfil or

comply with the terms and conditions of the Contract.

Department: the New Jersey Department of Human Services. As used

throughout the Manual, it also means, where appropriate from the
context, the division, commission, bureau, office, unit or other
designated component of the Department of Human Services
responsible for the administration of particular Contract Programs.

Department Head: the administrative or executive head of the State

Official’s agency or his or her designee. The Commissioner of
Human Services has designated Departmental Component Ethics Liaison
Officers to grant the approval defined above.

Departmental Component: the division, bureau, commission, office or

other unit within the Department responsible for the negotiation,
administration review, approval, and monitoring of certain social
service or training Contracts.

Depreciation: the process of allocating the cost of a tangible fixed

asset (e.g., buildings, office equipment and computer equipment)
less salvage value, over its estimated useful life in a rational
and systematic manner.

Designated Entity: that group or county board which has been given
the authority by the Department of Human Services to solicit human
service proposals for the review and comment and recommended
acceptance for third-party social service Contracts. Although the
RFP is handled by a group other than the Departmental Component,
the Contract is signed and finalized by the Departmental Component.

Direct Benefit: acceptance by a State Official from the sponsor of an

Event or any other person of travel, meals, accommodation, waiver
of conference or Event fee or any other costs associated with
attending the Event for which no payment is made by the State but
is not intended to mean nominal refreshments such as nonalcoholic
beverages and snacks (bagels, doughnuts, pastries and cookies).

Disallowed Costs: those charges to a Contract that the Department

determines to be unallowable in accordance with applicable cost
principles, Department policies, or other conditions contained in
the Contract.

Donor: the public (except the State of New Jersey) or private entity
contributing match to a Contract.

Donor Agreement (Public or Private): a standard written agreement

between the Provider Agency and a public or private entity
providing match to be used in a SSBG service Contract. The standard
Donor Agreement is furnished by the Departmental Component.
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Employee Fidelity Bond (commercial blanket bond): coverage issued for
a stated amount on all regular employees of the Provider Agency
insuring against loss from employees’ dishonest acts.

Employers’ Liability Insurance: coverage against the common law

liability of an employer for injuries by accident or disease to
employees, as distinguished from the liability imposed by Workers’
Compensation Law.

Equipment: an article of nonexpendable tangible personal property

having a useful life of more than two years and an Acquisition Cost
of $5,000 or more per unit.

Event: a meeting, conference, seminar, speaking engagement,

symposium, training course, ground-breaking, ribbon cutting, meal,
open house, cocktail party, fundraiser, holiday party, social
function, or similar event that takes place away from the State
Official’s work location, is sponsored or co-sponsored by a non-
government source and the invitation for which is extended to the
State Official because of his/her official position.

Expiration: the cessation of the Contract because its term has ended.

Facilities: land and buildings or any portion thereof, equipment

individually or collectively, or any other tangible capital asset,
wherever located and whether owned or leased by the Provider
Agency.

Fair Market Value: the value determined to be a reasonable price for

a comparable item on the competitive market in the same geographic
area. Such determination is made in some cases by comparison
shopping and in others by formal appraisal procedures.

Federal Government Executive and Legislative Branch(es): an officer

or employee of any federal agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress.

Final Contract Closeout: the process by which the Department of Human

Service determines that all applicable administrative actions and
all required work of the Contract, with the exception of the final
audit, have been completed by the Provider Agency and the
Department.

Flexible Limits: an upper dollar limit which is established for each

Budget Category, and which may not be exceeded without an approved
Contract Modification. Flexible Limits are determined by adding an
amount to the approved Annex B Budget.

For-Profit Contract: a Contract in which a fixed dollar amount is

added to the Net Cost to determine the Contract Reimbursable

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 Ceiling. For-Profit Contracts are allowed only with for-profit
Provider Agencies.

General and Administrative or Indirect Costs: costs which are

incurred for common or joint objectives and which are not readily
subject to treatment as direct costs. These costs are not directly
traceable to a particular segment and probably could not be fully
eliminated if any one segment of the enterprise were discontinued.
General Liability Insurance: liability coverage for all premises and
operations for all general liability hazards, unless excluded.

Governing Board (also Board): the Provider Agency board, commission,

council or other organizational body which signs the Contract,
enacts Provider Agency policy regarding Contract services, and is
responsible to the Department for Contract compliance.
Indirect Benefit: acceptance by a State Official from the Event
sponsor or any other person of reimbursement for costs of travel,
meals, accommodation, event fees, or any other costs associated
with attending the Event for which no reimbursement is made by the
State but is intended to mean nominal refreshments such as
nonalcoholic beverages and snacks (bagels, doughnuts, pastries and
cookies).

Initial Advance Payment: the first payment made by check or other

appropriate payment mechanism to a Provider Agency during the
Contract term before expenses are incurred or services are
provided.

In-Kind Contributions: property or services (except the services of

volunteers) which benefit the Contract Program and which are
contributed by a public entity without charge to the Provider
Agency. Included as In-Kind Contributions are public contributions
formerly designated as CCE (Certified Cash Expenditures).

Insurance Declaration Page: a document that lists most of the vital

information about the Insurance policy. The declaration page
states the name and address of the name insured or insured party;
the location of the property insured along with its location and
description; the value and replacement value of property insured;
the inception and expiration date of the policy period, the premium
and any other conditions, terms, exclusions and endorsements.

Interest: the cost incurred for the use of borrowed funds. Interest
costs are generally paid at fixed intervals by the user.

Interested Party: 1. Any person, or employee, representative or agent

thereof, who is or may reasonably be anticipated to be subject to
the regulatory, licensing or supervisory authority of the State
Official’s agency; 2. Any supplier, or employee, representative or
agent thereof; 3. Any organization that advocates or represents the
position of its members to the State Official’s agency; 4. Any
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 organization a majority of whose members are as described in
paragraphs 1 through 3 above.

Letter of Approval: the written correspondence between the

Departmental Component and Provider authorizing a Contract
Modification approval pending submission and approval of a P1.10
Contract Modification form (Attachment A).

Limits: the dollar amount of insurance carried for the types of

insurance listed.

Line Item: each entry of cost within Budget Category listed in the
Annex B (e.g., the salary or wages for each position listed under
the Budget Category of Personnel).
Lower Tier Covered Transaction(s) (Contract/Subcontract): the
Contract between DHS and the Provider Agency and all subsequent
subcontracts, down to the lowest level, that may result from the
initial Contract.

Lower Tier Participant(s) (Provider Agency/Subcontract): the Provider

Agency and all subcontractors, down to the lowest level, that may
result from the initial Contract.

Management Decision: the evaluation by the federal or State awarding

agency or the pass-through entity of the audit findings and
corrective action plan and the issuance of a written decision as to
what corrective action is necessary.

Marketable Asset: any item of value that can be sold, bartered or

traded.

Match: a percentage or designated amount of funds required as Cost

Sharing for certain Department of Human Services Contracts. Such
requirements may be Departmental or statutory.
Merger: occurs where one corporation absorbs another of relatively
equal size and importance and remains in existence while the other
is dissolved.

Minority: a person who is:

African American, having origins in any of the black racial

groups in Africa;

Hispanic, having Spanish culture, with origins in Mexico,

South or Central America, or the Caribbean Islands,
regardless of race;

Asian-American, having origins in and of the original

peoples of the Far East ,Southeast Asia, Indian
sub-continent, Hawaii, or the Pacific Islands;

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 American Indian or Alaskan native (Native American), having
origins in any of the original peoples of North America and
who maintain cultural identification through tribal
affiliations or community recognition.

Minority Agency: a business or organization, profit or non-profit,

which is:

A sole proprietorship, partnership, or joint venture in which

at least 51% of the ownership interest is held by minorities
and the policy-making, management and daily business
operations are controlled by one or more of the minorities who
own it; or

A corporation or other business entity authorized under the

laws of the United States whereby 51% of the stockholders,
board of directors, ownership or management of daily business
operations is controlled by one or more minorities.

Modified Accrual Basis of Reporting: the reporting method in which

all unpaid expenditures and uncollected Revenue attributable to the
Contract (i.e., expenditures which are allocated to the Contract
and have been incurred during the Contract term and Revenue which
has been earned during the Contract term) are paid or collected by
a specified date after the Expiration or Termination of the
Contract. All such post-Contract payments or collections are then
reported on the final expenditure report.

Net Cost: the Total Cost less Revenue.

Non-Cost-Related Contract: a Contract for which the total value is

determined by a means other than Cost Analysis. Price Analysis is
the most common method employed.

Notice: an official written communication between the Department and

Provider Agency. All Notices shall be delivered in person or
certified mail, return receipt requested, and shall be directed to
the persons and addresses specified for such purpose in the
annex(es) or to such other persons as either party may designate in
writing.

The Notice shall also be sent by regular mail and shall be presumed
to have been received by the addressee five Days after being sent
to the last address known by the Departmental Component.

Open Purchase Service(s): a contract service that is purchased on a

fee for service or an as needed basis and in which the number of
units to be purchased may not be fixed. Such contract service
program usually do not have a reimbursable ceiling.

Pass-through Entity: a non-federal entity, which includes a State,

local government, non-profit organization and for-profit
Revised July 2009
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 organization that transmits a federal or state award to a Provider
Agency or a subcontractor to carry out a federal or State program.

Payment Rate: the agreed upon amount to be paid to the Provider

Agency per single unit of service delivered under the Contract.

Person: an individual corporation, company, association, authority,

firm, partnership, society, state, local government or
organization.

Pre-Award Survey: the examination and evaluation of certain records

and documents to determine the adequacy of the financial management
and administrative systems of a potential or current Provider
Agency prior to the issuance of a new or successor Contract with
the Provider Agency.

Preliminary Contract Closeout: the process whereby a Departmental

Component reconciles the amount of funding paid to a Provider
Agency during the Contract term against the Final Report of
Expenditures (FROE) or the latest Report of Expenditure (ROE)
submitted by the Provider Agency to the Departmental Component.

Price Analysis: the evaluation of price data without analysis of the

separate cost components in arriving at prices to be paid for
Contract services. The Price Analysis method of determining
Contract value is applicable to Non-Cost-Related Contracts.

Principal: officer, director, owner, partner, key employee or other

person within the Provider Agency with primary management or
supervisory responsibilities; or person who has a critical
influence on or substantive control over the Contract whether or
not employed by the Provider Agency.

Product/Completed Operation: a form of liability insurance which

covers accidents arising out of operations which have been
completed or abandoned, provided the accident occurs away from the
premises owned, rented, or controlled by the insured.

Professional Liability/Malpractice: coverage for the Provider Agency

and health care providers in its employ, acting under their scope
of duties, while providing medical and social services care to the
clients.

Program: a specific service. A Program is generally represented by

each column in the Contract Expense Summary of the Annex B:
Contract Budget.

Program Income: all income generated by the Provider Agency as a

result of Department supported activities (e.g., third party health
insurance such as Medicaid, Medicare, or private insurance plans).
Program Income does not include restricted or unrestricted public
or private donations to the Provider Agency.

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Property Insurance: a broad form of insurance coverage for damage or
loss to real and personal property.

Provider Agency (also Provider): the public or private organization

which has a social service or training Contract with the
Department.

Reasonableness: a cost is reasonable if, in its nature or amount, it

does not exceed that which would be incurred by an ordinarily
prudent person in the conduct of competitive business.

Recipient (Contractee or Provider Agency): the legal entity that

enters into a contractual arrangement with any Departmental
Component.

Reimbursable Ceiling: the cost of the Contract to the Departmental

Component and the maximum payment to the Provider agency.

Replacement Equipment: property acquired with Department funds to

take the place of other Equipment purchased with Department funds.
Replacement Equipment must serve the same function as the Equipment
replaced and must be of the same nature or character, although not
necessarily the same model, grade or quality.

Revenue: the total income generated by the Provider Agency from its
Programs and activities.

Significant Events: a known or anticipated program, financial or

administrative event or circumstance of a nature and extent that
can reasonably be expected to diminish the quality or quantity of
services to clients, or to influence or to jeopardize the ability
of the Provider Agency to deliver contracted services, or to meet
responsibilities under the Contract and which requires Notice to
the Departmental Component. Examples include
Legal/Administrative/Financial/Services such as, but not limited
to, Bankruptcy petition, Merger, Acquisition, Affiliation,
Consolidation, Civil or Criminal action taken against an employee
of the agency, a finding of abuse or neglect against an employee of
the agency and Planned Relocation or change in Service location(s).

Staff Member: a person who receives all or part of his/her income

from the Provider Agency’s payroll.

Standard Language Document: the document which establishes the non-

negotiable obligations, responsibilities, rights and relationships
of the Contract parties.

State: the State of New Jersey.

State Agency: any of the principal departments in the Executive

Branch of the State Government (not including the Department of
Human Services) and division, board, bureau, office, commission or
other instrumentality within the legislature of the State and any
Revised July 2009
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 office, board, bureau or commission within or created by the
Legislative Branch, and any independent State authority,
commission, instrumentality or agency. A county or municipality
shall not be deemed an agency or instrumentality of the State.

State Official: any State Officer or employee or special State

Officer or employee as defined in the Conflict of Interest Law,
N.J.S.A. 52:13D-13(b) and (e).

Subrecipient (Subcontractee): the legal entity that enters into a

Contractual arrangement with a Contractee or another Subcontractee,
no matter how many interceding administrative Tiers (levels)
separate the parties.

Termination: an official cessation of the Contract, prior to the

expiration of its term, that results from action taken by the
Department or the Provider Agency in accordance with provisions
contained in the Contract.

Tier: each successive, separate level of administrative organization

beginning with the Department of Human Services and ending with the
Provider of service.

Total Cost: all costs including the cost of approved Equipment.

Total Operating Costs: the total operating cost(s) excluding the cost
of Equipment. The term Total Operating Costs is applicable only to
Cost-Related Contracts.
Trade-In: the difference between the amount that would have been paid
for Replacement Equipment without a trade-in and the amount paid
with the trade-in. The term refers to the actual difference, not
necessarily the trade-in value shown on an invoice.

Transfer of Governing Board: occurs when the Provider Agency remains

intact, but assigns control or governance to a new entity or
Governing Board.

Umbrella Organization: an affiliation among two or more business

entities whereby each remains distinct, but join to form a new
collective directing organization. The new organization may be
given management or service control, without acquiring the assets
or liabilities of the existing entities.

Umbrella Policy: a policy that provides limits above the standard

limits in the base policy, and/or covers areas of liability not
covered in a standard policy.

Unit Cost: (1) the Contract Reimbursable Ceiling minus Equipment

divided by the Budgeted Units of Service or (2) the cost to the
Department minus any Equipment expenditures during a given period
divided by the Actual Units of Service rendered during that period.

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Unit of Service: the breakdown of the services used as a standard of
measurement (e.g., hours, roundtrips, or meals).

Workers’ Compensation Insurance: benefits payable to an employee,

without regard to liability, required by State law in case of
illness, injury, disability, or death as a result of occupational
hazards.

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(Page 13)
 STATE OF NEW JERSEY
DEPARTMENT OF HUMAN SERVICES

Contract Policy and Information Manual (CPIM)

PROVIDER AGENCY

TABLE OF CONTENTS

FUNDAMENTAL PRINCIPLES
INTRODUCTION
SCOPE OF POLICY CIRCULARS AND INFORMATION MEMORANDA
GLOSSARY OF TERMS

P1.00 CONTRACT NEGOTIATIONS AND REVISIONS

P1.01 Documents and Conditions Required for Processing,

Executing and Documenting a DHS Third Party
Contract (Promulgated: July 20, 2009, Effective:
August 1, 2009)

P1.02 Timely Execution, Renewal Conditions and Sanctions

for Contracts (Promulgated: August 11, 2005,
Effective: January 1, 2006)

P1.03 Charitable Registration and Investigation Act

(Promulgated: May 1, 1995, Effective: May 1, 1995)

P1.04 Request for Proposal (Promulgated: November 16,

1998, Effective: November 16, 1998)

P1.05 Concurrent Contract Term and Provider Agency

Fiscal Year (Promulgated: July 1, 1988, Effective:
July 1, 1988)

P1.06 Standardized Board Resolution Form (Promulgated:

July 20, 2009, Effective: August 1, 2009)

P1.09 The Acquisition, Affiliation, Consolidation or

Merger of a Provider Agency (Promulgated: September
1, 1997, Effective: September 1, 1997)

July 2009
Page 1 of 6
 P1.10 Contract Modification (Promulgated: February 24,
2005, Effective: July 1, 2004 & shall be
implemented as new contracts commence or existing
contracts are renewed thereafter)

P1.11 Significant Events (Promulgated: August 11, 2005,

Effective: October 1, 2005)

P1.12 Clusters (Promulgated: August 11, 2005, Effective:

retroactively for Division of Mental Health
Services contract to July 1, 2003(FY 2004) and for
all other DHS Departmental Components’ contracts as
of July 1, 2004)

DYFS P1.50 Two-Year Contracting (Promulgated: July 1, 1988,

Effective: July 1, 1988)

P2.00 CONTRACT STANDARD LANGUAGE

P2.01 Department of Human Services' Standard Language

Document for Social Service and Training Contracts
(Promulgated: July 20, 2009, Effective: August 1,
2009)

P3.00 PROGRAMMATIC INFORMATION

P3.03 Bilingual and Bicultural Diversity in Contracts

(Promulgated: June 14, 1996, Effective: August 1,
1996)

DYFS 3.52 Annex A – Standard Language Title XX Purchase of

Service Contract, DYFS Form 7-33a
(Promulgated: May 10, 1982, Effective May 10, 1982)

P4.00 FISCAL STANDARDS AND INFORMATION

P4.03 Lobbying (Promulgated: February 1, 1985, Effective:

February 1, 1985)

P4.05 Equipment (Promulgated: January 21, 2005,

Effective: January 21, 2005)

DDD P4.07 Collapsing Direct Care Positions for Budgetary

Purposes (Promulgated August 1, 2000, Effective:
August 1, 2000)

P4.10 Advance Payments (Promulgated June 1, 1997,

Effective: June 1, 1997)

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 P4.16 Restrictions on the Use of Federal Funds to
Influence the Awarding of Contracts or
Subcontracts, (Federal Lobbying) (Promulgated:
September 1, 1993, Effective: September 1, 1993)

P5.00 ELIGIBILITY INFORMATION

P5.01 Client Eligibility - Minimal Department

Standards (Promulgated July 1, 1998, Effective:
July 1, 1988)

P5.10 Client Eligibility - Commission for the Blind

and Visually Impaired (Promulgated: June 22, 1984,
Effective: July 1, 1984)

P5.20 Client Eligibility - Division of Mental

Health and Hospitals (Promulgated: June 22, 1984,
Effective: July 1, 1984)

P5.30 Client Eligibility - Division of Mental Retardation

(presently the Division of Developmental
Disabilities) (Promulgated: June 22, 1984,
Effective: July 1, 1984)

P5.45 Client Eligibility - Division of Youth and

Family Services (Promulgated: March 24, 1986,
Effective: April 1, 1986)

P5.46 Exception to Policy Circular P5.45, Client

Eligibility - Division of Youth and Family
Services (Promulgated: February 1, 1985, Effective:
February 1, 1985)

P6.00 DONOR AGREEMENTS/MATCHING FUNDS

P6.01 Match Requirements for Social Services Block

Grant Service Contracts (Promulgated: June 1, 1983,
Effective: July 1, 1983)

P7.00 CONTRACT CLOSEOUT AND AUDIT INFORMATION

P7.01 Contract Closeout (Promulgated: July 15, 2001,

Effective: July 15, 2001)

P7.05 Pre-Award Survey (Promulgated: July 1, 1988,

Effective: July 1, 1988)

P7.06 Audit Requirements (Promulgated: June 1, 2001,

Effective for fiscal years ending May 31, 2001, and
thereafter)
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 DMHSP7.07 Operational Incentive Pilot (Promulgated: January
24, 2006, Effective: Effective retroactively for
DMHS contracts to July 1, 2005 and shall be
implemented as new contracts commence or existing
contracts are renewed thereafter.)

P8.00 GENERAL MANAGEMENT STANDARDS AND INFORMATION

P8.01 Access to Records and Facilities; Retention of

Contract Records; Confidentiality (Promulgated:
July 1, 1988, Effective: July 1, 1988)

P8.05 Conflict of Interest (Promulgated: July 1, 1988,

Effective: July 1, 1988)

P8.10 Nondiscrimination/Americans with Disabilities

Act (Promulgated: November 1, 1994, Effective:
November 1, 1994)

P8.13 Copyrights (Promulgated: November 21, 2007,

Effective: November 21, 2007)

P8.14 Minimum Standards for Insurance (Promulgated: July

20, 2009, Effective: August 1, 2009)

P9.00 MONITORING

P9.02 Department and Provider Agency Monitoring of

Level of Service Delivery (Promulgated: July 1,
1988, Effective: July 1, 1988)

P9.05 Contract Default (Promulgated: June 14, 1996,

Effective: August 1, 1996)

MISCELLANEOUS

P-Misc.03 Provider Agency Chief Executive Officer and

Contract Program Director (Promulgated: July 1,
1988, Effective: July 1, 1988)

P-Misc.04 Persons Delivering Contract Services

(Promulgated: July 1, 1988, Effective: July 1,
1988)

P-Misc.06 Child Abuse or Neglect (Promulgated: July 1, 1988,

Effective: July 1, 1988)
July 2009
Page 4 of 6
 P-Misc.07 Financial Transactions with Clients, Patients and
Residents (Promulgated: August 1, 2000, Effective:
August 1, 2000)

INFORMATION MEMORANDA

P84-2 Match Requirement for FY '85 Social Services

Block Grant Funding Increase
(Effective: October 1, 1984)

P85-2 Requirements of SLEPA Contracts

(Effective: July 1, 1985)

P85-4 Match Requirement for FY '86 Social Services

Block Grant Funding Increase
(Effective: July 1, 1985)

P89-2 Application of Executive Order No. 189

(Effective: May 1, 1989)

P90-1 Sufficiency of Funds/Contract Confirmation Letter

(Effective: January 12, 1990)

P91-1 Reallocation of Funds - Clarification - P6.01,

Match Requirements for Social Services Block Grant
services Contracts (Effective: December 6, 1991)

P94-1 Debarments, Suspensions and Disqualification

Pursuant to Executive Order #34-1976
(Effective: July 1, 1994)

P94-2 State of New Jersey Policy on Sexual Harassment

(Effective: November 1, 1994)

P99-1 Applicability of the Federal Davis-Bacon Act

and the New Jersey Prevailing Wage Act
(Effective: May 1, 1999)

P99-2 Subcontracts (Effective: May 1, 1999)

P99-3 Access to the Department of Human Services (DHS)

Contract Policy and Information Manual and Contract
Reimbursement Manual on the DHS Website (Effective
April 25, 2005)

P00-1 Federal Debarment, Suspension Ineligibility and

Voluntary Exclusion Requirements
(Effective: January 3, 2000)
July 2009
Page 5 of 6
 P02-1 Staff Attendance at Conferences or Other Events
Sponsored by Department of Human Services’ Provider
Agencies (Effective: March 1, 2002)

P02-2 Business Registration (Effective: March 1, 2002)

P04-1 Revised Audit Requirements, Policy Circular P7.06,

Section III, A. and B. (Effective: February 9,
2004)

P05-1 Cognizant Contracting (Effective: August 11, 2005)

P07-1 Affirmative Action Requirements (Effective:

November 21, 2007)

P09-1 New Site for the Publication of the Department of

Human Services’ (DHS) Notice of the Availability of
Grant Funds (Effective: July 20, 2009)

POLICY GUIDEINES

PG93-1 Loans to Provider Agency Employees

(Effective: June 7, 1993)

PG97-1 Equitable Interest in Contract Purchased Equipment

(Effective: February 1, 1997)

PG00-1 Auditors Access to Client Records

(Effective: August 1, 2000)

July 2009
Page 6 of 6
 Information Memorandum POO-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: January 1, 2000

SUBJECT: Federal Debarment, Suspension, Ineligibility and

Voluntary Exclusion Requirements

EFFECTIVE: January 3, 2000

The purpose of this memorandum is to inform Provider Agencies and

Departmental Components that federal Executive Order 12549 requires a
certification by the Provider Agency and all subsequent subcontractors
that it has not been debarred, suspended, proposed for debarment,
declared ineligible or voluntarily excluded from federally funded
Contracts. This certification is currently a requirement in P1.04,
Request for Proposal and is required for all contracts as well.

In addition to the defined terms in the Glossary of the Manual, the

following terms, when capitalized, shall have meaning as stated:

DEFINITIONS

Lower Tier Covered Transactions or Transaction (Contract/subcontract)

means the Contract between DHS and the Provider Agency and all
subsequent subcontracts, down to the lowest level, that may result
from the initial Contract.

Lower Tier Participant or Participant (Provider Agency/subcontractor)

means the Provider Agency and all subcontractors, down to the lowest
level, that may result from the initial Contract.

Principal means officer, director, owner, partner, key employee or

other person within the Provider Agency with primary management or
supervisory responsibilities; or person who has a critical influence
on or substantive control over the Contract whether or not employed by
the Provider Agency.

CERTIFICATION PROCESS

The attached Certification Regarding Debarment, Suspension,

Ineligibility and Voluntary Exclusion for Lower Tier Covered
Transactions must be signed by the Lower Tier Participant(s) and will
 IMPOO-1

become an attachment to the Contract for all Contracts of $100,000 or

more that contain as little as one dollar of federal funds. Contracts
that contain no federal funds are not subject to the certification
process. If the Provider Agency chooses to subcontract, a blank
certification must be included in the subcontract package and the
completed, signed certification will become part of the subcontract.
The Provider Agency and subsequent subcontractors may rely on the
certification presented to them unless it is known to be erroneous.

The Federal Debarment list may be found at the following Web site:
HTTP://EPLS.ARNET.GOV

This requirement will be incorporated inn the following standard

language documents: Standards Language Document for Social Service
and Training Contracts, Individual Provider Agreement and the Tuition
Agreement. When the language is added as a revision to each of the
standard language documents, this information memorandum will be
rescinded.

Attachment

Issued by:

2
 Information Memorandum POO-1
Attachment 1

READ THE ATTACHED INSTRUCTIONS BEFORE SIGNING THIS CERTIFICATION.

THE INSTRUCTIONS ARE AN INTEGRAL PART OF THE CERTIFICATION.

Certification Regarding Debarment, Suspension, Ineligibility

and Voluntary Exclusion
Lower Tier Covered Transactions

1. The Lower Tier Participant (Provider Agency/subcontractor) certifies,

by submission of the attached contract, that neither it nor its
principals are presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in
this contract by any Federal department or agency.

2. Where the Lower Tier Participant (Provider Agency/subcontractor) is

unable to certify to any of the statements in this certification, such
Lower Tier Participant (Provider Agency/subcontractor) shall attach an
explanation to this certification.

_______________________________________
Name and Title of Agency Director

_______________________________________
Signature Date

Agency Name: _____________________________________________

Contract #: ___________ Federal ID #:______________

This certification is required by the regulations implementing

Executive order 12549, Debarment and Suspension, 29 CFR Part 76,
Section 76.510.
 Information Memorandum POO-1
Attachment 2

Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion
Provider Agency/Subcontractor Contracts

Instructions for Certification

1. By signing and submitting the attached Contract, the Lower Tier

Participant (Provider Agency/subcontractor) is providing the
certification set out below.

2. The certification in this clause is a material representation of

facts upon which reliance was placed when this Transaction
(Contract) was entered into. If it is later determined that the
Lower Tier Participant (Provider Agency/subcontractor) knowingly
rendered an erroneous certification, in addition to other
remedies available to the Federal Government, the Departmental
Component with which this Transaction (Contract) originated may
pursue available remedies, including suspension and/or debarment.

3. The Lower Tier Participant (Provider Agency/subcontractor) shall

provide immediate written notice to the Departmental Component to
which this Contract is submitted if at any time the Lower Tier
Participant (Provider Agency/subcontractor) learns that its
certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.

4. The terms used in this certification are consistent with those

set out in the Definitions and Coverage sections of rules
implementing Federal Executive Order 12549. You may contact the
Departmental Component to which this Contract is submitted for
assistance in obtaining a copy of those regulations.

5. The Lower Tier Participant (Provider Agency/subcontractor) agrees

by submitting this Contract that, should the Contract be entered
into, it shall not knowingly enter into any subcontract with a
subcontractor who is proposed for debarment under 48 CFR part 9,
subpart 9.4, debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this Contract, unless
authorized by the Federal department or agency with which this
Contract funding originated.
 IMPOO-1
Attachment 2
6. The Lower Tier Participant (Provider Agency/subcontractor)
further agrees by submitting this Contract that it will include
this clause titled "Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion--Lower Tier
Transactions", without modification, in all Lower Tier Covered
Transactions (subcontracts) and in all solicitations for Lower
Tier Covered Transactions (subcontracts).

7. A Lower Tier Participant (Provider Agency/subcontractor) may rely

upon a certification of a subcontractor that it is not proposed
for debarment under 48 CFR part 9, subpart 9.4, debarred,
suspended, ineligible, or voluntarily excluded from covered
Transactions, unless it knows that the certification is
erroneous. A Lower Tier Participant (Provider Agency/
subcontractor) may decide the method and frequency by which it
determines the eligibility of its Principals. Each Participant
may, but is not required to, check the List of Parties Excluded
from Federal Procurement and Nonprocurement Programs.

8. Nothing contained in the foregoing shall be constructed to

required establishment of a system of records in order to render
in good faith the certification required by this clause. The
knowledge and information of a Lower Tier Participant (Provider
Agency/subcontractor) is not required to exceed that which is
normally possessed by a prudent person in the ordinary course of
business dealings.

9. Except for contracts authorized under paragraph 5 of these

instructions, if a Provider Agency knowingly enters into a Lower
Tier Covered Transaction with a subcontractor who is proposed for
debarment under 48 CFR part 9, subpart 9.4, suspended, debarred,
ineligible, or voluntarily excluded from participation in this
Contract, in addition to other remedies available to the Federal
Government, the Departmental Component with which this Contract
originated may pursue available remedies, including suspension
and /or debarment.

2
 Policy Circular P1.12

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Clusters

EFFECTIVE: This revised Policy Circular shall become effective on July

1, 2013.

PROMULGATED: June 14, 2013

SUPERCEDES: Policy Circular P1.12, dated August 11, 2005.

PURPOSE: The purpose of this Policy Circular is to instruct all Provider

Agencies and DHS Departmental Components’ contracting staff on the policy
and procedures for identifying and utilizing Clusters within the Budget.

I. SCOPE

This Policy Circular applies to DHS Third Party Social Services and
Training Contracts administered by the; 1) Division of Developmental
Disabilities; 2) Division of Mental Health and Addiction Services;
and 3) Division of Family Development.

II. DEFINITIONS

In addition to the terms defined in the DHS Contract Policy and

Information Manual, and the DHS Contract Reimbursement Manual, the
following terms, when capitalized, shall have meanings as stated:

Cluster means one or more service-related Programs designated by the

Departmental Component, and identified in the Contract.

III. POLICY

The following three Departmental Components have identified service-

related programs that may be combined to form Clusters:

1) Division of Developmental Disabilities (see criteria; DDD

Attachment 1);
2) Division of Mental Health and Addiction Services (see criteria;
DMHAS Attachment 2); and
3) Division of Family Development (see criteria; DFD Attachment 3).

For contracting purposes, service-related program components

identified within a Cluster category will enable Provider Agencies to
 P1.12

move funds between these service-related programs to offset a deficit

identified in one program with a surplus in another service-related
program within the same Cluster category. However, it is important to
note that Provider Agencies are precluded from moving funds between
Cluster categories to offset a deficit identified in one Cluster
category with a surplus in another Cluster category without an
approved contract modification as required by Policy Circular P1.10.

A form is attached to this policy, DHS Attachment 4, which is

required to be completed annually and updated as necessary by all
provider agencies that have designated clusters. When Clusters are
added or deleted within a Contract term, a Contract Modification is
required.

1. Level of Service and/or Performance Outcomes Requirements

Each contracted service program component will have a minimum

level of service and/or performance outcomes identified as part
of the Annex A Contract requirements. These minimum
requirements must be maintained as a prerequisite for any funds
being transferred between service-related programs within the
same Cluster.

2. Funding Source

Services funded under any one of the following sources may be

clustered (by funding source), unless otherwise prohibited by
the funding source’s regulations or policies.

a. Single funding source

b. Multiple funding sources for the same service
c. State funds
d. Federal funds

Service program components that are funded by a federal

grant will generally not be Clustered with services funded
by other funding sources. However, where two or more
service components are solely funded by the same federal
grant, the services may be Clustered unless otherwise
restricted by the grant language.

3. Fixed-Unit Rate Service Programs

Service program components funded under the fixed-unit rate

method of payment will not be Clustered.

4. Required Form

The authorized Provider Agency signatory shall sign a Cluster

Designation Form, Attachment 4, if any clusters are designated.

2
 P1.12

Issued By:

_______________________________________

Howard Mass, Director

Office of Administration

_______________________________________

Gerald Suozzo,
Chief of Staff

3
 P1.12
Attachment 1

DIVISION OF DEVELOPMENTAL DISABILITIES

CLUSTER CATEGORIES

1. Community Care Cluster: Cost Reimbursement programs only, including:

a. Group Homes
b. Supervised Apartments
c. Supportive Living Arrangements
d. All Other Direct Residential Services
e. Community Care Residences (Skill)
f. Day Habilitation (including Special Needs)
g. Supported Employment
h. All Direct Support Services (Family Support, Respite, Case Management, etc.)

* Important Note: A Fixed Rate program within the Community Care Cluster must remain independent of any
Cost Reimbursement program. Reporting of Fixed Rate program elements (budgets/expenditures) must remain
separate and may not be combined with any Cost Reimbursement program information.

2. Emergency Capacity: Any Emergency Capacity program must remain its own and separate
budget and reporting cluster.

3. New Initiative/Expansion Cluster: Resources and costs related to new programs in their first
year of operation must be maintained and reported in the New Initiatives/Expansion Cluster for
the initial year of operation separate and distinct from the “Community Care Cluster”.
Preservation of resources and costs related to new program is necessary to ensure any surplus
resulting from a delay in start-up of the program is not used to offset costs in other clusters.
Further, confining cost reporting in this cluster will assist the Division in analyzing how actual
placements and costs line up against budgeted projections.

While the typical preservation of funds in this cluster is for the initial year of operation, the
Office of Contract Administration retains the prerogative to require an agency to preserve
resources and costs in this cluster for a period of longer than one year, if necessary.

4. Cognizant or Pass-thru Cluster: This cluster will be utilized for any occurrence where DDD is
the contracting entity but placement is being funded from a non-DDD source. This cluster may
include, but is not limited to, placements funded within DDD contracts by the Division of Mental
Health and Addiction Services or the Department of Children and Families.

5. Non-Direct Service/Special Program Cluster: This cluster will be utilized for any non-direct
care program. Such programs may include, but are not limited to:
a. Support Coordination
b. Fiscal Intermediary Services
c. Special Non-Direct Care Programs

6. Purchase of Care Cluster: This cluster will be utilized for any purchase of care, fee for service
based contracts (non-cost reimbursement).

4
 P1.12
Attachment 2

DIVISION OF MENTAL HEALTH AND ADDICTION SERVICES

CLUSTER CATEGORIES

DMHS recognizes three distinct program Clusters:

(1) Community Care cost-reimbursement programs, including:

Designated Screening
Emergency Services
Outpatient Services
Partial Care
Residential Services
P.A.T.H.- Programs for Assistance in the Transition from
Homelessness
I.C.M.S.- Integrated Case Management Services
Systems Advocacy
I.F.S.S.- Intensive Family Support Services
Self-Help Centers
Supported Employment
P.A.C.T.-Program for Assertive Community Treatment
Criminal Justice Programs

(2) Special Revenues: Programs which utilize special revenues

and which require separate accountability by DMHAS. Examples
are: Child Residential programs for which DMHAS establishes
final Medicaid rates; and Welfare to Work programs via
Division of Family Development (DFD) which are federally
funded.

(3) New Initiatives:

a) New Community Care program awards will be treated as

Clusters during the initial service phase-in, or until the
program budget is stable. This will typically result in
the new program treated as a Cluster during the first two
years, with an additional year possible if necessary.

b) New Revenue Initiatives, such as the Adult Mental Health

Rehabilitation Medicaid revenue initiative for PACT and
Adult Residential, will require the targeted revenue to be
restricted or clustered during the two year phase-in
period( a third year to be added if necessary), with
program expenditures and other revenue not restricted by
Cluster.

5
 P1.12
Attachment 3

DIVISION OF FAMILY DEVELOPMENT

CLUSTER CATEGORIES

The Division of Family Development will recognize the following

categories of Clustered Services. In the contracts for clustered
services, it may be required to separate federal or state funded
components. If this is the case, it will be so designated on the Annex
B Summary Sheet.

1. Child Care Resource and Referral (CCRR) Agency contracts

• Subsidy support for federally and state funded programs

• Non-voucher Quality programs

2. WFNJ (Work First New Jersey) Transportation Services

3. Family Worker Outreach

4. SSH (Social Services for the Homeless)

5. SSBG (Social Services Block Grant) Homeless Assistance

6. SAIF (Supportive Assistance for Individuals and Families)

Intensive Case Management

7. Refugee Resettlement Programs

8. New Initiatives, Special Projects or Expansion programs will

have Clusters designated on Annex B.

6
 P1.12
Attachment 4

DEPAPRTMENT OF HUMAN SERVICES

Cluster Designation Form

The Department of Human Services has defined the term “Cluster” in DHS
Policy Circular P1.10 (Contract Modification) and this policy, as one
or more service-related Programs designated by the Departmental
Component, and identified in the Contract. For contracting purposes,
the applicable Cluster determines the extent to which a Provider Agency
can offset deficits in one program with surpluses in another program,
without penalty, subject to other provision in this policy. Note: The
contract settlement process will be performed on a cluster-by-cluster
basis.

PROVIDER AGENCY: ______________________________________________________

CONTRACT #: _____________________ CONTRACT TERM:_____________________

CONTRACT CLUSTER (complete one sheet for each cluster):

Program Name

1. ____________________________________________________________________

2. ____________________________________________________________________

3. ____________________________________________________________________

4. ____________________________________________________________________

5. ____________________________________________________________________

6. ____________________________________________________________________

7. ____________________________________________________________________

8. ____________________________________________________________________

SIGNATURES:

________________________________ _________________________________
Provider Agency Date

7
 Policy Circular DYFS 1.50

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES
DIVISION OF YOUTH AND FAMILY SERVICES

SUBJECT: Two-year Contracting

EFFECTIVE: This policy circular shall become effective on July 1,

1988, and shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular DYFS 1.50, promulgated November 5,

1986.

The purpose of this policy circular is to establish the policy and

procedures for implementing two-year Contracts in the Division of
Youth and Family Services (DYFS).

I. SCOPE

This policy circular applies to all DYFS Contracts designated by

the Division as eligible for two-year terms.

II. POLICY

A. Except in those circumstances outlined in Section B below,

social services Contract in DYFS may be executed for two-
year terms.

The implementation of two-year Contract terms have the

advantage of:

1. increase administrative simplicity for the Division and

for the Provider Agencies, and

2. greater stability for Provider Agencies in planning for

service delivery and funding needs.

B. The decision to implement two-year Contracts terms with

specific Contract will be made by the DYFS Regional Offices.
In making such decisions, the factors listed below will be
considered.

1. Public agencies will not be given Contract with two-

year terms because of restriction in the New Jersey
Local Public Contracts Law which prohibits local public
 DYFS P1.50

agencies from executing Contract with longer than 12-

month terms.

2. Contracts which are funded by an unstable funding

source, such as the Refugee Resettlement Program, will
not be given two-year terms.

3. New Contract Provider Agencies will not be given two-

year terms in their first year of funding.

4. Provider Agencies with identified

contracting/management problems will not be given two-
year Contract terms. Contracting/management problems
may be identified by a Contract audit report, Pre-Award
Survey, or by a Division monitoring report.

C. Provider Agencies which have two-year Contract terms will

receive equitable treatment from the Division with regard to
all funding increases available or decreases required, The
fact that a Provider Agency has a two-year Contract will not
penalize that Provider Agency if additional funding
available for Contract services. Similarly, in the case of
a reduction in funding, a Provider Agency with a two-year
term will be as vulnerable to any necessary Contract
reductions as a Provider Agency with a one-year term.

D. The process for receiving and considering recommendations

from the county planning bodies will be the same for two-
year Contracts as for one-year Contracts.

III. PROCEDURES

A. Contract Document for Two-Year Contracts

The Contract documents for a two-year Contract will consist

of the following items:

1. Standard Language Document- A two-year Contract will

have a single Standard Language Document for the two-
year term. On the signature page of the Standard
Language Document, the Contract effective date and the
Contract expiration date will indicate the two-year
Contract term.

2. Programmatic Annex- A single programmatic annex (Annex

A) will be prepared and will include information which
applicable to the full two-year Contract term.
Specifically, items in the Annex A which shall be
written to include two-year data are: Contract term,
2
 DYFS P1.50

Contract level of service delivery, service days,

number of clients to be served, and goals and
objectives.

3. Fiscal Annex- The fiscal annex (Annex B, and/or Annex

B-2) of a two-year Contract will cover the full term of
the Contract. Special considerations for preparation
of the fiscal annex are outlined below.

a. For Cost-Related Contracts

(1) Annex B (Budgets)

In accordance with the policies and procedures of

the Contract Reimbursement Manual, there will be
at least two budgets for a two-year Contract. The
total number of budgets required will depend on
the Provider Agency’s fiscal year in relation to
the Contract term. (See Section 5 of the Contract
Reimbursement Manual for additional information,)
All budgets for a two-year term will be submitted
simultaneously by the Provider Agency during the
Contract negotiations.

Each budget must reflect it proportionate share of

all Contract costs, applicable to the particular
budget period. A budget may be modified during
the Contract term, as outlined in Section III.D.2
of this circular and in accordance with Policy
Circular P1.10 Contract Modification.

(2) Cover Page for Annex B

For the sake of clarity, a cover page for the

Contract Annex B shall be prepared which
specifies:

-the budget period and Reimbursable Ceiling for

each budget of the Contract;

-the Contact term (2 years); and

-the aggregate Reimbursable for the Contract,

i.e., the sum of the Reimbursable Ceilings for
the Contract budgets.

3
 DYFS P1.50

(3) Schedules of Estimated Claims

Separate estimated monthly claims shall be

projected by the Provider Agency reflecting each
budget submitted for the Contract term.

b. For Contracts Paid on a Rate

A single Annex B-2 will be completed by the

Division at the beginning of the Contract term and
will be effective for the full two-year Contract
term unless revised by a Contract Modification,
If the Contract has a maximum funding amount, this
amount will be included for the two-year and
specified in the Annex B-2. This amount will also
be reflected in the Annex B for a Cost-Related
Contract which is paid on a rate.

c. Supporting Documentation

Supporting documentation for the fiscal Annex

shall be submitted by the Provider Agency during
Contract negotiations and, if appropriate, will be
included as attachments to the fiscal Annex. Such
supporting documentation includes, but is not
limited to, the Provider Agency’s most recent
audited financial statements, organizational
structure of the Provider Agency, and donor
agreements.

In cases in which supporting documents are not

available for the full two-year Contract term,
such documents may be submitted to the Division
during the Contract term, as permitted by the
Division. Specifically, with regard to execution
and submission of donor agreements during the
Contract term, refer to Policy Circular P6.01,
Match Requirements for Social Services Block Grant
Service Contracts.

B. Division Documents

The following Contract documents used by the Division shall

be completed as indicated, for a two-year Contract.

4
 DYFS P1.50

1. Transmittal Letter

At the beginning of a two-year Contract, the Regional

Office shall issue a transmittal letter to the Provider
Agency which states:

- the aggregate Reimbursable Ceiling for a Cost-

Related Contract; and

- the Payment Rate and, if applicable, the maximum

Contract funding, for a Non-Cost-Related Contract.

2. Contract Information Form (CIF)

The Regional Office will complete a single CIF for the

full two years of the Contract term, using the
aggregate Contract Reimbursable Ceiling to identify the
Division’s funding obligation.

C. Advance Payment

The amount of the advance payment available under a two-year

Contract will be the Contract’s first two months’ estimated
claim. (See Policy Circular P410, Advance Payments, for
additional information.) Advances will be issued at the
beginning of the two-year Contract terms and recouped,
according to Division procedures, throughout the Contract
term.

D. Budget Flexibility for Cost-Related Contracts

In a two-year Contract, flexibility between/among budgets in

the Contract will be allowed within limits described below.

1. Overspending

A Provider Agency will not be allowed to overspend in

the Contract.

2. Underspending and Carry-Forward Amount

If a Provider Agency underspends a budget in the

Contract, the unspent amount, with Division approval,
may be carried forward from the expiring budget to a
succeeding budget within the current Contract. In
order to carry forward unspent funds, the Provider
Agency must submit a request for a Contract
Modification.

5
 DYFS P1.50

Approval for the Contract Modification will be granted

by the DYFS Regional Office only if the modification is
justified and appropriate. Prior to submitting a
Contract Modification, the Provider Agency shall ensure
that sufficient funds remain in the expiring budget to
cover all applicable expenses of that budget period.

Issued by:

6
 Policy Circular P1.01

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Documents and Conditions Required for Processing,

Executing and Documenting a DHS Third Party Contract

EFFECTIVE: This policy circular shall become effective immediately.

PROMULGATED: July 20, 2009

SUPERSEDES: P1.01, Documents and Conditions Required for Processing,

Executing and Documenting a DHS Third Party Contract,
promulgated February 19, 2008.

I. SCOPE

This policy circular applies to all DHS Third Party Contracts and
Individual Provider Agreements.

II. PURPOSE:

The purpose of this circular is to: standardize the requirements for

executing a contract Department wide. It is also intended to reduce
or eliminate risk to the Department by assuring the inclusion of
essential Contract documents in the DHS contract file or on site at
the contract provider agency. The DHS also seeks to clarify the
requirements pertaining to the documents and to track the receipt
and compliance status of required documents.

III. POLICY

A. Minimum requirements:

Contracts shall not be executed without the minimally required

documents. The following documents are the minimum required
when executing a contract regardless of the Contract value or
funding source or Departmental Component responsible for
managing the contract:

• DHS Departmental Component Contract Award/Renewal letter;

• A list or letter containing the contact persons in the

Departmental Component that are resources for the provider
agency, including the name, title, phone and e-mail
information. The list would minimally include the
Contract Manager or Supervisor, the Contract Administrator
and, where applicable, the person responsible for
payments;
 P1.01

• A copy of the Required Documents Checklist (Attachment 1);

• Two Standard Language Documents (SLD), each with original

signatures by the Contract Provider’s Board authorized
signatory (CPIM, P2.01). The appropriate SLD for the
Provider Agency will be identified by the Departmental
Component;

• Signed and dated N.J.S.A. 52:34-13.2 (formerly known as

Executive Order 129);

• Signed and dated Public Law, Chapter 51 and 271 and

Executive Order 117(for–profits organizations only)

• Two duplicates of the appropriate Fiscal Budgets: either

an Annex B, B-2 and/or Budget Summary each with original
signatures by the Contract Provider’s Board Authorized
signatory (CPIM, P2.01):

o An Annex B (including the Contract Information Form,

Contract Expense Summary, Contract Expense Detail-
Personnel, Contract Expense Detail-Other than
Personnel, and the following six schedules: Cost
Allocation Data, Revenue, Applicable Credits, Related
Organization, Depreciation/Use Allowance, Cost of
Equipment;

o An Annex B-2; or

o A Budget Summary;

• An Annex A (or a description of the project/initiative)

(or an Annex A Update Form for a renewal);

• Performance Outputs or Outcomes (these may be in included

in the Annex A);

• A copy of the Provider Agency’s Insurance Policy

Declaration page(s) showing the amounts and types of
insurance to ensure compliance with Policy Circular P8.14,
Minimum Standards for Insurance. The “State of New
Jersey, Department of Human Services and the Departmental
Component” must be named as the additional insured (and
its mailing address); Also bonding certificates/insurance
must be submitted where applicable (CPIM, P2.01);
(Individual Providers’ do not have to indemnify the State,
however, they must provide a copy of their Malpractice
Insurance Declaration/face sheet showing the amount of
their coverage);

2
 P1.01

• A copy of the Certificate of Incorporation (CPIM, P1.01);

• A completed Standardized Board Resolution Form (signed by

either the President/Chairperson or Secretary for the
Board) stating who is authorized to sign the Contract,
invoices and checks relating to the contract, and also
addresses other contract commitments. (CPIM, P1.06) and
(CRM, 5.3); and

• A copy of the Certification of Employee Information Report

(Certificate, hereafter) issued by the NJ Department of
the Treasury, Division of Contract Compliance and Equal
Employment Opportunity (IMP07-1), or a copy of the
recently completed EEO Employee Information AA302 form
(AA302 hereafter) (the provider agency is responsible for
submitting the original completed AA302 to the Division of
Contract Compliance for processing and forwarding the
Certification to their contract administrator upon
completion (within 60 day of submission.).

B. Other requirements

a. The following documents, if not available at the time the

contract is executed, must be provided or be available on site
(see Attachment 1 for allowable options) within 30 days of
executing the contract:

• A dated, current list of board members, their terms, the

officers, each member’s home address, and any business
address or affiliation. (CPIM, P1.01);

• A copy of all applicable licenses;

• A list of all contracts and grants to be awarded to the

Provider Agency by any federal, State, local government, or
private agency during the Contract term. The awarding
agency, amount, term, and the type of service(s) of the
contract/grant(s) must be listed;

• A chart showing the organizational structure of the Provider

Agency (P1.01, P-Misc.03);

• A copy of the Agency’s current Personnel Manual or Employee

Handbook;

• A copy of the Provider Agency’s Conflict of Interest Policy

(CPIM, P8.05);

• A copy of the Provider Agency’s Affirmative Action Policy;

3
 P1.01

• A copy of the Provider Agency’s By-Laws (current or latest

revision) (CPIM, P1.01) (Note: the cover sheet for the By-
laws or each individual policy should show a date of Board
review no older than 3 years.);

• A copy of all local certificates of occupancy (where

applicable);

• A copy of the lease or mortgage(s) (CRM, 4.5);

• A copy of the Annual Report to the Secretary of State (CPIM,

P1.01, P1.04);

• A copy of the State of New Jersey Business Registration;

• A copy of the Annual Report – Charitable Organization (CPIM,

CO-8, P1.04);

• A copy of the Provider Agency’s most recently completed audit

(CPIM, P1.01, P7.06);

• A copy of the most recent Tax Exempt Form 990, if the Agency
is an incorporated not-for-profit, or a copy of the most
recent U.S. Corporation Income Tax Return, Form 1120, if the
Agency is incorporated as a for-profit;

• A copy of the Agency’s Procurement Policy (CRM, 2.3);

• A current Equipment inventory of items purchased with DHS

funds (CPIM, P4.05) (Note: the inventory shall include: a
description of the item, a State identifying number or code,
original date of purchase, date of receipt, location at the
Provider Agency, person(s) assigned to the equipment,
etc..);and

• A copy of all Subcontracts or Consultant Agreements, related

to the DHS Contracts, signed and dated by both parties (CPIM,
P2.01).

• A copy of a Business Associate Agreement (BAA) for Health

Insurance Portability Accountability Act of 1996 compliance,
if applicable, signed and dated.

• Reports; any programmatic, fiscal and close out reports as

required by the contract.

b. A Departmental Component may require a Provider Agency to

complete additional contract forms (e.g. unique reporting or
attendance forms). See Attachment #1.

4
 P1.01

IV. PROCEDURES

A. Agency Contract Documents:

The following contract documents are to be returned to the

Provider Agency upon execution of the contract:

 SLD (one of the two originally signed documents);

 Annex B, B-2 or Budget Summary (one of the two originally
signed documents); and
 Annex A (or Annex A Update Form for a renewal); and
 Payment Schedule (if applicable, a copy of completed,
signed document).

The remaining, required contract documents may be copied and

returned to the Provider Agency; or, if the volume of paper makes
this impractical, each document that is included in the official
contract can be specifically referenced in a letter to the provider
agency acknowledging receipt, approval and its inclusion in the
official contract file.

B. Access to documents:

Certain DHS Contracting forms are available for downloading

from the DHS website. No documents may be altered in any
manner except for the insertion of required information. The
DHS Version of the Manuals is the legally binding version.

C. Authorized signatory:

Electronic signatures are permissible per N.J.S.A. 12A:12-3, et

seq., and are therefore permissible on documents transmitted
electronically. It is up to the Departmental Component to
determine if any electronic signature document must be followed
up with an originally signed document.

D. Sanctions:
Payment may be withheld until all required documents have been
submitted. Non-compliance with this policy may result in a
notice of termination to the Provider Agency or any other
action deemed necessary by the Departmental Component.

E. Requirements for updating contract documents:

The Provider Agency is responsible to assure that the

Departmental Component is provided with updates to any
documents that have been changed. Updates are required to be
submitted within 10 business days of the change or as otherwise
approved by the Departmental Component.

F. Requirements for Policy content:

5
 P1.01
1. Wherever there is a requirement for an Provider Agency to
submit a copy of the Provider Agency's policy for a
particular subject matter (e.g. Conflict of Interest,
Procurement practices. Affirmative Action, etc.), there is
a corresponding DHS policy circular detailing the
essential content requirements.
2. Where the Provider Agency's policy does not meet the
essential criteria as defined in DHS policy, the Provider
Agency's policy must be amended to include the required
information. The revised policy must show the date of the
revision and the signature of a Board authorized
signatory.
G. Provider Agencies that have contracts with more than one DHS
Departmental Component must submit duplicate contract documents
based on the Departmental Component's requirements.
Each Departmental Component maintains its own files and
internal procedures regarding contract documents. Therefore,
although it may be duplicative to submit certain items to
multiple Department Components, this is still necessary.
H. Checklist:
The Provider Agency checklist is attached. (Attachment 1)

Chief of Staff

Department of Human Services

6
 P1.01
Attachment 1
DEPARTMENT OF HUMAN SERVICES

REQUIRED CONTRACT DOCUMENTS CHECKLIST

Instructions: The Departmental Component is to:

• check off all of the required documents the provider agency needs to submit (or have available for an onsite review, if noted);
• send a copy of this form to the provider agency for signature and return along with the required documents;
• document and monitor the compliance status of the submissions by completing the last four columns; and
• assure this form is completed annually as part of the preparation of a contract package.
Contract #___________________________________________________________________________________
Contract Agency______________________________________________________________________________
Contract Term________________________________________________________________________________
Provider Agency’s authorized signatory__________________________________________________________

Departmental Component______________________________________________________________________
DHS Reviewer & Title__________________________________________________________________________

Compliance status-for DHS completion

Agency Check if the Check if NOT in Check if N/A

Required Documents needs to document compliance or document is to
provide to submitted is on add other be reviewed at
DHS only if file and in comments the Agency.
checked compliance Include date
when reviewed
Onsite

DHS Award letter

A Letter /list containing DHS contact persons
A copy of the Required Contract Documents Checklist
Two Standard Language Documents
A Signed/dated N.J.S.A.52:34-13.2 Certification form
(Formerly Executive Order 129)
A Signed/Dated P.L. 2005, Chapters 51 & 271 & Executive
Order 117.
Annex B, B-2 or Budget Summary
Annex A or Annex A Update
Performance Outputs/Outcomes
Copy of Insurance Declaration Page(s) and/or Malpractice
Insurance
Copy of Certificate of Incorporation
Board Resolution form with authorized Signatories
Board Resolution/DHS forms for match responsibilities
A dated current Board Members list
A copy of all applicable licenses
A list of all contracts and grants (if not on the Annex B)
A organizational structure chart
A copy of the Personnel Manual or Employee Handbook
Copy of the Certification of Employee Information Report or
recent completed Employee Information Report- AA302 form
Copy of the Provider’s Affirmative Action Policy
Copy of the Conflict of Interest Policy
Copy of Provider Agency’s By-Laws
A Signed/dated Business Associate Agreement (BAA), if
applicable
Copy of all local certificates of occupancy
Copy of Lease or Mortgage (s)
Copy of the Annual Report to the Secretary of State
Copy of the State of NJ Business Registration
Copy of the Annual Report-Charitable Organization
Copy of the latest Audit
Copy of Tax Exempt Form 990
Copy of U.S. Corporation Income Tax Return , form 1120
Copy of Procurement Policy
Current Equipment Inventory
Copy of Subcontracts/Consultant agreements
Copy of signed Payment Schedule, if applicable
Reports:
Programmatic
Fiscal
Close out

Other Departmental Component-specific documents (D.C. is

to specify documents):

7
 P1.01
Attachment 1

8
 Policy Circular P1.02

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Timely Execution, Renewal Conditions and Sanctions

for Contracts

EFFECTIVE: This policy circular shall become effective on

January 1, 2006 and shall then be implemented
immediately.

PROMULGATED: August 11, 2005

SUPERSEDES: Policy Circular P1.02, promulgated July 1, 1988

RELATED POLICY: Circular P1.01, Documents and Conditions Required

for Processing, Executing and Documenting a DHS
Third Party Contract.

The purpose of this circular is to advise Department personnel and

Provider Agencies of the documents and conditions required for the
timely execution for new and renewal Third Party Contracts.

I. SCOPE

This policy circular applies to all DHS Third Party Contracts

including both initial and renewal contracts.

II. POLICY

A. Time frames for DHS distribution and provider agency

submission of contract documents:

Contract renewal packages are to be sent out by the

Departmental Component at least three months prior to the
renewal date.

Completed contract packages are to be received by the

Departmental Component at least one month prior to the renewal
date.

B. Contract Renewal. Unless a contracted provider agency or

individual provider is otherwise notified in writing 60 days
prior to the end date of the current contract term it can be
assumed that the contract is to be renewed, subject to the
terms and conditions negotiated with the Departmental
Component.
 P1.02

2
 Policy Circular P1.03

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Charitable Registration and Investigation Act

EFFECTIVE: This policy circular shall become effective

immediately

PROMULGATED: May 1, 1995

SUPERSEDES: Policy Circular P1.03, promulgated July 1, 1988.

The purpose of this circular is to advise private non-profit

Provider Agencies of the necessity to be in compliance with the
Charitable Registration and Investigation Act of 1994, P.L. 1994
Chapter 16 (N.J.S.A. 45:17A-18 et seq.) The Act applies to non-
profits with fiscal years ending December 31, 1994 and
thereafter.

I. SCOPE

This policy circular applies to all private non-profit

Provider Agencies that contract with the Department of Human
Services.

II. POLICY

Private non-profit Provider Agencies must be in compliance

with the Charitable Registration and Investigation Act of
1994 and all reporting and auditing requirements of the
Division of Consumer Affairs, Office of Consumer Protection.

III. PROCEDURES

A. In accordance with Policy Circular P1.01, Contract

Proposal Process, the Provider Agency must make
available to the Department for review, documentation
that demonstrates its compliance with all conditions of
the Charitable Registration and Investigation Act
effective on August 10, 1994. A copy of the booklet
covering the Act can be obtained by writing the
Division of Consumer Affairs, Office of Consumer
Protection, P.O. Box 45021, Newark, NJ 07101 or by
telephoning (973) 504-6215.

B. Every registered organization, unless otherwise exempt,

is required to file an annual Registration Statement
with the Division of Consumer Affairs, Office of
 2 P1.03

Consumer Protection, Department of Law and Public

Safety within six months of the close of its fiscal
period.

Issued by:
 Policy Circular P1.04

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Request for Proposal

EFFECTIVE: This policy circular is effective November 16, 1998

with its adoption in the New Jersey Register and shall
be implemented immediately.

PROMULGATED: November 16, 1998

SUPERSEDES: Policy Circular P1.04, promulgated December 15, 1997.

The purpose of this circular is to establish procedures in accordance

with N.J.A.C. 10:3-3, Request for Proposal, when making a request for
proposal (RFP).

I. SCOPE

This policy circular applies to all Departmental Components, the

County Human Services Advisory Councils (CHSACs) and Designated
Entities when Departmental Components choose to issue an RFP, and
to all groups or entities responding to the Department's RFPs for
Contracts for the provision of third-party social services or
training. The RFP process shall not be required for renewal or
expansion of Department purchase of service contracts, unless the
Departmental Component determines to do so. This policy is
promulgated to provide a consistent approach to contracts which
do not fall within the parameters of the Bidding Law, N.J.S.A.
52:34-6 et seq., and as a supplement to the Publication of
Grants, N.J.S.A. 52:14-34.4,5,6.

II. DEFINITIONS

In addition to defined terms included in the Glossary of the

Manual, the following terms, when capitalized, shall have the
meanings as stated:

Applicant means the person, agency or entity responding to an

RFP.

County Human Services Advisory Councils (CHSACs) means councils

appointed by the government of each county to review county-
level human service activities and to serve as the primary
vehicle for local public input into New Jersey Department of
Human Services' decision making. The activities of the County
Human Services Advisory Councils include, but are not limited
to, the issuance, review and comment on human service proposals;
preparation of allocation plans; review of existing purchase of
service contracts; and coordination and consolidation of the
local human services delivery systems.
 2 P1.04

Designated Entity means that group or county board which has been
given the authority by the Department of Human Services to
solicit human service proposals for review and comment and
recommended acceptance for third-party social service Contracts.
Although the RFP is handled by a group other than the
Departmental Component, the Contract is signed and finalized by
the Departmental Component.

Minority means a person who is:

African-American, having origins in any of the black racial

groups in Africa;

Hispanic, having Spanish culture, with origins in Mexico,

South or Central America, or the Caribbean Islands,
regardless of race;

Asian-American, having origins in and of the original

peoples of the Far East, Southeast Asia, Indian sub-
continent, Hawaii, or the Pacific Islands; or

American Indian or Alaskan native (Native American), having

origins in any of the original peoples of North America and
who maintains cultural identification through tribal
affiliations or community recognition.

Minority Agency means a business or organization, profit or non-

profit, which is:

A sole proprietorship, partnership, or joint venture in

which at least 51% of the ownership interest is held by
minorities and the policy-making, management and daily
business operations are controlled by one or more of the
minorities who own it; or

A corporation or other business entity authorized under the

laws of the United States whereby 51% of the stockholders,
board of directors, ownership or management of daily
business operations is controlled by one or more minorities.

III. PROCEDURES

The Departmental Component and the CHSACs/Designated Entity shall

follow the procedures set forth in this circular when requesting
proposals for the provision of third-party social service or
training Contracts.

A. Request for Proposal

 3 P1.04

1. The Departmental Component or the CHSAC/Designated

Entity shall issue a public announcement of the
availability of funds for the purchase of services in
accordance with N.J.S.A. 52:14-34.4, 34.5, 34.6. The
announcement shall be made in a manner to permit
reasonable competition among eligible Provider
Agencies.

a. The Departmental Component shall publish the

announcement in:

1) the New Jersey Register, and

2) publications directed toward Minority

populations.

b. The Departmental Component may choose a second

notification regarding the RFP announcement as
follows:

1) mail the announcement to all known potential

Applicants, including those that may
provide similar, but not the specific
service requested, minority
organizations, and culturally diverse
and sensitive groups;

2) publish notices in newspapers of general

distribution; or

3) upload the notice of the RFP on the Human

Services On Line (HSOL) Web Page on the
internet to allow access to the information
by computer.

2. The Departmental Components may choose to have bidders'

conferences. Technical information regarding the RFP
may be disseminated at such a meeting.

3. The CHSACs/Designated Entities, at minimum, shall use

the standards set forth in this policy when they are
delegated the responsibility to solicit proposals for
the Department. The Department will be a signatory to
the contract in this instance. In all other instances,
the Departmental Component shall notify the
CHSAC/Designated Entity of the RFP, if appropriate.

4. The proposal process shall be completed within 120 days

of publication, inclusive of all the informal review
processes. See section III.K. below for exceptions.
 4 P1.04

5. Within 3 business days after a potential Applicant has

requested a proposal package, the Departmental
Component or the CHSAC/Designated Entity shall forward
a proposal package to or may be picked up by those
prospective Applicants responding to the public
announcement. In addition, when the CHSAC/Designated
Entity has been delegated the responsibility to
solicit proposals on behalf of the Department, all
appropriate Department procedures, as set forth in
this policy circular, and county procedures, as
appropriate, must be followed. The proposal package
shall contain, at minimum, the following information
and requirements:

a. the amount of funds available, the source of

funds, the purpose, scope, and goals of the
programs and services solicited, and any specific
conditions, requirements, and/or constraints such
as spending caps or Match requirements;

b. all requirements which must be fulfilled for the

proposal to be evaluated;

c. the type of Provider Agencies eligible to submit

a proposal for consideration;

d. a request for a list of the board of directors and

officers of the Applicant agency;

e. the address/number to which the proposal is to be

sent, the submission deadline (time and date)
after which no applications will be accepted, time
frames for review of the proposal and awarding of
Contracts, and the target date for implementation;

f. the name and address of a contact person who can

provide technical assistance;

g. funding proposal evaluation criteria as delineated

in Section III.D. below;

h. a disclaimer stating the following: "The

Department reserves the right to reject any and
all proposals when circumstances indicate that it
is in its best interest to do so. The
Department's best interests in this context,
include, but are not limited to, loss of funding,
inability of the Applicant to provide adequate
services, indication of misrepresentation of
information and/or non-compliance with State and
federal laws and regulations, any existing
 5 P1.04

Department Contracts, and procedures set forth in

this policy circular”;

i. The following statements:

1) It is anticipated that the resulting contract

will contain approximately dollars
in funding;

2) Needed for the privatization of State

service/program only:

a) in accordance with guidelines

established by the New Jersey Executive
Commission on Ethical Standards, be
advised that Department employees or
former employees are eligible to submit
proposals to this RFP; and

b) These services were previously State

operated. Therefore, if awarded this
contract, your provider agency may be
responsible to maintain, administer and
dispose of public records previously
maintained by the State of New Jersey as
defined by N.J.S.A. 47:3-16 and must
agree to do so under the terms of the
contract.

j. the appropriate information, forms and a list of

required supporting documents as included in
Section III.D. below;

k. a copy of Executive Order No. 189 (1988) regarding

conflict of interest, Attachment A;

l. a list of depository libraries throughout the

State (see Information Memorandum P89-1) where
Applicants may review the Department's Contract
Reimbursement Manual and Contract Policy and
Information Manual prior to responding to the RFP;

m. the terms and conditions which must be met to

comply with specific funding requirements and
Department contracting rules and regulations, such
as the Standard Language Document, the
Department's Contract Reimbursement Manual and
Contract Policy and Information Manual; and

n. the Statement of Assurances and the requirement

that it must be properly signed by the Chief
 6 P1.04

Executive Officer or equivalent and returned with

the application package. See Appendix B.

o. statement explaining the informal review process

and that requests for reviews to the -

1) Departmental Component must be completed

within the time frame specified in the RFP or
within 30 Days after receipt of the
CHSAC/Designated Entity recommendation, and

2) CHSAC/Designated Entity must be completed

within the 90-Day CHSAC process time period
and prior to the recommendations being sent
to the Departmental Component.

B. Sole Source Services

Where there is none or only one response to the RFP, after

specifications of the RFP have been cited and all criteria
of this policy have been met, documentation of any and all
efforts to obtain multiple responses shall be kept in the
Department RFP file. Documentation shall also be retained
of every contact made by the Departmental Component or
CHSAC/Designated Entity to find a Provider Agency to fulfill
the required services.

C. Internal Controls for Proposals

1. The Departmental Component or CHSAC/Designated Entity

shall maintain all correspondence to and from the
Departmental Component or CHSAC/Designated Entity,
whichever is applicable, in a file retained in the
individual program RFP records.

2. Correspondence shall be kept in a file by a staff

person different from the staff personnel who are on
the review panel and participating in the review and
selection process.

3. The following information, at minimum, shall be

maintained by the responsible unit:

a. name of the program;

b. submission deadline date;

c. date the completed proposal is received from the

Applicant;
 7 P1.04

d. name of the Department or CHSAC/Designated Entity

staff person receiving the proposal for review and
selection;

e. decision of the review panel in awarding the

Contract; and

f. date the decision letter notifying the Applicant

of acceptance or rejection was sent.

4. All proposal packages are to be sent to Applicants via

first class mail, hand delivered or picked up in
person, as decided by the Departmental Component, to
ensure timely receipt by the Applicant.

5. Proposal packages from Applicants are to be date and

time stamped upon receipt.

6. All decision letters concerning acceptance and

rejection shall have the same date and shall be mailed
via first class mail on that day.

7. When a CHSAC/Designated Entity is handling the RFP

process, all documentation shall be forwarded to the
Departmental Component responsible for finalizing the
Contract for final approval and retention.

8. The Departmental Component shall communicate to the

CHSAC/Designated Entity the outcome of any Departmental
Component informal review on an CHSAC/Designated Entity
RFP and forward a copy of the final award letter.

9. When the RFP is for the privatization of DHS

services/programs, the Departmental Components must
ensure that:

a. Department employees intending to bid on a

privatization Contract notify the New Jersey
Executive Commission on Ethical Standards
(Commission) in writing, with a copy to
Departmental Component management, as soon as
possible and before the application deadline.

b. the Departmental Component director or other

designated operations officer shall submit an
affidavit to the Commission, stating that the
named employee(s) had no substantial involvement
in any of the following:

1) the decision to privatize the service/program

or the on-going privatization process,
 8 P1.04

2) the preparation of the RFP, and

3) the evaluation of the bids;

c. the Privatization Participation Documentation

Form, Attachment C, is completed, thus identifying
all persons involved with the privatization
project and those eligible to respond to the RFP;

d. the Departmental Component shall maintain records

identifying all individuals involved in the
privatization process, including but not limited
to, the employee's letter to the Executive
Commission on Ethical Standards, the affidavit,
and a list of all persons working on the
privatization project;

e. when the situation warrents, a blind review may be

appropriate.

D. Funding proposal program summary and evaluation data; list

of required information

The funding proposal requirements shall apply to all

proposals submitted to a Departmental Component or
CHSAC/Designated Entity. Each proposal submitted to a
Departmental Component or CHSAC/Designated Entity shall
contain the following:

1. the funding proposal cover sheet, which shall include

at minimum:

a. incorporated name of the Agency,

b. Agency type (i.e., profit, non-profit, hospital-

based, public)

c. federal ID,

d. Charities Registration number (if applicable),

e. address,

f. contact person - name, title, phone number, fax

number and E-mail address (if applicable),
g. total dollar amount requested,

h. fiscal year end, and,

i. an authorization signature of the Chief Executive

Officer to submit the proposal.
 9 P1.04

2. a brief statement on the Applicant's mission and goals

- history, purpose, goals and objectives.

3. as requested by the Departmental Component, a need

justification - a description of the basis for
concluding that each of the proposed service(s) is
needed in the community and the factors that make the
Applicant the most capable of providing the service(s),
which may include:

a. nature of the problem;

b. existing services;

c. current statistics;

d. current studies that have been conducted, either

within the community or state-wide, relevant to
the services being requested in the proposal;

e. Applicant's capability to provide the same or

similar services as those existing in the
community and/or the Applicant's capability to
provide a new type of service not currently
available in the community; and

f. target population and characteristics.

4. geographic areas to be serviced.

5. specific information regarding -

a. the service goals and objectives including a

description of what is to be gained by the clients
or the provision of the service, and

b. the manner in which service outcome objectives

will be measured.

6. if the client population to be served requires limited

English speaking and/or bicultural services, describe
how access to the program, the program itself,
outreach, and referral are culturally relevant and
linguistically appropriate for the population to be
served, including the client and family.

7. an indication of those services that will require a

subcontract for provision of the services requested
including a list of the subcontracts by Provider
Agency, if known.

8. a program approach, including the following -

 10 P1.04

based on the parameters set forth in the RFP, an

overview of the total service package including a
description of how the services will be implemented and
the time frames involved. The narrative shall address
client population and geographic areas served; and for
each component of the program package, the following
information shall be provided as indicated:

a. a description of the service activities or methods

that will be employed to achieve the service
objective;

b. a description of how the agency will oversee the

operation, the procedures utilized for monitoring
the performance of the service activities, and how
it will measure and evaluate the quality of
service;

c. as needed, a definition of each service component

to be provided, including the purpose and goal of
each;

d. if applicable, an indication of the number, skills

and qualifications of the staff that will perform
the above service activities, as well as the use
of any volunteers. A table of organization for
administration and personnel position titles, and
job descriptions for each position shall be
included;

e. if there are fees, a description of fees for

service, sliding fee schedules and waivers of
fees; and

f. as appropriate, a description of client data to be

recorded, the use of this data by the Applicant,
the means of maintaining confidentiality of client
records and data, and the retention schedule of
client records and schedule for destruction.

9. information on the accessibility of services, when

specified by the Departmental Component, such as -

a. the hours and days that each service will be

available to clients, including how emergencies
are handled; for example, closings, client crisis,
after-hours contacts;

b. a list and description of the location(s) where

each service will be provided to clients
 11 P1.04

(including in-home services, if that is an

option);

c. a description of transportation options for

clients in obtaining each service; and

d. a description of handicapped accessibility

accommodations.

10. as needed, the eligibility requirements and referral

processes, such as -

a. a description of the priorities for accepting

clients into the program and the procedures to be
followed to ensure that all clients meet the
eligibility requirements for admission;

b. an explanation of intake procedures;

c. an explanation of referral mechanisms and

processes (formal and informal) and community
outreach procedures. Describe the accommodations
made for non-English speaking individuals; and

d. as appropriate, termination procedures, including

a list of the various reasons for termination, a
description of the termination procedures (client-
and program-initiated), the appeals process, and
follow-up services; as well as how non-English
speaking persons are accommodated in this process,
shall be included.

11. dependent upon the service requested, an indication of

the level of service anticipated throughout the
contract period; for example, the number of clients to
be served, number of meals served, round trips for
transportation, hours.

12. when requested by the Departmental Component in the

RFP, information on service coordination, specify
ancillary agencies that will be frequently utilized in
combination with the service being proposed for
funding, including any already existing relationships
and agencies which will be referral sources for these
services, including how formal coordination and
referral agreements will be accomplished. A commitment
letter and/or an affiliation agreement should also be
requested.

13. when requested by the Departmental Component in the

RFP, information on current programs managed by the
Applicant and the funding sources;
 12 P1.04

14. a completed budget proposal, Annex B, B-2 or a budget

appropriate to the service(s) being requested and a
statement indicating the anticipated startup costs for
the service;

15. a signed debarment certification statement (Attachment

D) that the applicant is not debarred, suspended,
proposed for debarment, declared ineligible, or
voluntarily excluded from federally funded contracts.

In addition, if awarded the Contract, the Applicant

must have a signed copy of Attachment D on file for all
subcontracted funds.

16. a checklist shall be maintained by the responsible unit

or the review panel chairperson regarding receipt of
the following information. This information need only
be reviewed by the responsible unit or the chairperson
for receipt and completeness and then maintained in the
RFP file. A copy of the checklist may be distributed
to the review panel to assure them the proposal is
complete.

a. a copy of the Applicant's present organizational

chart;

b. a copy of the most recent organization-wide audit

report;

c. a copy of the Applicant's code of ethics and/or

conflict of interest policy;

d. a list of the board of directors, officers and

terms of office of each;

e. documentation of the Applicant's charitable

registration status;

f. a copy of the Applicant’s certificate of

incorporation;

g. original and/or copies of letters of commitment

from the collaborators; and

h. a list of the name(s) and address(es) of those

entities providing support and/or money to help
fund the program for which the proposal is being
made.

E. Composition of the review panel

 13 P1.04

1. The unit responsible for RFP coordination shall convene

a review panel of at least three persons to assess,
rate and rank proposals to recommend an Applicant for
funding. The panel shall be broadly representative and
culturally diverse. In no case shall any panel convene
absent representation of one minority, including that
of the CHSAC or the Designated Entity. The responsible
unit shall present an objective process to the review
panel for the purpose of rating the proposals.

2. A panel member must disqualify himself or herself from

the panel when he or she has any interest, financial or
otherwise, direct or indirect, in the results of the
panel's evaluations (see Conflict of Interest Law,
N.J.S.A. 52:13D-12 et seq.)

3. The panel should consist of a diverse group of people

having expertise in areas such as contracting, finance,
and programs/services. Members may include DHS
regional and county representatives, community
representatives and clients/consumers; or an
allocations review panel under the auspices of the
CHSAC/Designated Entity.

4. The rating system to be used in evaluating criteria,

such as numeric, will generally be determined by the
responsible unit.

5. Recommendations of the panel are regarded as

confidential until the awards are publicly announced.

F. Evaluation of the proposal

1. All meetings of the review panel shall have

documentation, including a summary of the results of
the meeting.

2. The evaluation of Applicants' proposals shall be in

writing using a pre-established evaluation form that
explains the rating system used for the evaluation.

3. Proposals shall be evaluated by a review panel to

ensure satisfactory documentation, capability, clarity,
reasonableness and consistency with the needs and
requirements of the RFP.

G. Evaluation of the Applicant

The Applicant shall be evaluated to determine the following,

an on-site evaluation may be conducted by the Departmental
Component or CHSAC/Designated Entity, if deemed necessary.
The CHSAC/Designated Entity shall evaluate the Applicant on
 14 P1.04

only those factors with which they are familiar or about

which they have accurate information. The Departmental
Component is responsible for evaluation of all information
presented by the Applicant as specified in the RFP. The
following should be included in the presentation:

1. ability to comply with all terms and conditions of the

Standard Language Document and its associated annexes
and the Department's Contract Reimbursement Manual and
Contract Policy and Information Manual;

2. prior history in the delivery of the same or similar

services;

3. qualifications of staff;

4. adequacy of facilities;

5. ability to manage the fiscal aspects of the Contract,

including a satisfactory past history (a pre-award
survey may be necessary prior to the signing of the
Contract);

6. ability of the program and management initiatives to

ensure accountability of the staff, for example,
supervision and training of staff, planned levels of
service, and contingency plans to ensure attainment of
objectives;

7. evidence of ability (including satisfactory past

performance and evaluation) to provide the proposed
services to the target population, including limited
English proficient and bicultural populations;

8. evidence of the existence of adequate resources,

facilities, and equipment to operate the proposed
program;

9. review of required documents; and

10. opinions of references or other agencies that contract

with the Applicant.

H. Notification of Decision

1. Upon determining which proposals are most responsive

and advantageous to the needs of the clients to be
served or services to be rendered, costs and other
factors considered, the Departmental Component shall
notify all Applicants in writing of its selection
within the time frames specified in the request for
proposal, not to exceed 90 Days from publication in the
 15 P1.04

New Jersey Register. The informal review process must

be completed in a time frame appropriate to the
Departmental Component’s policies which are referenced
in the RFP, and the total RFP process may not exceed
120 days from publication in the New Jersey Register.

2. Acceptance letters shall indicate that:

a. the award is contingent on Contract negotiation

and that if, anytime before or during the Contract
negotiations, it is found that the Applicant
awarded the Contract is incapable of providing the
necessary services or has misrepresented any
material fact or its ability to handle the funding
or provide the solicited services, the award may
be rescinded. The rescission shall be made in
writing, specifying why the award has been
withdrawn.

b. the Contract is not binding until funding has been

verified and the Department's Standard Language
Document and the Contract confirmation letter are
signed by both parties.

I. Retention of Documentation

Awarded Contracts, signed originals, all support materials

and the record copy shall be retained by the Departmental
Component for 3 years after the termination of the Contract
and 4 years thereafter at the records center prior to
destruction. Unsuccessful proposals shall be retained for 3
years by the Departmental Component and then may be
destroyed. The materials to be retained include the RFP,
the Applicant’s proposals, all evaluation sheets,
documentation from review panel meetings, all privatization
documentation, and any other documentation which details why
the agency was selected or not selected.

J. Contract Negotiations

At the time an award is made to the Applicant, negotiations

shall proceed with the process of preparing and submitting a
formal Contract proposal package to the Department in
accordance with Department of Human Services Policy Circular
P1.01, Contract Proposal. The initial proposal as modified
and agreed to by both parties may serve as the initial Annex
A, program description (see the Contract Reimbursement
Manual and Contract Policy and Information Manual) for the
Contract.

K. Exceptions to Procedures
 16 P1.04

1. The 120 day limitation may be adjusted accordingly by

the Departmental Component if:

a. the announcement of the availability of funds

limits the Department to less than 90 Days for
allocation, obligation, and/or expenditure of
funds, or

b. the process requires an extension because of the

services being requested or unforeseen
circumstances.

2. When there is an emergent danger and/or risk to the

health and welfare of clients as a result of strict
adherence to this policy circular, an exemption from
the full RFP process may be granted and signed by the
person in charge of the Departmental Component.

Issued by:
 P1.04
Attachment A

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

ADDENDUM TO REQUEST FOR PROPOSAL

FOR SOCIAL SERVICE AND TRAINING CONTRACTS

Executive Order No. 189 establishes the expected standard of

responsibility for all parties that enter into a contract with the
State of New Jersey. All such parties must meet a standard of
responsibility which assures the State and its citizens that such
parties will compete and perform honestly in their dealings with the
State and avoid conflicts of interest.

As used in this document "provider agency" or "provider" means

any person, firm, corporation, or other entity or representative or
employee thereof which offers or proposes to provide goods or services
to or performs any contract for the Department of Human Services.

In compliance with Paragraph 3 of Executive Order No. 189, no

provider agency shall pay, offer to pay, or agree to pay, either
directly or indirectly, any fee, commission, compensation, gift,
gratuity, or other thing of value of any kind to any State officer or
employee or special State officer or employee, as defined by N.J.S.A.
52:13D-13b and e, in the Department of the Treasury or any other
agency with which such provider agency transacts or offers or proposes
to transact business, or to any member of the immediate family, as
defined by N.J.S.A. 52:13D-13i, of any such officer or employee, or
any partnership, firm, or corporation with which they are employed or
associated, or in which such officer or employee has an interest
within the meaning of N.J.S.A. 52:13D-13g.

The solicitation of any fee, commission, compensation, gift,

gratuity or other thing of value by any State officer or employee or
special State officer or employee from any provider agency shall be
reported in writing forthwith by the provider agency to the Attorney
General and the Executive Commission on Ethical Standards.

No provider agency may, directly or indirectly, undertake any

private business, commercial or entrepreneurial relationship with,
whether or not pursuant to employment, contract or other agreement,
express or implied, or sell any interest in such provider agency to,
any State officer or employee or special State officer or employee
having any duties or responsibilities in connection with the purchase,
acquisition or sale of any property or services by or to any State
agency or any instrumentality thereof, or with any person, firm or
entity with which he is employed or associated or in which he has an
interest within the meaning of N.J.S.A. 52:13D-13g. Any relationships
subject to this provision shall be reported in writing forthwith to
the Executive Commission on Ethical Standards, which may grant a
waiver of this restriction upon application of the State officer or
employee or special State officer or employee upon a finding that the
present or proposed relationship does not present the potential,
actuality or appearance of a conflict of interest.
 P1.04
Attachment A

No provider agency shall influence, or attempt to influence or

cause to be influenced, any State officer or employee or special State
officer or employee in his official capacity in any manner which might
tend to impair the objectivity or independence of judgment of said
officer or employee.

No provider agency shall cause or influence, or attempt to cause

or influence, any State officer or employee or special State officer
or employee to use, or attempt to use, his official position to secure
unwarranted privileges or advantages for the provider agency or any
other person.

The provisions cited above shall not be construed to prohibit a

State officer or employee or special State officer or employee from
receiving gifts from or contracting with provider agencies under the
same terms and conditions as are offered or made available to members
of the general public subject to any guidelines the Executive
Commission on Ethical Standards may promulgate.
 P1.04
Attachment B
Department of Human Services
Statement of Assurances

As the duly authorized Chief Executive Officer/Administrator, I am aware that submission to the Department of Human Services of the
accompanying application constitutes the creation of a public document and as such may be made available upon request at the
completion of the RFP process. This may include the application, budget, and list of applicants (bidder’s list). In addition, I certify
that the applicant:

• Has legal authority to apply for the funds made available under the requirements of the RFP, and has the institutional, managerial
and financial capacity (including funds sufficient to pay the non Federal/State share of project costs, as appropriate) to ensure
proper planning, management and completion of the project described in this application.

• Will give the New Jersey Department of Human Services, or its authorized representatives, access to and the right to examine all
records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with
Generally Accepted Accounting Principles (GAAP). Will give proper notice to the independent auditor that DHS will rely upon
the fiscal year end audit report to demonstrate compliance with the terms of the contract.

• Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance
of personal or organizational conflict of interest, or personal gain. This means that the applicant did not have any involvement in
the preparation of the RFP, including development of specifications, requirements, statement of works, or the evaluation of the
RFP applications/bids.

• Will comply with all federal and State statutes and regulations relating to non-discrimination. These include but are not limited to:
1.) Title VI of the Civil Rights Act of 1964 (P.L. 88-352;34 CFR Part 100) which prohibits discrimination on the basis of race,
color or national origin; 2.) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794; 34 CFR Part 104), which
prohibits discrimination on the basis of handicaps and the Americans with Disabilities Act (ADA), 42 U.S.C. 12101 et. seq.; 3.)
Age Discrimination Act of 1975, as amended (42 U.S.C. 6101 et. seq.; 45 CFR part 90), which prohibits discrimination on the
basis of age; 4.) P.L. 2975, Chapter 127, of the State of New Jersey (N.J.S.A. 10:5-31 et. seq.) and associated executive orders
pertaining to affirmative action and non-discrimination on public contracts; 5.) federal Equal Employment Opportunities Act;
and 6.) Affirmative Action Requirements of PL 1975 c. 127 (NJAC 17:27).

• Will comply with all applicable federal and State laws and regulations.

• Will comply with the Davis-Bacon Act, 40 U.S.C. 276a-276a-5 (29 CFR 5.5) and the New Jersey Prevailing Wage Act, N.J.S.A.
34:11-56.27 et. seq. and all regulations pertaining thereto.

• Is in compliance, for all contracts in excess of $100,000, with the Byrd Anti-Lobbying amendment, incorporated at Title 31 U.S.C.
1352. This certification extends to all lower tier subcontracts as well.

• Has included a statement of explanation regarding any and all involvement in any litigation, criminal or civil.

• Has signed the certification in compliance with federal Executive Orders 12549 and 12689 and State Executive Order 34 and is
not presently debarred, proposed for debarment, declared ineligible, or voluntarily excluded. Will have on file signed
certifications for all subcontracted funds.

• Understands that this provider agency is an independent, private employer with all the rights and obligations of such, and is not a
political subdivision of the Department of Human Services.

• Understands that unresolved monies owed the Department and/or the State of New Jersey may preclude the receipt of this award.

Applicant Organization Signature: Chief Executive Officer or Equivalent

Date Typed Name and Title

6/97
 P1.04
Attachment C

Privatization Participation Documentation Form

Departmental Component: Section/Unit:

Program/Service: Privatization Decision Date:

List all Involved in the Involved in the Involved in the For Whom an
Persons: Decision to Preparation of the Evaluation of the Affidavit was
Privatize RFP Bids submitted to the
Ethical Commission

Name:
Position:

Name:
Position:

Name:
Position:

Name:
Position:

Name:
Position:

Name:
Position:

Prepared by: Date:

(PRINT)
Title: Telephone #:
CPMU 4/95 Page of
 P1.04
Attachment D

READ THE ATTACHED INSTRUCTIONS BEFORE SIGNING THIS CERTIFICATION.

THE INSTRUCTIONS ARE AN INTEGRAL PART OF THE CERTIFICATION.

Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion
Lower Tier Covered Transactions

1. The prospective lower tier participant certifies, by submission of

this proposal, that neither it nor its principals is presently
debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from participation in this transaction by
an Federal department or agency.

2. Where the prospective lower tier participant is unable to certify

to any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

Name and Title of Authorized Representative

Signature Date

This certification is required by the regulations implementing

Executive order 12549, Debarment and Suspension, 29 CFR Part 98,
Section 98.510
 P1.04
Attachment D

Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion
Lower Tier Covered Transactions

Instructions for Certification

1. By signing and submitting this proposal, the prospective lower

tier participant is providing the certification set out below.

2. The certification in this clause is a material representation of

facts upon which reliance was placed when this transaction was
entered into. If it is later determined that the prospective
lower tier participant knowingly rendered an erroneous
certification, in addition to other remedies available to the
Federal Government the department or agency with which this
transaction originated may pursue available remedies, including
suspension and/or debarment.

3. The prospective lower tier participant shall provide immediate

written notice to the person to which this proposal is submitted
if at any time the prospective lower tier participant learns that
its certification was erroneous when submitted or had become
erroneous by reason of changed circumstances.

4. The terms covered transaction, debarred, suspended, ineligible,

lower tier covered transaction, participant, person, primary
covered transaction, principal, proposal, and voluntarily
excluded, as used in this clause, have the meaning set out in the
Definitions and Coverage sections of rules implementing Executive
Order 12549. You may contact the person to which this proposal
is submitted for assistance in obtaining a copy of those
regulations.

5. The prospective lower tier participant agrees by submitting this

proposal that, should the proposed covered transaction be entered
into, it shall not knowingly enter into any lower tier covered
transaction with a person who is proposed for debarment under 48
CFR part 9, subpart 9.4, debarred, suspended, declared
ineligible, or voluntarily excluded from participation in this
covered transaction, unless authorized by the department or
agency with which this transaction originated.

6. The prospective lower tier participant further agrees by

submitting this proposal that it will include this clause titled
 P1.04
Attachment D

“Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion--Lower Tier Covered Transaction,” without
modification, in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.

7. A participant in a covered transaction may rely upon a

certification of a prospective participant in a lower tier covered
transaction that it is not proposed for debarment under 48 CFR
part 9, subpart 9.4, debarred, suspended, ineligible, or
voluntarily excluded from covered transactions, unless it knows
that the certification is erroneous. A participant may decide the
method and frequency by which it determines the eligibility of its
principals. Each participant may, but is not required to, check
the List of Parties Excluded from Federal Procurement and
Nonprocurement Programs.

8. Nothing contained in the foregoing shall be construed to require

establishment of a system of records in order to render in good
faith the certification required by this clause. The knowledge
and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary
course of business dealings.

9. Except for transactions authorized under paragraph 5 of these

instructions, if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person who is
proposed for debarment under 48 CFR part 9, subpart 9.4,
suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies
available to the Federal Government, the department or agency
with which this transaction originated may pursue available
remedies, including suspension and/or debarment.
 Policy Circular P1.05

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Concurrent Contract Term and Provider Agency

Fiscal Year

EFFECTIVE: This policy circular shall become effective on

July 1, 1988, and shall be implemented
immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular P1.05, promulgated September 15,

1984.

The purpose of this circular is to ensure that Contract terms are

concurrent with the Provider Agency's fiscal year.

I. SCOPE

This policy circular applies to all Cost-related

Contracts.

II. POLICY

A. It is the goal of the Department to make the terms of

every Cost-related Contract concurrent with the
Provider Agency's fiscal year. Such alignment will
facilitate the single audit concept, eliminate
duplicate expenditure reporting, and establish
consistency with the Provider Agency's books, records
and annual financial statement.

1. One-year Term Contract

The Contract term and Provider Agency's fiscal

year shall be concurrent.

2. Two-year Term Contract

The Contract term shall be concurrent with the two

fiscal years of the Provider Agency.

B. The Department shall not require any Provider Agency to

change its fiscal year.
 2 P1.05

III. PROCEDURES

A. In order to implement this policy, the Department may:

1. write a Contract with a less than or more than

one-year term, with the date of Termination and
the date of the Provider Agency's fiscal-year-end
being the same date; or

2. modify the term of the current Contract, in

accordance with Policy Circular P1.10, Contract
Modification, in order to make the successor
Contract concurrent with the Provider Agency's
fiscal year.

B. If implementation of this policy would produce an undue

hardship for a Provider Agency or the Department, the
appropriate Departmental Component must make a written
request to the Contract Policy and Management Unit for
an exception. Any such request must include adequate
explanation and documentation to support an exception
to this policy. An exception will be granted only in
extraordinary situations.

Issued by:
 Policy Circular P1.06

State of New Jersey

Department of Human Services

SUBJECT: Standardized Board Resolution Form

EFFECTIVE: This policy shall become effective August 1, 2009.

PROMULGATED: July 20, 2009

SUPERCEDES: Standardized Board Resolution Form, promulgated

November 21, 2007

PURPOSE: The purpose of this policy circular is to standardize the

content of the Provider Agency Board Resolutions across all Department
of Human Services (DHS) Departmental Components to assure that all of
the required obligations are identified and committed to by the
Provider Agency Board.

I. SCOPE

This policy circular applies to all DHS Third Party incorporated

contracted Provider Agencies, Universities/Colleges and for-
profit organizations.

II. POLICY

Periodically Boards of Directors in conducting the business of

their organizations attest to their actions or decisions by way
of written resolutions. The DHS requires Contract Providers to
complete and file the attached standard board resolution when
executing a DHS Third Party Social Service Contract.

A. Requirements for completion, updating and submission

The Attachment I, Page 1 is to be completed by the Agency

and the same for Attachment II.

When any changes occur which would affect the contents of

the form, the Board is to convene and complete a new Board
 P1.06
Resolution and submit it to the Departmental Component
within 10 business days of the change unless otherwise
specified in the DHS policy.

The completed form is to be returned to the Departmental

Component with all other required contract documents as part
of the contract package. (See Policy Circular P1.01,
Documents and Conditions Required for Processing, Executing
and Documenting a DHS Third Party Contract.)

Issued by:

Chief of Staff
Department of Human Services
 Policy Circular P1.06
Attachment I
STANDARDIZED BOARD RESOLUTION

The Board endorses the following commitments as defined in this

document:

1. Health Insurance Portability and Accountability Act (HIPAA)*

Specific to HIPAA (Health Insurance Portability and

Accountability Act), the above noted Provider Agency is either
(check A or B):

___ A) a covered entity (as defined in 45 CFR 160.103)

___ B) a non-covered entity and has executed a DHS Business

Associate Agreement (BAA) last dated ________.

___ C) a non-covered entity that will not be receiving or sharing

personal health information.

Once executed, the BAA will be included in the Departmental

Component’s official contract file. The BAA will be considered
applicable indefinitely unless there is a change in the Provider
Agency’s status, information or the content of the BAA, in which
case it is the responsibility of the contracted Provider Agency
to revise the BAA.

The Board agrees that if there is any change in their BAA Status
the Departmental Component will be immediately notified and the
appropriate information provided within 10 business days.

* This section is not applicable for DCF Office of Education

Contracts.

2. Legal Advice

The Board acknowledges that the Department of Human Services does

not and will not provide legal advice regarding the contract or
about any facet of the relationship between the Department of
Human Services and the Provider Agency. The Board further
acknowledges that any and all legal advice must be sought from
the Provider Agency's own attorneys and not from the Department
of Human Services.

Page 1 of 1
 P1.06
Attachment II

DEPARTMENT OF HUMAN SERVICES (DHS)

Standardized Board Resolution Form

Supporting Information for Contract # _______________ for Contract

Period _________________________ to ______________________________.

Agency: ___________________________________________________________

Certification:

We certify that the information contained in, or included with, this

contract document is accurate and complete.

__________________________________ __________________________
Chairperson, Board of Directors Date

__________________________________ ___________________________
Executive Director Date

Authorized Signatories for Contract documents, checks and invoices

are: (List full name and title)(add additional pages, if needed)

__________________________________ _________________________________
Name Title

__________________________________ _________________________________
Name Title

__________________________________ _________________________________
Name Title

Page 1 of 1
 Policy Circular P1.09

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: The Acquisition, Affiliation, Consolidation, or

Merger of a Provider Agency

EFFECTIVE: September 1, 1997

PROMULGATED: September 1, 1997

The purpose of this policy circular is to establish Department policy

and procedures regarding the continuation of a Contract when a Provider
Agency Acquisition, Affiliation, Consolidation, Merger, etc. occurs.

I. SCOPE

This policy circular applies to all Provider Agency Contracts that

are affected by an Acquisition, Affiliation, Consolidation,
Merger, etc. Other synergies and corporate takeovers, although
not defined in this circular, do not preclude this circular from
applying to those situations.

II. DEFINITIONS

In addition to the defined terms included in the Glossary of the

Manual, the terms listed below, when capitalized, shall have
meanings as stated.

Acquiring Organization means the business entity that

acquires, affiliates, consolidates, merges, etc. with a Provider
Agency.
Acquisition means the takeover of one corporation by another,
if both parties retain their legal existence after the
transaction.

Affiliation means the association of two or more entities for

the advancement of a specific goal or purpose.

Consolidation occurs when two or more corporations cease to

exist, and by the same process a new one is created, taking over
the assets and assuming the liabilities of those passing out of
existence.

Marketable Asset means any item of value that can be sold,

bartered or traded.

Merger occurs where one corporation absorbs another of

relatively equal size and importance and remains in existence
while the other is dissolved.
 2 P1.09

Transfer of Governing Board occurs when the Provider Agency

remains intact, but assigns control or governance to a new entity
or Governing Board.

Umbrella Organization means an affiliation among two or more

business entities whereby each remains distinct, but join to form
a new collective directing organization. The new organization may
be given management or service control, without acquiring the
assets or liabilities of the existing entities.

III. POLICY

A. A Department Contract is not a Marketable Asset that may be

purchased from a Provider Agency by another organization
through an Acquisition, Affiliation, Consolidation, Merger,
etc. Because a Department Contract is a negotiated
instrument that establishes responsibilities between the
Department and the Provider Agency, the Department is
contractually obligated to the original signatory party(ies)
only. If a Provider Agency is merged with, consolidated
with, enters into any form of Affiliation, such as an
umbrella arrangement, etc., or is otherwise acquired by
another organization, the Department is not obligated to
honor the conditions, terms, or fiscal arrangements of the
Contract or assume any of the liabilities of the Acquiring
Organization.

B. Department Contracts are not automatically assignable or

assumable by the Acquiring Organization, and consent, in
writing, for the transfer or renewal of any and all Contract
rights is required from the Departmental Component(s) by the
Acquiring Organization.

C. Any anticipated change(s) in the corporate or legal status of

a Contract signatory during the Contract term shall be
transmitted, in writing, to the Departmental Component(s) at
least 90 Days prior to the intended change(s) or takeover.

D. Whenever an Acquiring Organization acquires, affiliates,

consolidates, merges, etc. with a Provider Agency, the
Departmental Component may:

1. Continue the current Contract with the Acquiring

Organization and modify the Contract in accordance with
Contract Modification Policy Circular P1.10.

2. Continue the Contract on a conditional basis as

stipulated in a Contract Modification, provided that the
Acquiring Organization complies with all conditions
indicated within the specified time frames established
by the Departmental Component in the Contract
Modification.
 3 P1.09

3. Terminate the current Contract based on an evaluation of

the criteria and documentation submitted in accordance
with Section IV. of this circular and issue a Request
for Proposal (RFP) according to Department Policy
Circular P1.04.

E. The Department reserves the right to issue a Request For

Proposal (RFP) for any subsequent renewal Contracts when an
Acquisition, Affiliation, Consolidation, Merger, etc. occurs.

F. Although title to all Equipment purchased through a

Department Contract rests with the Provider Agency, the
Department’s equitable interest in that Equipment does not
end or diminish with an Acquisition, Affiliation,
Consolidation, Merger, etc. In addition, the Department has
the right to require the transfer of any Equipment directly
to the Department or to an eligible non-State party
designated by the Department.

G. Failure to submit the documentation required as outlined in

Section IV. of this circular will result in a delay in the
Departmental Component rendering a final decision on Contract
continuation.

IV. PROCEDURES

A. Whenever an Acquisition, Affiliation, Consolidation, Merger,

etc. is anticipated, the Acquiring Organization and/or
Provider Agency should provide the required information
listed below. Time frames listed below are approximate due
dates and refer to Days before the intended Contract takeover
date.

90 Days

A Provider Agency shall notify the contracting Departmental

Component(s), in writing, of the anticipated takeover date of
the Acquisition, Affiliation, Consolidation, Merger, etc.
The Notification shall be accompanied by a dated copy of the
Provider Agency’s Board minutes indicating that the Board has
discussed the intended Acquisition, Affiliation,
Consolidation, Merger, etc.

The minutes shall include the results of the approval vote

and any other pertinent information. Such information shall
include, as a minimum, a written statement, signed by the
Provider Agency Chief Executive Officer, that establishes the
name of the Acquiring Organization and the exact date of the
intended Acquisition, Affiliation, Consolidation, Merger,
etc.
 4 P1.09

75 Days

A Board resolution by the Acquiring Organization must be

received by the Departmental Component(s) prior to the
projected take over of the Contract indicating its desire for
a continuance of the Department of Human Services Contract.
The Board shall also submit, at the same time, correspondence
on company letterhead indicating the authorized signatories
for Contracts, invoices and checks. In addition, the
Acquiring Organization shall submit:

1. A plan explaining how the Acquiring Organization will

effect the Acquisition, Affiliation, Consolidation or
Merger including safeguards to be taken to protect
contracted services.

2. A plan outlining how the Acquiring Organization will

notify current clients served under the existing
Contract including any impact on the clients.

This information shall be retained on file by the

Departmental Component(s) for reference.

60 Days

The following information must be submitted by the Acquiring

Organization to the Departmental Component(s) for review
before a determination can be made regarding a continuation
of the current Contract.

1. Required Acquiring Organization documents shall be

current and attested to regarding their validity, in
writing, by the Board of the Acquiring Organization.
Current minimum documents required to determine if a
continuation of the current Contract is warranted, are:

a. Certificate of Incorporation
b. Current list of Board Members
c. Current list of Chief Operating Officers
d. Conflict of Interest policy
e. Federal ID number
f. Personnel policies
g. Copy of the By-laws
h. Copy of the Acquisition, Affiliation,
Consolidation, Merger, etc. agreement
i. Chief Executive Officer (CEO) statement certifying
that the Acquiring Organization is in compliance
with all State, federal laws and regulations

2. The name and address of the Acquiring Organization,

including the address(es) of all program sites(s) for
Department contracted services.
 5 P1.09

3. A chart of the newly formed organization showing the new

structure, along with a functional statement(s) noting
the duties and/or responsibilities of all units that are
associated with delivering contracted services to the
Department.

4. A copy of the Acquiring Organization’s balance sheet for

all units that are associated with delivering contracted
services to the Department which shows all merged assets
and liabilities, as of the intended date of association
or takeover in accordance with the Financial Accounting
Standards Board (FASB) standards and/or interpretations.

5. A copy of the most recent annual organization-wide

single audit of the Acquiring Organization, a corrective
action plan, if needed, and a remedy of any
unsatisfactory condition(s) present at the Acquiring
Organization. In addition, any other financial
information concerning the Acquisition, Affiliation,
Consolidation, Merger, etc. requested by the
Departmental Component(s) must be submitted prior to any
consideration for a continuation of the current
Contract.

6. A list, if appropriate, of all federal, state, local

government or private agency contracts and grants
awarded to the Acquiring Organization that overlaps the
term of the Department Contract. The list shall include
as a minimum: the awarding agency and address, amount of
the award, period of performance, purpose of the
contract/grant and a contact telephone number of the
granting agency.

7. A written statement from the Acquiring Organization that

the newly formed entity recognizes its responsibility
for any corrective action plan(s), questioned costs, or
Contract overpayments incurred by its predecessor
organization (Provider Agency) that may be identified in
any subsequent audits of Contract(s) assumed by the
Acquiring Organization.

45 Days

The decision by a Departmental Component(s) to authorize or

disapprove a continuation of the current Contract shall be
rendered based on submitted documentation, timeliness of
submitted documentation, and one or more of the following
criteria:

1. The Acquiring Organization has a history of providing

the same or like service to individuals demonstrating
needs similar to the Department’s clients.
 6 P1.09

2. The service history indicates that the Acquiring

Organization, if they had a contractual relationship
with the Department has been satisfactory in:

a. meeting contractual performance outcomes if

stipulated in the Contract(s);

b. providing accurate and timely interim reports as

specified in any prior Department Contract; and

c. providing acceptable contracted Levels of Service

(LOS).

3. The Acquiring Organization, where appropriate, has

received the endorsement of the Department-affiliated
local planning entity, i.e., county mental health board;
county human services advisory council; children's
inter-agency coordinating council; etc.

4. The Acquiring Organization has/or is capable of

presenting an acceptable plan which has a cost equal to
or less than the acquired Provider Agency’s service
delivery cost, while ensuring the professional
capability to provide Department of Human Services
contracted services.

5. There is no disruption of service or diminution of the

quality of service, including no loss of service days,
while ensuring that an appropriate continuity of care
and/or treatment is maintained, unless written
permission to the contrary is obtained from the
Departmental Component(s).

B. A written notification that establishes the Departmental

Component’s intention to issue an RFP, authorize a Contract
continuation or require a conditional Contract continuation
shall be transmitted to the Acquiring Organization only after
all required information and documentation from the Acquiring
Organization is date stamped received. Up to sixty (60) Days
after receiving all required documentation, the Departmental
Component shall send written notification to the Acquiring
Organization by certified mail of its decision, or advise, in
writing, if an extension is needed.

Issued By:
 Policy Circular P1.10

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICE

SUBJECT: Contract Modification

EFFECTIVE: This policy circular shall become effective on July 1,

2004 and shall be implemented as new contracts commence
or existing contracts are renewed thereafter.

PROMULGATED: February 24, 2005

SUPERSEDES: Policy Circular P1.10, promulgated September 13, 2002.

PURPOSE: The purpose of this policy circular is to outline the

Department's requirements to obtain a Contract
Modification. All material changes to the approved
Contract shall be discussed and agreed to in writing by
all parties through use of the Contract Modification
process.

I. SCOPE

This policy circular applies to all Third-Party Social Service

and Training Contracts.

II. DEFINITIONS

In addition to the terms defined in the DHS Contract Policy and

Information Manual, the DHS Contract Reimbursement Manual, or the
Standard Language Document (P2.01), the following terms, when
capitalized, shall have meanings as stated.

Annex B Budget means the Attachments to the Contract Standard

Language Document and Standardized Agreement containing
financial information.

Budget Category means one of the major groupings of cost

identified in the Contract Budget Annex B form.

Closeout means the process, whereby the Departmental

Component reconciles the amount of funding paid to a Provider
Agency during the Contract term against the final Report of
Expenditures (ROE) or the latest ROE submitted by the
Provider Agency to the Departmental Component, and also the
final process by which the Department of Human Services
determines that all applicable administrative actions and all
required work of the Contract have been completed by the
Department and the Provider Agency.
 Policy Circular P1.10

Cluster means one or more service-related Programs designated

by the Departmental Component, and identified in the
Contract.

Contract means one of the Department’s social service or

training Contracts with a Provider Agency. Terms and
conditions of the Contract are included in the Standard
Language Document, Annex (es), appendices, attachments and
Contract Modifications (including any approved assignments
and subcontracts) and supporting documents. The Contract
constitutes the entire binding agreement between the
Department and the Provider Agency.

Contract Modification means the formal procedures entailing

the Department’s written approval on the P1.10 Contract
Modification Form (Attachment A) to allow certain
programmatic and/or financial changes in the Contract during
the Contract term.

Cumulative Increase means the combined effect of all budget

changes within a Budget Category.

Departmental Component means the division, bureau,

commission, office, or other unit within the Department
responsible for the negotiation, administrative review,
approval, and monitoring of certain social service or
training contracts.

Equipment means an article of nonexpendable tangible personal

property having a useful life of more than two years and an
Acquisition Cost of $5,000 or more per unit.

Flexible Limits means an upper dollar limit which is

established for each Budget Category, and which may not be
exceeded without an approved Contract Modification. Flexible
Limits are determined by adding an amount to the approved
Annex B Budget.

Letter of Approval means the written correspondence between

the Departmental Component and Provider Agency authorizing a
Contract Modification approval pending submission and
approval of a P1.10 Contract Modification Form (Attachment
A).

Line Item means each entry of cost within a Budget Category

listed in the Annex B Budget (e.g., the salary or wages for
each position listed under the Budget Category of Personnel).

Mail means letter, e-mail or legible facsimile (fax)

transmission of applicable documents.

Net Cost means “Total Cost” less “Revenue”.

2
 Policy Circular P1.10

Program means a specific service. A Program is generally

represented by each column in the Contract Expense Summary of
the Annex B Budget.

Reimbursable Ceiling means the cost of the Contract to the

Departmental Component and the maximum payment to the
Provider Agency.

Revenue means the total income generated by the Provider

Agency from its Programs and activities.

Total Cost means all costs, excluding profit, but including

the cost of approved equipment.

3
 Policy Circular P1.10

III. POLICY

A. Contract Modifications are required under the following

circumstances:

1. Change in the Reimbursable Ceiling.

2. Increase in Total Cost.

3. Change in the Contract term.

4. Change in any Budget Category which exceeds the

Flexible Limits as stated in this policy under
Section III. E.

5. Transfer of budgeted cost across DHS Contracts, or

Clusters as identified in the Contract.

6. Transfer of federal and/or other revenue across DHS

Contracts, or Clusters as identified in the
Contract.

7. Change to the method of allocating General and

Administrative costs.

a) This includes any changes in an approved

indirect cost rate, its application, or
increases/decreases to the indirect cost
amount allocated to the contract.

8. The addition or deletion of any Budget Category (A

through M individually) from the Budget.

9. The addition of Line Items within Budget Category

(B) Consultants and Professional Fees.

10. The addition of any item of equipment not in the

approved budget, above $5,000 per item.

11. Change in the payment methodology.

12. Change in the payment rate(s).

13. Change in target population.

14. Change in contracted performance standards.

15. Change in contracted level of service.

16. Change in contracted staff/client ratios.

17. Change in subcontractors providing direct services

or subcontracted direct services. (See Standard
Language Document P2.01, section 5.02)
 Policy Circular P1.10

B. Authority and Exceptions

1. This Policy shall not supercede existing State of

New Jersey or Department of Human Services policies
including but not limited to those on Procurement,
Revenue Sharing, Clusters, Reporting, Closeout,
Audit Policies, the DHS Contract Policy and
Information Manual, the DHS Contract Reimbursement
Manual, or the Standard Language Document (P2.01)
except that:

a. The Annex B Contract Expense Detail for

Personnel (reporting of salary line items) is
required for the third quarter expense report
and the final Report of Expenditure (ROE). It
is not required for the first quarter or
second quarter interim expense reports.

2. The Department reserves the right to require

Provider Agencies to submit a detailed Annex B
Budget and supporting documentation, indicating all
adjustments to Budget Categories as an
accompaniment to a Contract Modification, and
including, but not limited to, the following
conditions:

a. Inclusion of new initiatives;

b. Under-spending based on an expenditure report
analysis;
c. A new Provider Agency;
d. An unsatisfactory audit;
e. A failure to meet Contract performance
indicators as defined in the Contract;
f. A reporting problem; and
g. An agency requiring intensive monitoring or
technical assistance.

3. Failure to complete a required Contract

Modification to the applicable Departmental
Component may result in:

a. Adjustments to the contract terms and

conditions;
b. Notice of Contract Default;
c. Recoupment of Funds; and
d. Other adjustments or actions deemed necessary.

5
 Policy Circular P1.10

C. Procedures for Requesting a Contract Modification or a

Pre-Approval

1. A Contract Modification may be requested by the

Provider Agency or the Department, and must be
completed by the Provider Agency.

2. For Pre-Approval requests, which are at the option

of the Provider Agency, the Provider Agency may
telephone or mail the Departmental Component
requesting approval to proceed with a Contract
Modification. An approved request shall be
followed-up in writing by the Provider Agency and
responded to in writing via a Letter of Approval
pending standard Contract Modification procedures.

3. When a Contract Modification for cost-related

services is initiated, the Provider Agency shall
submit a revised Annex B Budget, the applicable
P1.10 Contract Modification Form, Attachment A and
any other Contract documents affected.

4. When a Contract Modification entails any change in

rate information, the appropriate Departmental
Component will complete a revised Annex B-2:
Contract Rate Information Summary.

5. The Departmental Component shall forward copies of

the approved P1.10 Contract Modification Form and
attachments to the Provider Agency and other
offices as necessary for inclusion as part of the
official contract file.

6. The Department must approve a Contract Modification

prior to its effective date. Generally, a Contract
Modification is not retroactive. There are five
exceptions to this requirement:

a. In accordance with Policy Circular P9.02,

Department and Provider Agency Monitoring of
Budgeted Units of Service;

b. In a Cost-Related Contract where payment is

based on a provisional rate, a retroactive
Contract Modification may be required in
conjunction with a revision of the provisional
rate or the establishment of the final rate;

c. In a Non-Cost Related contract where payment

is based on a rate established by an outside
rate setting authority such as a home state,
county, or other prime user;
6
 Policy Circular P1.10

d. When the Department must do so in order to

meet specific administration and/or
operational responsibilities or to promote
contract efficiencies; or

e. For all Contracts executed and entered into as

of July 1, 2004 through and including the
Promulgation date of this Policy.

D. Approvals, Effect and Notification

1. Contract Modifications shall be approved or

disapproved, in whole or part, by an official of
the Departmental Component authorized to perform
this function. This official shall sign the
Contract Modification Form and shall enter the
approved effective date.

2. A Provider Agency's use of Contract funds does not

establish the Department's level of participation
in the financing of successor Contracts.

3. The last approved Contract Budget and program annex

(es) for the Contract term are the documents of
record, and they will be utilized when conducting
the Closeout process. (Refer to P7.01 Contract
Closeout).

4. A Contract Modification request must be received by

the Contract Administrator prior to the last month
of the Contract term. Subsequent requests will be
reviewed at the discretion of the Departmental
Component.

5. Within 10 business days from the date of receipt of

a Contract Modification Request, the Department
shall approve or reject the Contract Modification.
If the request is still under consideration at the
end of 10 business days, the Department will inform
the Provider Agency in writing as to the reasons,
and provide a date when a decision may be expected,
such date not to exceed 30 calendar days from the
date of receipt of fully completed materials. A
Contract Modification shall be deemed to be
approved, if within 30 calendar days from the date
of receipt of fully completed materials, there is
no written Departmental response.

7
 Policy Circular P1.10

6. Letters shall be presumed to be received by the

addressee no later than five business days from the
postmark, after being sent to the last address
known by the sender. Transmissions which are not
electronically date stamped shall be presumed to be
received by the sender no later than five business
days after being sent to the last address known by
the sender.

E. Granting of Flexibility for Budget Management

1. A Provider Agency shall be granted flexibility in

managing Contract budgets based on the
establishment of Flexible Limits.

2. A Provider Agency shall be allowed to reallocate

funds, within the Flexible Limits, without notice
to a Departmental Component, and without a Contract
Modification, except where any single condition
specified in III.A has occurred.

3. Flexible Limits shall apply only to an executed

Contract.

4. Flexible Limits shall change only when a Contract

Modification has been approved.

5. When Flexible Limits have been reached or are

expected to be exceeded, a Provider Agency must
request a Contract Modification by following the
procedure specified in this Policy.

6. A Departmental Component is not responsible for the

effect of Provider Agency misapplication or
miscalculation of Flexible Limits.

7. Separate Flexible Limits must be developed and

applied for each Budget Category as described in
III.E.8:

a. Within a Cluster.

b. For Direct Costs (All costs which are not

classified as General and Administrative).

c. For General and Administrative costs.

8
 Policy Circular P1.10

8. Applicable Budget Categories and Allowable Budget

Modification Flexible Limits are:

a. Personnel Category, Category A

(This Budget Category has been split, for
modification purposes to treat Fringe Benefits
separately from other Personnel Line Items).

1) A Cumulative Increase in total salaries,

excluding Fringe Benefits, of more than
five percent (5%) from the approved Annex
B Budget.

2) A Cumulative Increase in Fringe Benefit

costs of more than fifteen percent (15%)
from the approved Annex B Budget.

b. Other Than Personnel, Categories B, C, D, F

(These Budget Categories have been
consolidated for modification purposes except
that “Specific Assistance to Clients” is
maintained as a separate Budget Category).

1) A Cumulative Increase in the combined

value of Other Than Personnel categories
* of more than ten percent (10%) from the
approved Annex B Budget.

The 10% Flexible Limit is applied only to

the combined value of the following Annex
B Budget categories, (B+C+D+F) x 10%:

*(B) Consultants & Professional Fees

*(C) Materials and Supplies
*(D) Facility Costs
*(F) Other

c. Specific Assistance to Clients, Category E

1) All changes below the approved Annex B

Budget require a modification.

2) A Cumulative Increase of more than

fifteen percent (15%) from the Approved
Annex B Budget requires a Contract
Modification.

9
 Policy Circular P1.10

d. Equipment, Category I

1. An item of equipment not included in the

approved Annex B Budget of over $5,000
per item requires a Contract
Modification.

2. A Cumulative Increase of more than ten

percent (10%) from the Approved Annex B
Budget requires a Contract Modification.

9. Flexible Limits for the Budget Categories above are

determined by calculating an amount based on the
allowable Total Cost for the Budget Category as
contained in the approved Annex B Budget. The
allowable Total Cost for the Budget Category shall
be adjusted by an amount as stipulated in III.E.8
to create the Flexible Limit.

10. The calculation of the State’s share of allowable

costs, and of all other funds and revenues within
the budget, shall be managed in the same manner
upon which those funds and revenues are budgeted,
regardless of whether a Contract Modification
impacts Total Cost, Net Cost or Reimbursable
Ceiling.

a. Where it is clear that State funding is the

“last dollar in” as in deficit funded
contracts, the State’s share of the
modification shall always be presumed as the
last dollar to be allocated.

b. Where State and other funds are Budgeted

through the use of matching percentages, as in
an approved federal financial participation
rate (i.e. Title XIX), the State share of the
modification shall be similarly calculated.

F. Required Forms

1. Contract Modifications which have no budget impact

require Attachment “A” the P1.10 Contract
Modification Form.

2. Contract Modifications which have a budget impact

require Attachment “A”, the P1.10 Contract
Modification Form, and an Annex B Budget.

10
 Policy Circular P1.10

3. Contract Modifications which affect the Personnel

Budget Category also require the Annex B Contract
Expense Detail for Personnel. (This detail is also
required with the initial budget and with the final
Report of Expenditures).

4. The Annex B Contract Expense Detail for Other Than

Personnel is required when a line item is added
within Budget Category (B), Consultants and
Professional Fees.

5. A Worksheet (attached) is provided as an example of

the intended calculation of Flexible Limits under
this Policy. The Provider Agency may request
confirmation of Flexible Limits at any time. Such
requests and confirmations do not serve, on their
own, to alter Flexible Limits. The Worksheet is
not a required document for any Contract
Modification, or any other purpose.

Issued by:

________________________________________
Gretchen Jacobs, Director
Office of Contract Policy and Management

_____________________________________
Jacob Eapen, Assistant Commissioner
Budget, Finance, Administration, Real
Estate and Information Technology

11
 Policy Circular P1.10
Attachment A

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES
P1.10 CONTRACT MODIFICATION FORM

Provider Agency Name Modification #

Fiscal-Year-End Contract Term thru

Contract # Cognizant Contract: Yes No

Division(s) affected by the Modification

Date of most recently approved Contract Modification:

Requested effective date for this Contract Modification:
Check applicable area(s) for modification:

1) _____Change to the Reimbursable Ceiling: from to

2) _____Increase in Total Cost: from to
3) _____Change in the Contract term: currently from __/__/__ to /__/__/__ to the revised term __/__/__ to
__/__/__
4) _____Change exceeding the Flexible Limits.
5) _____Transfer of budgeted cost across DHS Contracts or Clusters.
6) _____Transfer of federal and/or other revenue across DHS Contracts or Clusters.
7) _____Change to the method of allocating G&A, the indirect cost rate and/or its application.
8) _____Addition or deletion of an entire Budget category (A through M individually).
9) _____Addition of Line Items within Budget Category (B) Consultants and Professional Fees.
10) _____Equipment not in approved budget above $5,000 per item.
11) _____Change in payment methodology.
12) _____Change in the payment rate(s)
13) _____Change in target population
14) _____Change in contracted performance standards
15) _____Change in contracted level of service
16) _____Change in contracted staff/client ratios.
17) _____Change of Subcontractors providing direct services or change to subcontracted direct services.

Please attach an explanation

This form, its attachments and/or revised section(s) of the programmatic Annex A and/or the revised itemized Annex
B Budget or Rate Information Summary, constitute this entire Contract Modification. The persons whose signatures
appear below agree to this Contract Modification.

BY: BY:
(Signature) (Signature)

(Type name) (Type name)

Title Title

Provider Departmental
Agency: Component:

Date: Date:

DATE EFFECTIVE:
OCP&M rev 2/05 (To be completed by the Department)
Page 1 of ___
 Policy Circular P1.10
SAMPLE WORKSHEET
NOT REQUIRED FOR CONTRACT MODIFICATIONS
Provider Name________________________
Contract Number _ _ _ - _ _ _ _ - _ _ (______)
Contract, Program or Cluster Name (if Clustered)________________________

a ** b c*** d e f **** g h*

G & A Portion,as Allow able

Upper Budget Cumulative Revised Current
TOTAL Agency a Percent, borne Currently Approved Modification Changes, this
Lim it Changes Made to Budget Request
G & A ** by this Contract / Annex "B" Budget Flexible Limits Request Only
(c+(cxd)) Date (c+f+g)
Cluster Percentage

Budget Category
Salaries (A) $ 3,000,000 5% $ 3,150,000 $ (174,450) $ 2,825,550
Fringes (A) $ 750,000 15% $ 862,500 $ 112,500 $ 862,500
Other Than Personnel (B.C,D & F) $ 150,000 10% $ 165,000 $ 15,000 $ 165,000
Specific Assistance to Clients (E) $ 50,000 15% $ 57,500 $ 7,500 $ 57,500
Equipment (I) $ 30,000 10% $ 33,000 $ 3,000 $ 33,000
Total Operating Costs $ 3,980,000 $ (36,450) $ - $ 3,943,550

General & Adm inistrative (G):

Salaries (A) $ 1,000,000 27% $ 270,000 5% $ 283,500 $ 13,500 $ 283,500
Fringes (A) $ 500,000 27% $ 135,000 15% $ 155,250 $ 20,250 $ 155,250
Other Than Personnel (B.C,D & F) $ 100,000 27% $ 27,000 10% $ 29,700 $ 2,700 $ 29,700
Total for G&A Only $ 1,600,000 $ 432,000 $ 36,450 $ - $ 468,450

Moved to Other Contracts, Programs

or Clusters
Total Cost $ 4,412,000 $ - $ - $ 4,412,000
Less Revenue
Net Cost $ 4,412,000 $ - $ - $ 4,412,000
Profit
Reim bursable Ceiling $ 4,412,000 $ - $ - $ 4,412,000

*The "Revised Current Budget Request" is a cumulative amount and should include all amounts the Provider has previously moved, including amounts w ithin the Flexible Limits.

** Total Agency G & A represents 100% of the Agency G & A irregardless of Division or Program. The calcualtion of allow able G & A may generally be a more complex manual process w here G &
A is fixed or controlled by factors outside the control of DHS. The percent is the portion of G & A borne by this contract / cluster.
*** Allow able costs only
**** Provides an example of the flexibility provided under P1.10 w here Contract Modifications are not required.
 Policy Circular P1.11

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Significant Events

EFFECTIVE: This policy shall become effective on October 1, 2005

and shall then be implemented immediately.

PROMULGATED: August 11, 2005

PURPOSE: The purpose of this circular is to instruct DHS

Contracted Provider Agencies on the criteria for
identifying significant events that may impact on the
provider’s organization and DHS Contracts.

I. SCOPE

This policy circular applies to all DHS Third Party Social

Service and Training Contracts.

II. DEFINITIONS

Significant Events means a known or anticipated program,

financial or administrative event or circumstance of a nature and
extent that can reasonably be expected to diminish the quality or
quantity of services to clients, or to influence or to jeopardize
the ability of the Provider Agency to deliver contracted
services, or to meet responsibilities under the Contract and
which requires Notice to the Departmental Component. Examples
include Legal/Administrative/Financial/Services such as, but not
limited to, Bankruptcy petition, Merger, Acquisition,
Affiliation, Consolidation, Civil or Criminal action taken
against an employee of the agency, a finding of abuse or neglect
against an employee of the agency and Planned Relocation or
change in Service location(s).

III. POLICY

A. Criteria For Notification

Notification by the Provider Agency to a DHS Departmental

Component is required for Significant Events including, but
not limited to:

1. The taking of any action by the Provider Agency which

adds or eliminates significant personnel or program
functions covered by the contract.
 Policy Circular P1.11

a. Changes in salary line items are generally not

reportable as a Significant Event, unless other
criteria for Significant Event reporting are
affected (such as: the elimination or addition of
DHS funded positions would be reportable; however
the use of temporary overtime, or payment of
overtime to individual line items to meet daily
operational needs are not reportable.);

2. Changes in the compensation, bonuses or benefit

packages of the Provider Agency personnel covered in
the DHS contract, and specifically the principal
decision makers and/or the highest managerial
personnel within the Provider Agency, when such changes
are different, by a standard of reasonableness, than
those offered or provided to other Provider Agency
staff;

3. Any administrative, financial, service or program event

or circumstance which can reasonably be expected to
adversely impact on the provider’s operation or service
delivery. Such events may include but are not limited
to:

o suspension or revocation of license;

o loss of lease;
o union strike/action;
o child abuse investigation;
o changes in corporate by laws;
o loss of Insurance;
o loss of funding associated with the contract;
o significant facility damage; and
o client or other law suits

4. Changes, additions to or loss of any funding sources

(other than DHS) supporting the contract; and

5. Changes which are long term in nature and can

reasonably be expected to continue into a new Contract
period.

B. Unreported Significant Events

In circumstances where the Departmental Component learns of

a Significant Event (e.g. through a site review, audit or
other media) that was not reported the non compliance with
this Policy shall be brought to the attention of the
contract signatory and the Provider Agency’s Board by postal
mail.
2
 Policy Circular P1.11

3
 Policy Circular P1.11

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Significant Events

EFFECTIVE: This policy shall become effective on October 1, 2005

and shall then be implemented immediately.

PROMULGATED: August 11, 2005

PURPOSE: The purpose of this circular is to instruct DHS

Contracted Provider Agencies on the criteria for
identifying significant events that may impact on the
provider’s organization and DHS Contracts.

I. SCOPE

This policy circular applies to all DHS Third Party Social

Service and Training Contracts.

II. DEFINITIONS

Significant Events means a known or anticipated program,

financial or administrative event or circumstance of a nature and
extent that can reasonably be expected to diminish the quality or
quantity of services to clients, or to influence or to jeopardize
the ability of the Provider Agency to deliver contracted
services, or to meet responsibilities under the Contract and
which requires Notice to the Departmental Component. Examples
include Legal/Administrative/Financial/Services such as, but not
limited to, Bankruptcy petition, Merger, Acquisition,
Affiliation, Consolidation, Civil or Criminal action taken
against an employee of the agency, a finding of abuse or neglect
against an employee of the agency and Planned Relocation or
change in Service location(s).

III. POLICY

A. Criteria For Notification

Notification by the Provider Agency to a DHS Departmental

Component is required for Significant Events including, but
not limited to:

1. The taking of any action by the Provider Agency which

adds or eliminates significant personnel or program
functions covered by the contract.
 Policy Circular P1.11

a. Changes in salary line items are generally not

reportable as a Significant Event, unless other
criteria for Significant Event reporting are
affected (such as: the elimination or addition of
DHS funded positions would be reportable; however
the use of temporary overtime, or payment of
overtime to individual line items to meet daily
operational needs are not reportable.);

2. Changes in the compensation, bonuses or benefit

packages of the Provider Agency personnel covered in
the DHS contract, and specifically the principal
decision makers and/or the highest managerial
personnel within the Provider Agency, when such changes
are different, by a standard of reasonableness, than
those offered or provided to other Provider Agency
staff;

3. Any administrative, financial, service or program event

or circumstance which can reasonably be expected to
adversely impact on the provider’s operation or service
delivery. Such events may include but are not limited
to:

o suspension or revocation of license;

o loss of lease;
o union strike/action;
o child abuse investigation;
o changes in corporate by laws;
o loss of Insurance;
o loss of funding associated with the contract;
o significant facility damage; and
o client or other law suits

4. Changes, additions to or loss of any funding sources

(other than DHS) supporting the contract; and

5. Changes which are long term in nature and can

reasonably be expected to continue into a new Contract
period.

B. Unreported Significant Events

In circumstances where the Departmental Component learns of

a Significant Event (e.g. through a site review, audit or
other media) that was not reported the non compliance with
this Policy shall be brought to the attention of the
contract signatory and the Provider Agency’s Board by postal
mail.
2
 Policy Circular P1.11

3
 Policy Circular DYFS 1.50

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES
DIVISION OF YOUTH AND FAMILY SERVICES

SUBJECT: Two-year Contracting

EFFECTIVE: This policy circular shall become effective on July 1,

1988, and shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular DYFS 1.50, promulgated November 5,

1986.

The purpose of this policy circular is to establish the policy and

procedures for implementing two-year Contracts in the Division of
Youth and Family Services (DYFS).

I. SCOPE

This policy circular applies to all DYFS Contracts designated by

the Division as eligible for two-year terms.

II. POLICY

A. Except in those circumstances outlined in Section B below,

social services Contract in DYFS may be executed for two-
year terms.

The implementation of two-year Contract terms have the

advantage of:

1. increase administrative simplicity for the Division and

for the Provider Agencies, and

2. greater stability for Provider Agencies in planning for

service delivery and funding needs.

B. The decision to implement two-year Contracts terms with

specific Contract will be made by the DYFS Regional Offices.
In making such decisions, the factors listed below will be
considered.

1. Public agencies will not be given Contract with two-

year terms because of restriction in the New Jersey
Local Public Contracts Law which prohibits local public
 DYFS P1.50

agencies from executing Contract with longer than 12-

month terms.

2. Contracts which are funded by an unstable funding

source, such as the Refugee Resettlement Program, will
not be given two-year terms.

3. New Contract Provider Agencies will not be given two-

year terms in their first year of funding.

4. Provider Agencies with identified

contracting/management problems will not be given two-
year Contract terms. Contracting/management problems
may be identified by a Contract audit report, Pre-Award
Survey, or by a Division monitoring report.

C. Provider Agencies which have two-year Contract terms will

receive equitable treatment from the Division with regard to
all funding increases available or decreases required, The
fact that a Provider Agency has a two-year Contract will not
penalize that Provider Agency if additional funding
available for Contract services. Similarly, in the case of
a reduction in funding, a Provider Agency with a two-year
term will be as vulnerable to any necessary Contract
reductions as a Provider Agency with a one-year term.

D. The process for receiving and considering recommendations

from the county planning bodies will be the same for two-
year Contracts as for one-year Contracts.

III. PROCEDURES

A. Contract Document for Two-Year Contracts

The Contract documents for a two-year Contract will consist

of the following items:

1. Standard Language Document- A two-year Contract will

have a single Standard Language Document for the two-
year term. On the signature page of the Standard
Language Document, the Contract effective date and the
Contract expiration date will indicate the two-year
Contract term.

2. Programmatic Annex- A single programmatic annex (Annex

A) will be prepared and will include information which
applicable to the full two-year Contract term.
Specifically, items in the Annex A which shall be
written to include two-year data are: Contract term,
2
 DYFS P1.50

Contract level of service delivery, service days,

number of clients to be served, and goals and
objectives.

3. Fiscal Annex- The fiscal annex (Annex B, and/or Annex

B-2) of a two-year Contract will cover the full term of
the Contract. Special considerations for preparation
of the fiscal annex are outlined below.

a. For Cost-Related Contracts

(1) Annex B (Budgets)

In accordance with the policies and procedures of

the Contract Reimbursement Manual, there will be
at least two budgets for a two-year Contract. The
total number of budgets required will depend on
the Provider Agency’s fiscal year in relation to
the Contract term. (See Section 5 of the Contract
Reimbursement Manual for additional information,)
All budgets for a two-year term will be submitted
simultaneously by the Provider Agency during the
Contract negotiations.

Each budget must reflect it proportionate share of

all Contract costs, applicable to the particular
budget period. A budget may be modified during
the Contract term, as outlined in Section III.D.2
of this circular and in accordance with Policy
Circular P1.10 Contract Modification.

(2) Cover Page for Annex B

For the sake of clarity, a cover page for the

Contract Annex B shall be prepared which
specifies:

-the budget period and Reimbursable Ceiling for

each budget of the Contract;

-the Contact term (2 years); and

-the aggregate Reimbursable for the Contract,

i.e., the sum of the Reimbursable Ceilings for
the Contract budgets.

3
 DYFS P1.50

(3) Schedules of Estimated Claims

Separate estimated monthly claims shall be

projected by the Provider Agency reflecting each
budget submitted for the Contract term.

b. For Contracts Paid on a Rate

A single Annex B-2 will be completed by the

Division at the beginning of the Contract term and
will be effective for the full two-year Contract
term unless revised by a Contract Modification,
If the Contract has a maximum funding amount, this
amount will be included for the two-year and
specified in the Annex B-2. This amount will also
be reflected in the Annex B for a Cost-Related
Contract which is paid on a rate.

c. Supporting Documentation

Supporting documentation for the fiscal Annex

shall be submitted by the Provider Agency during
Contract negotiations and, if appropriate, will be
included as attachments to the fiscal Annex. Such
supporting documentation includes, but is not
limited to, the Provider Agency’s most recent
audited financial statements, organizational
structure of the Provider Agency, and donor
agreements.

In cases in which supporting documents are not

available for the full two-year Contract term,
such documents may be submitted to the Division
during the Contract term, as permitted by the
Division. Specifically, with regard to execution
and submission of donor agreements during the
Contract term, refer to Policy Circular P6.01,
Match Requirements for Social Services Block Grant
Service Contracts.

B. Division Documents

The following Contract documents used by the Division shall

be completed as indicated, for a two-year Contract.

4
 DYFS P1.50

1. Transmittal Letter

At the beginning of a two-year Contract, the Regional

Office shall issue a transmittal letter to the Provider
Agency which states:

- the aggregate Reimbursable Ceiling for a Cost-

Related Contract; and

- the Payment Rate and, if applicable, the maximum

Contract funding, for a Non-Cost-Related Contract.

2. Contract Information Form (CIF)

The Regional Office will complete a single CIF for the

full two years of the Contract term, using the
aggregate Contract Reimbursable Ceiling to identify the
Division’s funding obligation.

C. Advance Payment

The amount of the advance payment available under a two-year

Contract will be the Contract’s first two months’ estimated
claim. (See Policy Circular P410, Advance Payments, for
additional information.) Advances will be issued at the
beginning of the two-year Contract terms and recouped,
according to Division procedures, throughout the Contract
term.

D. Budget Flexibility for Cost-Related Contracts

In a two-year Contract, flexibility between/among budgets in

the Contract will be allowed within limits described below.

1. Overspending

A Provider Agency will not be allowed to overspend in

the Contract.

2. Underspending and Carry-Forward Amount

If a Provider Agency underspends a budget in the

Contract, the unspent amount, with Division approval,
may be carried forward from the expiring budget to a
succeeding budget within the current Contract. In
order to carry forward unspent funds, the Provider
Agency must submit a request for a Contract
Modification.

5
 DYFS P1.50

Approval for the Contract Modification will be granted

by the DYFS Regional Office only if the modification is
justified and appropriate. Prior to submitting a
Contract Modification, the Provider Agency shall ensure
that sufficient funds remain in the expiring budget to
cover all applicable expenses of that budget period.

Issued by:

6
Policy Circular P2.01
 P2.01
Attachment 1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

STANDARD LANGUAGE DOCUMENT

FOR SOCIAL SERVICE AND TRAINING CONTRACTS

This CONTRACT is effective as of the date recorded on the

signature page between the Department and the Provider Agency
identified on the signature page.

WHEREAS the New Jersey Department of Human Services (the

"Department") has been duly designated under the authority of N.J.S.A.
30:1A-1, 30:1-11, 30:1-12, and 30:1-20 to administer or supervise the
administration of social service and training programs and has, in
turn, designated the Departmental Component to be directly responsible
for the funding, implementation and administration of certain social
service and training programs, including the program(s) covered by this
Contract; and

WHEREAS the Department desires that the Provider Agency provide

services and the Provider Agency has agreed to provide services in
accordance with the terms and conditions contained in this Contract;

THEREFORE the Department and the Provider Agency agree as follows:

I. DEFINITIONS

For the purposes of this document, the following terms, when

capitalized, shall have meanings as stated:

Additional Insured means an endorsement to an insurance policy

extending the coverage to the State of New Jersey against loss in
accordance with the terms of the policy. Designating the State as an
additional insured permits the Department to pay the premium should the
insured fail to do so.

Annex (es) means the attachment(s) to this document containing

programmatic and financial information.

Consumer means an individual receiving services from or funded in

whole or in part by DHS or one of its departmental components.

Contract means this document, the Annex (es), any additional

appendices or attachments (including any approved assignments,
subcontracts or modifications) and all supporting documents. The
Contract constitutes the entire agreement between the parties.

Page 1
June 2010
 P2.01
Attachment 1

Contractor means the person or entity entering into this contract

with DHS or one of its departmental components.

Department means the New Jersey Department of Human Services. It

means, where appropriate from the context, the division, commission,
bureau, office, unit or other designated component of the Department of
Human Services responsible for the administration of particular
Contract programs.

Departmental Component means the divisions, bureau, commissions,

office or other unit within the Department responsible for the
negotiation, administration review, approval, and monitoring of certain
social service or training Contracts.

Expiration means the cessation of the Contract because its term

has ended.

Notice means an official written communication between the

Department and the Provider Agency. All Notices shall be delivered in
person or by certified mail, return receipt requested, and shall be
directed to the persons and addresses specified for such purpose in the
Annex(es) or to such other persons as either party may designate in
writing.

The Notice shall also be sent by regular mail and shall be

presumed to have been received by the addressee five Days after being
sent to the last address known by the Department.

Provider Agency means the person or entity entering into this

contract with DHS or one of its departmental components.

Subcontractee means the legal entity that enters into a

Contractual arrangement with a Contractee (Contracted Provider Agency)
or another Subcontractee, no matter how many interceding administrative
Tiers (levels) separate the parties.

Termination means an official cessation of this Contract, prior to

the expiration of its term, that results from action taken by the
Department or the Provider Agency in accordance with provisions
contained in this Contract.

II. BASIC OBLIGATIONS OF THE DEPARTMENT

Section 2.01 Payment. As established in the Annex (es), payment

for Contract services delivered shall be based on allowable
expenditures or the specified rate per unit of service delivered. Such
payment(s) shall be authorized by the Department in accordance with the
time frames specified in the Annex (es). Total payments shall not
exceed the maximum Contract amount, if any, specified in the Annex
(es). All payments authorized by the Department under this Contract
Page 2
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 P2.01
Attachment 1

shall be subject to revision on the basis of an audit or audits

conducted under Section 3.13 Audit or on the basis of any Department
monitoring or evaluation of the Contract.

Section 2.02 Referenced Materials. Upon written request of the

Provider Agency, the Department shall make available to the Provider
Agency copies of federal and State regulations and other material
specifically referenced in this document.

III. BASIC OBLIGATIONS OF THE PROVIDER AGENCY

Section 3.01 Contract Services. The Provider Agency shall provide

services to eligible persons in accordance with all specifications
contained in this Contract.

Section 3.02 Reporting. The Provider Agency shall submit to the

Department programmatic and financial reports on forms provided by the
Department. The reporting frequency and due date(s) are specified and
sample forms to be used are included in the Annex (es), or otherwise
made available by the Departmental Component.

Section 3.03 Compliance with Laws. The Provider Agency agrees in

the performance of this Contract to comply with all applicable federal,
State and local laws, rules and regulations (collectively, “laws"),
including but not limited to the following: State and local laws
relating to licensure; federal and State laws relating to safeguarding
of client information; the federal Civil Rights Act of 1964 (as
amended); P.L. 1975, Chapter 127, of the State of New Jersey (N.J.S.A.
10:5-31 et seq.) and associated executive orders pertaining to
affirmative action and nondiscrimination in public contracts; the
federal Equal Employment Opportunity Act; Section 504 of the federal
Rehabilitation Act of 1973 pertaining to non-discrimination on the
basis of handicap, and regulations thereunder; the Americans With
Disabilities Act (ADA), 42 U.S.C. 12101 et seq. Failure to comply with
the laws, rules and regulations referenced above shall be grounds for
Termination of this Contract for cause.

If any provision of this Contract shall conflict with any federal

or State law(s) or shall have the effect of causing the State to be
ineligible for federal financial participation in payment for Contract
services, the specific Contract provision shall be considered amended
or nullified to conform to such law(s). All other Contract provisions
shall remain unchanged and shall continue in full force and effect.

Section 3.04 Business Associate Agreements and State

Confidentiality Statues. DHS is a covered entity pursuant to the
Health Insurance Portability and Accountability of 1996, 42 U.S.C.A.
§1320d et seq. (HIPAA); 45 CFR Parts 160 and 164. Before a Provider
Agency obtains or is permitted to access to, create, maintain or store
Protected Health Information (PHI) as part of its responsibility under
Page 3
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 P2.01
Attachment 1

this contract, the Provider Agency shall first execute a Department of

Human Services Business Associate Agreement (BAA). A Provider Agency,
whose work under this Contract does not involve PHI is not required to
execute a BAA. DHS shall have the sole discretion to determine when a
Provider Agency’s work will involve PHI. Protected Health Insurance
shall have the same meaning as in 45 CFR 160.103.

Provider Agencies that enter any subcontract where the work for
the subcontract involves a Consumer’s PHI shall require its
subcontractor to execute a BAA that meets all the requirements of
HIPAA, including those in 45 CFR 164.504(e). A standard form of BAA is
available for Provider Agency’s use from the Department. If the BAA is
breached by the Provider Agency, or its subcontractor, the Provider
Agency shall notify the Department within 24 hours of the breach. The
Department may, in its sole discretion and at any time, request a BAA
compliance audit or investigation of the Provider Agency or its
subcontractor with which the Provider Agency has entered into a BAA.
The Provider Agency shall cooperate with all Department requests for a
BAA compliance audit and/or investigation and shall require that its
subcontractor cooperate with all Departmental requests for BAA
compliance audits and investigations.

In addition to the confidentiality requirements of HIPAA if

applicable, a Provider Agency shall maintain the confidentiality of all
certificates, applications, records and reports (“Records”) that
directly or indirectly identify any consumer and shall not disclose
these records except where disclosure is consistent with applicable DHS
regulations, the BAA, if any, and is:
1. to the consumer, or his or her legal guardian, if any, or if
the consumer is a minor , to the consumer’s parent; or
2. necessary to carry out the work of this Contract;
3. in response to a proper inquiry for information, but not
Records, as to the consumer’s current medical condition to any
relative, friend, or to the consumer’s personal physician or attorney,
if it appears that the information is to be used directly or indirectly
for the benefit of the consumer; or
4. relevant to a consumer’s current treatment and is being
disclosed to the staff of another community agency, screening service,
short-term care or psychiatric facility.

Section 3.05 Business Registration. According to P.L. 2001, c.

134 (N.J.S.A. 52:32-44 et seq.) all profit and non-profit corporations
(domestic and foreign), as well as, all limited partnerships, limited
liability companies, and limited liability partnerships must submit
annual reports and associated processing fees (annual business
registration) to the Division of Revenue, Department of the Treasury
commencing with the year after they file for their Certificate of
Incorporation with the State of New Jersey. No State agency (the
Department) may Contract with a Provider Agency if the Provider has not
filed for its incorporation papers or filed its annual business
registration. Furthermore, no Provider Agency that Contracts with the
Page 4
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 P2.01
Attachment 1

Department shall enter into any subcontract unless the subcontractor

can demonstrate that it is incorporated in the State of New Jersey or
its annual business registration is current. Failure to comply with
this paragraph or the citation referenced above shall be grounds for
the Department to Terminate this Contract for cause.

Section 3.06 Set-Off for State Tax and Child Support. Pursuant to
N.J.S.A. 54:49-19, if the Contractor is entitled to payment under the
contract at the same time as it is indebted for any State tax (or is
otherwise indebted to the State) or child support, the State Treasurer
may set off that payment by the amount of the indebtedness.

Section 3.07 Source Disclosure. N.J.S.A. 52:34-13.2 that codified

Public Law 2005, c.92 and Executive Order 129 requires when submitting
a Request for Proposals and/or contract, the Provider Agency shall
submit as part of their proposal and/or contract Certification listing
where their contracted services will be performed and if the contracted
services, or an portion thereof, will be subcontracted and where any
subcontracted services will be performed.

Any changes to the information submitted in the Source Disclosure

Certification during the term of the contract must be immediately
reported to the Director of the Division of Purchase and Property and
to the departmental component within the Department for whom the
contracted services are being performed. A Service Provider that shifts
its activities outside the United States and its constituent
Commonwealths and territories without prior written affirmation by the
Director attesting to the fact that extraordinary circumstances
required the shift or that the failure to shift the services would
result in the infliction of economic hardships to the State of New
Jersey, shall deemed to be in breach of contract which would be subject
to termination by the Department.

Section 3.08 Contractor Certification and Disclosure of Political

Contributions. N.J.S.A. 19:44A-20.13-20.25 that codified Public Law
2005, Chapter 51 and Executive Order 134, and Executive Order 117
require that any for-profit agency that seeks or contracts to provide
services in the amount of $17,500 or more must submit to the Department
the Certification and Disclosure of Political Contribution forms. This
form includes a certification that the business entity has not, during
certain specified time frames, solicited or made any contribution of
money, pledge of reportable contributions, including in-kind
contributions, to any candidate committee and/or election fund of the
Governor or Lieutenant Governor, any legislative leadership committee
or any State, county or municipal political party committee. The form
also requires disclosure of any of the above referenced reportable
contributions made by the business entity, its principals, officers,
partners, directors, spouses, civil union partners and resident
children.

Page 5
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 P2.01
Attachment 1

If awarded a contract, the Contractor/Bidder will, on a continuing

basis, continue to report any Contribution it makes during the term of
the contract, and any extension(s) thereof. Failure to do so will
result in termination of the contract and could result in the debarment
from public contracting of the Contractor/Bidder for a period of up to
five years.

Non-profit organizations are exempted from the requirements of

Section 3.08

Section 3.09 Contract Certification and Political Contribution

Disclosure Form. The Provider Agency is advised of its responsibility
to file an annual disclosure statement of political contributions with
the New Jersey Election Law Enforcement Commission (ELEC), pursuant to
P.L. 2005, c.271, section 3 if the contractor receives contracts in
excess of $50,000 from a public entity in a calendar year. It is the
Provider Agency’s responsibility to determine if filing is necessary.
Failure to so file can result in the imposition of financial penalties
by ELEC. Additional information about this requirement is available
from ELEC at 888-313-3532 or at www.elec.state.nj.us/.

Section 3.10 Affirmative Action. During the performance of this

Contract, the contractor (Provider Agency) agrees as follows:

The Provider Agency and its subcontractor, will not discriminate

against any employee or applicant for employment because of age, race,
creed, color, national origin, ancestry, marital status, affectional or
sexual orientation, gender or disability.

The Provider Agency will also take affirmative action to ensure

that such applicants are recruited and employed, and that employees are
treated during employment, without regard to their age, race, creed,
color, national origin, ancestry, marital status, affectional or sexual
orientation, gender or disability. Such action shall include, but not
be limited to the following: employment; promotion; demotion; or
transfer; recruitment or recruitment advertising; layoff or
termination; rates of pay or other forms of compensation and, selection
for training, including apprenticeship. The Provider Agency agrees to
post in conspicuous places that are readily available to employees and
applicants for employment, notices to be provided by the Public Agency
Compliance Officer setting forth provisions of this non-discrimination
clause.

The Provider Agency or subcontractor shall state, in all

solicitations or advertisements for employees placed by or on behalf of
the contractor, that all qualified applicants will receive
consideration for employment without regard to age, race, creed, color,
national origin, ancestry, marital status, affectional or sexual
orientation, gender or disability.

Page 6
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 P2.01
Attachment 1

The Provider Agency or subcontractor, where applicable, will send

to each labor union or representative or workers with which it has a
collective bargaining agreement or other contract or understanding, a
notice, to be provided by the agency contracting officer advising the
labor union or workers' representative of the contractor's commitments
under this Act and shall post copies of the notice in conspicuous
places available to employees and applicants for employment.

The Provider Agency or subcontractor agrees to comply with the

regulations promulgated by the Treasurer pursuant to P.L. 1975, c. 127,
as amended and supplemented from time to time and the Americans with
Disabilities Act.

The Provider Agency or subcontractor agrees to make a good faith

attempt to employ minority and female workers consistent with the
applicable county employment goals prescribed by N.J.A.C. 17:27-5.2
promulgated by the Treasurer pursuant to P.L. 1975, c. 127, as amended
and supplemented from time to time or in accordance with a binding
determination of the applicable county employment goals determined by
the Division of Contract Compliance & EEO pursuant to N.J.A.C. 17:27-
5.2 promulgated by the Treasurer pursuant to P.L. 1975, c. 127, as
amended and supplemented from time to time.

The Provider Agency or subcontractor agrees to inform in writing

appropriate recruitment agencies in the area, including employment
agencies, placement bureaus, colleges, universities, and labor unions,
that it does not discriminate on the basis of age, creed, color,
national origin, ancestry, marital status, affectional or sexual
orientation, gender or disability, and that it will discontinue the use
of any recruitment agency which engages in direct or indirect
discriminatory practices.

The Provider Agency or subcontractor agrees to revise any of its

testing procedures, if necessary, to assure that all personnel testing
conforms with the principles of job-related testing, as established by
the statutes and court decisions of the State of New Jersey and as
established by applicable Federal law and applicable Federal court
decisions.

The Provider Agency and subcontractor agree to review all

procedures relating to transfer, upgrading, downgrading and layoff to
ensure that all such actions are taken without regard to age, creed,
color, national origin, ancestry, marital status, affectional or sexual
orientation, gender or disability, and conform with the applicable
employment goals, consistent with the statutes and court decisions of
the State of New Jersey, and applicable Federal law and applicable
Federal court decisions.

The Provider Agency and its subcontractors shall furnish such

reports or other documents to the Division of Contract Compliance & EEO
as may be requested by the Office from time to time in order to carry
Page 7
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 P2.01
Attachment 1

out the purposes of these regulations, and public agencies shall

furnish such information as may be requested by the Division of
Contract Compliance & EEO for conducting a compliance investigation
pursuant to Subchapter 10 (N.J.A.C. 17:27).

Section 3.11 Department Policies and Procedures. In the

administration of this Contract, the Provider Agency shall comply with
all applicable policies and procedures issued by the Department
including, but not limited to, the policies and procedures contained in
the Department's Contract Reimbursement Manual (as from time to time
amended) and the Department's Contract Policy and Information Manual
(as from time to time amended). Failure to comply with these policies
and procedures shall be grounds to terminate this Contract.

Section 3.12 Financial Management System. The Provider Agency's

financial management system shall provide for the following:

(a) accurate, current and complete disclosure of the financial

results of this Contract and any other contract, grant,
program or other activity administered by the Provider
Agency;

(b) records adequately identifying the source and application of

all Provider Agency funds and all funds administered by the
Provider Agency. These records shall contain information
pertaining to all contract and grant awards and
authorizations, obligations, unobligated balances, assets,
liabilities, outlays and income;

(c) effective internal control structure over all funds, property

and other assets. The Provider Agency shall adequately
safeguard all such assets and shall ensure that they are used
solely for authorized purposes;

(d) comparison of actual outlays with budgeted amounts for this

Contract and for any other contract, grant, program or other
activity administered by the Provider Agency;

(e) accounting records supported by source documentation;

(f) procedures to minimize elapsed time between any advance

payment issued and the disbursement of such advance funds by
the Provider Agency; and

(g) procedures consistent with the provisions of any applicable

Department policies and procedures for determining the
reasonableness, allowability and allocability of costs under
this Contract.

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Section 3.13 Audit. The Department requires timely submission of

the Provider Agency's annual organization-wide audit. Non-compliance
will be grounds for termination.

Audits shall be conducted in accordance with Policy Circular

P7.06, Audit Requirements, Generally Accepted Auditing Standards as
specified in the Statements on Auditing Standards issued by the
American Institute of Certified Public Accountants; Government Auditing
Standards issued by the Comptroller General of the United States and
the Single Audit Act Amendments of 1996 (The Single Audit Act); Office
of Management and Budget Circular A-133, Audits of States, Local
Governments and Non-Profit Organizations and New Jersey OMB Circular
04-04-OMB, Single Audit Policy for Recipients of Federal Grants, State
Grants and State Aid.

At any time during the Contract term, the Provider Agency's

overall operations, its compliance with specific Contract provisions,
and the operations of any assignees or subcontractors engaged by the
Provider Agency under Section 5.02 Assignment and Subcontracts may be
subject to audit by the Department, by any other appropriate unit or
agency of State or federal government, and/or by a private firm or
firms retained or approved by the Department for such purpose.

Whether or not such audits are conducted during the Contract term,
a final audit of Contract operations, including the relevant operations
of any assignees or subcontractors, may be conducted after Contract
Termination or Expiration.

The Provider Agency is subject to audit up to four years after

Termination or Expiration of the Contract. If any audit has been
started but not completed or resolved before the end of the four-year
period, the Provider Agency continues to be subject to such audit until
it is completed and resolved.

Section 3.14 Federal Davis-Bacon Act and New Jersey Prevailing

Wage Act. Any Department Contract containing federal funds in excess
of $2,000 utilized for the construction, alteration, renovation, repair
or modification of public works or public buildings to which the
federal government is a party, or any contract for similar work on
public works financed with federal funds must comply with the federal
Davis-Bacon Act, 40 U.S.C. section 276a et seq. The Davis-Bacon Act
requires that the contractor must pay the prevailing wages to each
designated worker class engaged under the contract at wage rates
determined by the U.S. Secretary of Labor.

In addition, any State funds in excess of $2,000 utilized through

a subsequent Provider Agency contract or subcontract for any public
work in which the Department is a party, or for public work to be done
on property or premises leased or to be leased by the Department shall
comply with the NJ Prevailing Wage Act, N.J.S.A. 34:11-56.27. Such
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contracts or subcontracts shall contain a provision stating that the

prevailing wage rate, as designated by the New Jersey Commissioner of
Labor, must be paid to all designated classes of workers employed
through said contracts or subcontracts. The Provider Agency must
determine if the New Jersey Prevailing Wage Act applies and follow all
directives per N.J.S.A. 34:11-56 et seq.

Section 3.15 Contract Closeout. The Provider Agency shall comply

with all requirements of Policy Circular P7.01, Contract Closeout,
including the timely submittal of the Final Report of Expenditures and
any other financial or programmatic reports required by the Department.
All required documentation is due within 120 Days of Contract
Expiration, Non-renewal or Termination.

IV. Expiration, Non-Renewal and/or Termination

The Department may in accordance with the sections below allow a

Contract to expire and or not be renewed.

Section 4.01. The Department or Provider Agency may let this

Contract expire at the end of the contract term upon 60 Days' advance
written Notice to the other party for any reason whatsoever, including
lack of funding by the Department. In the case of contract awards that
are made on a time limit basis (i.e. Federal Grant, Special
Appropriation; one time funding to support a program), the 60 day
notice is not required.

Section 4.02 Contract Settlement. When a Contract has expired

under any section of Article IV of this Contract or Policy Circular
P9.05, Contract Default, the Provider Agency shall be prohibited from
incurring any additional obligations of Contract funds. The Department
may allow costs that the Provider Agency could not reasonably avoid
during the Expiration process to the extent that said costs are
determined to be necessary and reasonable.

The Provider Agency and Department shall settle or adjust all

accounts in a manner specified by the Department and shall be subject
to a final audit under Section 3.13 Audit.

The Department may terminate or suspend this Contract in

accordance with the sections listed below.

Section 4.03 Default and Termination for Cause. If the Provider

Agency fails to fulfill or comply with any of the terms or conditions
of the Contract, in whole or in part, the Department may by Notice
place the Provider Agency in default status, and take any action(s)
listed in accordance with Department Policy Circular P9.05, Contract
Default. Notice shall follow the procedures established in the Policy
Circular.

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The above notwithstanding, the Department may immediately upon

Notice terminate the Contract prior to its expiration, in whole or in
part, whenever it is determined that the Provider Agency has
jeopardized the safety and welfare of the Department's clients,
materially failed to comply with the terms and conditions of the
Contract, or whenever the fiscal or programmatic integrity of the
Contract has been compromised. The Notice of Termination shall state
the reason for the action(s); the Provider Agency's informal review
options, time frames and procedures; the effective date of the
Termination; and the fact that a request for a review of the decision
for action(s) does not preclude the determined action(s) from being
implemented.

Section 4.04 Termination by the Department or Provider Agency.

The Department or Provider Agency may terminate this Contract upon 60
Days' advance written Notice to the other party for any reason
whatsoever, including lack of funding by the Department.

The parties expressly recognize and agree that the Department's

ability to honor the terms and conditions of this Contract is
contingent upon receipt of federal funds and/or appropriations of the
State legislature. If during the term of this Contract, therefore, the
federal and/or the State government reduces its allocation to the
Department, the Department reserves the right, upon Notice to the
Provider Agency, to reduce or terminate the Contract.

Section 4.05 Termination Settlement. When a Contract is

terminated under any section of Article IV of this Contract or Policy
Circular P9.05, Contract Default, the Provider Agency shall be
prohibited from incurring additional obligations of Contract funds.
The Department may allow costs that the Provider Agency could not
reasonably avoid during the Termination process to the extent that said
costs are determined to be necessary and reasonable.

The Provider Agency and Department shall settle or adjust all

accounts in a manner specified by the Department and shall be subject
to a final audit under Section 3.13 Audit.

V. ADDITIONAL PROVISIONS

Section 5.01 Application of New Jersey Law. This Contract shall

be governed, construed and interpreted in accordance with the laws of
the State of New Jersey including the New Jersey Contractual Liability
Act (N.J.S.A. 59:13-1 et seq.).

Section 5.02 Assignment and Subcontracts. This Contract, in whole

or in part, may not be assigned by the Provider Agency or assumed by
another entity for any reason, including but not limited to changes in
the corporate status of the Provider Agency, without the prior written
consent of the Department. Upon prior written notice of a proposed
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assignment, the Department may: (1) approve the assignment and continue
the Contract to term; (2) approve the assignment conditioned upon the
willingness of the assignee to accept all contractual modifications
deemed necessary by the Department; or (3) disapprove the assignment
and either terminate the Contract or continue the Contract with the
original Provider Agency.

The Provider Agency may not subcontract any of the services that
it has committed to perform or provide pursuant to this Contract
without the prior written approval of the Department. Such consent to
subcontract shall not relieve the Provider Agency of its full
responsibilities under this Contract. Consent to the subcontracting of
any part of the services shall not be construed to be an approval of
said subcontract or of any of its terms, but shall operate only as an
approval of the Provider Agency’s request for the making of a
subcontract between the Provider Agency and its chosen subcontractor.
The Provider Agency shall be responsible for all services performed by
the subcontractor and all such services shall conform to the provisions
of this Contract.

Section 5.03 Client Fees. Other than as provided for in the Annex
(es) and/or Departmental Component specific policies, the Provider
Agency shall impose no fees or any other types of charges of any kind
upon recipients of Contract services.

Section 5.04 Indemnification. The Provider Agency shall assume

all risk of and responsibility for, and agrees to indemnify, defend and
hold harmless the State of New Jersey and its employees from and
against any and all claims, demands, suits, actions, recoveries,
judgments and costs, and expenses in connection therewith on account of
the loss of life, property or injury or damages to the person, body or
property of any person or persons, whatsoever, which shall arise from
or result directly or indirectly from (1) the work, service or
materials provided under this Contract; or (2) any failure to perform
the Provider’s obligations under this Contract or any improper or
deficient performance of the Provider’s obligations under this
Contract. This indemnification obligation is not limited by, but is in
addition to, the insurance obligations contained in this Contract.

Furthermore, the provisions of this indemnification clause shall

in no way limit the obligations assumed by the Provider under this
Contract, nor shall they be construed to relieve the Provider from any
liability nor preclude the State of New Jersey, its Agencies, and/or
the Department of Human Services from taking any other actions
available to them under any other provisions of this Contract or
otherwise in law.

The Provider’s liability under this agreement shall continue after

the termination of this agreement with respect to any liability, loss,

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expense or damage resulting from the acts occurring prior to

termination.

Section 5.05 Insurance. The Provider Agency shall maintain

adequate insurance coverage. The State of New Jersey, Department of
Human Services and the Departmental Component shall be included as an
Additional Insured on any insurance policy applicable to this Contract.
Should the Provider Agency fail to pay any premium on any insurance
policy when due, the Department may pay the premium and, upon Notice to
the Provider Agency, reduce payment to the Provider Agency by the
amount of the premium payment. The Provider Agency is responsible for
forwarding a copy of its insurance policy declaration page to the
Contracting Departmental Component for its contract files.

Section 5.06 Modifications and Amendments. If both parties to

this Contract agree to amend or supplement this Contract, any and all
such amendments or supplements shall be in writing and signed by both
parties. The amendment or supplement shall incorporate the entire
Contract by reference and will not serve to contradict, amend or
supplement the Contract except as specifically expressed in the
amendment or supplement.

Section 5.07 Statement of Non-Influence. No person employed by

the State of New Jersey has been or will be paid any fee, commission,
or compensation of any kind or granted any gratuity by the Provider
Agency or any representative thereof in order to influence the awarding
or administration of this Contract.

Section 5.08 Exercise of Rights. A failure or a delay on the part

of the Department or the Provider Agency in exercising any right, power
or privilege under this Contract shall not waive that right, power or
privilege. Moreover, a single or a partial exercise shall not prevent
another or a further exercise of that or of any other right, power or
privilege.

Section 5.09 Recognition of Cultural Sensitivity. The Provider

Agency agrees in the performance of this Contract to be sensitive to
the needs of the minority populations of the State of New Jersey. This
sensitivity includes the employment, if possible, of a culturally
diverse staff that can communicate with, and be representative of, the
community it serves.

The Provider Agency shall make programs linguistically appropriate

and culturally relevant to underserved minority groups within the
community. Appropriate accommodations for services shall be developed
and maintained for those minority individuals who are deprived of
reasonable access to those services due to language barriers or ethnic
and cultural differences. In addition, Provider Agencies shall make
certain that all programs and services are reflective of the
demographic needs of the community, while providing all minorities the
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opportunity to experience any and all available social services

irrespective of their ethnic or cultural heritage.

Section 5.10 Copyrights. The State of New Jersey reserves a

royalty-free, nonexclusive and irrevocable right to reproduce, publish
or otherwise use any work or materials developed under a Department or
federally funded contract or subcontract. The Department also reserves
the sole right to authorize others to reproduce, publish or otherwise
use any work or materials developed under said contract or subcontract.

Section 5.11 Successor Contracts. If an audit or Contract close-

out reveals that the Provider Agency has failed to comply with the
terms and/or conditions of this Contract, the Department reserves the
right to make all financial and/or programmatic adjustments it deems
appropriate to any other Contract entered into between the Department
and the Provider Agency.

Section 5.12 Sufficiency of Funds. The Provider Agency shall

recognize and agree that both the initial provision of funding and the
continuation of such funding under the Contract is expressly dependent
upon the availability to the Department of funds appropriated by the
State Legislature from State and/or Federal revenue or such other
funding sources as may be applicable. A failure of the Department to
make any payment under its contract with the Provider Agency or to
observe and adhere its performance obligation under the contract as a
result of the failure of the Legislature to appropriate the funds
necessary to do so shall not constitute a breach of the Contract by the
Department or default thereunder and the Department shall not be held
financially liable therefore. In addition, future funding shall not be
anticipated from the Department beyond the duration of the Contract
with the Provider Agency and in no event shall the contract be
construed as a commitment by the Department to expend funds beyond the
termination date set therein.

Section 5.13 Collective Bargaining. State and federal law allow

employees to organize themselves into a collective bargaining unit.
Funds provided under this Contract shall not be utilized to abridge the
rights of employees to organize themselves into a collective bargaining
organization or preclude them from negotiating with Provider Agency
management. Funds may be utilized for legitimate and reasonable
management purposes at the direction of the Provider Agency during the
process of collective bargaining organization.

Section 5.14 Independent Employer Status. Employees of Provider

Agencies that Contract with the Department of Human Services are
employees of the Provider Agency, not the State.

In accordance with the National Labor Relations Act, 29 U.S.C.A.

152(2) and State law, N.J.S.A. 34:13A-1 et seq., Provider Agencies are
independent, private employers with all the rights and obligations of

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such, and are not political subdivisions of the Department of Human

Services.

As such, the Provider Agency acknowledges that it is an

independent contractor, providing services to the Department of Human
Services, typically through a contract-for-services agreement. As
independent contractors, Provider Agencies are responsible for the
organization's overall functions which includes the overseeing and
monitoring of its operations, establishing the salary and benefit
levels of its employees, and handling all personnel matters as the
employer of its workers.

The Provider Agency acknowledges its relationship with its

employees as that of employer. While the Department has an adjunct
role with Provider Agencies through regulatory oversight and ensuring
contractual performance, the Provider understands that the Department
is not the employer of a Provider Agency's employees.

The Provider Agency further acknowledges that while the Department

reimburses Provider Agencies for all allowable costs under the
Contract, this funding mechanism does not translate into the Department
being responsible for any of the elements of any collective bargaining
agreements into which Provider Agencies may enter. Moreover, each
Provider Agency understands that it is responsible for funding its own
programs and is not limited to the amount of funding provided by the
Department, and, in fact, is encouraged to solicit non-State sources of
funding, whenever possible.

Section 5.15 Executive Order No. 189. Executive Order No. 189
establishes the expected standard of responsibility for all parties
that enter into a contract with the State of New Jersey. All such
parties must meet a standard of responsibility that assures the State
and its citizens that such parties will compete and perform honestly in
their dealings with the State and avoid conflicts of interest.

In compliance with Paragraph 3 of Executive Order No. 189, no

Provider Agency shall pay, offer to pay, or agree to pay, either
directly or indirectly, any fee, commission, compensation, gift,
gratuity, or other thing of value of any kind to any State officer or
employee or special State officer or employee, as defined by N.J.S.A.
52:13D-13b and e, in the Department of the Treasury or any other agency
with which such Provider Agency transacts or offers or proposes to
transact business, or to any member of the immediate family, as defined
by N.J.S.A. 52:13D-13i, of any such officer or employee, or any
partnership, firm, or corporation with which they are employed or
associated, or in which such officer or employee has an interest within
the meaning of N.J.S.A. 52:13D-13g.

The solicitation of any fee, commission, compensation, gift,

gratuity or other thing of value by any State officer or employee or
special State officer or employee from any Provider Agency shall be
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reported in writing forthwith by the Provider Agency to the Attorney

General and the Executive Commission on Ethical Standards.

No Provider Agency may, directly or indirectly, undertake any

private business, commercial or entrepreneurial relationship with,
whether or not pursuant to employment, contract or other agreement,
express or implied, or sell any interest in such Provider Agency to,
any State officer or employee or special State officer or employee
having any duties or responsibilities in connection with the purchase,
acquisition or sale of any property or services by or to any State
agency or any instrumentality thereof, or with any person, firm or
entity with which he is employed or associated or in which he has an
interest within the meaning of N.J.S.A. 52:13D-13g. Any relationships
subject to this provision shall be reported in writing forthwith to the
Executive Commission on Ethical Standards, which may grant a waiver of
this restriction upon application of the State officer or employee or
special State officer or employee upon a finding that the present or
proposed relationship does not present the potential, actuality or
appearance of a conflict of interest.

No Provider Agency shall influence, or attempt to influence or

cause to be influenced, any State officer or employee or special State
officer or employee in his official capacity in any manner which might
tend to impair the objectivity or independence of judgment of said
officer or employee.

No Provider Agency shall cause or influence, or attempt to cause

or influence, any State officer or employee or special State officer or
employee to use, or attempt to use, his official position to secure
unwarranted privileges or advantages for the Provider Agency or any
other person.

The provisions cited above shall not be construed to prohibit a

State officer or employee or special State officer or employee from
receiving gifts from or contracting with Provider Agencies under the
same terms and conditions as are offered or made available to members
of the general public subject to any guidelines the Executive
Commission on Ethical Standards may promulgate.

Section 5.16 Salary Compensation Limitation (Excludes Physician

and Advanced Practice Nurses). The amounts paid under this contract to
the Provider Agency for employee compensation are subject to the
following conditions:

(i) Full-time Salary Compensation Limitation. No monies under

the contract shall be paid to the Provider Agency for costs of any
individual salary (including bonuses) to be paid to any of the Provider
Agency’s full-time employees (excluding Physician and Advanced Practice
Nurses) in excess of the schedule set forth below:

Full-time Salary Compensation Limitation Schedule

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Full-time Salary Compensation Limitations vary as follows: Only

one Full-time Salary Compensation Limitation shall be applicable
to each Provider Agency. This includes the aggregate of all
contracts held with: 1) the Department of Human Services and 2)
the Department of Children and Families.

For Provider Agencies with gross revenue (based on the last

annual audit report) for the entire organization of:

a) Over $20 million, the limitation shall be $141,000

(Benchmark Salary),
b) Over $10 million, but less than or equal to $20 million the
limitation shall equal 90% of the Benchmark Salary
($126,900),
c) Over $5 million, but less than or equal to $10 million the
limitation shall equal 85% of the Benchmark Salary
($119,850),
d) Less than $5 million, the limitation shall equal 75% of the
Benchmark Salary ($105,750).

(ii) Part-time Salary Compensation Limitation. The salary

compensation limitation for a part-time employee, or for an employee
whose time is only partly spent on activities compensated under this
contract, shall be calculated by prorating the compensation for the
position as prescribed under the Full-time Salary Compensation
Limitation Schedule. The prorated percentage shall be specified in the
Annex B and shall be determined by the regular number of work hours for
that Part-time title or that the employee is scheduled to work on
matters compensated under this contract;
(iii) Any salary paid to any employee in excess of these
limitations must be paid out of funds received from sources other than
this Contract, or funds other than those received from other contracts
held within the Department of Human Services or Department of Children
and Families;

(iv) The Full - or Part-time Salary Compensation Limitation will

apply to cost reimbursement contracts at the time of contract renewal;

(v) Any fixed/fee for service rate contracts set prior to the
adoption of this amendment is not subject to the salary compensation
limitations prescribed in Section 5.16(i) or (ii), however, any
fixed/fee for service rate contract set prior to the adoption of this
amendment that is subsequently renewed at a higher rate are subject to
the Salary Compensation Limitation Schedule prescribed in Section 5.16
(i) or (ii);

(vi) Any fixed/fee for service rate developed for a new program
or service in an existing contract are subject to the Salary
Compensation Limitation Schedule prescribed in Section 5.16(i) or (ii);

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(vii) Any new contracts entered into after the date of the
adoption of this amendment are subject to the Salary Compensation
Limitation Schedule prescribed in Section 5.16 (i) or (ii).

Section 5.17 Salary Compensation Limitation for Physician and

Advanced Practice Nurses. The amounts paid under this contract to the
Provider Agency to compensate Physicians and Advanced Practice Nurses
are subject to the following conditions:

(i) A maximum compensation of $212,000 per annum, regardless of

the amount of gross revenues of the entire organization;

(ii) Part-time Physicians and Advanced Practice Nurse’s

compensation will be calculated pursuant to Section 5.16 (ii).

Section 5.18 Compensation Limitation for Fringe Benefits. This

section is being reserved for future consideration.

Section 5.19 Compensation Limitation for Employee Severance

Agreement. Unless an exception has been approved by the Departmental
Component for a specific circumstance, the amounts paid under this
contract to the Provider Agency for an employee severance agreement are
subject to the following conditions:

(i) The Provider Agency has an established written uniform

severance agreement for all employees covered under the contract;

(a) No monies shall be paid to the Provider Agency for a

severance payment to any employee in excess of the equivalent
of two (2) weeks compensation (salary and fringe benefits);

(b) No monies shall be paid to the Provider Agency for a

severance payment to any employee that has been employed by
the Provider Agency for less than one (1) year of continuous
employment; and

(c) No monies shall be paid to the Provider Agency for a

severance payment to any employee that was discharged for
cause (as cause is determined by the Provider Agency’s
policies).

(ii) If the Provider Agency does not have an established written

uniform severance agreement, no monies shall be paid to the Provider
Agency for a severance payment for any employee covered under the
contract.

Section 5.20 Compensation Limitation for Employee Travel Expenses.

The amounts paid under this contract to the Provider Agency for
staff travel including; conference and registration fees, mileage
reimbursement, meals and incidental expenses (M&IE), parking, and
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overnight lodging accommodations for employees who are compensated in

whole or in part under this contract are subject to the following
conditions:

(i) General Provisions:

(a) In- and out-of-state travel must be directly related to the

employee’s duties as set forth in the contract and/or be required
for accreditation and/or licensure of the contracted program;

(b) For in-state travel and for out-of-state travel that is

within 50 miles of the border of the State where the Provider
Agency is located, no monies provided under the contract shall be
used for employee lodging expenses unless previously approved by
the Departmental Component;

(c) Travel costs may be charged on an actual basis and may

include a mileage reimbursement rate, as well as meals and
incidental expenses (M&IE) up to, but not to exceed the Federal
reimbursement rates (refer to the Federal internet web site,
http://www.gsa.gov. for current rates) in effect at the time the
employee traveled.

(ii) In-State Provisions: The Provider Agency may not approve

any in-state travel reimbursement in excess of two-hundred and fifty
dollars ($250.00) per employee, per event, unless written approval is
obtained from the departmental component’s contracting authority prior
to such travel;

(iii) Out-of-State-Provisions:

(a) The Provider Agency must obtain prior-approval from the

departmental component’s contracting authority for an employee’s
out-of-state travel, regardless of travel costs, unless such
travel is no further than 50 miles from the border of the state
where the Provider Agency is located, and travel costs per
employee are less than two-hundred and fifty dollars ($250.00);
and

(b) Out-of-state travel (excluding travel no further than 50

miles from the border of the State where the Provider Agency is
located) or travel costs in excess of the two-hundred and fifty
dollar ($250.00) limit by the employee, that was not pre-approved
by the departmental component’s contracting authority shall not
be eligible for reimbursement under the contract.

Section 5.21 Compensation Limitation for Employee Tuition

Reimbursement. The amounts paid under this contract to the Provider

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Agency for tuition reimbursement and related expenses are subject to

the following conditions:

(i) No monies paid to the Provider Agency under the contract

shall be used for any costs incurred by the Provider Agency’s employees
to attend any educational courses including tuition, textbooks,
supplies, etc. unless such courses are required by the contract or for
program licensure, certification, and/or Medicaid standards; or;

(ii) No monies paid to the Provider Agency under the contract

shall be used for any costs incurred by the Provider Agency’s employees
to attend educational courses including tuition, textbooks supplies,
etc. unless such courses are towards a field of service related to the
Provider Agency’s contract and the allocated contract monies do not
exceed the lesser of $5000 or 1% of the Provider Agency’s total annual
operating budget; and

(iii) There are monies allocated in the Provider Agency’s

approved contract budget for the specific educational expenses
consistent with Section 5.21(i) and (ii).

Section 5.22 Compensation Restriction for Provider Agency

Sponsored Meetings, Conferences, Training, or Special Events. The
amounts paid under this contract to the Provider Agency for the cost of
administrative meetings, conferences, or special events are subject to
the following condition:

(i) No such monies under the contract shall be paid to the

Provider Agency for costs associated with meetings, conferences, or
special events where agency staff is the beneficiary of the event.
Unallowable costs include, but are not limited to the following: meals
and refreshments, entertainment, overnight lodging, receptions or other
social functions held for honoring all staff;

(ii) The Provider Agency may use monies under the contract to
cover training-related costs such as modest facility costs and nominal
refreshments, e.g. coffee, tea, water, soda, donuts, pastries, cookies,
and bagels.

Section 5.23 Criteria for and Processing a Vehicle Request. The

Provider Agency may request a new or replacement vehicle to be paid
from monies under the contract only under the following conditions:

(i) The Provider Agency must request written approval from the
departmental component’s contracting authority to purchase or replace a
vehicle and each request must be accompanied by the following
supporting documentation. The request may be denied even if all
supporting documentation is supplied. Documentation required includes:

(a) Explanation as to why the purchase or replacement of the

vehicle is required to fulfill contractual obligations;
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(b) Assurance that no one Provider Agency employee will be

permanently assigned the vehicle;

(c) Assurance that the Provider Agency has sufficient funds to

cover the vehicle’s operating costs for the anticipated useful
life of the vehicle;

(d) Submission of three (3) written bids for the same year,
make, model, and option package;

(e) If the vehicle is a replacement vehicle, documentation

consistent with Section 5.23 (ii) below;

(f) Any exceptions to the criteria and purchasing requirements

(Section 5.23 (i) (a)-(e)), will be dealt with on a case by case
basis with the departmental component’s contracting authority;
and

(g) If the request is approved, the Provider Agency shall be

required to purchase the vehicle from the lowest-priced vendor
consistent with Section 5.23 (i) (d).

(ii) The Provider Agency may request to replace an existing

vehicle under any of the following conditions:

(a) odometer reading exceeds 125,000;

(b) vehicle age is 10 years or older;

(c) repair costs to maintain operational capacity of vehicle

would exceed fifty (50) per cent of current trade-in Blue Book
value of vehicle;

(d) repair costs have exceeded fifty (50) per cent of the
current trade-in Blue Book value over the course of the past
year;

(e) vehicle was involved in an accident and deemed “totaled” by

the insurance carrier; and

(f) upon written request supported by sufficient documentation,

the Departmental component’s contracting authority determines
that the vehicle is no longer road worthy and unsafe to drive.

(iii) If the Provider Agency receives approval to purchase a

vehicle, the maximum cost of the vehicle including all dealer fees and
charges may not exceed $25,000 per vehicle. This limitation excludes
passenger vans, or specialized and adaptive vehicles for handicapped
consumers.

Page 21
June 2010
 P2.01
Attachment 1

(iv) When a Provider Agency has a fleet management program that

includes leased vehicles, the Provider Agency may obtain approval on a
program basis so that the Provider Agency does not require approval on
a vehicle basis.

Page 22
June 2010
 P2.01
Attachment 2

CONTRACT SIGNATURES AND DATES

The terms of this Contract have been read and understood by the
persons whose signatures appear below. The parties agree to comply
with the terms and conditions of the Contract set forth on the
preceding pages in Articles I through Article V, and any related
Annexes.

This Contract contains ____ pages and is the entire agreement of

the parties. Oral evidence tending to contradict, amend or supplement
the Contract is inadmissible; the parties having made the Contract as
the final and complete expression of their agreement.

BY: BY:
(signature) (signature)

(type name) (type name)

TITLE: TITLE:
(type) (type)

PROVIDER DEPARTMENTAL
AGENCY: COMPONENT:
(type) (type)

DATE: DATE:

Contract Effective Date:________________

Contract Expiration Date:_______________

Contract Number:________________________

Contract Ceiling:_______________________

Federal ID#:____________________________

Provider Contact Individual:_____________________________________

(Print Name)
 Policy Circular P3.03

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Bilingual and Bicultural Diversity in Contracts

EFFECTIVE: This policy circular shall be implemented August 1,

1996.

PROMULGATED: June 14, 1996

The purpose of this policy is to establish guidelines for the

Departmental Components and Provider Agencies to ensure that all
persons have equal access to Department of Human Services (DHS) funded
programs.

I. SCOPE

This policy applies to all Contracts.

II. DEFINITIONS

Minority means a person who is:

African-American, having origins in any of the black racial

groups in Africa;

Hispanic, having Spanish culture, with origins in Mexico,

South or Central America, or the Caribbean Islands,
regardless of race;

Asian-American, having origins in and of the original peoples

of the Far East, Southeast Asia, Indian sub-continent,
Hawaii, or the Pacific Islands;

American Indian or Alaskan native (Native American), having

origins in any of the original peoples of North America and
who maintain cultural identification through tribal
affiliations or community recognition.

III. POLICY

A. All Provider Agencies must be responsive to the needs of the

minority populations. Programs funded by DHS must be
linguistically appropriate and culturally relevant to the
populations being served in the community.
 2 P3.03

B. In accordance with Policy Circular P2.01, Department of Human

Services' Standard Language Document for Social Service and
Training Contracts, Departmental Components must ensure that
appropriate accommodations be developed and maintained for
those minority individuals who are deprived of reasonable
access to services because of language or ethnic and cultural
differences.

C. Departmental Components must ensure that Provider Agencies

address bilingual/bicultural issues in the Annex A, Program
Description, of the Standard Language Document for Social
Service and Training Contracts. The issues should include,
but not be limited to, the following:

1. indicating the percentage of minority and limited

English speaking and bicultural persons utilizing the
services provided by the Provider Agency, denoting the
source of the information;

2. indicating how the needs of the limited English speaking

and bicultural populations are being met, including but
not limited to, staffing and processes to mitigate
language barriers, such as bilingual agency
publications, answering machine messages and affiliation
agreements with bilingual and bicultural provider
agencies;

3. listing changes necessary to ensure access to programs

and how the Provider Agency plans to accommodate those
changes; and

4. describing the outreach and referral procedures to

ensure that all limited English speaking and bicultural
persons have access to the services needed.

Issued by:
 Policy Circular DYFS 3.52
DYFS Providers Only

DEPARTMENT OF HUMAN SERVICES

DIVISION OF YOUTH AND FAMILY SERVICES

SUBJECT: Annex A to Standard Language Title XX Purchase of

Service Contract, DYFS Form 7-33a

EFFECTIVE DATE: 5-10-82

REPLACES: 10-25-78

PURPOSE AND USE

The Annex A is used by provider agencies to outline to DYFS programmatic

information about a proposed contract.

RESPONSIBILITY FOR COMPLETING THE FORM

The Annex A is completed in quadruplicate by the provider agency and

submitted to the regional office as part of the contract proposal package
for each new contract and each time a contract is renewed.

INSTRUCTIONS FOR COMPLETING ANNEX A

Contract I.D.# Enter on each page of the Annex A, the six character
contract identification number assigned to your contract by the Regional
Business Office.

PART I - GENERAL AGENCY INFORMATION

SECTION I - IDENTIFICATION

Provider Agency Enter the name of the provider agency as it appears on

the contract.

Mailing Address Enter the mailing address of the provider agency.

Telephone No. Enter the area code and telephone number of the provider
agency.

Federal Identification No. Enter the Federal identification number

assigned to the provider agency.

Effective Dates Enter the date the contract will commence and the date it
will terminate.
EFFECTIVE: 5-10-82 2 DYFS 3.52
REPLACES: 1--25-78

Contract Ceiling $ Enter the dollar amount of the contract ceiling as it

appears on line D, column 3 of the Annex B, DYFS Form 7-33b.

Chief Executive Officer Enter the name of the person responsible for all
contract operations as designated by resolution of the governing body.

Title Enter the title of the chief executive officer of the provider
agency.

Address Enter the mailing address of the chief executive officer.

Telephone No. Enter the area code and telephone number where the chief
executive officer can be contacted.

All notices relevant to this contract should be sent to: Enter the name,
title, mailing address, area code and telephone number of the person at
the provider agency whom DYFS sends all notices regarding the contract.

Program Name Enter the name of the Title XX program.

Site Address(es) Enter the address(es) of the program site(s).

Telephone No. Enter the area code(s) and telephone number(s) of the
program site(s).

Program Director Enter the name of the director of the program.

Title XX Service Definition Enter the formal title and definition of the
Title XX service being rendered as it appears in the most recent New
Jersey Comprehensive Annual Service Program Plan.

SECTION II - AUTHORIZED SIGNATURES

Name and Position Enter the name and position of the person(s) authorized
to sign or be responsible for each transaction listed.

# of Signatures Required Enter the number of signatures required for each

transaction.

SECTION III - SERVICE DAYS

Service will be provided as follows For each day of the week, enter the
hours that service will be provided.

Emergency Provisions Describe any special arrangements which have been

made to handle emergencies, e.g., radio station, special telephone number,
alternate site, etc.
EFFECTIVE: 5-10-82 3 DYFS 3.52
REPLACES: 1--25-78

Service will not be provided on the following: List the occasions and
dates when service will not be provided, e.g., Christmas, December 25,
Independence Day, July 4, etc.

PART II - PROGRAM OPERATIONS

SECTION I - PROGRAM SUMMARY AND EVALUATION PLAN

This section is self explanatory.

SECTION II. UNIT OF SERVICE

Unit of Service Definition (s) Describe, with the assistance of the

Regional contract staff, the unit used to measure the quantity of service
delivered. (e.g., preschool child care program - "one 10 hour day in
which the minimum program requirements are met"; transportation program
"one one-way trip", counseling program - "one direct service hours"' etc.)

Components Enter the type(s) of service provided in this column. (e.g.,

infant care, pre-school, homemaker, transportation, etc.)

Type of Units Enter the type of unit used to measure each component.
(e.g., days, hours, miles, matches, etc.)

Total # of Units Enter the total number of units which the agency
provides. Exception: for contracts in which level of service will be
measured by multiplying days by spaces (e.g., child care) enter the number
of spaces for which the Division is contracting.

# of Contract Units Enter the number of units for which DYFS is

contracting. Exception: for contracts in which level of service will be
measured by multiplying days by spaces (e.g., child care) enter the number
of spaces for which the Division is contracting.

# Of Unduplicated Clients Enter the number of clients the agency will

service. (Only fill in this column when instructed to do so by the
regional office.)

# Of Optional Enrollees Child care centers are to enter the maximum number
of overenrolled spaces to be allowed within the contract. This figure may
not exceed fifteen percent of the number of contracted spaces.

SECTION III. MONTHLY CONTRACTED LEVEL OF SERVICE

A monthly contracted level of service chart is to be completed for each

component.

Component Enter the type of service provided.

EFFECTIVE: 5-10-82 4 DYFS 3.52
REPLACES: 1--25-78

Column 1. Month Enter the name of each contract month.

Columns 2 through 7 are to be completed only for contracts which compute

level of service by multiplying days by spaces.

Column 2. Poss. Serv. Days. For each contracts month, enter the number
of days it would be possible to provide service if there were no
holidays or training days in the month. Do not include weekends
unless the program is usually open on weekends.

Column 3. Non-Service Days (Hol.) Indicate the number of holidays (not to

exceed 13 annually) on which service will not be provided in
each month.

Column 4. Non-Service Days (Trng. Days) Indicate the number of days in

each month that service will not be provided due to training
(not to exceed 2 annually).

Column 5. Non-Funded Days If service will not be provided for a block of

time beyond the holidays and training days within the contract
period list these days as non-funded days.

Column 6. Mthly. Serv. Days For each contract month, subtract the sum of
columns 3, 4, and 5 from columns 2 to determine the actual
monthly service days and enter this figure.

Column 7. # Sp. Under Cont. Enter the number of spaces under contract
each month.

Column 8. Monthly Contracted L.O.S. Multiply each number in column 6 by

the number in column 7. Enter the products in column 8.

Contracts for which level of service is not computed by

multiplying days by spaces should merely fill in the number of
units they will deliver each month.

Annual Totals Add and enter the sums of columns 2,3,4,5,6, and 8.

PART III. - PROGRAM MANAGEMENT

SECTION I - ESSENTIAL DOCUMENTS

This Section is self explanatory.

SECTION II - PROGRAM COMPLIANCE CALENDAR

This section is completed by the DYFS Field Coordinator.

EFFECTIVE: 5-10-82 5 DYFS 3.52
REPLACES: 1--25-78

Month 1_______________________ Enter the name of the first month of the

contract. Describe any changes the agency must make or documents the
agency must supply by the end of the first month of the contract. (e.g.,
Month 1 April. "The agency must develop a termination policy.")

Month 2 - Month 12_____________ Continue the above procedure for each

succeeding month of the contract.

DISTRIBUTION

Original and 2 copies - DYFS Regional Office

Copy - Provider Agency File

EFFECTIVE: 5-10-82 DYFS 3.52
REPLACES: 1--25-78

ATTACHMENT A - PERSONNEL INFORMATION SHEET

PURPOSE AND USE

The Personnel Information Sheet is used by the provider agency to record

background information regarding all employees of the agency.

The form is used by DYFS to verify that the provider agency has employed
staff sufficiently qualified to meet the requirements of the contract.

RESPONSIBILITY FOR COMPLETING THE FORM

The form is completed in quadruplicate by the provider agency and attached

to the Annex A, DYFS Form 7-33a, as part of the proposal package submitted
for each new or renewal contract.

INSTRUCTIONS FOR COMPLETING THE FORM

Contract I.D. # Enter the six character contract identification number

assigned to your contract by the Regional Business Office.

List All Full and Part Time Positions List the title of each full time
and part time position in your agency.

Column (2) through (5) Complete the remainder of the form by listing for
each position, in the appropriate column, the following information:

• name of person in the position;

• the hours the employee works daily;
• the types of degrees, licenses, certificates, etc. that the
employee possesses which are pertinent to his/her position; and
• any additional credits, training, and experience, pertinent to the
position, that the employee has obtained.

DISTRIBUTION

Original and 2 copies - DYFS Regional Office

Copy - Provider Agency File

EFFECTIVE: 5-10-82 DYFS 3.52
REPLACES: 1--25-78

ATTACHMENT B - CHILD CARE CENTER GROUP COMPOSITION

PURPOSE AND USE

The form is used to demonstrate that adequate adult coverage has been
arranged to care for children during all hours that a child center is in
operation.

RESPONSIBILITY FOR COMPLETING THE FORM

The form is completed in quadruplicate by the child care center staff and
submitted to the regional office with Annex A to the Standard Language
Title XX Purchase of Service Contract, DYFS Form 7-33a whenever a new
Annex A is submitted and whenever there are changes.

INSTRUCTIONS FOR COMPLETING THE FORM

Contract I.D. # Enter the six character contract identification number

assigned to your contract by the Regional Business Office.

Site Address Enter the address of the program site. A separate group
composition form must be completed for each site.

Age Group Enter ages covered by each group of children.

At each hour Enter the number of adults and the number of children
present in each group.

DISTRIBUTION

Original and 2 copies - DYFS Regional Office

Copy - Provider Agency File

 DYFS 7-33a
(rev. 5/82)
Page 1
State of New Jersey
DEPARTMENT OF HUMAN SERVICES
Division of Youth and Family Services

ANNEX A - STANDARD LANGUAGE TITLE XX PURCHASE OF SERVICE CONTRACT

Contract I.D.#_________
PART I. GENERAL AGENCY INFORMATION

SECTION I. - IDENTIFICATION

Provider Agency __________________________________________________________

Mailing Address __________________________________________________________

__________________________________________ Telephone # ( ) _____________

Federal Identification # _________________________________________________

Effective Dates _________to________ Contract Ceiling $ ________________

Chief Executive Officer __________________________________________________

Title _______________________________________________________________

Address _____________________________________________________________

_____________________________________ Telephone # ( ) _____________

All notices relevant to this contract should be sent to:

Name ________________________________________________________________

Title _______________________________________________________________

Mailing Address _____________________________________________________

_____________________________________ Telephone # ( ) _____________

Program Name _____________________________________________________________

Site Address(es) _________________________________________________________

__________________________________________________________________________

__________________________________________ Telephone # ( ) _____________

Program Director _________________________________________________________

Title XX Service Definition ______________________________________________

 DYFS 7-33a
(rev. 5/82)
Page 2

ANNEX A - STANDARD LANGUAGE TITLE XX PURCHASE OF SERVICE CONTRACT

Contract I.D. #__________

I. GENERAL AGENCY INFORMATION

SECTION II. - AUTHORIZED SIGNATURES

List names and positions of persons authorized to sign the following.

Give number of persons required to sign each transaction.

# OF SIGNATURES
NAME POSITION REQUIRED

Title XX 1.________________ _________________ ____1____

Contract 2.________________ _________________
3.________________ _________________

DYFS 7-32 1. _______________ _________________ ____1____

Monthly 2. _______________ _________________
Financial 3. _______________ _________________
Report

DYFS AR 50/54 1.________________ _________________ _____1____

Invoice 2.________________ _________________
3.________________ _________________

Contract 1.________________ _________________ _____1____

Budget 2.________________ _________________
Modification 3.________________ _________________

Checks 1.________________ _________________ __________

2.________________ _________________
3.________________ _________________

Other 1.________________ _________________ __________

Contracts & 2.________________ _________________
Agreements 3.________________ _________________

Fee Assessors 1.________________ _________________ __________

2.________________ _________________

Fee Collectors 1.________________ _________________

2.________________ _________________
 2
DYFS 7-33a
(rev. 5/82)
Page 3

ANNEX A - STANDARD LANGUAGE TITLE XX PURCHASE OF SERVICE CONTRACT

Contract I.D. #__________

PART I - GENERAL AGENCY INFORMATION

SECTION III - SERVICE DAYS

Service will be provided as follows:

(Fill in time)

Sunday_____-_____Monday_____-_____Tuesday_____-_____Wednesday_____ - _____

Thursday_____ - _____Friday_____ - _____Saturday_____ - _____

Emergency Provisions: ____________________________________________________

__________________________________________________________________________

Service will not be provided on the following:

OCCASION DATE(S)
 DYFS 7-33a
(rev. 5/82)
Page 4

ANNEX A - STANDARD LANGUAGE TITLE XX PURCHASE OF SERVICE CONTRACT

PART II - PROGRAM OPERATIONS

Section I - PROGRAM SUMMARY AND EVALUATION PLAN

Write a brief, concise, descriptive summary of your agency and this

program. The description should present a clear picture of what, why,
where, how, and for whom service is provided.

Include as a minimum:

• your agency's purpose, philosophy, goals and objectives;

• details about the program including a description of neighborhood

where located, the facilities used by the agency and other programs
sponsored by the agency;

• evidence of the need for the service in the community;

• any limitations, restrictions or priorities on service delivery;

• any unique capabilities (e.g., multi-lingual, special reading

programs, etc); and

• the circumstances of any previous contact with the division, state,

municipal, county public agencies or other related projects and
contracts.

If this is a renewal package, describe at a minimum:

• any change in the information requested above;

• how your agency has developed and made progress toward its goal in
the past year; and

• how each recommendation of the program evaluations (e.g., self-

evaluation, DYFS evaluation, child care food program evaluation,
homemaker evaluation, etc.) of the previous contract will be
addressed in the proposed contract.

Describe how your agency will evaluate this proposed contract (effectiveness of the program, its
goals and objectives, and efficiency of the procedures used.) Include an explanation of how your
agency's internal evaluation method will interface with the evaluation process of the Division and
who (by title) will have what responsibilities in this process.
 DYFS 7-33a
(rev. 5/82)
Page 5

ANNEX A - STANDARD LANGUAGE TITLE XX PURCHASE OF SERVICE CONTRACT

Contract I.D. #_____________

PART II - PROGRAM OPERATIONS

SECTION II - UNIT OF SERVICE

Unit of Service Definition(s) ____________________________________________

__________________________________________________________________________

NUMBER OF NUMBER OF NUMBER OF

TYPE OF TOTAL NUMBER CONTRACT UNDUPLICATED OPTIONAL
COMPONENTS UNITS OF UNITS UNITS CLIENTS* ENROLLEES**

• where applicable
• ** for child care center services only (this figure represents a maximum
number of overenrolled spaces; the actual figure may fluctuate below
this throughout the year).
 DYFS 7-33a
(rev. 5/82)
Page 6

ANNEX A - STANDARD LANGUAGE TITLE XX PURCHASE OF SERVICE CONTRACT

Contract I.D. #__________

PART II - PROGRAM OPERATIONS

SECTION III. - MONTHLY CONTRACTING LEVEL OF SERVICE

______________________
Component

POSSIBLE NON NON- MONTHLY # SP MONTHLY

SERVICE SERVICE DAYS FUNDED SERV. UNDER CONTRACT
MONTH DAYS HOL. TRNG. DAYS DAYS CONT. LOS

1ST

2ND

3RD

4TH

5TH

6TH

7TH

8TH

9TH

10TH

11TH

12TH
ANNUAL
TOTALS

Note: Contracts for which level of service is not computed by multiplying

days by spaces need complete columns 1 and 8 only.
 DYFS 7-33a
(rev. 5/82)
Page 7

ANNEX A - STANDARD LANGUAGE TITLE XX PURCHASE OF SERVICE CONTRACT

PART III - PROGRAM MANAGEMENT

SECTION 1 - ESSENTIAL DOCUMENTS

The following essential documents must be part of your contract package

and must be updated as they change:

1. Annex A related essential documents

• *Copy of certificate of incorporation;

• Copy of Annual Report to Secretary of State;
• List of names, titles, and addresses of current board
members;
• *Copy of local certificate of occupancy;
• *Copies of all written policies which effect the Title XX
contracts;
• *Copies of Municipal, Fire, Health, and Building Approvals
(for on-site group programs);
• Copy of license to provide service (if required);
• Copy of courtesy inspection report (if required);
• Evidence of liability insurance policy;
• Personnel information Sheet; and
• Child Care Center Group Composition Sheet (child care
centers)

2. Annex B related essential documents

• Copy of the most recent agency audit/or fiscal statement;

• Copy of the most recent IRS 990 (private agencies only);
• Copy of bonding certificate;
• Copy of current lease;
• Copy of tax exempt certificate or letter; and
• Copy of Annual Report of a Charitable Organization (CO-1 or
C0-3)

3. Copies of any contract or agencies related to the Title XX program

*In a renewal contract additional copies of these documents need to be

sent only if some changes has occurred or if the agency is informed by
the Division that an additional copy is needed.
 Policy Circular P4.03

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Lobbying

EFFECTIVE: This policy circular shall become effective February 1,

1985, and shall be implemented immediately.

PROMULGATED: February 1, 1985

The purpose of this circular is to identify those lobbying activities

which are unallowable costs. The contents of this circular are based
on a revision of federal OMB Circular A-122, "Cost Principles for Non-
Profit Organizations", Lobbying and Related Activities, published in
the Federal Register Volume 49, Number 83, April 27, 1984. This
policy does not limit a Provider Agency's ability to engage in any
lobbying activities. Rather, the circular specifies which activities
the Department will fund. A Provider Agency may engage in other
lobbying activities and fund these activities from another source.

I. SCOPE

This policy circular applies to all Provider Agencies with Cost-

Related social services and training Contracts.

II. POLICY

A. Costs associated with the following lobbying activities are

unallowable:

l. Any attempt to influence the outcome of any federal,

State, or local election, referendum, initiative, or
similar procedures through in-kind or cash
contributions, endorsements, publicity or similar
activity;

2. Establishing, administering, contributing to or paying

the expense of a political party, campaign, political
action committee or other organization established for
the purpose of influencing the outcome of any election;

3. Any attempt to influence the introduction of federal or

State legislation or the enactment or modification of
pending federal or State legislation through
communication with a member or employee of the United
States Congress or State legislature (including
 2 P4.03

efforts to influence State or local officials to engage

in similar lobbying activity), or with a government
official or employee in connection with a decision to
sign or veto enrolled legislation;

4. Any attempt to influence the introduction of federal or

State legislation or the enactment or modification of
pending federal or State legislation by preparing,
distributing or using publicity or propaganda, or by
urging other persons to contribute to or participate in
any mass demonstration, march, rally, fund-raising
drive, lobbying campaign, letter writing, telephone
campaign; or

5. Legislative liaison activities, including attending

legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the
effect of legislation, when the activities are carried
on in support of or in preparation for an effort to
engage in unallowable lobbying.

B. Costs associated with the following lobbying activities are

allowable:

l. Providing technical and factual information to the

United States Congress or the State legislature on a
topic directly related to the performance of a Contract
if:

a) the information is given in response to a

documented request;

b) the information is readily obtainable and can be

readily put in deliverable form; and

c) costs for travel, lodging or meals are incurred to

offer testimony at a regularly scheduled
Congressional hearing in response to a written
request from the Chairman or Ranking Minority
Member of the Committee or Subcommittee conducting
the hearing.

2. Any attempt to influence State legislation in order to

directly reduce the cost or to avoid material
impairment of the Provider Agency's authority to
perform the Contract.

3. Any activity specifically authorized by statute to be

undertaken with funds from the Contract.
 3 P4.03

III. PROCEDURES

A. Unallowable lobbying costs, as identified in Section A, must

be treated as other unallowable activity costs in accordance
with the Contract_Reimbursement Manual.

B. Time logs, calendars or similar records documenting the

portion of an employee's time that is treated as an indirect
cost shall not be required for the purposes of complying
with this circular, unless:

l. during any calendar month, the employee engages in

allowable and unallowable lobbying activities which
together total more than 25% of his/her compensated
hours of employment;

2. during the previous five-year period, the Provider

Agency has at any time materially misstated allowable
or unallowable costs.

Issued by:

Robert D. Prunetti, Director Samuel F. Penza

Office of Planning and Policy Assistant Commissioner
Department of Human Services
 Policy Circular P4.05

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Equipment

EFFECTIVE: This policy circular shall become effective on January

21, 2005 and shall be implemented immediately.

PROMULGATED: January 21, 2005

SUPERSEDES: Policy Circular P4.05, promulgated July 1, 1988.

The purpose of this circular is to advise Department personnel and

Provider Agencies of policies and procedures to be followed in regard
to Equipment.

I. SCOPE

This policy circular applies to all Provider Agencies.

II. DEFINITIONS

In addition to defined terms included in the Glossary of the

Manual, the following terms, when capitalized, shall have
meanings as stated:

Replacement Equipment means property acquired with Department

funds to take the place of other Equipment purchased with
Department funds. Replacement Equipment must serve the same
function as the Equipment replaced and must be of the same nature
or character, although not necessarily the same model, grade or
quality.

Trade-In means the difference between the amount that would have
been paid for Replacement Equipment without a trade-in and the
amount paid with the trade-in. The term refers to the actual
difference, not necessarily the trade-in value shown on an
invoice.

III. POLICY AND PROCEDURES

A. Purchase of Equipment

Department funding of Equipment is allowable, if prior

approval is granted by the Department and is in accordance
with the July 1986 Contract Reimbursement Manual, Section
2.3, Procurement Standards.
 2 P4.05

B. Department Interest in Equipment

Title to all Equipment purchased in whole or in part under a

Contract is held by the Provider Agency. The State,
however, maintains an equitable interest in all such
Equipment.

1. New Equipment

When the Acquisition Cost of an item of Equipment is

contained in the Annex B: Contract Budget, the State's
percentage of interest in the Equipment is the same
percentage as the State share of the Contract Total
Cost.

2. Replacement Equipment

The State's percentage of interest in Replacement

Equipment is calculated as follows:

a. Step 1. In accordance with III.B.1 above,

determine the State's percentage of
interest in the original Equipment which
is being replaced.

b. Step 2. Determine the percentage of the

Replacement Equipment's cost that was
covered by Trade-In or sale proceeds
from the original Equipment which is
being replaced.

c. Step 3. Multiply the Step 1 percentage by the

Step 2 percentage.

d. Step 4. If an additional outlay for the

Replacement Equipment is charged to the
Contract, calculate the State's
percentage of that additional outlay in
accordance with the procedures explained
in III.B.1 above. Add the resulting
percentage to that derived in Step 3.

3. For items of Equipment having an Acquisition Cost of

$5,000 or more, all of which was paid by Department
funds, the Department has the right to require transfer
of the Equipment (including title) to the State or to
an eligible non-State party named by the Department.
Such transfer may occur at any time.

C. Use of Equipment

The following policies govern the use of Equipment purchased

with Department funds:
 3 P4.05

1. Equipment may be used by the Provider Agency in the

project or program for which it was acquired as long as
needed, whether or not the project or program continues
to be supported by federal or Department funds.

2. When no longer needed for the original project or

program, the Provider Agency, with approval of the
Department, may use the Equipment in other projects or
programs currently or previously sponsored by the
federal or State government, with first preference
being given to those administered by the Department.

3. If Equipment is being used less than full time in the

project or program for which it was originally
acquired, the Provider Agency must make it available
for use in other projects or programs currently or
previously sponsored by the federal or State
government, provided such other use will not interfere
with the work on the original project or program.
First preference for such other use shall be given to
other projects or programs administered by the
Department.

D. Equipment Replacement

1. In cases where Equipment wears out or becomes obsolete,

Replacement Equipment may become necessary.

2. Replacement Equipment is subject to the requirements of

this circular and to all other requirements applicable
to original Equipment, unless the State's percentage of
interest in the original Equipment was ten percent or
less, or the product of that percentage of interest
multiplied by the amount received for Trade-In or sale
is $500 or less.

3. Replacement Equipment may be acquired through Trade-In

or sale of the original Equipment and application of
the Trade-In or sale proceeds to the Acquisition Cost
of the Replacement Equipment. In either case, the
transaction must be one which a prudent person would
make in like circumstances.

4. The Provider Agency has the option of supplementing the

Trade-In or sale proceeds of the original Equipment
with funds from another funding source. In such cases,
the State will maintain an interest in only that
portion of the Acquisition Cost of the Replacement
Equipment paid with Department funds (Trade-In or sale
proceeds included).
 4 P4.05

E. Disposition of Unneeded Equipment

1. Prior written approval of the Department is required

for the disposition of Equipment in which the
Department has an equitable interest and which is no
longer needed by the Provider Agency.

2. The Department will determine if it has any further

need for the Equipment. At the Department's
discretion, this may be done by physical inspection of
the Equipment.

3. In cases where the Department has further need for the

Equipment, the Department will ensure that the
Equipment is placed in an appropriate program and will
carry out all necessary transfer proceedings, including
transfer of title. The Provider Agency will be
entitled to be paid an amount computed by multiplying
the Fair Market Value of the Equipment by the non-State
percentage of interest in the Equipment.

4. In cases where the Department has no further need for

the Equipment, disposition of the Equipment will be
made as follows:

a. Equipment with an Acquisition Cost of Less than

$5000 -

The Equipment may be retained, sold or otherwise

disposed of by the Provider Agency, with no
further obligation to the Department.

b. Equipment with an Acquisition Cost of $5000 or

More -

The Equipment may be retained or sold by the

Provider Agency, and the Department shall have the
right to an amount calculated by multiplying the
Fair Market Value or the proceeds from sale by the
State's percentage of interest in the Equipment.
If the Equipment is sold, $500 or ten percent of
the total sale proceeds, whichever is greater, may
be retained by the Provider Agency for selling and
handling expenses. If the Contract under which
the Equipment was acquired is still receiving
funds from the Department and if the Department
approves, the net amount due to the State may be
used for allowable costs of the Contract.
Otherwise, the remainder of the proceeds will be
transferred to the Department within ten Days of
closing the sale.
 5 P4.05

F. Equipment Management

1. Asset records must be maintained for all Equipment

purchased with Department funds. The minimum
requirements for such records are outlined below:

a. Date Acquired: the day, month and year each piece

or group of like pieces of Equipment was received
at the Provider Agency.

b. Contract Information: the identification number of

the Contract under which the Provider Agency
acquired the Equipment.

c. Quantity: the number of like pieces of Equipment

purchased.

d. Description: a brief description of the Equipment.

This includes the manufacturer's model and serial
numbers, if any, or an identification number
assigned by the Provider Agency. A label bearing
the serial or other identification number must be
affixed to the piece of Equipment.

e. Acquisition Cost: the actual unit cost of the

Equipment.

f. State's Interest: the percentage of the Equipment

paid with Department funds.

g. Vendor: the name of the vendor from which the

Equipment was purchased.

h. Invoice Number: the number of the invoice that

accompanied each piece of Equipment from the
vendor.

i. Payment: the number, date and amount of the

check(s) used to pay for the Equipment.

j. Physical Inventory Information: the date of the

last physical inventory. The location, use, and
condition of each piece of Equipment as of the
last physical inventory must also be noted.

k. Date and Method of Disposal: if applicable, the

date the Equipment was disposed of and the method
of disposal (e.g., transferred, sold, scrapped,
stolen).

l. Proceeds from Disposal: the proceeds, if any, from

the disposal of Equipment.
 6 P4.05

2. A physical inventory of Equipment must be taken and the

results reconciled with the asset records at least once
every two years to verify the existence, current
utilization, and continued need for the Equipment.
With Department approval, statistical sampling
procedures may be used. Any difference between
quantities determined by physical inspection and those
shown in the asset records must be investigated to
determine the reason for the differences.

3. A control system must be in effect to ensure adequate

safeguards to prevent loss, damage or theft of
Equipment. Any loss, damage, or theft must be
investigated and fully documented.

4. Adequate maintenance procedures must be implemented to

keep the Equipment in good condition.

5. Where Equipment is to be sold and the Department has an

interest in the Equipment, selling procedures must be
established which will provide for competition and
result in the highest possible return.

6. The Provider Agency must follow sound and prudent

management practices by having adequate insurance to
protect itself against loss. It is the responsibility
of the Provider Agency to maintain reasonable and
adequate insurance for Equipment and other assets
through the purchase of insurance or the use of a
funded self-insurance program.

Issued by:

__________
Jacob Eapen Gretchen Jacobs, Director
Assistant Commissioner Office of Contract Policy and
Department of Human Services and Management
 Policy Circular DDD P4.07

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Collapsing Direct Care Positions for Budgetary Purposes

EFFECTIVE: This policy circular shall become effective on August 1,

2000, and shall be implemented as new Contracts commence
or existing Contracts are renewed thereafter.

PROMULGATED: August 1, 2000

SUPERSEDES: Information Memorandum DDD P98-1, Collapsing Direct Care

Positions for Budgetary Purposes, Division of
Developmental Disabilities' Pilot Project dated May
15, 1998.

I. SCOPE

This policy circular applies to Division of Developmental

Disabilities' Contracts that have more than one group home or
adult training program.

II. POLICY

Division of Developmental Disabilities (DDD) Provider Agencies

will be allowed, with division approval, to collapse budgeted
direct care supervisory and non-supervisory staff positions into
similar groupings to facilitate budget monitoring and
reconciliations. The direct care supervisory and direct care
non-supervisory staff shall be the only positions permitted
personnel budget groupings. This procedure will be permitted
only if the conditions as listed in the policy section of this
circular are met. The conditions required are:

A. The Provider Agency shall exhibit a strong financial

position, an effective accounting system, and a
satisfactory level of service as evidenced by the most
recent audit report and program monitoring reports.

B. The Provider Agency must meet the staffing requirements of

current licensing standards.

III. PROCEDURES

A. Approval Process

1. If a Provider Agency wishes to collapse supervisory

and/or non-supervisory direct care staff in the
 DDD P4.07
2

Contract budget, they must petition the division, in

writing, at least 4 months before the start date of
the Contract, requesting an approval for the grouping
of eligible positions.

2. The DDD shall contact the Provider Agency at least 3½

months prior to the Contract start date through
written correspondence or e-mail of its
approval/disapproval of the Provider Agency
"collapsing" request.

3. Once an approval is granted by the division, it is not

necessary to seek approval for any subsequent renewal
Contract unless conditions at the Provider Agency have
changed, making the Provider Agency fall outside the
scope of this circular or below the eligibility
standards as outlined in the policy section of this
circular.

B. Budget Requirements

1. Direct care supervisory and direct care non-

supervisory staff are the only allowable groupings and
shall be listed by program site with the associated
number of positions and total hours per week worked.

2. Each of the direct care supervisory and non-

supervisory groupings shall be subject to the greater
than 5% line item requirement of Policy Circular
P1.10, Contract Modification, Section III.D.2.d.1.

3. Personnel positions other than supervisory and/or non-

supervisory direct care staff shall be listed in the
Annex B Budget as required in the Contract
Reimbursement Manual, specifically by position
title/name, position number, hours per week and total
reimbursable cost.

C. General Requirements

1. The Annex A staffing schedule shall correspond to the

respective reimbursable costs listed in the Annex B.

2. If a direct care supervisory or non-supervisory position

remains vacant for longer than one month, this information,
along with the respective grouping, program site and
related budgeted costs shall be reported to the Division no
later than the end of the second vacant month. This
 DDD P4.07
3

requirement shall be valid even if a position is filled by

a part-time or substitute individual.

3. The Provider Agency must be able to correct any deficiency

discovered as a result of any monitoring or required report
that jeopardizes the Provider's eligibility for the
collapsing accommodation. The correction must be
accomplished within any reasonable time frame negotiated by
the Provider Agency and DDD.

4. If DDD is part of a cognizant Contract, DDD shall notify

the other cognizant Departmental Component(s) prior to the
Contract start date regarding the grouping of any
supervisory or non-supervisory direct care positions.

Issued by:
 Policy Circular P4.10

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Advance Payments

EFFECTIVE: This policy circular shall become effective on June 1,

1997, and shall be implemented as new Contracts commence
or existing Contracts are renewed thereafter.

PROMULGATED: June 1, 1997

SUPERSEDES: Policy Circular P4.10, promulgated July 1, 1988.

The purpose of this circular is to advise Department personnel and

Provider Agencies of policies and procedures to be followed in
determining the need for and authorization of an Initial Advance
Payment.

I. SCOPE

This circular applies to all Contracts.

II. DEFINITION

Initial Advance Payment means the first payment made by check or

other appropriate payment mechanism to a Provider Agency during
the Contract term before expenses are incurred or services are
provided.

III. POLICY

A. The Department shall not issue Initial Advance Payments prior

to the Contract effective date. An Initial Advance Payment
shall also not be issued before the Contract has been signed
by both parties.

B. If an Initial Advance Payment is issued, it shall be based on

one month’s estimated expenditures. The payment will be made
as soon as possible after the start of the Contract term. The
Department reserves the right not to authorize an Initial
Advance Payment.

C. The Departmental Component may issue an Initial Advance

Payment greater than one month, when it is determined, via
the procedures section of this circular, that a larger
advance amount is necessary to prevent a Provider Agency from
incurring cash flow problems.

D. Each Departmental Component shall develop internal criteria

based on its operational functions and funding source(s) that
will be used to evaluate any Provider Agency request for an
Initial Advance Payment greater than one month. Provider
 2 P4.10

Agencies may contact the appropriate Departmental Component

for the criteria.

IV. PROCEDURES

A. Whenever a Provider Agency requests an Initial Advance

Payment greater than one month in accordance with criteria
developed by each Departmental Component, it shall request
the advance, in writing, with sufficient justification. The
Initial Advance Payment may equal 2 months of the Contract’s
estimated expenditures provided that the Departmental
Component chief executive or his/her designee authorizes the
request.

B. If an Initial Advance Payment is issued, the advance shall:

1. not exceed a Contract's monthly estimated expenditures;

unless an exemption per paragraph IV.A. has been
granted.

2. not exceed the Contract ceiling when added to all other

estimated monthly Contract expenditures.

C. All Contract payments (initial and interim) shall be

deposited in an interest bearing account until the funds are
expended for operating costs, unless:

1. The Contract is for less than $120,000; or

2. The best reasonably available interest bearing account

would not be expected to earn interest in excess of $250
per year on the cash balances; or

3. The depository would require an average or minimum

balance so high that it would not be feasible within the
expected cash resources.
D. Interest earned on an advance in any year of a Contract term
in excess of $250 shall be remitted to the appropriate
Departmental Component or utilized within the contracted
program(s) at the discretion of the Departmental Component.

Issued by:

_____________________
Paul W. Maksimow
Assistant Commissioner
Department of Human Services
 Policy Circular P4.16

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Restrictions on the Use of Federal Funds to Influence

the Awarding of Contracts or Subcontracts (Federal
Lobbying)

EFFECTIVE: This policy circular shall become effective on September

1, 1993, and shall be implemented immediately.

PROMULGATED: September 1, 1993.

The purpose of this circular is to establish Department policy with

regard to the federal Interim Final Rule promulgated by the Federal
Office of Management and Budget. The policy circular prohibits
Recipients and Subrecipients from using appropriated federal funds for
lobbying the Executive or Legislative Branches of the federal
government in connection with any specific Contract or subcontract.

I. SCOPE

This policy circular applies to all Provider Agencies that receive

in excess of $100,000 in federal funding via a specific federal
grant program, contract, or cooperative agreement from a
Departmental Component(s) through a Contract or subcontract.

II. DEFINITIONS

In addition to the defined terms included in the Glossary of the

Manual, the following terms, when capitalized, shall have
meanings as stated.

Executive and Legislative Branch(es) means an officer or employee

of any federal agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress.

Person means an individual, corporation, company, association,

authority, firm, partnership, society, state, or local government.

Recipient (Contractee or Provider Agency) means the legal entity

that enters into a contractual arrangement with any Departmental
Component.

Subrecipient (Subcontractee) means the legal entity that enters

into a contractual arrangement with a Contractee or another
Subcontractee, no matter how many interceding administrative Tiers
(levels) separate the parties.
 2 P4.16

Tier means each successive, separate level of administrative

organization beginning with the Department of Human Services and
ending with the provider of service.

III. POLICY

A. Pursuant to Section 319 of Public Law 101-121, Title 31 of

the United States Code, as amended per Section 1352, all
Recipients and Subrecipients of federal grant, contract, or
cooperative agreement funding are prohibited from using
appropriated federal funds to pay a Person to lobby on their
behalf with the Executive or Legislative Branch(es) of the
federal government in the awarding of a specific Contract or
subcontract.

B. All Recipients and Subrecipients that request or receive in

excess of $100,000 from a specific federal grant, contract,
or cooperative agreement through a Departmental Component
Contract or Tier subcontract, shall complete and forward to
the Tier directly above, a Certification Regarding Lobbying
form (Attachment A) covering the term of the Contract or
subcontract. The Certification Regarding Lobbying form
certifies that no federal appropriated funding at the
Recipient or Subrecipient level was used to pay a Person to
lobby the Executive or Legislative Branch(es) of the federal
government.

C. All Recipients and Subrecipients that request or receive in

excess of $100,000 from a specific federal grant, contract or
cooperative agreement through a Departmental Component
Contract or Tier subcontract shall also complete and forward
to the Tier directly above a Disclosure of Lobbying
Activities form (Attachment B) covering the term of the
Contract or subcontract when non-federal funds were used to
pay a Person to lobby the Executive or Legislative Branch(es)
of the federal government.

D. A Disclosure of Lobbying Activities form must be completed at

the end of each calendar quarter in which there occurs any
event that requires disclosure or that materially affects the
accuracy of the information contained in any disclosure form
previously filed by such person under section III.C. above.
Materiality includes:

1. a cumulative increase of $25,000 or more in the amount

paid or expected to be paid for influencing or
attempting to influence a covered federal action;

2. a change in the Person(s) or individual(s) influencing

or attempting to influence a covered federal action; and
 3 P4.16

3. a change in the officer(s), employee(s), or Member(s) of

Congress contacted to influence or attempt to influence
a covered federal action.

E. A separate certification form is required for each specific

federal grant, contract or cooperative agreement amount in
excess of $100,000 funded per Contract or subcontract.
Federal grant, contract or cooperative agreement funding
amounts in a Department Contract or Tier subcontract shall
not be added together to provide "cumulative" totals for
determining federal lobbying applicability. The Departmental
Component shall notify the Contractee of the total federal
grant, contract or cooperative agreement funding in the
Contract that is subject to the Lobbying regulations.

F. If a subsequent Contract Modification during a Contract, or

subcontract term causes the federal funding to exceed
$100,000 during the term, a Recipient or Subrecipient shall
complete and forward a certification, and if required, a
completed disclosure form to the Tier above.

G. The Departmental Component shall ensure that all applicable

ensuing Tiers (Contractee or Subcontractee) are notified of
all federal lobbying form(s) and filing requirements. This
responsibility includes the obligation to make it clear to
the next lower Tier that the information must be passed to
each subsequent Tier thereafter until the eventual provider
of service has been contacted.

H. Submitting an erroneous certification or disclosure form

shall constitute a failure to file the required certification
or disclosure. If a Person fails to file a required
certification or disclosure, the United States or the
Department of Human Services may pursue all available
remedies, including those listed in Attachment C of this
circular, as authorized by section 1352, Title 31, of the
United States Code.

IV. PROCEDURES

A. All Recipients and Subrecipients shall complete and sign the

Certification Regarding Lobbying form. The completed form
shall be sent to the Tier above it; however, the form does
not have to be forwarded any further. All Tiers that receive
the Certification Regarding Lobbying form shall keep the
completed form on file with their Contract documents.

B. When Recipients or Subrecipients are required to complete the

Disclosure of Lobbying Activities form, the form shall be
forwarded to each successive Tier until it reaches the
appropriate Departmental Component. The Disclosure of
Lobbying Activities form(s) from the last non-Departmental
 4 P4.16

Tier must be submitted to the Departmental Component to allow

sufficient time to transmit all required information to the
federal government.

C. If there is a cognizant Contract, the Cognizant contract

administrator shall be responsible for placing the completed
Certification Regarding Lobbying form and a copy of the
Disclosure of Lobbying Activities form, if required, in the
cognizant contract file. The Cognizant contract
administrator shall forward the disclosure form to the
Departmental Component of origin (non-cognizant division).
The Departmental Component of origin shall forward the
completed Disclosure of Lobbying Activities form to the
appropriate Health & Human Services section of the federal
government.

D. The completed Disclosure of Lobbying Activities form(s) shall

be compiled, collated and submitted by the Departmental
Component on a calendar quarterly basis to the appropriate
grant making section of the U.S. Department of Health and
Human Services.

Issued by:

__________________________
Paul W. Maksimow
Acting Assistant Commissioner
Budget, Finance and Administration
 P4.16
Attachment A

CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and belief,
that:

(1) No Federal appropriated funds have been paid or will be paid, by

or on behalf of the undersigned, to any Person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, the
making of any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment,
or modification of any Federal contract, grant, loan, or
cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid
or will be paid to any Person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract,
grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions.

(3) The undersigned shall require that the language of this

certification be included in the award documents for all subawards
at all tiers (including subcontracts, subgrants, and contracts
under grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance

was placed when this transaction was made or entered into. Submission of
this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any Person who
fails to file the required certification shall be subject to a civil penalty
of not less than $10,000 and not more than $100,000 for each such failure.

By:__________________________________________________Date:____________
(Signature of Authorized Official)

For:__________________________________
Name of Grantee Contract Number_______________

__________________________________
Title of Grant Program Contract Term_________________
 P4.16
Attachment B
Page 1 of 3
Appendix B to Part_____---- Disclosure Form to Report Lobbying
DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden disclosure)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract a. bid/offer/application a. initial/filing
b. grant b. initial award b. material change
c. cooperative agreement c. post award
d. loan For material Change Only:
e. loan guarantee
f. loan insurance year_____ quarter_____
date of last report

4. Name and address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter
Name and address of Prime:
Prime Subawardee
Tier______,if known

Congressional District, if known: Congressional District, if known:

6. Federal Department/Agency 7. Federal Program Name/Description:

CFDA Number, if applicable _______________________

8. Federal Action Number, if known 9. Award Amount, if known:

$

10. a. Name and Address of Lobbying Entity: b. Individuals Performing Services (including
(if individual, last name, first name, MI): address if different from No. 10A)
(Last Name, First Name, MI)

(attach Continuation Sheet(s) SF-LLL-A, if necessaary)

11. Amount of Payment (check all that 13. Type of Payment (check all that apply):
apply: a. retainer
$__________ actual planned
b. one-time fee
12. Form of Payment (check all that apply): c. commission
d. contingent fee
a. cash
e. deferred
in-kind: specify: nature_________
value__________ f. other: specify: _____________________
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, Including
officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11:

(Attach Continuation Sheet(s) SF-LLL-A, if necessary)

15. Continuation Sheet(s) SF-LLL-A attached:
Yes No

16.Information requested through this form is

authorized by title 31 USC section 1352. This Signature:_____________________________
disclosure of Lobbying activities is material
representation of fact upon which reliance was placed Print Name: ___________________________
by the tier above when this transaction was made or
entered into. This disclosure is required pursuant to
31 USC. This information will be reported to the Title: ________________________________
Congress semi-annually and will be available for public
inspection. Any person who fails to file the required Telephone: _________________ Date: _____________
disclosure shall be subject to a civil penalty of not
less than $10,000 and not more than $1000,000 for each
failure.
Federal Use Only: Authorized for Local Reproduction
Standard Form-LLL
 P4.16
Attachment B
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBYYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient,
at the initiation or receipt of a covered federal action, or a material change to a previous filing, pursuant to
title 31 USC section 1352. The filing of a form is required for each payment or agreement to make payment to
any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a member of
Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with a
covered federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form
is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to
the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered federal action for which lobbying activity is and/or has been secured to
influence the outcome of a covered federal action.

2. Identify the status of the covered federal action.

3. Identify the appropriate classification of this report. If this is a followup report caused by a material
change to the information previously reported enter the year and quarter in which the change occurred. Enter
the date of the last previously submitted report by this reporting entity for this covered federal action.

4. Enter the full name, address, city, state and zip code of the reporting entity include congressional
district, if known. Check the appropriate classification of the reporting entity that designates if it is,
or expects to be, a prime or subaward recipient. Identify the tier of the subawardee , e.g., the first
subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and
contract awards under grants.

5. If the organization filing the report in item 4 checks "Subawardee", then enter the full name, address, city,
state and zip code of the prime federal recipient. Include congressional district, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one
organizational level below agency name, if known For example, Department of Transportation, United States
Coast Guard.

7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the
full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.

8. Enter the most appropriate federal identifying number available for the federal action identified in item 1
(e.g., Request for Proposal (RFP) number: Invitation for Bid (IFB) number; grant announcement number; the
contract, grant, or loan award number; the application/proposal control number assigned by the federal
agency). Include prefixes, e.g., "RFP-DE-90-001."

9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter
the federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting
entity identified in item 4 to influence the covered federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different
from 10(a). enter Last Name, First Name, and Middle Initial (MI).

11. Enter the amount of compensation paid or reasonably to be paid by the reporting entity (item 4) to the
lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned).
Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment
made or planned to be made.

12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind
contribution, specify the nature and value of the in-kind payment.

13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.

14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be
expected to perform, and the date(s) of any services rendered. Include all preparatory and related
activity, not just spent in actual contact with federal officials. Identify the federal official(s) or
employee(s) contacted or the officer(s), employee(s), or member(s) of Congress that ere contacted.

15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.

16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

Public reporting burden for this collection of information is estimated to average 30 minutes per response,
including time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. Send comments regarding the burden
estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the Office of Management and Budget. Paperwork Reduction Project (0348 0046). Washington, D C
20503.
 P4.16
Attachment B
Page 2 of 2

DISCLOSURE OF LOBBYING ACTIVITIES

CONTINUATION SHEET
Approved by OMB
0348-0046

Reporting Entity:______________________________Page_____of_____

Authorized for Local Reproduction

Standard Form – LLL-A
 P4.16
Attachment C

LOBBYING PENALTIES

A. Any Person who makes expenditure prohibited herein shall be

subject to a civil penalty of not less than $10,000 nor more than
$100,000 for each such expenditure.

B. Any Person who fails to file or amend the disclosure form, as

required, shall be subject to a civil penalty of not less than
$10,000 nor more than $100,000 for each such failure.

C. A filing or amended filing on or after the date on which an

administrative action for the imposition of a civil penalty is
commenced does not prevent the imposition of such civil penalty
for a failure occurring before that date.

D. In determining whether to impose a civil penalty and the amount of

any such penalty, the nature, circumstances, extent and gravity of
the violation shall be considered. Additional considerations
shall include; the effect on the ability of the Person to continue
in business, any prior violations by the Person, the degree of
culpability of such Person, the ability of the Person to pay the
penalty, and other matters as appropriate.

E. First time offenders, absent aggravating circumstances, shall be

subject to a civil penalty of $10,000. Second and subsequent
offenses shall be subject to appropriate civil penalty between
$10,000 and $100,000 based on the circumstances.

F. An imposition of a civil penalty under this section does not

prevent the United States or Department from seeking any other
remedy that may apply to the same conduct that is the basis for
the imposition of such civil penalty.
 Policy Circular P5.01

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Client Eligibility - Minimal Department Standards

EFFECTIVE: This policy shall become effective July 1, 1988, and

shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular P5.01, promulgated June 22, 1984.

The purpose of this circular is to set forth the basic criteria to be

used in determining and redetermining client eligibility. Contracting
Departmental Components have developed additional eligibility and
admission standards in order to ensure that services are delivered to
those individuals most in need. These additional eligibility and
admission standards may not be inconsistent with applicable federal
and State laws or with the criteria contained in this circular. These
standards are included in the Manual as follows:

P5.10 - Commission for the Blind and Visually Impaired

P5.20 - Division of Mental Health and Hospitals
P5.30 - Division of Developmental Disabilities
P5.45 - Division of Youth and Family Services
P5.46 – Exception to Policy Circular P5.45, Client Eligibility,
Division of Youth and Family Services

The standards outlined below and the eligibility standards of the

contracting Departmental Component must be met for the
applicant/recipient to receive/continue to receive service.

I. SCOPE

This policy circular applies to all social service Contracts

regardless of the contracting Departmental Component. This
circular does not apply to controlled research projects where
client participation is determined by the research specifications
rather than by these principles.

II. POLICY

A. GENERAL ELIGIBILITY PRINCIPLES

1. The Department is responsible for ensuring that

services are delivered to those most in need;
therefore, target populations have been established.
 P5.01
2

Priority for all Department services are listed below.

The priorities are not in any significant order.

a. Persons at risk of abuse, neglect, or abandonment;

b. Victims of abuse, neglect, or abandonment;
c. Persons experiencing emotional disorders;
d. Persons at risk of institutionalization;
e. Persons inappropriately institutionalized;
f. Persons physically handicapped, visually or
hearing impaired;
g. Persons developmentally disabled;
h. Underserved minority populations; and
i. Low income persons.

2. Rights and Responsibilities of Individuals Applying for

Services

At the time of application for service, applicants

shall be informed of eligibility requirements and of
their rights and responsibilities under the social
service program. These rights and responsibilities are
outlined below.

a. Citizenship and Residency

Any individual who resides in New Jersey may

qualify to receive service regardless of
citizenship or duration of residency.

b. Nondiscrimination

Applicants for or recipients of service shall not

be discriminated against due to race, color,
creed, religion, ethnic background, national
origin, marital status, handicap, age, or sex, and
may be subject only to conditions and limitations
applicable alike to all persons.

c. Right to Administrative Hearing/Administrative

Review

Applicants for or recipients of service or

individuals acting on their behalf may appeal the
denial, reduction, termination of service, the
failure to act upon a request for service with
reasonable promptness, or the level of quality of
service. The individual shall be informed of the
procedure for requesting an administrative
hearing/administrative review at the time a
 P5.01
3

request is made for service or prior to a

reduction or termination of service.

d. Confidential Nature of Client Information

The applicant for or recipient of service has a

right to confidentiality regarding any information
collected in determining or redetermining
eligibility for service. If the documentation of
eligibility requires contacting outside sources,
(including employers) and the applicant or
recipient wished to keep the nature of the service
confidential, the applicant is entitled to request
that such contacts be made by the Departmental
Component administering the Contract.

e. Provision of Information

Applicants for or recipients of service or

individuals acting on their behalf are obligated
to provide or to obtain all information necessary
to establish eligibility.

f. Reporting Changes

Applicants for or recipients of service or

individuals acting on their behalf are obligated
to report promptly any changes which may affect
eligibility.

3. Application for Service

This section outlines minimum requirements that must be

met in processing applications.

a. Timeliness

Individuals wishing to apply for service must be

given the opportunity to do so without undue delay.

b. Decision/Notification

A decision must be made on each completed

application and written notice given to the
applicant within 30 Days from the date all
necessary documents have been received.
 P5.01
4

c. Denial of Service

If a decision is made to deny service, the

applicant must be notified in writing of the
decision, the reason(s) why service is being
denied and his/her right to and the procedure for
requesting an administrative hearing/administra-
tive review. (For exceptions to this requirement,
see paragraph 7 below.)

4. Minimum Client Information Requirements

The Provider Agency will maintain written individual

records, containing at least the following information
for all applicants and recipients. This information
will not be used as a basis for determining if service
or what kind of service will be provided. It will be
used for statistical purposes only.

a. Name
b. Address
c. Social security number
d. County of residence
e. Age
f. Race
g. Date of eligibility determination or
redetermination

5. Exceptions to Minimum Client Information Requirements

In the cases of two services - crisis intervention, and

information and referral - exceptions to collecting the
minimum information are allowable. This is due to
either the emergency nature of the service (crisis
intervention) or the duration of the service and the
limited client contact (information and referral),
which may make it impossible to obtain all the client
information required. In these two services, an
attempt should be made by the Provider Agency to obtain
all client information as specified in paragraph 4
above. However, if all information cannot be obtained,
the Provider Agency shall include as much information
as possible. At minimum, a count of clients who
receive services must be maintained. Exceptions to
collecting minimal client information for other
services is allowable only with prior written approval
of the Department's Contract Policy and Management
Unit.
 P5.01
5

6. Reduction or Termination

A recipient whose service is being reduced or

terminated must be notified in writing at least 10 Days
prior to such action by the Provider Agency. At this
time the individual must be informed of his/her rights
to an administrative hearing/administrative review.

7. Exception to Written Notice

In protective services cases, when the

applicant/recipient's confidentiality and/or safety
might be jeopardized, written notice need not be sent.
Documentation of the circumstances which prohibit
notifying the applicant/recipient in writing must be
entered in the individual's case record. Documentation
of how the applicant/recipient was notified, e.g.,
interview or telephone call, shall be noted in the case
record.

Issued by:
 Policy Circular P5.10

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Client Eligibility - Commission for the Blind and

Visually Impaired

EFFECTIVE: This policy circular shall become effective July 1,

1984, and shall be implemented immediately.

PROMULGATED: June 22, 1984

SUPERSEDES: Policy Circular P5.01, promulgated June 27, 1983, and

P5.02 and P5.03, promulgated November 28, 1983.

The purpose of this policy circular is to outline specific client

eligibility requirements for the Commission for the Blind and Visually
Impaired - funded social services. This policy circular supplements
Department client eligibility requirements included in Policy Circular
P5.01, Client Eligibility.

I. SCOPE

This policy circular applies to all contracted social services

funded by the Commission for the Blind and Visually Impaired.

II. POLICY AND PROCEDURES

A. Eligibility Criteria

One of the following eligibility criteria must be met in

order for an individual to be eligible to receive services.
The individual must be:

1. Visually Impaired. An individual is considered

visually impaired if his/her vision is 20/70 or less in
the better eye with proper corrections, (20/70 means
that the person sees at 20 feet what a normally sighted
person would see at 70 feet); or

2. Legally Blind. An individual is legally blind if

his/her vision is 20/200 or less in the better eye with
proper corrections or if there is a field restriction
of vision limited to 20 degrees or less, (20/200 means
that person sees at 20 feet what a normally sighted
person would see at 200 feet); or

3. Multiply Handicapped. An individual is considered

multiply handicapped if, in addition to being blind or
visually impaired, he/she has at least one additional
handicapping condition which interacts and results in
 P5.10
-2-

problems so complex that restorative/rehabilitative

efforts designed for either handicapping condition will
not result in achieving the goal of maximum independent
living.

B. Application Procedures

Application for social services provided by the Commission

for the Blind and Visually Impaired shall be made at the
Provider Agency.

C. Eligibility Redetermination

Redetermination of eligibility is not required. Once an

individual is determined eligible, the service is provided
until it is no longer needed.

D. Fees

No fees are charged by the Provider Agency to clients

receiving services.

Issued by:
 Policy Circular P5.20

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Client Eligibility - Division of Mental Health and

Hospitals

EFFECTIVE: This policy circular shall become effective July 1,

1984, and shall be implemented immediately.

PROMULGATED: June 22, 1984

SUPERSEDES: Policy Circular P5.01, promulgated June 27, 1983, and

P5.02 and P5.03, promulgated November 28, 1983.

The purpose of this circular is to outline specific client eligibility

requirements for Division of Mental Health and Hospitals - funded
social services. This policy circular supplements Department client
eligibility requirements included in Policy Circular P5.01, Client
Eligibility.

I. SCOPE

This policy circular applies to all contracted social services,

funded by the Division of Mental Health and Hospitals.

II. POLICY AND PROCEDURES

A. Eligibility Criteria

1. The goal of the mental health system is to provide

comprehensive services to everyone in need; however,
target populations have been established to ensure that
those who are in the greatest need and/or those who
have been traditionally underserved receive services.
The priorities are not intended to be exclusionary.

2. The target populations for admission into mental health

services are listed below. Target Group I is a higher
priority than Target Group II; however, the order of
listed populations within each of these target groups
is not significant.

Target Group I

- Adults and children currently in a State/county/local

psychiatric hospital who could live in the community
with appropriate services.

- Adults and children in the community, with a history

of State/county/local psychiatric hospitalization,
who are in serious risk of re-hospitalization.
 2 P5.20

Target Group II

- Children (17 or younger) who are mentally,

emotionally and functionally impaired.

- Elderly (65 or older) who are mentally, emotionally

and functionally impaired.

- Minorities (Black and/or Hispanic or other minority

groups identified in the county plan) who are
mentally, emotionally and functionally impaired.

- Rural poor who are mentally, emotionally and

functionally impaired.

- Urban poor who are mentally, emotionally and

functionally impaired.

B. Application Procedures

Application for community mental health services can be made

at the local community mental health agency (the Provider
Agency). The Provider Agency will make a clinical
assessment of each applicant to determine the need for
services.

C. Eligibility Redetermination

Redetermination of client eligibility is an ongoing process

which includes an assessment of the client's needs and
abilities.

D. Client Fees

Client fees are charged for the following services on the

basis of a client's ability to pay:

- outpatient;
- partial care (adults only); and
- emergency.

Client fee schedules for services are approved by the

Division of Mental Health and Hospitals. Copies of fee
schedules are on file with the Provider Agency and the
Division of Mental Health Services and Hospitals.

Issued by:
 Policy Circular P5.30

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Client Eligibility - Division of Mental Retardation

EFFECTIVE: This policy circular shall become effective July 1,

1984, and shall be implemented immediately.

PROMULGATED: June 22, 1984

SUPERSEDES: Policy Circular P5.01, promulgated June 27, 1983, and

P5.02 and P.503, promulgated November 28, 1983.

The purpose of this policy circular is to outline specific client

eligibility requirements for functional services through the Division
of Mental Retardation. This policy circular supplements Department
client eligibility requirements included in Policy Circular P5.01,
Client Eligibility.

I. SCOPE

This policy circular applies to all contracted social services

funded by the Division of Mental Retardation

II. DEFINITION

Mentally Retarded means a state of significant subnormal

intellectual development with reduction of social competence in a
minor or adult person; this state of subnormal intellectual
development shall have existed prior to adolescence and is
expected to be of life duration (N.J.S.A. 30:4-23).

Mentally Deficiency shall mean the state of mental retardation in

which reduction of social competence is so marked that persistent
social dependency requiring guardianship of the person shall have
been demonstrated or be anticipated (N.J.S.A. 30:4-23).

Functional Services shall mean those services and programs in the

Department available to provide the mentally retarded with
education, training, rehabilitation, adjustment, treatment, care
and protection (N.J.S.A. 30:4-23).

III. POLICY AND PROCEDURES

A. In the Division of Mental Retardation, there are four

separate processes for determining eligibility depending on
the service to be delivered. The first process for
Community Services includes the following services: Purchase
of Care, Group Homes, Supervised Apartments, Family Care,
 P5.30
2

Foster Grandparents, Skill Development Homes, Supportive

Living Apartments, Case Management, Adult Activities, and
Home Assistance. The second process is for Day Training
Services; the third for Infant Stimulation and Pre-School
Services; and the fourth is for Citizen Advocacy Services.

B. COMMUNITY SERVICES

This includes Purchase of Care, Group Homes, Supervised

Apartments, Family Care, Foster Grandparents, Skill
Development Homes, Unsupervised Apartments, Case Management,
Adult Activities, and Home Assistance.

l. Eligibility Criteria

The following eligibility criteria must be met in order

for an individual to be eligible to receive Community
Services.

a. The individual must be a Mentally Retarded person.

To be classified as Mentally Retarded, the
following criteria must be met:

1. the person must meet the established

psychometric criteria for Mental Retardation;

2. their must be a demonstrated reduction in

social competence;

3. the retardation must have existed prior to

the age of eighteen; and

4. the retardation can reasonably be expected to

be of life duration.

b. The individual must be in need of Community

Services at the time of application.

c. For Home Assistance, which includes Personal Care

and Intervention Care, and Assistive Devices only,
in addition to the above eligibility criteria,
persons whose annual income does not exceed
established limits, as indicated on the Income
Schedule in Attachment 2, are eligible to receive
services.

2. Application Procedures

a. Application for services of the Division of Mental

Retardation shall be made by the individual in
need of service or person(s) authorized to do so.
 P5.30
3

Persons authorized to apply on a minor’s behalf

include parents, guardians, juvenile courts and/or
appropriate agencies having care of the minor. In
the case of an adult who is believed to be
Mentally Deficient, a court of competent
jurisdiction may apply. For an adult declared
Mentally Deficient, the court-appointed guardian
is authorized to make applications for Functional
Services.

b. Application shall be made to the regional office

of the Division of Mental Retardation serving the
county in which the individual resides. If the
individual is in a facility out of State, the New
Jersey address of the applicant shall be used to
determine county of residence. A list of
regional offices and the counties they serve is
included in Attachment 1.

c. For those services that require an income

screening (Personal Care and Intervention, Respite
Care, and Assistive Devices provided under Home
Assistance), the process for determining
eligibility is included, for informational
purposes only, in Attachment 2.

3. Redetermination of Eligibility

a. For all services provided in Community Services

redetermination of client eligibility is an
ongoing process which includes an assessment of
the client's needs and abilities. Further, as
stipulated in law, the Division of Mental
Retardation shall evaluate each Mentally Retarded
minor admitted to community service as he or she
approaches adulthood to determine if, by reason of
Mental Deficiency, the person will continue to
require protection and supervision of his/her own
interest, being incapable of managing oneself or
affairs as an adult (N.J.S.A. 30:4-165.5). By
implication, other individuals who are already
adults at the time of their admission into
Functional Services will be evaluated for the same
purpose. Moreover, the status of every adult
client previously determined either Mentally
Deficient or non-deficient shall be reviewed no
less than annually.

b. For those services that require an income

screening (Personal Care and Intervention, Respite
Care, and Assistive Devices provided under Home
Assistance) income eligibility will be
 P5.30
4

redetermined every 12 months. However, if the

client situation changes in any way which would
affect his/her eligibility, redetermination must
be completed within 30 Days of the change.

4. Fees

a. No fees are charged by the Provider Agency to

clients receiving services.

b. Clients receiving residential services may be

assessed a fee for service by the appropriate
county adjuster. The Provider Agency has no
responsibility for this process nor may it charge
clients any additional fees.

C. DAY TRAINING PROGRAMS

1. Eligibility Criteria

To be eligible to receive Day Training the individual

must be between the ages of three and twenty-one. To
receive service the following eligibility criteria must
be met.

a. Children from three to five must be classified as

"preschool handicapped in need of a Day Training
program.

b. Individuals age five to twenty one must be

classified as "eligible for Day Training".

Classification for both categories of Day Training

Services is made by the Local Educational Authority
(LEA).

2. Application Procedures

Individuals are determined eligible for Day Training

services by their LEA, i.e., the local public school.
Once the individual is classified as either "eligible
for Day Training" or "pre-school handicapped in need of
a Day Training program, referral is made by the LEA to
the appropriate regional office of the Division of
Mental Retardation. Once the individual is classified
by the LEA, services must begin within 30 Days.
 P5.30
5

3. Redetermination of Eligibility

Redetermination of eligibility for Day Training

Services is required at least every three years.
However, the client's parent(s) may request it be done
annually.

4. Fees

No fees are charged to clients receiving services.

D. INFANT STIMULATION AND PRE-SCHOOL PROGRAMS

1. Eligibility Criteria

The following eligibility criteria must be met in order

for an individual to receive services:

a. there must be severe chronic disability(ies)

attributable to mental or physical impairment, or
a combination of mental and physical impairments;

b. the disability is likely to continue indefinitely;

c. the disability results in substantial functional

limitations in three or more of the following
areas of major life activity: self-care, receptive
and expressive language, learning, mobility, self-
direction, capacity for independent living, and
economic self-sufficiency.

d. the disability reflects the person's need for a

combination and sequence of special,
interdisciplinary or generic care, treatment, or
other services which are of lifelong or extended
duration and are individually planned and
coordinated; and

e. the individual must be in need of the service at

the time of application.

2. Application Procedures

To receive service, application is made by the

individual or his/her parent or legal guardian directly
to the Provider Agency. The Provider Agency is
responsible for determining whether the individual
meets the eligibility criteria. Generally this
determination is done on the basis of a medical report
completed by a physician or psychologist or, in the
absence of a medical report, the assessment is done by
trained Provider Agency staff.
 P5.30
6

3. Redetermination of Eligibility

Redetermination of client eligibility is an ongoing

process which includes as assessment of the client's
needs and abilities.
4. Fees

No fees are charged to clients receiving services.

E. CITIZEN ADVOCACY PROGRAMS

1. Eligibility Criteria

All past, current or future clients of the Division of

Mental Retardation are eligible to receive service.
This includes meeting any of the three processes
outlined above.

2. Application Procedures

To receive service, application is made directly to the

Provider Agency which is responsible for determining
whether the individual meets the eligibility criteria.

3. Redetermination of Eligibility

Redetermination of clients eligibility is an ongoing

process which includes as assessment of the client's
needs and abilities.

4. Fees

No fees are charges to clients receiving services.

Issued by:
 DMR 5.30
Attachment 1

Regional Offices - DMR

Regional Office Counties Served

Central Regional Office Burlington

3rd Street, Building #5 Mercer
Bordentown, NJ 08505 Middlesex
(609) 298-5981 Monmouth
Ocean

Metropolitian Regional Office Bergen

35 North Fullerton Avenue Essex
Montclair, NJ 07042 Hudson
Passaic
Union

Northern Regional Office Hunterdon

Seber Road Morris
Doctor's Park, Building #3 Somerset
Hackettstown, NJ 07840 Sussex
(201) 852-1214 Warren

Southern Regional Office Atlantic

Route 30 and Elvins Avenue Camden
Hammonton, NJ 08037 Cape May
(609) 561-5070 Cumberland
Gloucester
Salem
 DMR 5.30
Attachment 2

This attachment outlines how the appropriate regional office of the

Division of Mental Retardation will determine income eligibility.
Income eligibility is applicable to Personal Care and Intervention,
Respite Care, and Assistive Devices provided under Home Assistance
only. Since the Provider Agency is not responsible for determining
income eligibility, this attachment is provided for informational
purposes only.

Family income will be determined according to the following steps:

- family size is determined according to the guidelines

included in Attachment 2-A, Family Size;

- gross income, is determined according to the guidelines in

Attachment 2-B, Income Resources and Exclusions; and

- the family size and gross income numbers already established,

used with Attachment 2-C, Income Schedule, will determine if
the applicant is eligible for services.
 DMR 5.30
Attachment 2-A

FAMILY SIZE

Computation of family size, which depends on the definition of

"family" below, is important because the income eligibility schedule
varies according to family size.

A. Definition of Family

For eligibility purposes, a family is either a multi-person or a

one-person family.

1. Multi-Person Families are:

- A married couple residing together.

- One or more children (other than emancipated minors)

residing with one or both of their parents or another person
related by blood or law.

- A child who resides with a person unrelated by blood or law

and whose legal relationship with his/her biological parents
has not been terminated by court order.

Such a child (e.g., foster child), for the purposes of

eligibility, continues to be considered a member of the
natural family (except for Indochinese, Cuban, or Haitian
Unaccompained Minors, who are considered one-person
families). The Provider Agency should consult with the
foster care placement agency for eligibility status.

2. One-Person Families are:

- An adult residing alone or with another adult(s) (other

than a spouse).

- An adult residing with children unrelated by blood or

law.

- A child who resides alone or with a person unrelated by

blood or law and whose legal relationship with his/her
biological parents has been terminated by court order.

- An Indochinese, Cuban, or Haitian Unaccompained Minor.

 2 DMR 5.30
Attachment 2-A

An emancipated minor, defined as a person under 18

years of age who is self-supporting or living
independently or whose behavior and whose request for
social services is not effectively under parental
control.

Note on Emancipated Minors: An emancipated minor is

never counted with his/her parents. If a child in the
household is emancipated in the sense of being self-
supporting, the child shall be considered an adult for
eligibility purposes. This means that the child is
considered a one-person family. While there may be
other circumstances besides economic self-support that
would properly characterize a person under 18 years of
age as emancipated (for example, a girl under 18 years
of age living with the family and caring for her
child), these additional circumstances are difficult to
set forth in advance, and each circumstance, other than
economic self-support, suggesting emancipation shall be
dealt with on a ad hoc basis.

B. Rules for Computing Family Size

Note: Family size must be determined for the same period over
which gross income is computed.

As a general rule, to compute family size for eligibility

purposes, count each married parent and natural and/or adoptive
child residing as a family in the same household.

A child is a person (1) under 18 years of age, (2) between

the ages of 18 and 21 who continues in a paid foster or
residential care placement, who is regularly attending a
school or training program below the college level, and/or
has an emotional, cognitive, or physical disability or (3)
any person age 18 who resides with his/her parent(s) and is
a full-time student in a secondary school or in the
equivalent level of vocational or technical training.

An emancipated minor, as previously defined, shall be

considered as an adult.

Married adults residing in the same household shall be

counted as members of the same family (multi-person family).

Unmarried adults residing in the same household shall each

be considered as a one-person family, unless an adult
resides also with his/her own child(ren) related by blood
 3 DMR 5.30
Attachment 2-A.

or law. Then that adult is part of a multi-person family

which includes his/her child(ren) and/or child(ren) related
by blood or law.

For child(ren) residing with unmarried parents who live

together, the father is counted in family size with only
those child(ren) for whom paternity has been legally
established. If both unmarried parents are included in
family size, only the income of the parent earning the
greater gross income is used to determine financial
eligibility.

A stepparent living with a spouse and the spouses's child is

considered part of a multi-person family, if the stepparent
is not legally responsible for the child.
 DMR 5.30
Attachment 2-B

INCOME RESOURCES AND EXCLUSIONS

NOTE: In computing income, only the earned income of family members

14 years of age or older is considered. However, unearned in-
come of family members of all ages is considered.

Allowable/Mandated Resources

Gross income means the sum of income received by an individual from

the following sources that are identified by the U.S. Census Bureau in
computing the median income.

A. Earned Income

- Money wages or salary means total money earnings received

for work performed as an employee, including wages, salary,
Armed Forces pay, commissions, tips, piece-rate payments,
and cash bonuses earned before deductions are made for
taxes, bonds, pensions, union dues, and similar purposes.

- Net income form non-farm self-employment means gross

receipts minus expenses from one's own non-farm business,
professional enterprise, or partnership. Gross receipts
include the value of all goods sold and services rendered.
Expenses include costs of goods purchased, rent, heat,
light, power, depreciation charges, wages and salaries paid,
business taxes (not personal income taxes), and similar
costs. The value of salable merchandise consumed by the
proprietors of retail stores is not included as part of net
income.

- Net income from farm self-employment means gross receipts

minus operating expenses from the operation of a farm by a
person on his/her own account, as an owner, renter, or
sharecropper. Gross receipts include the value of all
products sold, government crop loans, money received from
the rental of farm equipment to others, and incidental
receipts from the sale of wood, sand, gravel, and similar
items. Operating expenses include cost of feed, fertilizer,
seed, and other farming supplies, cash wages paid to
farmhands, depreciation charges, cash rent, interest on farm
mortgages, farm building repairs, farm taxes (not State and
federal income taxes), and similar expenses. The value of
fuel, food, or other farm products used for family living is
not included as part of net income.
 2 DMR 5.30
Attachment 2-B

B. Unearned Income

- Social Security includes Social Security pensions and

survivor's benefits, and permanent disability insurance
payments made by the Social Security Administration prior to
deductions for medical insurance and railroad retirement
insurance checks from the U.S. Government.

- Dividends, interest (on savings or bonds), income from

estates or trusts, net rental income or royalties include
dividends from stockholdings or membership in associations,
interest on savings or bonds, periodic receipts from estates
or trust funds, net income from rental of a house, store, or
other property to others, receipts from boarders or lodgers,
and net royalties.

- Public assistance or welfare payments include public

assistance payments such as AFDC, SSI, State supplemental
payments to SSI recipients, and general assistance (i.e.,
municipal welfare).

- Pensions and annuities include pensions or retirement

benefits paid to a retired person or his/her survivors by a
former employer or by a union, either directly or through an
insurance company, and periodic receipts from annuities or
insurance.

- Unemployment compensation means compensation received from

government unemployment insurance agencies or private
companies during periods of unemployment and any strike
benefits received from union funds.

- Worker's compensation means compensation received

periodically from private or public insurance companies for
injuries incurred at work. The cost of this insurance must
have been paid by the employer and not by the worker.

- Alimony.

- Child support.

- Veteran's pensions means money paid periodically by the

Veterans Administration to disabled members of the Armed
Forces or to survivors of deceased veterans, subsistence
allowances paid to veterans for education and on-the-job
training, as well as so-called "refunds" paid to ex-service
personnel as GI insurance premiums.
 3 DMR 5.30
Attachment 2-B

- Exclusions

Excluded from computation of gross income are the following:

- Per capita payments of or funds held in trust for any

individual in satisfaction of a judgment of the Indian
Claims Commission of the Court of Claims.

- Payments made pursuant to the Alaska Native Claims

Settlement Act to the extent such payments are exempt
from taxation under section 21(a) of the Act.

- Money received from sale of property, such as stocks,

bonds, a house, or a car (unless the person was engaged
in the business of selling such property, in which case
the net proceeds would be counted as income from non-
farm self-employment).

- Withdrawals of bank deposits.

- Money borrowed.

- Tax refunds or rebates.

- Gifts.

- Lump sum payments, (e.g., inheritances, insurance

payments, energy assistance, HUD settlements).

- Capital gains.

- The value of the coupon allotment under the Food Stamp

Act of 1977, as amended.

- The value of supplemental food assistance under the

Child Nutrition Act of 1966 and the special food
service program for children under the National School
Lunch Act, as amended.

- Any payment received under the Uniform Relocation

Assistance and Real Property Acquisition Policies Act
of 1970.

- Earned income of a child under 14 years of age (no

inquiry shall be made).
 4 DMR 5.30
Attachment 2-B

- Loans and grants, such as scholarships, obtained and

used under conditions that preclude their use for
current living costs.

- Any grant or loan to any undergraduate student for

educational purposes made or insured under any program
administered by the Commissioner of Education under the
Higher Education Act.

- Home produce utilized for household consumption.

- Payments to VISTA volunteers pursuant to Section 404

(g) of the Domestic Assistance Act of 1973.
 DMR 5.30
Attachment 2-C

INCOME SCHEDULE

FAMILY SIZE GROSS INCOME

PER YEAR

1 16,037

2 20,972

3 25,907

4 30,841

5 35,775

6 40,709

7 41,635

add for each

additional member 925
 Policy Circular P5.45

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Client Eligibility - Division of Youth and Family

Services

EFFECTIVE: This policy circular shall become effective April 1,

1986, and shall be implemented immediately.

PROMULGATED: March 24, 1986

SUPERSEDES: Policy Circular P5.45, promulgated June 17, 1985.

The purpose of this policy circular is to outline specific client

eligibility requirements for Division of Youth and Family Services
funded social services. This policy circular supplements Department
client eligibility requirements included in Policy Circular P5.01,
Client Eligibility.

I. SCOPE

This policy circular applies to all contracted social services

funded by the Division of Youth and Family Services.

II. POLICY AND PROCEDURES

A. Eligibility for social services may be determined according

to one of three distinct sets of criteria and procedures
outlined below:

1. Without Regard to Income

a. Protective Services (PRS)

(1) Eligibility Criteria

Persons classified as "in need of protective

services" are eligible for services. This
classification is determined by the following
authorities:

- a district office of DYFS (for children

only);

- a county welfare agency (CWA) (for adults

only);

- the Provider Agency (for adults - domestic

violence only).
 P5.45
2

In determining eligibility, income is not

considered for persons in any of the above
categories.

(2) Application Procedures

In order for an applicant to be eligible

without regard to income by reason of his/her
classification as "in need of protective
services," one of the above agencies is
required to document, in writing, in the
respective client case record, the
circumstances which support the determination
that the applicant is subject to or at risk of
abuse, neglect, or exploitation.

In addition, the Provider Agency records must

stipulate that the applicant is eligible for
services without regard to income due to
his/her being "in need of protective
services."

If the determination of eligibility has been

completed by a DYFS district office or CWA,
DYFS Form 26-19 is completed to document
eligibility. A copy of this form is forwarded
to any other provider of service when the
applicant requests a DYFS funded social
service from that Provider Agency.

(3) If the client has been determined by DYFS or a

CWA as eligible due to the "in need of
protective services," it is their respective
responsibility to complete the redetermination
every-6-months. Anytime there is a change in
eligibility, DYFS or the CWA will advise the
Provider Agency by forwarding the
determination form.

b. Juvenile-Family Court Services

1) Eligibility Criteria

Individuals determined by the Family

Part-Superior Court (the Family Court)
or its Crisis Intervention Unit as "in
need of juvenile-family court services"
are eligible to receive services. This
determination is verified by the
Provider Agency. Public Law 1982,
Chapter 80, which establishes juvenile-
family court services does not provide
for income screening. These clients
 P5.45
3

should be served without regard to

income.

(2) Application Procedures

In order for an applicant to be eligible

without regard to income by reason of their
classification as "in need of juvenile-family
court services," the Provider Agency is
required to document, in writing, in the
respective client case record, that the client
is receiving juvenile-family court services.

(3) Redetermination

Once the juvenile-family is eligible to

receive juvenile-family court services, the
service continues until it is no longer
needed.

2. Aid to Families with Dependent Children (AFDC) or

Supplemental Security Income (SSI)

a. Eligibility Criteria

Persons receiving AFDC (including those persons

whose needs were taken into account in determining
the needs of AFDC recipients) or persons receiving
SSI are eligible for services.

b. Application Procedures

If an applicant meets the AFDC or SSI status

condition, the Provider Agency's client record
must include the applicant's AFDC or SSI number
and must indicate the applicable status as the
condition for eligibility.

For day care or homemaker services, verification of

the applicant's AFDC or SSI status must be provided
by the AFDC or SSI program or by the applicant's
submission of appropriate documentation.

Examples of items an applicant may use to document

his/her status as an AFDC or SSI recipient include:

- a current Medicaid card;

- a recent SSI award letter;
- a copy of a recent SSI check; or
- a recent AFDC check stub.
 P5.45
4

c. Redetermination

In general, the Provider Agency must redetermine

eligibility of a client every 12 months. However,
if the client's situation changes in any way which
would affect his/her eligibility, redetermination
must be completed within 30 Days of the change.

3. Gross Monthly/Annual Family Income

NOTE: Gross monthly/annual family income is used to

establish eligibility for services only when the
applicant does not meet the criteria of (1) Without
Regard to Income PRS or "in need of juvenile-family
court services" or (2) AFDC or SSI.

a. Eligibility Criteria

Persons whose gross monthly/annual family income

does not exceed established limits, as indicated on
the Income Schedule in Attachment 1, are eligible
for services.

b. Application Procedures

The Provider Agency is responsible for determining

eligibility for services based on gross
monthly/annual family income.

(1) Process for Determining Eligibility

Determine gross monthly/family income, according to

the following steps:

determine the family size, according to the

guidelines included in Attachment 2, Family
Size;

determine gross income, according to

guidelines regarding allowable resources and
excludable resources in Attachment 3, Income
Resources and Exclusions; and

using the family size and gross income numbers

already established, refer to Attachment 1,
Income Schedule, to determine if the applicant
is eligible for services.

(2) Verification of Eligibility

One of two methods will be used to verify an

applicant's eligibility:
 P5.45
5

(a) Declaration of Amount and Source of Income

Declaration is the applicant's verbal

statement that indicates income maintenance
status (AFDC or SSI) or amount of income for
the applicant and/or family members. The
amount and source of the income need not be
documented. With the exception of day care
and homemaker services, eligibility for
services can be verified based on the
applicant's declaration.

(b) Documentation of Amount and Source of Income

for Day Care and Homemaker Services Only

Documentation is actual evidence verifying the

applicant's eligibility. Such documentation
may be (1) a copy of the source document, (2)
written statement of the Provider Agency
concerning the contents of the source
document, or (3) the Provider Agency's written
statement on the basis of verbal communication
with agencies or employers verifying the
applicant's and/or family members' income.

Examples of source documents of gross income

include:

- pay stubs, W-2, or 1040 forms;

- business records;
- pension statements;
- correspondence from employers or agencies
(e.g., Social Security Administration,
Veterans Administration, State employment
agencies) that indicate the specific
amount of the applicant's and/or family
members' income.

If an applicant alleges that income is

received as cash without a receipt,
documentation requires contacting the employer
for confirmation of the amount.

Documentation must be retained or written in

the individual applicant's case file.

(c) Redetermination

The Provider Agency must redetermine

eligibility of a client every 12 months.
However, if the client's situation changes in
any way which would affect his/her
 P5.45
6

eligibility, redetermination must be completed

within 30 calendar days of the change.

B. Fees

Client fees are only charged for Day Care services.

Client fee schedules for Day Care services are on file with
the Provider Agency and the Division.
 P5.45
Attachment 1

INCOME SCHEDULE

(Represents 80% of 1983 N.J. Median Income)

Family Size Maximum Allowable Gross Income

Per Month Per Year

1 $1,264 $15,162

2 1,652 19,827

3 2,041 24,493

4 2,430 29,158

5 2,819 33,823

6 3,207 38,489

7 3,280 39,362

8 3,353 40,238

9 3,426 41,112

10 3,499 41,987

11 3,572 42,862

12 3,645 43,737

For each family member over 12, add $73 to the maximum allowable gross
income per month.
 P5.45
Attachment 2

FAMILY SIZE

Computation of family size, which depends on the definition of "family"

below, is important because the income eligibility schedule varies
according to family size.

A. Definition of Family

For eligibility purposes, a family is either a multi-person or a

one-person family.

1. Multi-Person Families are:

- A married couple residing together.

- One or more children (other than emancipated minors)

residing with one or both of their parents or another
person related by blood or law.

- A child who resides with a person unrelated by blood or law

and whose legal relationship with his/her biological
parents has not been terminated by court order.

Such a child (e.g., foster child), for the purposes of

eligibility, continues to be considered a member of the
natural family (except for Indochinese, Cuban, or Haitian
Unaccompanied Minors, who are considered one-person
families). The Provider Agency should consult with the
foster care placement agency for eligibility status.

2. One-Person Families are:

- An adult residing alone or with another adult(s) (other

than a spouse).

- An adult residing with children unrelated by blood or law.

- A child who resides alone or with a person unrelated by

blood or law and whose legal relationship with his/her
biological parents has been terminated by court order.

- An Indochinese, Cuban, or Haitian Unaccompanied Minor.

- An emancipated minor, defined as a person under 18 years of

age who is self-supporting or living independently or whose
behavior and whose request for social services is not
effectively under parental control.

Note on Emancipated Minors: An emancipated minor is never

counted with his/her parents. If a child in the household is
emancipated in the sense of being self-supporting, the child
 2 P5.45
Attachment 2

shall be considered an adult for eligibility purposes. This

means that the child is considered a one-person family.
While there may be other circumstances besides economic self-
support that would properly characterize a person under 18
years of age living as emancipated (for example, a girl under
18 years of age living with the family and caring for her
child), these additional circumstances are difficult to set
forth in advance, and each circumstance, other than economic
self-support, suggesting emancipation shall be dealt with on
an ad hoc basis.

B. Rules for Computing Family Size

Note: Family size must be determined for the same period over
which gross income is computed.

As a general rule, to compute family size for eligibility

purposes, count each married parent and natural and/or adoptive
child residing as a family in the same household.

- A child is a person (1) under 18 years of age, (2) between the

ages of 18 and 21 who continues in a paid foster or residential
care placement, who is regularly attending a school or training
program below the college level, and/or has an emotional,
cognitive, or physical disability or (3) any person age 18 who
resides with his/her parent(s) and is a full-time student in a
secondary school or in the equivalent level of vocational or
technical training.

- An emancipated minor, as previously defined, shall be considered

as an adult.

- Married adults residing in the same household shall be counted

as members of the same family (multi-person family).

- Unmarried adults residing in the same household shall each be

considered as a one-person family, unless an adult resides also
with his/her own child(ren) related by blood or law; then that
adult is part of a multi-person family which includes his/her
child(ren) and/or child(ren) related by blood or law.

- For a child(ren) residing with unmarried parents who live to-

gether, the father is counted in family size with only that
child(ren) for whom paternity has been legally established. If
both unmarried parents are included in family size, only the
income of the parent earning the greater gross income is used to
determine financial eligibility.

- A stepparent living with a spouse and the spouse's child is

considered part of a multi-person family when the stepparents is
not legally responsible for the child.
 P5.45
Attachment 3

INCOME RESOURCES AND EXCLUSIONS

NOTE: In computing income, only the earned income of family members 14

years of age or older is considered. However, unearned income
of family members of all ages is considered.

Allowable/Mandated Resources

Gross income means the sum of income received by an individual from the
following sources that are identified by the U.S. Census Bureau in
computing the median income.

A. Earned Income

- Wages or salary means total earnings received for work performed

as an employee, including wages, salary, Armed Forces pay,
commissions, tips, piece-rate payments, and cash bonuses earned
before deductions are made for taxes, bonds, pensions, union
dues, and similar purposes.

- Net income from non-farm self-employment means gross receipts

minus expenses from one's own non-farm business, professional
enterprise, or partnership. Gross receipts include the value of
all goods sold and services rendered. Expenses include cost of
goods purchased, rent, heat, light, power, depreciation charges,
wages and salaries paid, business taxes (not personal income
taxes), and similar costs. The value of salable merchandise
consumed by the proprietors of retail stores is not included as
part of net income.

- Net income from farm self-employment means gross receipts minus

operating expenses from the operation of a farm by a person on
his/her own account, as an owner, renter, or sharecropper.
Gross receipts include the value of all products sold,
government crop loans, money received from the rental of farm
equipment to others, and incidental receipts from the sale of
wood, sand, gravel, and similar items. Operating expenses
include cost of feed, fertilizer, seed, and other farming
supplies, cash wages paid to farmhands, depreciation charges,
cash rent, interest on farm mortgages, farm building repairs,
farm taxes (not State and federal income taxes), and similar
expenses. The value of fuel, food, or other farm products used
for family living is not included as part of net income.

B. Unearned Income

- Social Security includes Social Security pensions and survivor's

benefits, and permanent disability insurance payments made by
the Social Security Administration prior to deductions for
medical insurance and railroad retirement insurance checks from
the U.S. Government.
 2 P5.45
Attachment 3

- Dividends, interest (on savings or bonds), income from estates

or trusts, net rental income or royalties include dividends from
stockholdings or membership in associations, interest on savings
or bonds, periodic receipts from estates or trust funds, net
income from rental of a house, store, or other property to
others, receipts from boarders or lodgers, and net royalties.

- Public assistance or welfare payments include public assistance

payments such as AFDC, SSI, State supplemental payments to SSI
recipients, and general assistance (i.e., municipal welfare).

- Pensions and annuities include pensions or retirement benefits

paid to a retired person or his/her survivors by a former
employer or by a union, either directly or through an insurance
company, and periodic receipts from annuities or insurance.

- Unemployment Compensation means compensation received from

government unemployment insurance agencies or private companies
during periods of unemployment and any strike benefits received
from union funds.

- Worker's compensation means compensation received periodically

from private or public insurance companies for injuries incurred
at work. The cost of this insurance must have been paid by the
employer and not the worker.

- Alimony.

- Child Support

- Veteran's pensions means money paid periodically by the Veterans

Administration to disabled members of the Armed Forces or to
survivors of deceased veterans, subsistence allowance paid to
veterans for education and on-the-job training, as well as so-
called "refunds" paid to ex-service personnel as GI insurance
premiums.

Exclusions

Excluded from computation of gross income are the following:

- Per capita payments of or funds held in trust for any individual

in satisfaction of a judgment of the Indian Claims Commission of
the Court of Claims.

- Payments made pursuant to the Alaska Native Claims Settlement

Act to the extent such payments are exempt from taxation under
Section 21(a) of the Act.
 3 P5.45
Attachment 3

- Money received from sale of property, such as stocks, bonds, a

house, or a car (unless the person was engaged in the business
of selling such property, in which case the net proceeds would
be counted as income from non-farm self-employment).

- Withdrawals of bank deposits.

- Money borrowed.

- Tax refunds or rebates.

- Gifts.

- Lump sum payments, (e.g., inheritances, insurance payments,

energy assistance, HUD settlements).

- Capital gains.

- The value of the coupon allotment under the Food Stamp Act of
1977, as amended.

- The value of supplemental food assistance under the Child

Nutrition Act of 1966 and the special food service program for
children under the National School Lunch Act, as amended.

- Any payment received under the Uniform Relocation Assistance and

Real Property Acquisition Policies Act of 1970.

- Earned income of a child under 14 years of age (no inquiry shall

be made).

- Loans and grants, such as scholarships, obtained and used under

conditions that preclude their use for current living costs.

- Any grant or loan to any undergraduate student for educational

purposes made or insured under any program administered by the
Commissioner of Education under the Higher Education Act.

- Home produce utilized for household consumption.

- Payments to VISTA volunteers pursuant to Section 404(g) of the

Domestic Assistance Act of 1973.
 Policy Circular P6.01
STATE OF NEW JERSEY
DEPARTMENT OF HUMAN SERVICES

SUBJECT: Match Requirements for Social Services Block Grant Service

Contracts

EFFECTIVE: This policy circular shall become effective on July 1, 1983,

and shall be implemented as new Contracts commence or
existing Contracts are renewed thereafter.

PROMULGATED: June 1, 1983

SUPERCEDES: Policy Circular P6.01, promulgated July 1, 1982

The purpose of this circular is to advise State and Provider Agencies of

match requirements for Social Services Block Grant Service Contracts.
These requirements have been established by the New Jersey Department of
Human Services; they are not requirements of the federal Department of
Health and Human Services.

I. SCOPE

This policy circular applies to all Contracts designated by the

State Agency as a Social Services Block Grant (SSBG) service
Contract. It does not apply to training contracts funded by the
Social Services Block Grant or by any other funding source.

II. DEFINITIONS

In addition to defined terms included in the Glossary of the

Manual, the following terms, when capitalized, shall have meanings
as stated:

Donor means the public (except the State of New Jersey) or private
entity contributing match.

Donor Agreement (Public or Private) means a standard written

agreement between the Provider Agency and a public or private
entity providing match to be used in the SSBG service Contract.
The standard Donor Agreement is furnished by the State Agency.

In-Kind Contributions means property or services (except the

services of volunteers) which benefit the Contract program and
which are contributed by a public entity without charge to the
Provider Agency. Included as In-Kind Contributions are public
contributions formerly designated as CCE (Certified Cash
Expenditures).
III. POLICY

A. Match is required by the Department for all SSBG service

Contracts. The amount of match required is 25 percent of a
base amount. This base amount is calculated by adding to the
Total Operating Budget the amount of any State Agency-approved
In-Kind Contributions and subtracting from this sum any Cost
Sharing not to be used as match.

B. The Provider Agency is responsible for obtaining the required

match.

C. Allowable sources and types of match for SSBG Service

Contracts are as follows:

1. Public Entities

The types of match discussed below may be contributed by

a public entity either to a public Provider Agency
(including itself) or to a private Provider Agency.

a. Cash donations include budget appropriations from

the State government and from local government
entities, e.g., freeholders, municipal governments,
school boards, housing authorities. With the
exception of budget appropriations from the State
government, cash donations from public entities must
be transferred to the Provider Agency and placed
under its administrative control.

b. In-Kind Contributions must be necessary in the

delivery of Contract services and must be utilized
during the term of the Contract. The value of
property purchased with federal funds may not be
included as an In-Kind Contribution, unless
specifically authorized by federal legislation.

The basis for determining the value of In-Kind

Contributions must be documented. (See Attachment 2
for information regarding the determination of the
value of In-Kind Contributions.)

2. Private Entities

Cash donations are the only allowable type of match from

private entities. Examples of such entities include
United Ways, foundations and individuals. Private
entities may donate cash to public or private Provider
Agencies or, if applicable, may support their own SSBG
service Contract. When the Donor is contributing to
another agency, the case must be transferred to the
 Provider Agency and placed under its administrative
control.

In-Kind Contributions are not allowed as match from

private entities.

D. Unallowable sources of match for SSBG service Contracts are as

follows:

1. Client Fees

2. Federal Funds, unless authorized by federal law to be

used to match other federal funds.

E. Match is to be used in the provision of the Contract services

described in the Annex(es).

F. The type(s), source(s), and amount(s) of all match must be

specified in the Annex(es) and must be approved by the State
Agency. Any change in the type(s), source(s), or amount(s)
of match shall be reported to the State Agency. (See Policy
Circular P1.10, Contract Modification.)

G. In cases where a Donor defaults on its Donor Agreement (Public

or Private) or makes delayed or reduced contributions, or the
Provider Agency is unable to generate the required match from
its own resources, the State Agency will not compensate for
any insufficiency of resources by increasing its Contract
payment(s) to the Provider Agency.

H. Resources used as match for an SSBG service Contract may not

be used to match expenditures in another program.

I. Provider Agency records of receipt and utilization of match

for SSBG service Contracts are subject to any audit performed
in compliance with the Contract's Standard Language Document.

IV. PROCEDURES

A. Provider Agency Responsibilities

1. Match Information

The Provider Agency shall complete the Match Information

Form by calculating the amount of match required and by
specifying the type(s), source(s), and amount(s) of all
match. This completed form shall be attached to the
Annex(es). A sample completed form is Attachment 1 to
this circular.

2. Documentation of Availability and Commitment of Match

a. State Resources

When State resources are to be used as match, the

amount of State resources shall be included on the
Match Information Form. The State Agency's final
approval of the Annex(es) will serve to confirm the
availability and commitment of State resources as
match for the Contract.

b. Provider Agency Resources

When the Provider Agency is furnishing match for its

own SSBG service Contract, a resolution shall be
made by its governing board stating the amount of
the match and outlining when it will be available
for use in the provision of Contract services.

c. Resources From Other Sources

When resources from a public or private entity other

than the State Agency or the Provider Agency are to
be contributed as match for use during the Contract
term, the Provider Agency and the Donor shall enter
into a Donor Agreement (Public or Private).

d. Requirements for Submitting Documentation of Match

to the State Agency

A copy(ies) of the Provider Agency's governing board

resolution and/or copy(ies) of a fully-executed
Donor Agreement(s) (Public or Private), documenting
the availability and commitment of match for either
the term of the Contract or for the first twelve
months of a longer-than-one-year Contract, must be
submitted to the State Agency prior to the
finalization of the SSBG service Contract.

In the case of a longer-than-one-year Contract, when

documentation of match has been provided for the
first twelve months of the Contract only, a
copy(ies) of the Provider Agency's governing board
 resolution and/or Donor Agreement(s) (Public or
Private) for the remainder the Contract term must be
submitted to the State Agency prior to the 12th month
of the Contract term.

3. Inclusion of Match in the Official Contract Budget

In accordance with guidelines and instructions in the

Department's Contract Reimbursement Manual, all cash
donations must be identified in the Annex B: Official
Contract Budget, and as Cost Sharing, will reduce the
Total Operating Budget. In-Kind Contributions are not to
be included in the Official Contract Budget.

B. State Agency Responsibilities

1. The State Agency shall use the guidelines established in

this circular to review and approve the type(s),
source(s), and amount(s) of donation(s) to be used as
match for a SSBG service Contract.

2. The State Agency shall provide standard Donor Agreements

(Public and Private) which must be used by the Provider
Agency with any third-party public or private Donor of
match. Sample copies of the standard Donor Agreements
(Public and Private) are Attachments 3 and 4 to this
policy circular.

3. The State Agency shall keep on file with the SSBG service
Contract, copies of any governing board resolutions
and/or Donor Agreements (Public or Private) pertaining to
the provision of match.

Issued by:
 P6.01
(Attachment 1)

MATCH INFORMATION FORM

Sample

Provider Agency: ABC Provider Agency

Address: Trenton, New Jersey

Contract Term:_______July 1, 1983_______ to ________June 30, 1984_______

I. Calculation of Match

Step 1: Insert amount of Total Operating Budget from

Line H of Annex B; Official Contract Budget. __$112,000__

Step 2: Insert the value of any State Agency approved

In-Kind Contribution. _____3,000__

Step 3: Add amounts from Steps 1 and 2. ___115,000__

Step 4: a. From page 10 of Annex B-1, enter the source

and amount of all Cost Sharing other than
Match.

(1) Medicaid Reimbursement 17,000

(2) Client Fees 2,000
(3) Ceta 6,000

b. Add the amounts listed in Step 4a and enter

this amount. ____25,000__

Step 5: Subtract amount obtained in Step 4b from subtotal

in Step 3. ____90,000__

Step 6: Multiply the amount in Step 5 by 25% to obtain _____x .25__

total amount of required match. ____22,500__

Step 7: To calculate the amount of required cash match,

subtract the amount listed in Step 2 from the _____3,000__
amount obtained in Step 6. ____19,500__

II. Type(s), Source(s), and Amount(s) of Match

List the source(s) and amount(s) of all match for the SSBG service Contract. For In-
Kind Contributions, attach additional sheets to indicate the Budget Category to which
the In-Kind applies and to justify the determined value of the In-Kind Contribution.
In addition, attach all documentation as to the availability and commitment of match.

Type Source Amount

A. Cash Donations Division of ---- 9,000

United Way 3,000
Provider Agency 7,500

B. In-Kind Contributions County ---- 3,000__

TOTAL MATCH $22,500
 P6.01
(Attachment 2)

DETERMINATION OF THE VALUE OF IN-KIND CONTRIBUTIONS

With State Agency approval, In-Kind Contributions from a public entity

may be counted as Match for a Social Services Block Grant service
Contract. The value of such In-Kind Contributions shall be established
as follows:

1. Personal Services. When a public Provider Agency or another

pubic entity furnishes the services of an employee, those
services shall be valued at the employee's regular rate of pay
(exclusive of fringe benefits and overhead costs) provided
those services are in the same skill for which the employee is
normally paid.

2. Expendable Personal Property. Expendable personal property

includes such items as expendable equipment, office supplies,
laboratory supplies, or workshop and classroom supplies. The
value assessed to expendable personal property shall not
exceed the market value of the property at the time of its use
as an In-Kind Contribution.

3. Nonexpendable Personal Property, Buildings, and Land, or Use

thereof. If the SSBG service Contract requires the use of
Equipment, buildings, or land, depreciation or use charges
shall establish their value as an In-Kind Contribution. In
addition, with State Agency approval, the full value of
Equipment or other capital assets and fair rental charges for
land may be allowed as the value of an In-Kind Contribution.

In either case, when determining the value of an In-Kind

Contribution, the following qualifications shall apply:

a. Nonexpendable personal property. The value of

nonexpendable personal property shall not exceed the fair
market value of Equipment and property of the same age
and condition, at the time of its use as an In-Kind
Contribution.

b. Loaned Equipment. The value of loaned Equipment shall

not exceed its fair rental value.

c. Building and land. The value of a building and land

shall not exceed its fair market value as established by
an independent appraiser (e.g., certified real property
appraiser) and certified by a responsible official of the
recipient.
 2 P6.01
(Attachment 2)

d. Use of space. The value of space shall not exceed the

fair rental value of comparable space as established by
an independent appraisal of comparable space and
facilities in a privately-owned building in the same
locality.
 P6.01
(Attachment 3)
Donor Agreement # _______

PUBLIC DONOR AGREEMENT

AGREEMENT between_______________________________________________________
________________________________(the "Provider Agency") and_____________
______________________________________________________(the "Donor").

WHEREAS the New Jersey Department of Human Services (the

"Department") has been duly designated to administer or supervise the
administration of social service programs, as defined in the New Jersey
State plans for social services; and

WHEREAS the Department desires that the Provider Agency deliver

services and the Provider Agency has agreed to deliver services; and

WHEREAS the Department's policies establish that resources donated

by a public donor in the form of cash or In-Kind Contributions (as
defined below) may, under certain conditions, be used as match in the
provision of social services; and

WHEREAS the Donor wishes to make a donation to support social

services;

THEREFORE, the Provider Agency and the Donor agree to the following
terms and conditions:

1. Definitions - For the purposes of this document, the following

terms, when capitalized, shall have meanings as stated:

A. Donated Resources means the total donation made by the Donor

as match. Donated Resources may include cash donations and/or
In-Kind Contributions.

B. In-Kind Contributions means property or services (except the

services of volunteers) which benefit the contract program and
which are contributed by a public entity without charge to the
Provider Agency. Included as In-Kind Contributions are public
contributions formerly designated as CCE (Certified Cash
Expenditures). All In-Kind Contributions under this agreement
are listed as Attachment 1 to this agreement.

2. Term - This Agreement shall begin on _____________, 20__ and shall

terminate on ___________, 20__, barring any outstanding obligations
to either party.

3. Donated Resources - The Donor agrees to provide Donated Resources

in an amount totaling $_____________to the Provider Agency.
Public Donor Agreement 2 P6.01
(Attachment 3)

4. Provision of Donated Resources - During the term if this agreement,

Donated Resources shall be contributed by the Donor to the Provider
Agency as follows:

Payment(s) Date Due Cash In-Kind* Total

_______ ________ ________

TOTAL _______ ________ ________

*See Attachment 3A for In-Kind Contributions.

5. Administrative Control of Donated Resources - Except for the

allowable Donor restrictions contained in paragraph 6 of this
agreement, all Donated Resources contributed in cash to the
Provider Agency under this agreement are donated on an unrestricted
basis. This is to ensure that Donated Resources are under the
administrative control of the Provider Agency. The Donor
understands that if any portion of the donation is made as In-Kind
Contributions, Attachment 1 to this agreement will be submitted
with the agreement to vouch for the validity of these costs.

6. Donor's Restrictions - The Donor restricts the use of Donated

Resources as follows:

Type of Service __________________________

Service Contract Title: __________________________
Service Contract #: __________________________

7. Provider Agency's Obligations - In consideration of the resources

donated, the Provider Agency agrees to use the Donated Resources in
accordance with the restrictions contained in paragraph 6 of this
agreement. The Provider Agency represents that the opportunity to
honor the Donor's restrictions in the provision of social services
is available.

It is understood that the provision of services is subject to

federal and State laws and administrative regulations and that
services will be provided in a manner necessary to ensure
compliance.
Public Donor Agreement 3 P6.01
(Attachment 3)

Upon request from the Donor, the Provider Agency shall make
available to the Donor the annex(es) to the service contract
specified in paragraph 6 of this agreement. In addition, upon
request from the Donor, the Provider Agency shall make available to
the Donor its reports to the State agency covering levels of
service and program expenditures under the service contract. The
Provider Agency shall not release confidential materials or
information concerning persons served under the service contract.

8. Donor's Obligations - It is the Donor's obligation to provide the

Donated Resources in the amount(s) and as scheduled in paragraph 4
of this agreement. The Donor understands that failure to meet the
payment schedule in paragraph 4 of this agreement may result in the
Provider Agency being unable to claim sufficient reimbursement to
fund its social service program.

The Donor's obligation to provide the Donated Resources as

specified in paragraph 4 of this agreement shall not be contingent
upon the Donor's ability to produce sufficient In-Kind
Contributions. The Donor agrees that if sufficient In-Kind
Contributions are not available to meet its obligation to the
Provider Agency, the balance of the donation will be paid in cash
before this agreement terminates.

In cases in which In-Kind Contributions are made, the Donor agrees

to submit to the Provider Agency monthly written reports attesting
to the value of the In-Kind Contributions as they are applied to
the social service program. The Donor understands that this report
is required by the State agency as documentation of program
expenses.

9. Donor's Representations - The Donor represents that the Donated

Resources are not currently being used to match expenditures in
another program.

In cases in which In-Kind Contributions are made, the Donor also

represents that the value of the In-Kind Contributions listed on
Attachment 1 to this agreement fairly represents their value to the
social service program.

10. Indemnification - The Donor indemnifies and holds the Provider

Agency harmless for any loss or disallowance of reimbursement that
the Provider Agency may suffer due to the inaccuracy of any
statement made in this agreement by the Donor.
Public Donor Agreement 4 P6.01
(Attachment 3)

11. Audit - The Donor agrees to cooperate in any audit of the source of
the Donated Resources. An audit may be conducted by or on behalf
of the Provider Agency, the Department, or the federal government.

The Donor understands that such an audit may include the sources of
cash and/or In-Kind Contributions. The Donor further understands
that it is responsible for maintaining sufficient documentation to
support each kind of donation.

12. Entire Agreement - This document contains all the terms and
conditions agreed to by the Provider and the Donor. Any amendment
or modification of this agreement must be approved by the
Department.

BY:___________________________ BY:_____________________________
Signature of Donor's Signature of the Provider
Authorized Representative Agency's Authorized
Representative

NAME:_________________________ NAME:_____________________________

TITLE:________________________ TITLE:____________________________

PROVIDER
DONOR:________________________ AGENCY:___________________________

DONOR PROVIDER
ADDRESS:______________________ ADDRESS:__________________________

______________________ __________________________

PHONE PHONE
NUMBER:_______________________ NUMBER:___________________________

DATED:________________________ DATED:____________________________

Donor Agreement # ____________________

Public Donor Agreement P6.01
(Attachment 3A)
ATTACHMENT 3A

IN-KIND CONTRIBUTIONS

List the total In-Kind Contributions applicable to each Contract

budget category. A detailed description of the In-Kind
Contribution for each budget category is to be attached.

A. Personal Services ____________________

B. Consultants and Professional Fees ____________________

C. Materials and Supplies ____________________

D. Facility Costs ____________________

E. Specific Assistance to Clients ____________________

F. Other ____________________

TOTAL IN-KIND CONTRIBUTIONS $___________________

 P6.01
(Attachment 4)
Donor Agreement # _______

PRIVATE DONOR AGREEMENT

AGREEMENT between_______________________________________________________
_________________________(the "Provider Agency") and____________________
____________________________________________________(the "Donor").

WHEREAS the New Jersey Department of Human Services (the

"Department") has been duly designated to administer or supervise the
administration of social service programs, as defined in the New Jersey
State plans for social services; and

WHEREAS the Department desires that the Provider Agency deliver

services and the Provider Agency has agreed to deliver services; and

WHEREAS the Department's policies establish that resources donated

from private sources may, under certain conditions, be used as match in
the provision of social services; and

WHEREAS the Donor wishes to make a cash donation to support social

services;

THEREFORE, the Provider Agency and the Donor agrees to the

following terms and conditions:

1. Term - This agreement shall begin on ______________________, 20___

and shall terminate on_____________, 20___, barring any outstanding
obligations of either party.

2. Donation - During the term of this agreement the Donor agrees to

make a total cash donation of $_________("Donated Resources") to
the Provider Agency.

3. Payment of Donated Resources - During the term of this agreement,

Donated Resources shall be contributed to the Provider Agency as
follows:

PAYMENT(S) DATE DUE AMOUNT

____________

TOTAL ____________
____________
Private Donor Agreement 2 P6.01
(Attachment 4)

4. Administrative Control of Donated Resources - Except for the

allowable Donor restrictions contained in paragraph 5 of this
agreement, all Donated Resources contributed to the Provider Agency
under this agreement are donated on an unrestricted basis. This is
to ensure that Donated Resources are under the administrative
control of the Provider Agency.

5. Donor's Restrictions - The Donor restricts the use of Donated

Resources as follows:

Type of Service: __________________

Service Contract Title: __________________
Service Contract #: __________________

6. Provider Agency's Obligations - In consideration of the resources

donated, the Provider Agency agrees to use the Donated Resources in
accordance with the restrictions contained in paragraph 5 of this
agreement. The Provider Agency represents that the opportunity to
honor the Donor's restrictions in the provision of social services
is available.

It is understood that the provision of services is subject to

federal and State laws and administrative regulations and that
services will be provided in a manner necessary to ensure
compliance.

Upon request from the Donor, the Provider Agency shall make
available to the Donor the Annex(es) of the service contract
specified in paragraph 5 of this agreement. In addition, upon
request from the Donor, the Provider Agency shall make available to
the Donor its reports to the State agency covering levels of
service and program expenditures under the service contract. The
Provider Agency shall not release confidential materials or
information concerning persons served under the service contract.

7. Donor's Obligation - It is the Donor's obligation to provide the

Donated Resources in the amount(s) and as scheduled in paragraph 3
of this agreement. The Donor understands that failure to meet the
payment schedule in paragraph 3 of this agreement may result in the
Provider Agency being unable to claim sufficient reimbursement to
fund its social service program.
Private Donor Agreement 3 P6.01
(Attachment 4)

8. Indemnification - The Donor indemnifies and holds the Provider

Agency harmless for any loss or disallowance of reimbursement that
the Provider Agency may suffer due to the inaccuracy of any
statement made in this agreement by the Donor.

9. Audit - The Donor agrees to cooperate in any audit of the source of

the Donated Resources. An audit may be conducted by or on behalf
of the Provider Agency, the Department, or the federal government.
The Donor understands that it is its responsibility to maintain
sufficient documentation to support the Donated Resources.

10. Entire Agreement - This document contains all the terms and
conditions agreed to by the Provider Agency and the Donor. Any
amendment or modification of this agreement must be approved by the
Department.

BY:_______________________________ BY:_____________________________
Signature of Donor's Authorized Signature of Provider Agency's
Representative Authorized Representative

NAME:_____________________________ NAME:___________________________

TITLE:____________________________ TITLE:__________________________

DONOR:____________________________ PROVIDER AGENCY:________________

DONOR ADDRESS:____________________ PROVIDER AGENCY ADDRESS:________

__________________________________ ________________________________

PHONE NUMBER:_____________________ PHONE NUMBER:___________________

DATED:____________________________ DATED:__________________________

DONOR AGREEMENT #_____________________

 Policy Circular P7.01

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Contract Closeout

EFFECTIVE: This policy circular shall become effective on

July 15, 2001, and shall be implemented
immediately.

PROMULGATED: July 15, 2001

SUPERSEDES: Policy Circular P7.01, promulgated July 1, 1988.

The purpose of this circular is to establish Department of Human

Services policy for Contract closeout.

I. SCOPE

This policy circular applies to all Contracts.

II. DEFINITIONS

In addition to the defined terms included in the Glossary of

the Manual, the following terms, when capitalized, shall
have meanings as stated:

Days means calendar days

Disallowed Costs means those charges to a Contract that the

Departmental Component determines to be unallowable in
accordance with applicable cost principles, Departmental
Component policies or other conditions contained in the
Contract.

Expiration means the cessation of the Contract because its

term has ended.

Final Contract Closeout means the process by which the

Departmental Component determines that all applicable
administrative actions and all required work of the Contract
have been completed by the Provider Agency and the
Departmental Component.

Preliminary Contract Closeout means the process whereby a

Departmental Component reconciles the amount of funding paid
to a Provider Agency during the Contract term against the
 P7.01
2

Final Report of Expenditures (FROE) or the latest Report of

Expenditure (ROE) submitted by the Provider Agency to the
Departmental Component.

Termination means an official cessation of a Contract, prior

to the Expiration of its term, that results from action
taken by the Departmental Component or the Provider Agency
in accordance with provisions contained in the Contract.

III. POLICY

A. Contract closeout shall be accomplished through a

combination of a Preliminary Contract Closeout and a
Final Contract Closeout, or solely by Final Contract
Closeout.

B. Preliminary Contract Closeout shall occur upon receipt

of the FROE; or, if applicable, any Contract
performance report(s) which is due at the Departmental
Component within 120 Days of Contract Expiration or
Termination. If the required report(s) has not been
received within the 120 Days, the Departmental
Component may utilize the last Report of Expenditures
(ROE) and performance report(s) received as the basis
for Preliminary Contract Closeout.

C. Final Contract Closeout shall occur as promptly as

feasible after Contract Expiration or Termination.
This includes, but is not limited to, recognition of
performance incentives or sanctions; review of the
services delivered during the Contract; disposition of
Department of Human Services Policy Circular P1.10
violations, if any; and settlement of any findings or
review associated with the Provider's audited financial
statements or a Department of Human Services audit.

D. Preliminary Contract Closeout or Final Contract

Closeout shall not affect or in any way restrict the
application of the Contract's provisions with regard to
the retention period for, or Department rights of
access to, Contract records.

E. At the time of Contract closeout, the Provider Agency

shall ensure that, when applicable, all expenditures
reported represent costs and services, which are
allocable to the Contract, and that the costs and
services are not attributable to a predecessor or
successor Contract.
 P7.01
3

F. Division-specific policy circulars may be promulgated

by Departmental Components to provide division specific
procedure(s) to augment this policy circular, but the
procedures may not limit, contradict, replace or amend
the conditions or intent of this policy circular.

IV. PROCEDURES

A. Preliminary Contract Closeout

The Provider Agency shall submit to the Departmental

Component within 120 Days of the end of the final
Contract quarter the latest performance reports,
FROE/ROE or other reports required by the terms and
conditions of the Contract.

B. Final Contract Closeout

The Provider Agency shall submit to the Department of

Human Services, within 120 Days after Contract
Expiration or Termination, all financial, audit,
performance, and/or other reports required by the terms
and conditions of the Contract.

C. General Requirements

1. After the required reports are received, the

Departmental Component shall make a financial
settlement including any payment adjustment(s) as
may be authorized by the terms and conditions of
the Contract. The Departmental Component may
consider audited financial statements,
reconciliation schedules, DHS policy P1.10
compliance reviews, level of service (LOS) reports
and receipt verification of donor matching funds
in completing Contract closeout.

2. The Departmental Component shall promptly pay the

Provider Agency for any amount due, but as yet
unpaid for the provision of Contract services.

3. The Provider Agency shall promptly refund to the

Departmental Component any amount determined to be
an overpayment, which the Departmental Component
has not authorized for retention by the Provider
Agency in the current Contract or in a successor
Contract.

4. Upon Contract Termination or Expiration without

renewal, the Provider Agency shall account for any
 P7.01
4

Equipment acquired with Contract funds, in

accordance with Policy Circular P4.05, Equipment.

5. Upon Contract Termination or Expiration without

renewal, the Provider Agency shall determine if
there is a residual inventory of materials and
supplies exceeding $1000 in total aggregate Fair
Market Value. If the materials and supplies are
not needed in any other project or program
currently or previously funded by the federal or
State government, the Provider Agency may retain
or sell the materials and supplies. In either
case, the Provider Agency shall compensate the
Departmental Component for its share in the value
of the materials and supplies, which is calculated
as the percentage of the DHS award to the total
program expenses. If the Provider Agency chooses
to sell the materials, the Provider Agency may
reduce the Departmental Component's share of the
sale proceeds by 10% for selling and handling
expenses.

Issued by:
 Policy Circular P7.05

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Pre-Award Survey

EFFECTIVE: This policy circular shall become effective July 1,

1988, and shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular P7.05, promulgated July 1, 1985.

The purpose of this circular is to inform Department personnel and

Provider Agencies of the policies and procedures concerning a Pre-
Award Survey.

I. SCOPE

This policy circular applies to all Provider Agencies.

II. DEFINITIONS

In addition to defined terms included in the Glossary of the

Manual, the following terms, when capitalized, shall have meaning
as stated:

Conditional Contract means a Contract between the Department and

Provider Agency, during which time special terms or conditions
specified in the Contract must be met by the Provider Agency, in
accordance with specified time frames.

Pre-Award Survey (also Survey) means a review to determine the

adequacy of the financial management system of a potential or
current Provider Agency, prior to the issuance of a new or
successor Contract with that Provider Agency.

III. POLICY

A. The Department is responsible for determining the need for a

Pre-Award Survey. A Pre-Award Survey must be conducted in
accordance with Attachment A of this circular.

B. In general, a Pre-Award Survey will be conducted if:

1. the Department of Human Services has not contracted

with the Provider Agency in the past two years;

2. the Provider Agency has exhibited problems in reporting

financial or program data as required by a current or
former Contract; or
 2 P7.05

3. the Provider Agency has demonstrated an inability to

meet federal or State requirements of a current or
former Contract.

C. In those cases in which a Pre-Award Survey cannot be

performed prior to the award or renewal of a Contract due to
the need for timely execution of the Contract, the
Department may issue a Conditional Contract. The terms of
the Conditional Contract shall include satisfactory
compliance by the Provider Agency with the recommendations
based on the Pre-Award Survey. The Survey should be
conducted during the period of the Conditional Contract. If
inadequacies exist, an improvement plan shall be required as
a prerequisite to continued funding.

D. There are situations where the type and magnitude of the

Provider Agency's operations are such that a pre-award desk
review of the most recent audited financial statements may
be made in lieu of an on-site survey with approval of the
manager/supervisor of the Departmental Component's
contracting unit.

IV. PROCEDURES

A. Responsibility of the Provider Agency

The Provider Agency is responsible for full, complete and

accurate disclosure of any information requested in order
for the Pre-Award Survey to be completed in a timely,
accurate manner.

B. Responsibilities of the Department

1. During initial Contract negotiations, the Department

shall:

a. determine if the potential Provider Agency

contracts with another unit within the Department
of Human Services. If yes, request the Contract
Policy and Management Unit to confirm the Provider
Agency's contract status within the Department.

b. request the Office of Auditing to ascertain if an

audit report and/or previous Pre-Award Survey of
the Provider Agency is on file. The Department
shall review such reports in determining the need
for a current Pre-Award Survey.

c. determine if a Pre-Award Survey is required

according to criteria stipulated in Paragraph
III.B of this circular and so advise the Office of
Auditing.
 3 P7.05

2. If a Pre-Award Survey is not required, Contract

negotiations shall proceed.

3. If a Pre-Award Survey is required, the Departmental

Component and the Office of Auditing shall determine in
consultation which one will conduct the Survey.

4. Copies of the completed Pre-Award Survey shall be

forwarded to the appropriate Departmental Component,
and the Department's Office of Auditing.

C. Utilization of the Pre-Award Survey by the Department

1. Contract negotiations may proceed when the results of

the Pre-Award Survey indicate that the Provider Agency
has an adequate financial management system.

2. Should the results of the Pre-Award Survey indicate

deficiencies in the Provider Agency's financial
management system, the Departmental Component shall
either:

a. proceed with Contract negotiations and develop a

plan, including timetables and deadlines, to
improve the Provider Agency's financial management
system. In such cases, the Departmental Component
will prepare a Conditional Contract with the
Provider Agency to include compliance with this
plan as a condition of the Contract; or

b. determine that the deficiencies are of such a

nature that Contract negotiations should be
discontinued and the proposed contract rejected.
In such cases, the Departmental Component shall
notify the Office of Auditing and the Provider
Agency of this decision.

3. Should the deficiencies in the Pre-Award Survey cause

disagreement among the Departmental Components with
regard to contracting with the Provider Agency, the
issue shall be resolved jointly by the Departmental
Components and the Contract Policy and Management Unit.

Issued by:
 P7.05
Attachment A
DEPARTMENT OF HUMAN SERVICES
PRE-AWARD SURVEY

1. Agency Proposed

2. Address Contract Period

Contract Funding $

3. Telephone Number Contract Number(s)

(if applicbale)

4. Director Federal I.D. #

5. Name and title of Provider Agency's contact person:

6. List of books and records maintained by the Provider Agency:

a.

b.

c.

d.

e.

f.

7. a. If the Provider Agency sponsors more than one program and/or

receives funds from more than one source, do accounting
records properly separate and identify various funding
sources and related disbursements? If not, briefly explain
the method of accounting for various funding sources and
programs in the accounting records and budget documents.

b. Is the financial and other data reported to other State and

federal governmental agencies consistent with that reported
to the Department?

8. a. Is an indirect cost rate or cost allocation plan utilized by

the Provider Agency?
 2 P7.05
Attachment A

b. Has the rate or plan been approved by a recognized

authority?

Explain method of accounting for indirect cost and attach

(approved) copies of computation of indirect cost rate, or cost
allocation plan, if available.

9. Are accounting records maintained?

a. On premises by an internal accounting staff?

b. Off premises by an employee?

Name: Address:

c. Off premises by an outside accountant retained as a

consultant?

Name: Address:

Not
Yes No Applicable

10. Does the Provider Agency have

the following:

a. New Jersey Non-Profit

Corporate Registration

b. New Jersey Sales Tax

Exemption Certificate

c. Tax Exempt Status

determination from IRS

Not
Yes No Applicable
2
 3 P7.05
Attachment A
11. Does the Provider Agency have
an approved operating license
as required? If not, please
explain. _____ ______

12. Has the Provider Agency under-

gone annual audits for the past
three years? _

If so, by whom? and when?

Obtain and analyze a copy of
latest audit report.

13. Are all employees who handle

cash, securities, and other
valuables bonded? If yes,
what is amount of bond. _

14. Has a determination been made

by the N.J. Department of Law
and Public Safety regarding
the Provider Agency's requirement
to file charities registration
data with the N.J. Attorney
General in compliance with
the Charitable Fund Raising
Act of 1971 (Amended)? _

a. If so, determine the

current status of the
Provider Agency's com-
pliance by contacting the
N.J. Department of Law
and Public Safety,
Charities Registration
Section.

Comments

3
 4 P7.05
Attachment A

b. Obtain a copy of latest

report filed with
Charities Registration
Not
Yes No Applicable

15. Does the Provider Agency have

formal procedures for:

a. Cash receipts

b. Petty Cash

c. Fixed asset records

(Policy Circular P4.05)

d. Notes/accounts payable

e. Purchases and expenses

f. Payroll and personnel

(to include "Time
Sheet" requirements)

g. Client attendance and

eligibility
(if applicable)

Obtain a copy of the above

procedures and documents
used to implement these
procedures, and determine
if there is adequate
segregation of duties.

16. Are Board meetings sche-

duled on a regular basis?
Obtain a list of current
Board members.

17. Does the Provider Agency have

written policies in accordance
with the Department's Contract
Policy and Information Manual
addressing:

a. Nepotism
(Policy Circular P8.05)

b. Conflict of Interest
(Policy Circular P8.05)
c. Non-discrimination
(Policy Circular P8.10)

4
 5 P7.05
Attachment A

18. Does the Provider Agency

currently have or anticipate
any type of litigation or
appeal process which might
impact upon its financial
condition?

Not
Yes No Applicable
19. Have all payroll tax
deductions been deposited
in a timely manner?

20. Have all payments for

employee benefit plans
been made in a timely
manner?

CONCLUSION:

As a result of our examination of the books and

(date)
records of the , it is our opinion that this
(Provider Agency)
agency (is, is not) financially viable and fiscally capable of
performing under contract with the State of New Jersey.

Signature, Name and Departmental

Component of person performing the
review

(Signature)

(Name)

(Departmental Component)

(Date) (Phone No.)

Signature of Appropriate Departmental

Component Contract Manager/Supervisor

Date:

5
 Policy Circular P7.06

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Audit Requirements

EFFECTIVE: This policy circular shall become effective immediately for Provider
Agencies with fiscal years beginning on or after December 26, 2014.

PROMULGATED: April 11, 2017

SUPERSEDED: Policy Circular P7.06 promulgated June 1, 2001; Information Memoranda

P04-1 promulgated February 9, 2004.

The Purpose of this circular is to advise Provider Agencies of the Department of Human
Services’ (the Department) audit requirements as mandated by the Federal Office of
Management and Budget (OMB) Uniform Administrative Requirements, Cost Principles and
Audit Requirements for Federal Awards (Uniform Guidance Subpart F) and the New Jersey
Department of the Treasury, Office of Management and Budget Circular Letter 15-08-OMB
(www.nj.gov/infobank/circular/cir1508_omb.pdf).

I. SCOPE

This policy circular applies to Provider Agencies (both public and private) receiving State
and federal financial assistance (Awards) from the Department (including direct and pass-
through State and federal funding). This circular also applies to subrecipients performing
services for Department Provider Agencies. It does not apply to contractors (vendors) that
carry out or administer a program (see NJ OMB Circular 15-08-OMB), or a social services
consumer that is a beneficiary of a program.

II. DEFINITIONS

In addition to the defined terms included in the Glossary of the Manual, the following terms,
when capitalized, shall have meanings as stated:

Audit Finding means deficiencies the Auditor is required by the Uniform Guidance to report
in the Schedule of Findings and Questioned Costs.

Auditor means an auditor that is a public accountant and that meets the general standards
specified in Generally Accepted Government Auditing Standards (GAGAS).

Award(s) includes State grants, State aid, and federal and State financial assistance in the
form of contracts, grants, loans, loan guarantees, property, capital funding agreements,
interest subsidies insurance, food commodities and other assistance to accomplish a public
purpose.

-1-
 Cognizant is a term used to designate audit responsibilities that this policy utilizes in conjunction
with the Departmental component that provides the most federal/State funding.

Corrective Action means action taken by the Provider Agency that a) corrects identified
deficiencies, b) produces recommended improvements; or demonstrates that audit findings are
either invalid or do not warrant Provider Agency action.

Departmental Component means the division, bureau, office or other unit within the Department
responsible for the negotiation, administration approval, closeout, and monitoring of certain
social service or training contracts.

Major Program means a federal/State program determined by the Auditor to be a major program
in accordance with the Uniform Guidance Subpart F.

Management Letter means a written communication from the Auditor to the Provider Agency
that provides instances of noncompliance and internal control weaknesses that are not material
but warrant the attention of those charged with governance at the Provider Agency.

Management Decision means the evaluation by the cognizant Departmental component of the
audit findings and corrective action plan and the issuance of a written decision as to whether or
not the audit finding(s) is sustained, the reasons for the decision, and the expected Provider
Agency action to repay disallowed costs, make financial adjustments, or take other action.

Pass-Through Entity means a non-federal entity, which includes a State, local government, non-
profit organization and for-profit organization that transmits a federal or State award to a
Provider Agency or a subcontractor to carry out a Federal or State program.

State Grant Compliance Supplement (www.nj.gov/treasury/omb/publications/grant.index.shtml)

is a document developed by the New Jersey Department of the Treasury, Office of Management
and Budget that contains compliance requirements to be tested by the Auditor to determine if
the Provider Agency has complied with requirements determined by the Department to
materially affect the award/program.

III. POLICY

A. All Provider Agencies that expend $750,000 or more in federal or State financial assistance
within their fiscal year must have annual single audits or program-specific audits performed
in accordance with Uniform Guidance Subpart F and State Policy.

B. All Provider Agencies that expend less than $750,000 in federal or State financial
assistance within their fiscal year, but expend $100,000 or more in State and/or federal
financial assistance within their fiscal year, must have either a financial statement audit
performed in accordance with Government Auditing Standards (Yellow Book) or a program-
specific audit performed in accordance with Uniform Guidance Subpart F and State policy.

C. Program-specific audits in accordance with Uniform Guidance Subpart F can be elected with
the approval of the cognizant Departmental component when a Provider Agency expends
Federal or State awards under only one federal or State program (includes Policy Circular
P1.12, Clusters) and the federal or State program’s statutes, regulations, or terms and
conditions of the contract award do not require a Uniform Guidance Subpart F audit.

-2-
 P7.06

D. Auditors must use the risk based approach described in Uniform Guidance Subpart F, Audit
Requirements, Section 200.518 to determine which federal/State programs are major
programs. Auditors also must use the criteria outlined in Sections 200.519 and 200.520
when making risk determinations for Federal/State programs.

E. Provider Agency audit reports must include a supplementary schedule of the Provider
Agency’s federal/State awards/expenditures. This schedule entitled Schedule of
Expenditures of Federal Awards and Expenditures of State Financial Assistance must show
for each award:

1. Federal/State Grantor Department

2. Pass-Through Grantor for Federal/State Awards
3. Program Title/name
4. Federal/State CFDA/Grant Award Number or Account Number
5. Award Period
6. Fiscal Year Expenditures

F. The Provider Agency must determine that services performed by subrecipients expending
$100,000 or more in federal and/or State awards are audited according to this policy. A
copy of this policy must be made part of the agreement with the subrecipient and the
Provider Agency may be required to assume the full requirements of a Pass-Through Entity
as detailed in Uniform Guidance Subpart F, Section 200.331.

G. When executing a contract, Provider Agencies must submit an audit report in accordance
with the requirements of Policy Circular P1.01, Documents and Conditions required for
Processing, Executing and Documenting a DHS Third Party Contract.

H. A Provider Agency that receives any amount of funding from the Department, including
those that expend less than $100,000 in combined federal and State awards within their
fiscal year, are subject to audit by the Department or its representatives at their discretion.
Any additional audits must be planned and performed in such a way to build upon the work
performed in accordance with this policy.

I. The reasonable cost of an audit is an allowable contract cost when conducted in accordance
with this policy. Failure to comply with this policy is grounds for termination proceedings
among other remedies under Policy Circular P9.05, Contract Default.

IV. PROCEDURES

A. Provider Agencies

1. The Provider Agency must submit one copy of the audit report to the Department’s
Office of Auditing ([email protected]) within 120 days after the Provider
Agency’s fiscal year end unless a formal extension request has been approved by the
cognizant Departmental component.

-3-
 P7.06

2. The Provider Agency must include a corrective action plan to address each audit finding
in the current year’s audit report if applicable. The corrective action plan must provide
the name(s) of the contact person(s) responsible for corrective action, the corrective
action planned, and the anticipated completion date. The Provider Agency must initiate
and proceed with corrective action as rapidly as possible and corrective action should
begin no later than upon receipt of the audit report.

3. The audit report submission must also include the Auditor’s latest external peer review
performed in accordance with Government Auditing Standards. NOTE: The Department of
Human Services reserves the right at its discretion to conduct or arrange for quality control reviews
of selected Provider Agency audits and accompanying workpapers.

4. When expenditures of federal Awards totaling $750,000 or more are incurred by the
Provider Agency during the fiscal year, it must submit a data collection form (Appendix X
to Part 200-Form SF-SAC), described in the Uniform Guidance Section 200.512(b), to
the Federal Audit Clearinghouse (FAC) (https://harvester.census.gov/facides). The
reporting package as described in the Uniform Guidance Subpart F, Section 200.512(b)
must also be forwarded. Both the data collection form and the reporting package must
be sent electronically to the Federal Audit Clearinghouse, within nine months of the audit
fiscal year end or within 30 days of the issuance of the audit report, whichever is sooner.

5. In accordance with Section 6.3 of the Department’s Contract Reimbursement Manual,

the Provider Agency must submit to the Cognizant Departmental Component (and other
appropriate Departmental Components when requested) copies of its worksheets used
to reconcile the Department’s final report of expenditures to the audited financial
statements.

6. When advised of deficiencies in the audit by the Office of Auditing, the Provider Agency
should, as necessary, work with its Auditor to address the deficiencies.

7. In procuring audit services, the Provider Agency must follow the Procurement Standards
in the Uniform Guidance Subpart D – Post Federal Award Requirements of the FAR (48
C.F.R. Part 42), as applicable. The Provider Agency must also include this policy
circular in its contract with the auditing firm. Whenever possible, the Provider Agency
must make positive efforts to utilize small businesses, minority-owned firms and
women’s business enterprises. The Department’s Office of Contract Policy and
Management website contains “Choosing an External Auditor: A Guide to Making An
Sound Decision” to assist agencies in the Auditor procurement process.

8. The Provider Agency must prepare a Schedule of Expenditure of Federal/State Awards

for the period covered by the agency’s financial statements which must include the total
federal/State awards expended as determined in accordance with Section 200.502 of
the Uniform Guidance Subpart F. (See also Section III. Policy)

9. Management letters issued by the Auditor to the Provider Agency must be submitted to
the Department’s Office of Auditing as part of the audit report submission when provided
as part of the engagement.

10. If the audit uncovers fraud, irregularities or illegal acts, knowledge of these acts must be
communicated immediately to the Audit Director, DHS Office of Auditing, PO Box 700,
Trenton, NJ 08625-0700 or (609) 292-9752.
-4-
 P7.06

B. Department of Human Services

1. The Cognizant Departmental Component must:

a. Monitor each Provider Agency to determine compliance with this policy;

b. Follow-up on audit findings to ensure that the Provider Agency takes appropriate and
timely corrective action. As part of audit follow-up, the Cognizant Departmental
Component must:

1) Issue a management decision as prescribed in Section 200.521, Management

Decision of the Uniform Guidance Subpart F;
2) Monitor the Provider Agency taking appropriate and timely corrective action.

c. Perform the duties of a pass-through entity for federal pass-through funds under the
Uniform Guidance Subpart F, (Section 200.331) and State Policy;

d. Work with the Department’s Office of Auditing to provide annual updates to the State
Grant Compliance Supplement and ensure that the compliance supplement focuses
the Auditor to test the compliance requirements most likely to cause improper
payments, fraud, waste, abuse or generate audit findings.

2. The Department’s Office of Auditing must:

a. Provide technical audit advice and assistance to Provider Agencies and their
Auditors;

b. Obtain or conduct quality control reviews from agency Auditors and provide the
results to other interested organizations including the New Jersey Office of
Management and Budget;

c. Perform desk reviews of audits conducted in accordance with this policy and advise
the Auditor, Cognizant Departmental Component and where appropriate, the
Provider Agency of any deficiencies found in the audits when the deficiencies require
corrective action by the Auditor;

d. Coordinate, to the extent practical, audits performed by or for other federal/State

agencies that may be required in addition to this policy so that those additional audits
build upon rather than duplicate audits performed in accordance with this policy;

e. Complete periodic reviews and update the Department’s section of the State Grant
Compliance Supplement; and

f. Request corrective action plans from recipients where applicable and ensure that
audit exceptions are resolved.

-5-
 P7.06

V. PROCEDURAL HISTORY
Policy Circular P7.06 as first promulgated April 1, 1991, and superseded on June 1, 2001.

Issued By:

___________________________________
Mark E. Talbot, CPA
Director, Office of Auditing

___________________________________
Bonny E. Fraser, Esq.
Assistant Commissioner for Legal Affairs
Office of Legal Affairs
Department of Human Services

-6-
 P7.06
Attachment A

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: The Provider Agency’s Licensed Public Accountant

SUBJECT: DEPARTMENT OF HUMAN SERVICES’ REQUIREMENTS FOR COMPLETION OF

PROVIDER AGENCY AUDIT

The purpose of this memo is to communicate the Department of Human

Services’ (the Department) audit requirement for conducting Single
Audits and Yellow Book audits of organizations or agencies which
contract with the Department to provide social or training services to
the Department's clients.

A. All Provider Agencies which expend either $300,000 or more in

federal Awards or $300,000 or more in State Awards, within their
fiscal year, in which the Department is the largest funding
source (Cognizant), must have an annual single audit performed in
accordance with federal OMB Circular A-133 and Department policy.
The reporting requirements are outlined in Attachment A, Sections
F and G. These Provider Agencies must also complete a
Notification of Licensed Public Accountant (NLPA) form
(Attachment B).

B. All Provider Agencies which expend $100,000 or more in combined

federal and State Awards but less than either $300,000 in federal
Awards or $300,000 in State Awards, within their fiscal year, in
which the Department is Cognizant, must have an annual
organization-wide financial statement audit performed in
accordance with generally accepted auditing standards and
Government Auditing Standards (Yellow Book audit).

This audit report shall be in accordance with Attachment A,

Section F, which includes a supplemental Schedule of Expenditures
of Federal Awards and/or a supplemental Schedule of Expenditures
of State Awards. A combined supplemental Schedule of
Expenditures of Federal and State Awards is acceptable. The
Independent Auditor’s Report shall contain an opinion on each
Schedule of Expenditures of Federal and State Awards that is
presented in the audit report.

These Provider Agencies shall also complete Attachment B (NLPA

form).
 2 P7.06
Attachment A
C. Provider Agencies that either expend less than $100,000 in
combined federal and State Awards or have another New Jersey
State department as the Cognizant department should not complete
the NLPA form. Organization-wide audits are not required by the
Department under these circumstances. If another Cognizant
department requires an organization-wide audit of a Provider
Agency, that audit report shall be forwarded to the Department of
Human Services when requested.

D. Provider Agencies that receive any amount of funding from the

Department, including those that expend less than $100,000 in
combined federal and State Awards, within their fiscal year, are
subject to audit by the Department or its representatives at
their discretion. It does not matter whether the Department is
Cognizant. Records must be made available on request, which
adequately identify the source and application of funds awarded.
As in all audits, accounting records must be supported by source
documentation.

E. The audit of a Provider Agency must be conducted:

1. by individual(s) with the following credentials -

a. a licensed certified public accountant or person

working for a licensed certified public accounting
firm; or

b. a public accountant licensed on or before December 31,

1970, or persons working for a public accounting firm
licensed on or before December 31, 1970, sufficiently
independent as defined by GAO standards, to produce
unbiased opinions, conclusions, or judgments;

2. annually on the Provider Agency’s fiscal year;

3. on an organization-wide basis to ascertain that the

financial statements fairly present the financial position
and results of operations, or changes in net assets, and
where appropriate, cash flows;

4. and completed within 120 days of the Provider Agency’s

fiscal year end; and

5. in accordance with (as currently amended) -

a. Generally accepted auditing standards established by

the American Institute of Certified Public Accountants
(AICPA).
 3 P7.06
Attachment A
b. Government Auditing Standards established by the
Comptroller General of the United States and issued by
the U.S. General Accounting Office.

c. The AICPA audit and accounting guides Audits of States,

Local Governments and Nonprofit Organizations and, as
applicable, AICPA industry audit guides and Statements
of Position.

d. Federal Single Audit Act of 1984 (P.L. 98-502) and the

Single Audit Act Amendments of 1996 (P.L. 104-156) if
expenditures of federal or State Awards are $300,000 or
more.

e. Federal OMB Circular A-133, “Audits of States, Local

Governments, and Nonprofit Organizations” if
expenditures of federal or State Awards are $300,000 or
more.

f. Federal OMB Circular A-133 Compliance Supplement.

g. Applicable Federal OMB Circulars A-87 “Cost Principles

for State and Local Governments” or A-122 “Costs
Principles for Nonprofit Organizations.”

h. New Jersey Department of the Treasury, OMB Circular 98-

07 “Single Audit Policy for Recipients of Federal
Grants, State Grants and State Aid Payments.”

i. New Jersey Department of the Treasury, OMB “State Grant

Compliance Supplement.”

j. New Jersey Department of Human Services’ Contract

Policy and Information Manual and Contract
Reimbursement Manual.

F. The Yellow Book audit report must include the following -

1. an opinion or disclaimer of opinion on the financial

statements taken as a whole.

2. presentation of financial statements in accordance with the

following applicable AICPA audit and accounting guides –
Audits of States, Local Governments and Nonprofit
Organizations, and as applicable, industry audit guides, and
Statements of Position.

3. a supplementary schedule and opinion thereon of the Provider

Agency’s expenditures of State and federal Awards, showing
expenditures by program (see the AICPA’s audit guides,
 4 P7.06
Attachment A
Audits of States and Local Governments, and Audits of Not-
for-Profit Organizations.

4. a Report on Compliance and on Internal Control Over

Financial Reporting Based on an Audit of Financial
Statements Performed in Accordance with Government Auditing
Standards.

5. disclosure in the notes to the financial statements if

penalty and interest are incurred for late payment or filing
of payroll taxes during the year of audit.

6. presentation of each reportable condition and material

compliance finding to include the condition, criteria,
cause, effect, recommendation and management's response
regarding corrective action.

7. a copy of the management advisory letter when provided as a

routine part of the audit engagement.

8. a report on irregularities or illegal acts, or indications

of such acts when discovered (a separate written report is
required).

G. The Single Audit report must include the following:

1. all the components of Attachment A, Paragraphs F.1 through

F.8 as noted above;

2. a Report on Compliance With Requirements Applicable to Each

Major Program and on Internal Control Over Compliance in
Accordance With OMB Circular A-133;

3. a Summary Schedule of Prior Audit Findings in accordance

with Section 315(b) of federal OMB Circular A-133;

4. a Schedule of Findings and Questioned Costs in accordance

with Section 505(d) of federal OMB Circular A-133; and

5. a data collection form if federal expenditures are $300,000

or more. Both the data collection form (A-133, Section
320(b)) and the reporting package (A-133, Section 320(c))
must be forwarded to the federal clearinghouse within 9
months of the audit fiscal year end.

H. Additional Requirements

1. If the audit uncovers or suggests any irregularities or

illegal acts, knowledge of these acts must be communicated
immediately by the independent public accountant to the
 5 P7.06
Attachment A
Audit Director, DHS Office of Auditing, PO Box 700, Trenton,
New Jersey 08625-0700.

2. The audit workpapers and reports must be retained by the

independent public accountant for a minimum of seven years
from the date of the audit report unless the accountant is
notified in writing by the Department for the need to extend
the retention period. The audit workpapers and reports
shall be made available upon request to the Department or
its designee(s).

3. The independent accountant is subject to an external quality

control review in accordance with Government Auditing
Standards at least once every three years.

4. Individuals who audit federal and State funds and are

responsible for planning or directing an audit, or
conducting substantial portions of the fieldwork or
reporting on the audit, are required to obtain 80 Continuing
Professional Education credits every two years, including 24
in government related subjects.

Issued by:

_____________________________
William M. Cutti, Director
Office of Auditing
Department of Human Services
 P7.06
Attachment B
NJ DEPARTMENT OF HUMAN SERVICES
NOTIFICATION OF LICENSED PUBLIC ACCOUNTANT*
(Supersedes prior P7.06 Attachment B dated 1/00)

Provider Agency Name:

Address:
Contact Individual and Title:
Agency Fiscal Year
Telephone No.: ___________________ To be Audited:
Federal ID No.: Charities Registration No.:
List All State and Federal Financial Assistance During the Fiscal Year Under Audit
Department Division Contract No. Contract Period Contract Amount
______________ ______________ ______________ ______________ ______________
__ __ __ __ __
______________ ______________ ______________ ______________ ______________
__ __ __ __ __
______________ ______________ ______________ ______________ ______________
__ __ __ __ __
Use back of form to list additional state and federal assistance.

Licensed Public Accountant (attach photocopy of firm’s license to practice)

Firm Name:
Address:
Telephone No. ___________________ Firm License No.:
E-Mail Address (optional): ___________
Currently Licensed to practice in the State(s) of: Expiration Date(s):
Anticipated Completion Date of Audit:
Contact Individual and Title:
Certification:
I certify that we are aware of the requirements in P7.06 and that the audit will comply with this
policy.

Signature _______________________ Title

Audit Report Deficiencies – Does your firm have any outstanding audit reports with deficiencies
with any provider agency contracting with the Department of Human Services? Yes
________ No
 2 P7.06
Attachment B

I certify that the above information is accurate. Any inaccurate information may result in
termination of your contract with the provider listed above.

Signature: _______________________ Title: ______________________________________

*This notification (NLPA) is to be sent to the Department of Human Services’ Office of Auditing
with the completed audit report. Although the NLPA form and the audit report shall be
submitted together, all of the information in the NLPA form should relate to the subsequent
year of the completed audit report. The anticipated audit completion date should not be more
than 120 days after the end of the fiscal year. The Provider Agency and the licensed public
accountant should fill out this form to this point in its entirety.
___________________________________________________________________________
___________________________________________________________________________

For Use By DHS Office of Auditing

Date Received: ___________________ Audit Control No.:

Date Verified: ______ By __________ Licensed:
Division: Approved: Not approved:
Revised 6/01
 P7.06
Attachment C

‘Pass-Through Entity Responsibilities

A Pass-Through Entity shall perform the following for the federal/State Awards it makes:

(1) Identify federal/State Awards made by informing each subcontractor of CFDA title and
number, Award name and number, Award year, if the Award is Research & Development,
and name of federal/State agency. When some of this information is not available, the Pass-
Through Entity shall provide the best information available to describe the federal/State
Award.

(2) Advise subcontractors of requirements imposed on them by federal laws, regulations, and the
provisions of contracts or grant agreements as well as any supplemental requirements
imposed by the Pass-Through Entity.

(3) Monitor the activities of subcontractors as necessary to ensure that federal/State Awards are
used for authorized purposes in compliance with laws, regulations, and the provisions of
contracts or grant agreements and that performance goals are achieved.

(4) Ensure that subcontractors expending $300,000 or more in either federal/State Awards during
the subcontractor’s fiscal year have met the audit requirements of this part for that fiscal year.

(5) Issue a Management Decision on audit findings within six months after receipt of the
subcontractor’s audit report and ensure that the subcontractor takes appropriate and timely
corrective action.

(6) Consider whether subcontractor audits necessitate adjustment of the Pass-Through Entity’s
own records.

(7) Require each subcontractor to permit the Pass-Through Entity and auditors to have access to
the records and financial statements as necessary for the Pass-Through Entity to comply with
this part.
 Policy Circular DMHS P7.07
DMHS Providers Only

State of New Jersey

Department of Human Services
Division of Mental Health Services

SUBJECT: Operational Incentives Pilot

EFFECTIVE: This policy circular shall become effective retroactively for Division
of Mental Health Services (DMHS) contracts to July 1, 2005 and
shall be implemented as new contracts commence or existing
contracts are renewed thereafter.

PROMULGATED: January 24, 2006

SUPERCEDES: This policy circular supercedes the DMHS Revenue Incentive

policy memoranda dated 2/11/91, 8/16/93, 10/24/95, 5/22/96, and
6/26/96.

PURPOSE:

The purpose of this policy circular is to establish guidelines for the DMHS pilot program
of Operational Incentives. Often, DMHS non-profit contracted providers do not have
sufficient reserves or fund balances to pay for infrastructure upgrades and replacements, or
cover short-term liabilities with operating funds or reserves, and therefore must rely on the
availability of one-time awards from DMHS, or their own ability to raise funds or borrow
funds. A policy for Operational Incentives, made available with certain limitations, would
enable providers to build a fund balance, from which emergency expenditures can be
made; equipment can be replaced; properties can be repaired; savings can be accrued; and
the provider’s financial viability improved. Contracted DMHS providers can receive
incentives that result from efficient and effective management and that promote improved
services to DMHS clients.

I. SCOPE

This policy applies to all Division of Mental Health Services (DMHS) non-profit, non-
hospital and non-governmental agencies with cost-reimbursement contracts that have
Annex B and B-1 budgets. Fixed price and fixed rate contracts are not affected by this
policy. Also contracts with hospital-based organizations, and governmental organizations,
are not affected by this policy. This is a pilot program for the Division of Mental Health
Services only.
II. DEFINITIONS

The following definition only pertains to this policy circular:

Operational Incentives: the net dollar savings realized from contracting efficiencies, after
performing the required level of service and satisfying the fiscal obligations. The
Operational Incentives amount is to be used as a saving reserve for cash flow needs
(working capital) and for expenditures consistent with the mission of the contracted
provider agency.

III. POLICY

A. EARNED INCENTIVE:

A DMHS Operational Incentives fund shall be earned by the contract

provider when approved by DMHS as part of the contract settlement
process, in recognition of the following:

• The provider’s final contract expenditure report indicates a net contract

surplus exists, defined as contract expenses less revenues;

Note: Final expenditure reports are always subject to DHS contract audit and/or
DMHS contract closeout reviews.

• The amount of the net contract surplus is equal to or less than the
maximum amounts allowed per this policy (refer to section B below);
• Contract surplus funds that are otherwise restricted by DHS, such as
federal funds which must be returned or reissued for program services,
cannot be included in the Operational Incentive Reserve;
• The DMHS contract provider has settled all outstanding debts, if any,
owed to DMHS;
• The contract provider has not been placed in “contract default” status by
any DHS Departmental Component in the past three years; and
• All major contract performance commitments for the recently concluded
contract have been satisfactorily addressed, as evaluated by DMHS.

B. ANNUAL CAP

Providers will be allowed to retain 100% of the current contract’s net

savings (accruals) identified from contract efficiencies (identified as
contract expenses less revenues) and approved by DMHS during the DMHS
contract settlement process for the Operational Incentive reserve. The
maximum amount of funds approved as an Operational Incentives reserve
for any single contract period is limited to three and a third percent (3.33%)
of the total contracted operating budget, up to the maximum of $400,000
per contract year up to three years and shall not exceed $1,200,000 in total.

2
 C. SEPARATE AUDITED ACCOUNT

The accumulated incentive funds shall be retained in a restricted reserve

account, known as “DMHS Operational Incentives Reserve”, and listed
clearly and separately on the Provider’s audited financial statements.

D. UTILIZATION

The DMHS Operations Incentive Reserve is intended to be a savings

reserve, available to meet cash-flow needs as working capital, and for
assisting the provider agency in meeting its mission. The Operational
Incentives Reserve as permitted by this policy is a time limited opportunity,
and prudent management would require that some amount of Operations
Incentives Reserve funds be retained for future needs.

Provider agencies are prohibited from utilizing Operations Incentive

Reserve funds to expand programming which requires ongoing funding,
thereby creating obligations for future budget cycles. Provider agencies are
also prohibited from utilizing Operations Incentive funds for Executive
Management staff bonuses. However, direct care and
administrative/support services staff may be granted a bonus.

Provider agencies that reach the maximum Operational Incentives Reserve

of $1.2 million may spend these funds in the current contract period, and
also add to the Reserve at the end of the contract period, but cannot exceed
the maximum amount of the Reserve at the end of the contract period.

E. DHS RECOUPMENT

Upon termination of the contractual relationship with the DMHS

Departmental Component, or upon dissolution of the original provider’s
corporation or related corporation, the contract provider shall refund to the
DMHS all remaining dollars in the DMHS Operational Incentives Reserve
account as of the date of contract termination corporation dissolution.

Issued By:

Jacob Eapen, Assistant Commissioner Kevin Martone, Assistant Commissioner

Budget, Finance, Administration, Division of Mental Health Services
Real Estate, & Information Technology Department of Human Services
Department of Human Services

3
 Policy Circular P8.01

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Access to Records and Facilities; Retention of Contract

Records; Confidentiality

EFFECTIVE: This policy circular shall become effective July 1, 1988,

and shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular P8.01, promulgated March 24, 1986.

The purpose of this circular is to advise Department personnel and

Provider Agencies of requirements for access to Provider Agency
records and facilities, retention of Contract records, and
confidentiality of client records.

I. SCOPE

This policy circular applies to all Contracts, as well as to all

approved assignments and subcontracts.

II. POLICY

A. Public Access

The policy delineated below reflects many of the provisions

of N.J.S.A. 47:1A-1 et seq., popularly called the "Right to
Know Law", as well as Department of Human Services
Administrative Order 2:01, "Confidential Nature of Records
and the Right to Know".

1. Certain Contract documents are considered public records

and therefore open to public inspection. For example:

- Standard language documents ("boilerplates");

- Appendices, and supporting materials;
- Programmatic and financial reports;
- Monitoring and evaluation reports;
- Audit reports.

2. Every citizen shall have the right to inspect the above-

designated public records during regular business hours
after prior arrangements are made with the State or
Provider Agency. Citizens shall also have the right,
under the supervision of an appropriate State or
Provider Agency official, to copy such records by hand
 2 P8.01

and also to have such records machine copied by the

State or Provider Agency upon payment of a reasonable
fee. Original records may not be removed from the State
or Provider Agency premises.

3. Client records of any kind, including, but not limited

to, case records, social histories, and eligibility,
medical, and psychological records, are not considered
to be public records and are not open to public
inspection. Any client name and other direct or
indirect identifying client information must be deleted
before Contract records are made public. (Refer to D.2
below regarding confidentiality.)

B. Government Access to Provider Agency Records and Facilities

1. The Provider Agency's services, books, records, and

facilities must be available to the Department or an
agent of the State or federal government for the
purposes of visitation, inspection, evaluation, or
audit. Such visitations, inspections, evaluations, and
audits, may be at any time and may be announced or
unannounced.

2. The Provider Agency must, during regular business hours,

make available to all such governmental agencies, or
any persons or organizations engaged thereby, its
financial, statistical, and program information, client
records, and other data relating to the Contract, in
order to permit audit examination, inspection, excerpts
and transcripts.

If the Provider Agency is located outside the State of

New Jersey, the Provider Agency shall make the records
available in New Jersey upon receiving a written
request for such records from the Department or its
representative.

3. The right of access to Provider Agency records is not

limited to the required four-year retention period
(refer to C below) but lasts as long as the records are
retained.

C. Retention of Records

1. The Provider Agency and its subcontractors must keep

adequate books and records, supporting documents,
statistical records, client records, and all other
records pertinent to the Contract, and with the
following qualifications, shall retain all such books
and records for four years after submission of the
final report.
 3 P8.01

a. If any litigation, claim, negotiation, audit or

other action involving the records has not been
resolved, the records must be retained until after
such resolution.

b. Records for Equipment acquired with federal/State

funds must be retained for three years after final
disposition, replacement, or transfer of the
Equipment.

c. If Contract records are transferred to or

maintained by the Department, the Provider Agency
has no further obligation with respect to those
records. If records are transferred to the
Department, the Department shall verify in writing
to the Provider Agency a listing of the records
which were received.

d. Public Provider Agencies are required to abide by

the Destruction of Public Records Law (N.J.S.A.
47:3-15 et seq.), and the General Records
Retention Schedule for County and Municipal
Agencies which is developed in accordance with the
law. A copy of the law and the schedule may be
obtained through the Department of State, Division
of Archives and Records Management.

2. Copies made by microfilming may be substituted for the

original records.

D. Confidentiality

1. All visitations, inspections, evaluations, and audits

shall be conducted in accordance with generally accepted
standards of privilege and confidentiality.

2. The Provider Agency must treat all personal records of

applicants for and recipients of Contract services in
accordance with all applicable federal and State
legislation and regulations, including Executive
Orders, governing access to and confidentiality of
records. With exceptions specified below, the Provider
Agency may not release or disclose records except to
authorized personnel of the Provider Agency, the
Department, or another appropriate unit, agency, or
agent of State or federal government which is approved
by the Department for receipt of the information.
Exceptions are as follows (see N.J.S.A. 30:4-24.3):

a. when release or disclosure is court-ordered;

b. when the applicant or recipient (or, if

appropriate, his or her parent or guardian) gives
 4 P8.01
prior written approval as to the information to be
released or disclosed and the person(s) and/or
agency(ies) to receive the information; and

c. when the Provider Agency is located outside the

State of New Jersey, release or disclosure may be
to authorized personnel of such other state's
local or state government.

Any release or disclosure of information shall

explicitly prohibit any unauthorized rerelease or
redisclosure of the information.

Issued by:
 Policy Circular P8.05

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Conflict of Interest

EFFECTIVE: This policy circular shall become effective on July 1,

1988, and shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES Policy Circular P8.05, promulgated June 1, 1983.

The purpose of this circular is to establish minimum standards for use

by Provider Agencies in the development and implementation of a
Conflict of Interest policy.

I. SCOPE

This policy circular applies to all Contracts.

II. DEFINITIONS

In addition to defined terms included in the Glossary of the

Manual, the following terms, when capitalized, shall have
meanings as stated:

Conflict of Interest (also Conflict) means a conflict, or the

appearance of a conflict, between the private interests and the
official responsibilities of a person in a position of trust.
Persons in a position of trust include Provider Agency Staff
Members, officers or Governing Board members.

Governing Board (also Board) means the Provider Agency board,

commission, council or other organizational body which signs the
Contract, enacts Provider Agency policy regarding Contract
services, and is responsible to the Department for Contract
compliance.

Staff Member means a person who receives all or part of his/her

income from the Provider Agency's payroll.

III. POLICY

Each Provider Agency must have written policies and procedures on

Conflict of Interest.

A. The purpose of such policies and procedures is to prevent

the personal interest of Staff Members, officers or
Governing Board members from:
 P8.05
2

1. interfering with the performance of their

responsibilities to the Provider Agency and its
clients; or

2. resulting in personal financial, professional and/or

political gain on the part of such persons at the
expense of the Provider Agency's and/or clients'
interest.

B. The policy must, at minimum, include provisions for

disclosure of situations when:

1. a member of the Governing Board is related to another member

of the Governing Board;

2. a member of the Governing Board is related to a Staff

Member;

3. a member of the Governing Board is also a Staff Member;

4. a Staff Member in a supervisory capacity is related to

another Staff Member he/she supervises;

5. a member of the Governing Board or a Staff Member receives

payment from the Provider Agency for any sub-contracts,
goods or services, such as consultant, laundry, maintenance,
construction or remodeling; and

6. a member of the Governing Board or a Staff Member is a

member of the governing body of a contributor to the
Provider Agency.

C. The policy must specify what procedures must be followed in

the event situations specified in B above occur. Possible
procedures include:

1 procedures for determining if a Conflict exists;

2. mandated or voluntary non-participation of Staff

Members, officers, or Governing Board members in a
situation in which there is a Conflict of Interest;

3. sanctions conforming to relevant State and federal

Conflict of Interest laws, rules and regulations; and

4. appeal and administrative review of imposed sanctions.

D. In addition, the policy must contain specific provisions

which ensure that any Provider Agency Staff Member, officer,
or Governing Board member does not participate in the
selection, award or administration of a procurement
transaction in which federal or State funds are used, where,
 P8.05
3

to his/her knowledge, any of the following has a financial

interest in that transaction:

1. the Staff Member, officer or Governing Board member;

2. any member of his/her immediate family;

3. his/her partner;

4. an organization in which any of the above is an

officer, director or employee; and

5. a person or organization with whom any of the above is

negotiating or has any arrangement concerning
prospective employment.

III. PROCEDURES

A. The Provider Agency must develop a written Conflict of

Interest policy in accordance with the minimum guidelines
specified in this circular.

B. The policy must be adopted by the Provider Agency's

Governing Board, in accordance with procedures in the
Board's by-laws.

C. A copy of the adopted policy, with a date for compliance,

must be furnished to Governing Board members, officers and
Staff Members, and must be posted in a conspicuous place of
the Provider Agency's facilities.

D. A copy of the policy must be forwarded to the Department for

review and filing with the Provider Agency's Contract
documents. Any revisions to the policy, as they are made
and adopted, must be forwarded to the Department.

Issued by:
 Policy Circular P8.10

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Nondiscrimination/Americans with Disabilities Act

EFFECTIVE: This policy circular shall become effective

immediately.

PROMULGATED: November 1, 1994

SUPERSEDES: Policy Circular P8.10, promulgated June 1, 1983

The purpose of this circular is to notify Provider Agencies of

prohibitions against discrimination and the need for reasonable
accommodation for those persons with disabilities employed by or using
the services of the Provider Agency.

I. SCOPE

This policy circular applies to all Contracts.

II. POLICY

Provider Agencies shall not discriminate against any applicant

for employment or services, nor against any employee or recipient
of service because of race, color, creed, religion, ethnic
background, national origin, marital status, disability, age or
sex.

A. Nondiscrimination

1. The Provider Agency must comply with all applicable

federal, State and local laws, rules and regulations,
including but not limited to the following: the federal
Civil Rights Act of 1964 (as amended); P.L. 1975,
Chapter 127, of the State of New Jersey (N.J.S.A. 10:5-
31 et seq.) and associated executive orders pertaining
to affirmative action and nondiscrimination on public
contracts; and the federal Equal Employment Opportunity
Act.

2. Provider Agencies must adopt procedures to ensure the

resolution of any complaint of discrimination. Such
procedures must incorporate appropriate due process
standards and provide for a prompt and equitable
resolution of the complaint.

3. Provider Agencies must publicly display a statement

notifying applicants for employment or services that
they do not discriminate and must include such a
 2 P8.10

statement in all publications and related materials

referring to Contract services. To this end, Provider
Agencies must use either:

a. a statement which at minimum includes assurance of

nondiscrimination as noted in Section A above; or

b. the following model statement:

"This agency does not discriminate against any

applicant for employment or services, nor against
any employee or recipient of service because of
race, color, creed, religion, ethnic background,
national origin, marital status, handicap, age or
sex (subject to conditions and limitations
applicable alike to all persons). Any complaint
of discrimination regarding employment or the
provision of services shall be referred to
(Indicate the appropriate Provider Agency person,
with title, address and telephone number.)"

B. Persons with Disabilities

1. The Provider Agency must comply with all applicable

federal, State and local laws, rules and regulations,
including but not limited to the following: Section 504
of the federal Rehabilitation Act of 1973 pertaining to
non-discrimination on the basis of disability and
regulations thereunder; and the Americans With
Disabilities Act (A), 42 U.S.C. 12101 et seq..

2. The Provider Agency must make reasonable accommodation

and program access for all individuals with
disabilities. This may include steps such as, but not
exclusive to: job restructuring, modification of
equipment, auxiliary aids and services to individuals
with vision or hearing impairments, removal of physical
barriers or providing the services by an alternate
means or location.

3. If there are any questions regarding ADA, please

contact the ADA Coordinator in the Departmental
Component with which you Contract.

Issued by:
 Policy Circular P8.13

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Copyrights

EFFECTIVE: This policy circular shall become effective on October

31 2007, and shall be implemented immediately.

PROMULGATION: October 31, 2007

SUPERCEDES: P8.13, Copyrights promulgated on March 1, 2002 and

became effective on the same date.

The purpose of this policy circular is to inform Department staff and

Provider Agencies of the Department's policy regarding copyrights.

I. SCOPE

This policy circular applies to all Contracts.

II. DEFINITION

In addition to the defined terms included in the Glossary of the

Manual, the term listed below, when capitalized, shall have
meaning as stated.

Copyrighted Material means an exclusive, legal right to adapt,

distribute, reproduce, publish or sell any information funded and
developed under a Department Contract or subcontract.

III. POLICY

A. The State of New Jersey, Department of Human Services

reserves a royalty-free, nonexclusive and irrevocable right
to reproduce, publish or otherwise use any work or materials
developed with State or federal funding under a Department
funded Contract or subcontract. The State of New Jersey,
Department of Human Services also reserves the sole right to
authorize others to reproduce, publish or otherwise use any
work or materials developed under said contract or
subcontract.

B. The contracting Departmental Component shall ensure that it

receives a copy of any Copyrighted Material.

C. When a Provider Agency decides to publish any Copyrighted

Material, the following steps shall be taken by the
Departmental Component:
 P8.13

1. Ensure that there is proper acknowledgment of the

source of funds used to develop the copyrighted work.
The following statement is sufficient:

This material is based upon work supported by the

Department of Human Services, State of New Jersey
under Contract # _________.

2. Ensure that the following disclaimer appears with the

publication:

Any opinions and conclusions or recommendations

expressed in this publication are those of the
author(s) and do not necessarily reflect the
official opinion of the State of New Jersey or
Department of Human Services.

3. Ensure that the Provider Agency includes in the

publication contract/agreement a reference that
stipulates the inclusion of a statement that protects
the rights of the State of New Jersey, Department of
Human Services with regards to Copyrighted Materials,
as well as the addition of contract/agreement language
that guarantees the inclusion of acknowledgment and
disclaimer statements for any State supported,
published material(s).

4. Determine whether it is in the best interest of the

Departmental Component to have the provider agency
obtain prior approval of any proposed commercial
publication, including approval of the process by which
a publisher is selected. If prior approval is
required, it must be included in the Contract Annex A.

D. Provider Agencies must have Department approval to keep

Program Income earned from license fees and royalties for
Copyrighted Material.

Issued by:

2
 Policy Circular P8.14

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Minimum Standards for Insurance

EFFECTIVE: This policy circular shall become effective on

August 1, 2009 and shall be implemented as new
Contracts commence or existing Contracts are
renewed.

PROMULGATED: July 20, 2009

SUPERSEDES: Policy Circular P8.14, promulgated July 15, 2001.

The purpose of this circular is to establish the minimum

standards for insurance coverage.

I. SCOPE

This policy circular applies to Provider Agencies that

are covered by the Department of Human Services’
Standard Language Document for Social Services and
Training Contracts and to Tuition Agreements. It does
not apply to Individual Provider Agreements (Contracts
with sole practitioners who are not incorporated),
Agreements with Another State Agency, or to two party
consultant agreements.

II. DEFINITIONS

In addition to defined terms included in the Glossary of the

Manual, the following terms, when capitalized, shall have
meanings as stated:

Additional Insured means an endorsement to an insurance

policy extending the coverage to the State of New Jersey,
Department of Human Services and its Departmental Component
against loss in accordance with the terms of the policy.
Designating the State of New Jersey, Department of Human
Services and its Departmental Component as an additional
insured permits the Department to pay the premium should the
insured fail to do so.

Broad Form means liability coverage that provides insurance

for multiple types of perils. A Broad Form policy provides
all risks coverage in one policy except for listed
exclusions.
 2 P8.14

Commercial Automobile Liability Insurance means coverage

that provides limits above the standard limits in the base
policy, and/or covers areas of liability not covered in a
standard policy.

Employee Fidelity Bond (commercial blanket bond) means

coverage issued for a stated amount on all regular employees
of the Provider insuring against loss from employees’
dishonest acts.

Employers’ Liability Insurance means coverage against the

common law liability of an employer for injuries by accident
or disease to employees, as distinguished from the liability
imposed by Workers’ Compensation Law.

General Liability Insurance means liability coverage for all

premises and operations for all general liability hazards,
unless excluded.

Insurance Declaration page means a document that lists most

of the vital information about the Insurance policy. The
declaration page states the name and address of the name
insured or insured party; the location of the property
insured along with its location and description; the value
and replacement value of property insured; the inception and
expiration date of the policy period, the premium and any
other conditions, terms, exclusions and endorsements.

Limits means the dollar amount of insurance carried for the

types of insurance listed.

Products/Completed Operations means a form of liability

insurance which covers accidents arising out of operations
which have been completed or abandoned, provided the
accident occurs away from the premises owned, rented, or
controlled by the insured.

Professional Liability/Malpractice means coverage for the

Provider and health care providers in its employ, acting
under their scope of duties, while providing medical and
social services care to the clients.

Property Insurance means a Broad Form of insurance coverage

for damage or loss to real and personal property.

Umbrella Policy means a policy that provides limits above

the standard limits in the base policy, and/or covers areas
of liability not covered in a standard policy.

Workers’ Compensation Insurance means benefits payable to an

employee, without regard to liability, required by State law
 3 P8.14

in case of illness, injury, disability, or death as a result

of occupational hazards.

III. POLICY

A. To conform to Section 5.05 of the Standard Language

Document, the Provider Agency shall secure liability
insurance in accordance with the minimum standards for
insurance coverage outlined in paragraph B. below and
maintain it in force for the term of the Contract. The
Provider shall maintain adequate insurance coverage. Such
Insurance policies must contain the provision that the
insurance provided in the Declaration page shall not be
canceled or non-renewed for any reason except after thirty
Days written Notice to the Department. The Provider agency
is responsible for forwarding a copy of its insurance policy
declaration page to the Contracting Departmental Component
for its contract files upon purchase or renewal. Public
entities, such as counties, municipalities or public school
districts, that are self insured must provide acknowledgment
that they are self-insured to the extent necessary to cover
liabilities imposed by law and assumed under the Contract.

B. The following are the minimum standards for insurance:

1. General Liability Insurance written on a commercial

liability occurrence form against any liability of the
Provider. Said insurance shall not be circumscribed by
an endorsement limiting the breadth of coverage. The
State of New Jersey, Department of Human Services and
the contracting Departmental Component shall be named
as Additional Insured. The policy shall include the
following:

a. Broad Form Comprehensive General Liability

b. Products/Completed Operations
c. Premises/Operations

The minimum limits of liability shall be: bodily injury

liability and property damage liability - $1,000,000
each occurrence $3,000,000 aggregate (may be written as
a combined single limit). An Umbrella Policy may be
used to supplement the base policy to meet the minimum
standards for insurance. The State of New Jersey,
Department of Human Services and the contracting
departmental component shall be named as an Additional
Insured.

2. Commercial Automobile Liability Insurance written to

cover cars, vans or trucks used by the Provider.
 4 P8.14

Limits of liability for bodily injury and property

damage should not be less than $2,000,000 each
occurrence. The State of New Jersey, Department of
Human Services and the contracting departmental
component shall be named as an Additional Insured.

3. Workers’ Compensation Insurance without regard to

liability, required by State law in case of illness,
injury, disability, or death as a result of a job
related accident.

4. Employer’s Liability Insurance is to be included with

limits of not less than:

$100,000 Bodily Injury, each occurrence

$100,000 Disease each employee
$500,000 Disease aggregate limit

5. Employee Fidelity Bond issued for a stated amount on

all regular employees of the Provider insuring against
loss from employees’ dishonest acts. The bond should
be for at least 15% of the full dollar amount of all
State of New Jersey contracts for the current year when
the combined dollar amount exceeds $50,000.

C. The Department will pay its share of the cost of insurance

that benefits all operations of the Provider Agency as
approved in Contract negotiations with Department staff.
Premiums may be charged directly to a Departmental Contract
when the insurance relates directly to the service(s)
performed in the Contract.
 Policy Circular P9.02

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Department and Provider Agency Monitoring of Level

of Service Delivery

EFFECTIVE: This policy circular shall become effective on

July 1, 1988 and shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular P9.02, promulgated November 5,

1986.

The purpose of this circular is to advise Department personnel

and Provider Agencies of policies and procedures for monitoring
contracted level of service delivery.

I. SCOPE

This policy circular applies to all Cost-Related and Non-

Cost-Related Contracts, with the exception of those
Contracts with no contractually agreed-upon upper payment
limit.

II. POLICIES AND PROCEDURES

A. Cost-Related Contracts

1. Establishment of Budgeted Units of Service

a. In a Cost-Related Contract, an accurate

projection of the Contract's Budgeted Units
of Service is essential because:

(1) it allows comparison of the cost of

similar services (through computation of
the Unit Cost);

(2) it represents the Provider Agency's

contractual commitment against which
actual performance will be measured; and

(3) in Contracts paid by means of a rate,

the rate is calculated based on the
Budgeted Units of Service.

Therefore, in negotiating the Contract,

consideration should be given to anticipated
 2 P9. 02

changes and any other factors which may impact on

the program's Budgeted Units of Service.

b. For renewal Contracts, in establishing the

Budgeted Units of Service, consideration
should be given to, among other factors,
historical data collected during the previous
Contract term.

c. For new Contracts, the Budgeted Units of

Service may be based on Department experience
with Contracts in the locality, which
provides comparable services under comparable
circumstances.

2. Department Monitoring Responsibilities

a. It is the responsibility of the Department to

monitor the Contract level of service
delivery on a regular basis through on-site
review and desk monitoring of appropriate
reports.

b. It is the responsibility of the Department to

conduct at least a quarterly analysis of
Contract performance, making a comparison of:

(1) actual versus Budgeted Units of

Service;

(2) actual versus projected

expenditures; and

(3) actual versus budgeted Unit Cost.

The purpose of this analysis is to ascertain

if services are being delivered in the
quantity and for the Unit Cost negotiated and
agreed to in the Contract.

c. If based on the quarterly analysis it is

determined that the actual performance level
differs from the Budgeted Units of Service -
whether higher or lower - the Department may
require a Contract Modification to revise the
Budgeted Units of Service and, as
appropriate, make corresponding adjustments
in the Contract Budget and/or Payment Rate.
For further information refer to Policy
Circular P1.10, Contract Modification.

d. If the Actual Units of Service are lower than

the Budgeted Units of Service, the Provider
 3 P9.02

Agency will be in default of the Contract,

and the Department may choose to pursue
default proceedings other than requiring a
Contract Modification. For further
information on default policies and
procedures, refer to Policy Circular P9.05,
Contract Default.

e. When Contract payment is based on a rate per

Unit of Service delivered, any change in the
Payment Rate, which results from a Contract
Modification, may be effective up to three
months prior to the execution of the
Modification. Failure to execute a Contract
Modification when Actual Units of Service
differ from Budgeted Units of Service may
result in:

(1) an overpayment by the Department if the

Actual Units of Service are higher than
the Budgeted Units of Service or;

(2) unreimbursed costs to the Provider

Agency if Actual Units of Service are
lower than Budgeted Units of Service
(since a Payment Rate may not be
adjusted upward based on a final report
of expenditures).

3. Provider Agency Monitoring Responsibilities

a. Provider Agencies should closely monitor

their level of service delivery during the
Contract term. It may take three months of
effective monitoring to obtain a meaningful
indication of the true performance in
relation to the Budgeted Units of Service.

b. At such time as it is determined that actual

performance differs from the Budgeted Units
of Service (whether higher or lower), the
Provider Agency should submit a request for a
Contract Modification to reflect more
appropriate Budgeted Units of Service. In
addition, corresponding revisions should be
requested in budgeted costs since a number of
expenditure items are dependent upon the
level of service delivery.

c. If Contract payment is based on a rate, any

change in the Payment Rate which results from
the Contract Modification may be effective up
to three months prior to the date of the
 4 P9. 02

Provider Agency's submission of the

Modification request.

B. Non-Cost-Related Contracts

The policies and procedures for monitoring the level of

service delivery in Non-Cost-Related Contracts are
essentially the same as those established above for
Cost-Related Contracts. However, since budgets and
expenditure reports are not submitted for Non-Cost-
Related Contracts, monitoring is based on a comparison
between the Actual Units of Service delivered and the
level agreed to in the Contract programmatic Annex. In
most cases, a Contract Modification should result when
a discrepancy exists between the two levels. (An
exception would occur when the actual level of service
is low and the Department chooses to pursue default
options other than Contract Modification.)

Provider Agencies with a Non-Cost-Related Contract

receive reimbursement based on a fixed payment rate
times the number of billable (eligible) Units of
Service. In only very rare circumstances will the rate
itself change as a result of a Contract Modification.
In most instances, a Contract Modification generated
for level of service reasons will result in a change in
the contracted level of service delivery and a
corresponding change in the Contract upper payment
limit.

Issued by:
 Policy Circular P9.05

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Contract Default

EFFECTIVE: This policy circular shall become effective on August

1, 1996, and shall be implemented for all Contracts.

PROMULGATED: June 14, 1996

SUPERSEDES: Policy Circular P9.05, promulgated July 1, 1988.

The purpose of this circular is to advise Department personnel and

Provider Agencies of the policies and procedures to be followed in
case of Provider Agency Contract Default.

I. SCOPE

This policy circular applies to all Contracts.

II. DEFINITIONS

In addition to defined terms included in the Glossary of the

Manual, the following terms, when capitalized, shall have
meanings as stated:

Action means Notice of an impending remedy, including Termination

of the Contract. The action may be implemented during the
current Contract or a subsequent Contract as appropriate.

Default means the Provider Agency has materially failed to

fulfill or comply with the terms and conditions of the Contract.

Notice means an official written communication between the

Department and the Provider Agency. All Notices shall be
delivered in person or by certified mail, return receipt
requested, and shall be directed to the person(s) and address(es)
specified for such purpose in the Annex(es) or to such other
persons as either party may designate in writing.

The Notice shall also be sent by regular mail and shall be

presumed to have been received by the addressee five days after
being properly sent to the last address known by the Department.

III. POLICY

A. The occurrence of, but not limited to, any of the following
by the Provider Agency shall be considered areas in which
the Provider Agency is in Default of the Contract:
 2 P9.05

1. failure to provide Contract services as described in

the Annex(es)to the Contract;

2. failure to provide the Contracted Budgeted Units of

Service or the level of service agreed to in the
Annex(es) to the Contract;

3. use of Contract funds for purposes other than those

approved by the Departmental Component and specified in
the Annex(es) to the Contract;

4. failure to submit timely reports, or submission of

reports/documents that are inaccurate or incomplete in
any material respect;

5. failure to comply with the terms and conditions of the

Standard Language Document or the policies and
procedures outlined in the Contract Policy and
Information and Contract Reimbursement Manuals;

6. conduct or acts, including but not limited to, adjudged

criminal activity on the part of the Provider Agency,
its officers, board members, or employees, which are
detrimental to the Department, Department clients or
the Provider Agency; and

7. sanctions or financial actions taken by third parties

against the Provider Agency that jeopardize the intent
or fulfillment of the Contract.

B. When the Provider Agency is in Default of the Contract, the

Departmental Component may take one or more of the following
Actions:

1. terminate the Contract in whole or in part;

2. temporarily withhold cash payments pending further

attempts for correction of the Default;

3. disallow all or part of the cost of the activity or

action not in compliance;

4. prohibit the Provider Agency from incurring additional

obligations;

5. discontinue any current or future contract

negotiations; and

6. take other remedies that may be legally available.

C. The Department shall allow all necessary and proper costs,

which the Provider Agency could not reasonably avoid during
Termination proceedings. Additional payments or costs are
 3 P9.05

not reimbursable unless written permission has been granted

by the Departmental Component.

D. Contract closeout procedures for Termination of the Contract

under this policy shall be the same as indicated in Policy
Circulars P7.01, Contract Closeout, and P7.06, Audit
Requirements.

E. Implementation of the procedures established in this policy

does not preclude the Department from implementing debarment
procedures as enumerated in Federal Executive Order 12549
and State Executive Order 34 (1976) or any other legal
rights available to the Department of Human Services.

F. The Provider Agency has the right to request an informal

review regarding any Action taken according to the specific
procedures established by the Departmental Component, which
shall be referenced in the Notice of Action.

G. If the Provider Agency fails to request an informal review

of the decision within 21 Days of receipt of the written
Notice of the decision to take Action or Terminate, the
Provider Agency shall forfeit all rights of review.

IV. PROCEDURES

A. The Departmental Component may provide technical assistance

to the Provider Agency to correct all non-compliant items
associated with the Default.

B. The Departmental Component shall establish time frames for

compliance. If corrective measures have not been taken
within the specified time frames, the Departmental Component
may take one or more of the Actions listed in III.B. of this
circular, including Termination.

C. The Departmental Component shall document all

communications, formal and informal, with the Provider
Agency regarding Default of the Contract, including the date
of each Notice to the Provider Agency and certification that
each was sent.

D. The Provider Agency shall be advised of the following in a

Notice of Action or Termination:

1. the reason for the Action(s);

2. the Provider Agency's right to request an informal

review, time frames and procedures;

3. the effective date of the impending Action or

Termination; and
 4 P9.05

4. that a request for an informal review of the decision

for Action does not preclude the determined Action from
being implemented.

E. If the Provider Agency requests an informal review of an

Action, the Departmental Component must respond to the
request for informal review in accordance with the specific
Departmental Component's informal review process.

Issued by:
 Policy Circular P-Misc.03

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Provider Agency Chief Executive Officer and Contract

Program Director

EFFECTIVE: This policy circular shall become effective on July 1,

1988, and shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular P-Misc.03, promulgated June 1, 1983.

The purpose of this circular is to clarify the term "Chief Executive

Officer" (CEO) and to specify the responsibilities of the CEO and the
Contract program director.

I. SCOPE

This policy circular applies to all Contracts.

II. POLICY

A. Chief Executive Officer

1. The Chief Executive Officer named in the Annex(es) is

responsible for all aspects of Contract services.

2. Because of the differences in the types of agencies

that contract with the Department, the following are
separate definitions for the CEO in:

a. Private for-profit and non-profit Provider

Agencies

In the case of private for-profit and non-profit

Provider Agencies, the CEO shall be either the
chairperson of the Agency's governing body or the
executive director of the Agency, as designated by
resolution of the governing body and consistent
with Agency by-laws.

b. Public Provider Agencies

In the case of public Provider Agencies, (e.g.,

municipalities and counties), the CEO shall be
either the chairperson of the Agency's governing
body (e.g., city council, board of supervisors,
board of chosen freeholders), or the Agency's
chief administrator (e.g., mayor, city manager,
 2 P-Misc .03

county administrator), as designated by resolution

of the governing body.

c. Educational Institutions

In the case of educational institutions, the CEO

shall be either the chairperson of the Agency's
governing body or the president of the
institution, as designated by resolution of the
governing body and consistent with the
institution's by-laws.

B. Program Director

The program director named in the Annex(es) must be directly

responsible for Contract services, and unless otherwise
specified in the Annex(es), must devote full time to the
Provider Agency to carry out that responsibility and to
supervise Provider Agency personnel in the administration
and/or delivery of Contract services.

C. If the position of CEO and/or program director should be or

become vacant during the term of the Contract, the
Department must be notified in writing. In addition, when
the vacancy is filled, the Department must be notified in
writing of the new CEO or program director.

Issued by:
 Policy Circular P-Misc.04

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Persons Delivering Contract Services

EFFECTIVE: This policy circular shall become effective on July 1,

1988, and shall be implemented immediately.

PROMULGATED: July 1, 1988

SUPERSEDES: Policy Circular P-Misc.04, promulgated November 5, 1986.

The purpose of this circular is to advise Department personnel and

Provider Agencies of policy concerning persons delivering Contract
services.

I. SCOPE

This policy circular applies to all Contracts.

II. POLICY

The Provider Agency is responsible for the delivery of all

Contract services, no matter how or by whom such services are
delivered.

A. Contract Personnel

Except for situations described in B and C below, all

Contract services are to be delivered by Contract personnel
who:

1. are employees of the Provider Agency;

2. meet the qualifications and carry out the duties and

responsibilities described in the Annex(es);

3. work the weekly time periods and receive the

compensation (or compensation within the range)
specified in the Annex B: Contract Budget; and

4. are covered by the Provider Agency's written personnel

policies which, except as may be limited by the terms of
the Annex B: Contract Budget, apply to all employees of
the Provider Agency.

B. Volunteers

1. The Provider Agency may use volunteers in the provision

of Contract services, provided that:
 2 P-Misc.04

a. the Annex(es) contain, at least, a detailed

description of the duties, responsibilities,
qualifications and standards of performance for
such volunteers;

b. volunteers are supervised by Contract personnel;

and

c. volunteers are not used to replace Contract

personnel except when authorized in writing by the
Department.

2. Subcontract Personnel

Contract services may be delivered by persons employed

under an approved assignment or subcontract.

Issued by:
 Policy Circular P-Misc.06

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Child Abuse or Neglect

EFFECTIVE: This policy circular shall become effective July 1,

1988, and shall be implemented immediately.

PROMULGATED July 1, 1988

SUPERSEDES: Policy Circular P-Misc.06, promulgated March 25, 1986.

The purpose of this policy circular is to advise Department and

Provider Agency personnel of Department policy and procedures to be
followed in the reporting of incidents of child abuse or neglect,
whether such report is based on a suspicion or a reasonable cause to
believe.

I. SCOPE

This policy circular applies to all Provider Agencies.

II. DEFINITION

For the purpose of this circular the following item shall have
meaning as stated:

Abused Child, as defined in N.J.S.A. 9:6-8.9, means a child under

the age of 18 years:

A. whose parent, guardian or other person having custody and

control inflicts or allows to be inflicted upon such child
physical injury by other than accidental means which causes
or creates a substantial risk of death, serious or protracted
disfigurement, protracted impairment of physical or emotional
health or protracted loss or impairment of the function of
any bodily organ;

B. whose parent, guardian or other person having custody and

control creates or allows to be created a substantial or
ongoing risk of physical injury to such child by other than
accidental means which would be likely to cause death,
serious or protracted disfigurement or protracted loss or
impairment of the function of any bodily organ;

C. whose parent, guardian or other person having custody and

control commits or allows to be committed an act of sexual
abuse against the child;

D. whose physical, mental or emotional condition has been

impaired or is in imminent danger of becoming impaired as the
 2 P-Misc.06

result of the failure of his/her parent, guardian or such

other person having custody and control, to exercise a
minimum degree of care: (1) in supplying the child with
adequate food, clothing, shelter, education, medical or
surgical care though financially able to do so or though
offered financial or other reasonable means to do so, or (2)
in providing the child with proper supervision or
guardianship, by unreasonably inflicting or allowing to be
inflicted harm, or substantial risk thereof, including the
infliction of excessive corporal punishment, or by any other
act of similarly serious nature requiring the aid of the
court; or

E. who has been willfully abandoned by his/her parent, guardian

or by such other person having custody and control.

III. POLICY

A. It is the responsibility of the Department of Human Services

to ensure that services to clients are provided in a safe and
secure environment. A major emphasis of the Department is to
put an obligation on any Department or Provider Agency
personnel who even suspect that a child may be abused or
neglected while under the care and/or supervision of the
Provider Agency, to report the incident immediately to the
Division of Youth and Family Services (DYFS). This immediate
response will help to ensure the safety of the child in
question as well as facilitate an investigation.

B. In accordance with N.J.S.A. 9:6-8.10, 8.14 and 2C:43-3 and 8,

any person having reasonable cause to believe that a child
may have been subjected to abuse or neglect is legally
obligated to report any and all information regarding the
incident or incidents to the Division of Youth and Family
Services. Failure to report is a disorderly persons offense.
A person convicted of a disorderly persons offense may be
fined up to $1,000 and may be sentenced to up to six months
in jail.

C. In accordance with N.J.S.A. 9:6-8.13, anyone acting pursuant

to this Act in making a report shall have immunity from any
liability, civil or criminal, that might otherwise be
incurred or imposed. Any such person shall have the same
immunity with respect to testimony given in any judicial
proceeding resulting from such report.

IV. PROCEDURES
 3 P-Misc.06

Reporting Requirements

A. Incidents of suspected child abuse or neglect involving

Provider Agency staff with children under their care and/or
supervision must be reported immediately to:

1. the DYFS Institutional Abuse Unit at 1-609-292-0617 (9

a.m. to 5 p.m. - Monday through Friday); or

2. the DYFS toll-free hotline number at 1-800-792-8610

(after 5 p.m. - Monday through Friday; 24 hours a day on
holidays and weekends).

B. Provider Agency staff having reasonable cause to believe that

a child has been abused or neglected in the child's own home
shall promptly report the incident(s) to:

1. the local DYFS District Office (9 a.m. to 5 p.m. -

Monday through Friday); or

2. the DYFS toll-free hotline number at 1-800-792-8610

(after 5 p.m. - Monday through Friday; 24 hours a day on
holidays and weekends).

C. When making a report, the reporting person shall provide,

whenever possible, the following information:

1. the name and approximate age of the child;

2. the name and address of the parent or guardian of the

child;

3. the name and location of the Provider Agency;

4. a description of the child's present condition and the

nature and extent of the abuse or neglect to which
he/she has been subjected, including an indication of
the seriousness of the situation and whether the child
appears to be in immediate or imminent danger; and

5. the name of the alleged perpetrator and any other

information known concerning the circumstances of the
suspected abuse or neglect.

Issued by:
 Policy Circular P-Misc.07

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

SUBJECT: Financial Transactions with Clients, Patients and

Residents

EFFECTIVE: This policy circular shall become effective on August

1, 2000, and shall be implemented immediately.

PROMULGATED: August 1, 2000

PURPOSE

The purpose of this circular is to establish minimum standards for use

by Provider Agencies in the development and implementation of a
Financial Transaction(s) with Clients, Patients and Residents Policy.

I. SCOPE

This policy circular applies to all Provider Agencies.

II. POLICY

A. Each Provider Agency shall have written policies and

procedures covering financial transaction(s) with clients,
patients and residents.

B. This Provider Agency policy shall advise staff, and

volunteers, that engaging in certain activities with respect
to financial transaction(s) with clients, patients and
residents are prohibited. These prohibitions shall include
the following:

1. Borrowing money from clients, patients and residents;

2. Engaging in any financial transaction with clients,

patients and residents, i.e., unauthorized loans,
purchases, etc.;

3. Selling to clients, including inviting sales persons to

meet with clients, patients and residents; and

4. Coercing any client, patient or resident to make a

purchase or loan.
 P-Misc.07
2

C. The policy shall specify the procedures to be followed when

an employee is in violation of the policy, including, but
not limited to, any administrative actions covering specific
offenses, such as:

1. A formal written reprimand;

2. A short suspension from work without pay; or

3. Termination.

III. PROCEDURES

A. The Provider Agency shall develop a written policy in

accordance with the minimum guidelines specified in this
circular.

B. The policy shall be adopted by the Provider Agency’s

Governing Board in accordance with procedures in the Board’s
by-laws.

C. A copy of the adopted policy with a date for compliance

shall be furnished to Board members, officers and staff and
posted in a conspicuous place in the facility.

Issued by:
 Information Memorandum P84-2

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Provider Agencies

DATE: October 1, 1984

FROM: Director
Office of Planning and Policy

SUBJECT: MATCH REQUIREMENT FOR FY'85 SOCIAL SERVICES BLOCK GRANT

FUNDING INCREASE

The purpose of this information memorandum is to specify the match

requirement for each county's FY'85 Social Services Block Grant
Funding increase.

The Department's 25% match requirement is in effect for all counties

for the level of funding received in FY'84, the "base" level. For FY
'85 only, county Human Services Advisory Councils were given the
option to establish either a 10% match rate or a 25% match rate on
funding received in FY'85 which is over and above the funding received
in FY'84. Attachment 1 to this memorandum is a list showing each
county, its Social Services Block Grant increase, and the percentage
match requirement the county chose.

All other requirements of Policy Circular P6.01, Match Requirement for

Social Services Block Grant Service Contracts must be followed in
regard to match, e.g., allowable and unallowable sources, documenta-
tion, and responsibilities.

Issued by:
 IM P84-2
Attachment 1

FY'85 SSBG INCREASES (INCLUDING STATE AND FEDERAL FUNDS)

County Match Option Amount to be matched

Atlantic 10% 144,122

Bergen 25% 373,019

Burlington 25% 233,401

Camden 10% 333,840

Cape May 25% 80,835

Cumberland 25% 167,559

Essex 10% 769,080

Gloucester 10% 163,755

Hudson 10% 818,528

Hunterdon 25% 22,230

Mercer 25% 182,130

Middlesex 25% 227,678

Monmouth 25% 218,790

Morris 25% 84,240

Ocean 25% 351,287

Passaic 25% 290,160

Salem 25% 59,648

Somerset 25% 51,090

Sussex 25% 39,288

Union 25% 226,200

Warren 25% 63,120

State $4,900,000
 Information Memorandum P85-2

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Provider Agencies DATE: July 1, 1985

FROM: Director
Office of Planning and Policy

SUBJECT: REQUIREMENTS OF SLEPA CONTRACTS

The purpose of this memorandum is to reiterate the requirements of the

State Law Enforcement Planning Agency (SLEPA) in contracts with
Provider Agencies.

A. Indirect Costs

In general, SLEPA funding is limited to direct assignable costs of

contract activities. This means that SLEPA contracts do not
usually contain a provision for indirect or general and
administrative (G&A) costs. Agencies which contract with both
SLEPA and the Department of Human Services should plan for this
carefully, since Department policies prohibit DHS Contracts from
paying G&A costs in excess of the proportionate or “fair” share
associated with DHS Contract activities.

B. Assumption of Costs

Funding of program activities by SLEPA is limited to 3 years with

the second and third years at a reduced funding level. The agency
must assume the reduced funding amounts for the second and third
years with other, non-SLEPA funding. At the end of the second
year, SLEPA requires that the agency continue the entire program
with other, non-SLEPA funding. Further, SLEPA policy states that
agencies must give detailed plans for their assumption of program
costs in the first year application.

Agencies should not assume that the Department of Human Services

will pick up any of the costs of continuing SLEPA-funded program
activities. This is true even if the service and the client
population are high priorities of the Department.

All requests to the Department for Contract funding must go

through local and Departmental planning and approval procedures in
effect at the time. The fact that a program is already operating
with SLEPA funding will not be a significant factor in evaluating
the program for DHS funding.

In summary, entering into a contract with SLEPA entails careful

planning by the agency, as spelled-out by SLEPA in its Application
Guide. Two factors, in particular, which should be recognized in
advance and planned for are SLEPA’s policies on funding for indirect
costs and agency assumption of program costs.
 IM P85-2
2

Issued by:
 Information Memorandum P85-4

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Provider Agencies

FROM: Director
Office of Planning and Policy

DATE: July 1, 1985

SUBJECT: MATCH REQUIREMENT FOR FY'86 SOCIAL SERVICES BLOCK GRANT

FUNDING INCREASE

The purpose of this information memorandum is to specify the match

requirement for each county's FY'86 Social Services Block Grant funding
increase.

The Department's match requirement is in effect for all counties for the
level of funding received in FY'84, the "base" level. For FY'85, county
Human Services Advisory Councils were given the option to establish
either a 10% match rate or 25% match rate on funding received in FY'85
which was over and above the funding received in FY'84 (refer to
Information Memorandum P84-2). Those counties which selected the 10%
match rate for the FY'85 funding increase may continue the 10% match
requirement for those funds. However, the Department encourages, where
possible, that a 25% match be required.

For FY'86, county Human Services Advisory Councils were given again the
option to establish either a 10% or 25% match rate on funding received
in FY'86 which is over and above the funding received in FY'85.
Attachment 1 to this memorandum is a list showing each county and the
percentage match requirement the county chose.

All other requirements of Policy Circular P6.01, Match Requirement for

Social Services Block Grant Service Contracts must be followed in regard
to match, e.g., allowable and unallowable sources, documentation, and
responsibilities.

Issued by:
 P85-4
Attachment 1

County Percentage Match Requirement

Atlantic 10%

Bergen 25%

Burlington 10%

Camden 10%

Cape May 25%

Cumberland 10%

Essex 10%

Gloucester 10%

Hudson 10%

Hunterdon 10%

Mercer 25%

Middlesex 25%

Monmouth 25%

Morris 25%

Ocean 25%

Passaic 25%

Salem 25%

Somerset 25%

Sussex 25%

Union 25%

Warren 25%
 Information Memorandum P89-2

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

FROM: Director
Office of Planning and Policy

DATE: May 1, 1989

SUBJECT: Application of Executive Order No. 189

The purpose of this memorandum is to inform Department and Provider

Agency personnel of the prohibitions and requirements of Executive
Order No. 189, signed by the Governor on July 20, 1988.

This Executive Order:

1. provides that persons providing goods or services or performing

contracts for the State be fully informed of State policies
concerning their relationships with State officers and that these
policies be uniformly applied by the various State agencies of
the Executive Branch;

2. supplements Executive Order No. 34 (1976) which provides the

grounds and procedures applicable to the debarment, suspension
and disqualification of State vendors; and

3. mandates that all Request for Proposals (RFPs) and contracts

include specific language pertaining to the prohibition of vendor
activities and such Guidelines as prepared by the Executive
Commission on Ethical Standards.

To comply with Executive Order No. 189, an Addendum incorporating the

specific language of the Executive Order was developed to use in
connection with RFPs and Contracts. Effective immediately, and until
such time as Department-wide RFP is developed, the Addendum
(Attachment 1) and the Guidelines (Attachment 2) must be included in
all Department RFPs.

The Addendum and Guidelines have been added to the Department’s

Standard Language Documents for Social Service and Training Contracts
(P2.01), Individual Provider Agreement (P2.05) and Tuition Agreement
(P2.07), effective for contracts beginning July 1, 1989.

Department employees must report the receipt or offer of any gift or

thing of value in writing to the Department’s Ethics Liaison Officer:
 2 IMP89-2

Ray Wolfinger, Esq.

Office of Legal and Regulatory Liaison
Division of Youth and Family Services
BOX 717
Trenton, NJ 08625

Copies of the full text of Executive Order Nos. 189 and 34

(Attachments 3 and 4 respectively) are attached to provide background
information.

Attachments

Issued by:
 IM P89-2
Attachment 1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

ADDENDUM TO REQUEST FOR PROPOSAL

FOR SOCIAL SERVICE AND TRAINING CONTRACTS

Executive Order No. 189 establishes the expected standard of

responsibility for all parties that enter into a contract with the
State of New Jersey. All such parties must meet a standard of
responsibility which assures the State and its citizens that such
parties will compete and perform honestly in their dealings with the
State and avoid conflicts of interest.

As used in this document "provider agency" or "provider" means

any person, firm, corporation, or other entity or representative or
employee thereof which offers or proposes to provide goods or services
to or performs any contract for the Department of Human Services.

In compliance with Paragraph 3 of Executive Order No. 189, no

Provider Agency shall pay, offer to pay, or agree to pay, either
directly or indirectly, any fee, commission, compensation, gift,
gratuity, or other thing of value of any kind to any State officer or
employee or special State officer or employee, as defined by N.J.S.A.
52:13D-13b and e, in the Department of the Treasury or any other
agency with which such Provider Agency transacts or offers or proposes
to transact business, or to any member of the immediate family, as
defined by N.J.S.A. 52:13D-13i, of any such officer or employee, or
any partnership, firm, or corporation with which they are employed or
associated, or in which such officer or employee has an interest
within the meaning of N.J.S.A. 52:13D-13g.

The solicitation of any fee, commission, compensation, gift,

gratuity or other thing of value by any State officer or employee or
special State officer or employee from any Provider Agency shall be
reported in writing forthwith by the Provider Agency to the Attorney
General and the Executive Commission on Ethical Standards.

No Provider Agency may, directly or indirectly, undertake any

private business, commercial or entrepreneurial relationship with,
whether or not pursuant to employment, contract or other agreement,
express or implied, or sell any interest in such Provider Agency to,
any State officer or employee or special State officer or employee
having any duties or responsibilities in connection with the purchase,
acquisition or sale of any property or services by or to any State
agency or any instrumentality thereof, or with any person, firm or
entity with which he is employed or associated or in which he has an
interest within the meaning of N.J.S.A. 52:13D-13g. Any relationships
subject to this provision shall be reported in writing forthwith to
the Executive Commission on Ethical Standards, which may grant a
 2 IM P89-2
Attachment 1

waiver of this restriction upon application of the State officer or

employee or special State officer or employee upon a finding that the
present or proposed relationship does not present the potential,
actuality or appearance of a conflict of interest.

No Provider Agency shall influence, or attempt to influence or

cause to be influenced, any State officer or employee or special State
officer or employee in his official capacity in any manner which might
tend to impair the objectivity or independence of judgment of said
officer or employee.

No Provider Agency shall cause or influence, or attempt to cause

or influence, any State officer or employee or special State officer
or employee to use, or attempt to use, his official position to secure
unwarranted privileges or advantages for the Provider Agency or any
other person.

The provisions cited above shall not be construed to prohibit a

State officer or employee or special State officer or employee from
receiving gifts from or contracting with Provider Agencies under the
same terms and conditions as are offered or made available to members
of the general public subject to any guidelines the Executive
Commission on Ethical Standards may promulgate.
 IMP89-2
Attachment 2

STATE OF NEW JERSEY

EXECUTIVE COMMISSION ON ETHICAL STANDARDS
GUIDELINES FOR EXECUTIVE ORDER No. 189

The following guidelines have been developed to assist State employees

and vendors in evaluating the conflict of interest potential in any
contract or Request for Proposal (RFP) process.

Example 1

Employee is out to lunch or dinner with a contractor, consultant or

any other private party which does or may do business with employee's
agency. The employee should either pick up the check (assuming the
employee has the authority or necessary approval), or pay for own meal
(and get receipt). The best advice is, of course, to avoid these
situations entirely.

Example 2

Employee is invited to a golf outing sponsored by a contractor,

consultant or any other private party which does or may do business
with employee's agency. Green fees, food and beverage will be paid
for by the sponsor. Employee should politely decline the invitation.

Example 3

Employee is offered tickets to sporting or other entertainment events

by a contractor, consultant or any other private party which does or
may do business with employee's agency. Employee should politely
decline the tickets. Payment by the employee for the ticket's face
amount is also unacceptable.

Example 4

Employee is at a convention and stops at a vendor or other hospitality

suite for a drink and hors d'oeuvres. Employee may accept hospitality
as long as reception or suite is open to all conference attendees.

Example 5

Employee receives gift at Christmas/Hannukah time of liquor, cheese,

etc. from a contractor, consultant or any other private party which
does or may do business with employee's agency. Employee should
decline the gift in the most gracious way possible.

Example 6
 2 IM P89-2
Attachment 2

Employee is a member of a professional organization to which he or she

pays dues (or his/her agency pays dues on behalf of employee).
Employee may attend functions run by the organization and any

additional fees and charges should be paid by the employee or his/her

agency. Employee should not attend functions if fees are paid by a
contractor, consultant or any other private party which does or may do
business with his/her agency.

Example 7

Employee is invited to a "ribbon cutting" or "groundbreaking" ceremony

at which a vendor is providing refreshments. Employee may attend as
long as he/she receives no special consideration.
 IMP89-2
Attachment 3

STATE OF NEW JERSEY

EXECUTIVE DEPARTMENT

EXECUTIVE ORDER NO. 189

WHEREAS, it is essential that all persons supplying goods or

services to the State of New Jersey, or performing contracts or
otherwise executing public works with the assistance of and subject to
the approval of the State, must meet a standard of responsibility
which assures the State and its citizens that such persons will both
compete and perform honestly in their dealings with the State and
avoid conflicts of interest; and

WHEREAS, the New Jersey Conflicts of Interest Law prohibits State

officers or employees and special State officers or employees from
having any interest or engaging in any activity that is in substantial
conflict with the proper discharge of their duties in the public
interest or from undertaking any employment or service which might
reasonably be expected to impair their objectivity or independence of
judgment; and

WHEREAS, the New Jersey Conflicts of Interest Law prohibits State

officers or employees and special State officers or employees from
acting in their official capacity in any matter wherein they have a
direct or indirect personal financial interest which might reasonably
be expected to impair their objectivity or independence of judgment;
and

WHEREAS, N.J.S.A. 52:34-19 provides that it shall be a

misdemeanor to pay any fee, commission, compensation, gift or gratuity
of any kind, directly or indirectly, to any person employed by the
Department of the Treasury or to any other person in the employ of the
State having any duties or responsibilities in connection with the
purchase or acquisition of any property or services by the State or
any agency or instrumentality thereof by or on behalf of any seller or
supplier of such goods or services or other party to a contract with
the State; and

WHEREAS, it is essential that persons providing goods or services

to, or performing contracts for, the State be fully informed of the
policies of the State concerning their relationships with State
officers or employees and special State officers or employees and that
these policies be uniformly applied by the various agencies of the
Executive Branch; and

WHEREAS, it is therefore necessary to supplement Executive Order

No. 34 (1976), which provides the grounds and procedures applicable to
the debarment, suspension and disqualification of State vendors, to
 2 IM P89-2
Attachment 3

encompass appropriate standards prohibiting conflicts of interest on

the part of present and prospective State vendors;

Now, therefore, I, Thomas H. Kean, Governor of the State of New

Jersey, by virtue of the authority vested in me by the Constitution
and by the Statutes of this State, do hereby ORDER and DIRECT:

1. As used in this Order, "vendor" means any person, firm,

corporation, or other entity which provides or offers or proposes to
provide goods or services to or performs any contract for any State
agency.

2. The executive head of each department or agency in the

Executive Branch with the lawful authority to engage in State
contracting shall, in accordance with the provisions of the
Administrative Procedures Act, N.J.S.A. 52:14B-1 et seq., promulgate
regulations supplementing those heretofore established pursuant to
Executive Order No. 34 (1976) governing the causes, conditions and
procedures applicable to determinations of debarment, suspension and
disqualification by the department or agency to include the minimum
standards hereinafter set forth. In addition to any other filing
required by law to be made, each executive head shall file with the
Attorney General and Treasurer a copy of such rules and regulations as
may be promulgated.

3. The rules and regulations referred to in Paragraph 2 shall

include the following prohibitions on vendor activities, the violation
of which shall render said vendor liable to debarment in the public
interest, pursuant to the procedures established by Executive Order
No. 34 (1976), by any Executive department or agency:

a. No vendor shall pay, offer to pay, or agree to pay, either

directly or indirectly, any fee, commission, compensation,
gift, gratuity, or other thing of value of any kind to any
State officer or employee or special State officer or
employee, as defined by N.J.S.A. 52:13D-13b. and e., in the
Department of the Treasury or any other agency with which
such vendor transacts or offers or proposes to transact
business, or to any member of the immediate family, as
defined by N.J.S.A. 52:13D-13i., of any such officer or
employee, or any partnership, firm, or corporation with
which they are employed or associated, or in which such
officer or employee has an interest within the meaning of
N.J.S.A. 52:13D-13g.

b. The solicitation of any fee, commission, compensation, gift,

gratuity or other thing of value by any State officer or
employee or special State officer or employee from any State
vendor shall be reported in writing forthwith by the vendor
to the Attorney General and the Executive Commission on
Ethical Standards.
 3 IM P89-2
Attachment 3

c. No vendor may, directly or indirectly, undertake any private

business, commercial or entrepreneurial relationship with,
whether or not pursuant to employment, contract or other
agreement, express or implied, or sell any interest in such
vendor to, any State officer or employee or special State
officer or employee having any duties or responsibilities in
connection with the purchase, acquisition or sale of any
property or services by or to any State agency or any
instrumentality thereof, or with any person, firm or entity
with which he is employed or associated or in which he has
an interest within the meaning of N.J.S.A. 52:13D-13g. Any
relationship subject to this provision shall be reported in
writing forthwith to the Executive Commission on Ethical
Standards, which may grant a waiver of this restriction upon
application of the State officer or employee or special
State officer or employee upon a finding that the present or
proposed relationship does not present the potential,
actuality or appearance of a conflict of interest.

d. No vendor shall influence, or attempt to influence or cause

to be influenced, any State officer or employee or special
State officer or employee in his official capacity in any
manner which might tend to impair the objectivity or
independence of judgment of said officer or employee.

e. No vendor shall cause or influence, or attempt to cause or

influence, any State officer or employee or special State
officer or employee to use, or attempt to use, his official
position to secure unwarranted privileges or advantages for
the vendor or any other person.

f. The provision cited above in paragraph 3a. through 3e. shall

not be construed to prohibit a State officer or employee or
special State officer or employee from receiving gifts from
or contracting with vendors under the same terms and
conditions as are offered or made available to members of
the general public subject to any guidelines the Executive
Commission on Ethical Standards may promulgate under
paragraph 3c.

4. The rules and regulations referred to in Paragraph 2, supra,

shall require that the prohibitions set forth in paragraph
3, supra, shall be included in all requests for proposals
issued by any State department or agency and in all
contracts executed on behalf of a State department or
agency, other than those of an interstate agency to which
New Jersey is a party and contracts entered into on behalf
of the interstate agency.
 4 IM P89-2
Attachment 3

5. Nothing required by this Order shall be construed to limit

the authority of any State department or agency to refrain
from contracting within the discretion allowed by law, or to
limit N.J.S.A. 52:34-19 or any other applicable statue or
regulation.

6. This Order shall take effect on the ninetieth day following

its execution.

GIVEN, under my hand and seal, this

20th day of July, in the Year of
(SEAL) Our Lord, one thousand nine hundred and
eighty-eight, and of the Independence of
the United States, the two hundred and
thirteenth.

/s/ Thomas H. Kean

Governor

Attest:

/s/ Michael R. Cole

Chief Counsel
 IMP 89-2
Attachment 4

STATE OF NEW JERSEY

EXECUTIVE DEPARTMENT

EXECUTIVE ORDER NO. 34

WHEREAS, it is essential that all persons supplying goods or

services to the State of New Jersey, or performing contracts or
otherwise executing public works with the assistance of and subject to
the approval of the State, must meet a standard of responsibility
which assures the State and its citizens that such persons will both
compete and perform honestly in their dealings with the State and
avoid secret or illicit dealing; and

WHEREAS, it is essential that such persons be fully informed of

policies of the State in this regard, and be afforded procedural
safeguards appropriate to circumstances which such policies may
occasion; and

WHEREAS, the courts have affirmed the duty and obligation of

State officials to develop and effectuate such policies; and

WHEREAS, it is essential that such policies be uniformly applied

by the various agencies of the Executive Branch, and that uniform
procedures be adopted to implement them;

Now, therefore, I Brendan T. Byrne, Governor of the State of New

Jersey, do hereby ORDER and DIRECT that:

1. Debarment, suspension and disqualification are measures

which shall be invoked by the State to exclude or render
ineligible certain persons from participation in contracts and
subcontracts with the State, or in projects or contracts
performed with the assistance of and subject to the approval of
the State, on the basis of a lack of responsibility. These
measures shall be used for the purpose of protecting the
interests of the State and not for punishment. To assure the
State the benefits to be derived from the full and free
competition between and among such persons and to maximize the
opportunity for honest competition and performance, these
measures shall not be invoked for any time longer than deemed
necessary to protect the interest of the State.

2. As used in this Order:

(a) "Debarment" means an exclusion from State contracting, on

the basis of a lack of responsibility evidenced by an
offense, failure, or inadequacy of performance, for a
reasonable period of time commensurate with the seriousness
of the offense, failure, or inadequacy of performance.
 2 IM P89-2
Attachment 4

(b) "Suspension" means an exclusion from State contracting for a

temporary period of time, pending the completion of an
investigation or legal proceedings.

(c) "Disqualification" means a debarment or a suspension which

denies or revokes a qualification to bid or otherwise
engage in State contracting which has been granted or
applied for pursuant to statute, or rules and regulations.

(d) "State" means the State of New Jersey, or any of the

departments or agencies in the Executive Branch of
government with the lawful authority to engage in
contracting.

(e) "Person" means any natural person, company, firm,

association, corporation, or other entity.

(f) "State contracting" means any arrangement giving rise to an

obligation to supply any thing to or perform any service
for the State, other than by virtue of State employment,
or to supply any thing to or perform any service for a
private person where the State provides substantial
financial assistance and retains the right to approve or
disapprove the nature or quality of the goods or service
or the persons who may supply or perform the same.

(g) "Affiliates" means persons having an overt or covert

relationship such that any one of them directly or
indirectly controls or has the power to control another.

3. The executive head of each department or agency in the

Executive Branch, with the lawful authority to engage in State
contracting, shall, within 90 days of the date of this Order and
in accordance with the provisions of the Administrative
Procedures Act (P.L. 1968, c. 410, C. 52:14B-1 et seq.),
promulgate rules and regulations governing the causes, conditions
and procedures applicable to determinations of debarment,
suspension and disqualification by that department or agency.
Such rules and regulations shall to the extent consistent with
existing law conform to the minimum standards hereinafter set
forth, but need not be limited to such standards. In addition to
any other filing required by law to be made, each executive head
shall file with the Attorney General and the Treasurer a copy of
such rules and regulations as may be promulgated.

4. Subject to the conditions hereinafter described, the rules

and regulations referred to in Section 3 supra, shall authorize
the department or agency to debar a person in the public interest
for any of the following causes:
 3 IM P89-2
Attachment 4

(a) Commission of a criminal offense as an incident to obtaining

or attempting to obtain a public or private contract, or
subcontract thereunder, or in the performance of such
contract or subcontract.

(b) Violation of the Federal Organized Crime Control Act of

1970, or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, perjury,
false swearing, receiving stolen property, obstruction of
justice, or any other offense indicating a lack of business
integrity or honesty.

(c) Violation of the Federal or State Antitrust Statutes, or of

the Federal Anti-Kickback Act (18 U.S.C. 874, 40 U.S.C. 276
b, c).

(d) Violations of any of the laws governing the conduct of

elections of the State of New Jersey or of its political
subdivisions.

(e) Violation of the "Law Against Discrimination" (P.L. 1945, c.

169, C. 10:5-1 et seq., as supplemented by P.L. 1975, c.
127), or of the act banning discrimination in public works
employment (C. 10:2-1 et seq.) or of the Act prohibiting
discrimination by industries engaged in defense work in the
employment of persons therein C. 114, L. 1942, C. 10:1-10 et
seq.).

(f) Violations of any laws governing hours of labor, minimum

wage standards, prevailing wage standards, discrimination in
wages, or child labor.

(g) Violations of any laws governing the conduct of occupations

or professions or regulated industries.

(h) Willful failure to perform in accordance with contract

specifications or within contractual time limits.

(i) A record of failure to perform or of unsatisfactory

performance has occurred within a reasonable time preceding
the determination to debar and was cause by acts within the
control of the person debarred.

(j) Violation of contractual or statutory provisions regulating

contingent fees.

(k) Any other cause affecting responsibility as a State

contractor of such serious and compelling nature as may be
determined by the department or agency to warrant debarment,
including such conduct as may be prescribed by the laws or
contracts enumerated in this paragraph even if such conduct
 4 IM P89-2
Attachment 4

has not been or may not be prosecuted as violations of such

laws or contracts.

(l) Debarment by some other department or agency in the

Executive Branch.

5. The rules and regulations concerning debarment required

herein shall include in substance the following conditions:

(a) Debarment shall be made only upon approval of the executive

head of the department or agency, except as otherwise
provided by law.

(b) The existence of any of the causes set forth in paragraph 4

of this Order shall not necessarily require that a person be
disbarred. In each instance, the decision to debar shall be
made within the discretion of the head of the department or
agency unless otherwise required by law, and shall be
rendered in the best interest of the State.

(c) All mitigating factors shall be considered in determining

the seriousness of the offense, failure or inadequacy of
performance and in deciding whether debarment is warranted.

(d) The existence of a cause set forth in subparagraphs (a),

(b), (c), (d), (e), (f), and (g) of paragraph 4 of this
Order shall be established upon the rendering of a final
judgment or conviction by a court of competent jurisdiction
or by an administrative agency empowered to render such
judgment. In the event an appeal taken from such judgment
or conviction results in reversal thereof, the debarment
shall be removed upon the request of the debarred person
unless other cause for debarment exists.

(e) The existence of a cause set forth in subparagraphs (h),

(i), (j), and (k) of paragraph 4 of this Order shall be
established by evidence which the department or agency
determines to be clear and convincing in nature.

(f) Debarment for the cause set forth in subparagraph (l) of

paragraph 4 of this Order shall be proper provided that one
of the causes set forth in subparagraph 4(a) through 4(k)
was the basis for debarment by the original debarring
agency. Such debarment may be based entirely on the record
of facts obtained by the original debarring agency, or upon
a combination of such facts and additional facts.

6. The rules and regulations concerning debarment required by

this Order shall include in substance the following provisions
regarding procedures, period of debarment and scope of debarment:
 5 IM P89-2
Attachment 4

(a) A department or agency seeking to debar a person or his

affiliates shall furnish such party with a written notice:
(i) stating that debarment is being considered, (ii) setting
forth the reasons for the proposed debarment, and (iii)
indicating that such party will be accorded an opportunity
for a hearing if he so requests within a stated period of
time. All such hearings shall be conducted in accordance
with the provisions of the Administrative Procedures Act.
However, where one department or agency has imposed
debarment upon a party, a second department or agency may
also impose a similar debarment without according an
opportunity for a hearing, provided that the second agency
furnishes notice of the proposed similar debarment to that
party, and accords that party an opportunity to present
information in his behalf to explain why the proposed
similar debarment should not be imposed in whole or in part.

(b) Debarment shall be for a reasonable, definitely stated

period of time which as a general rule shall not exceed 5
years. Debarment for an additional period shall be
permitted provided that notice thereof is furnished and the
party is accorded an opportunity to present information in
his behalf to explain why the additional period of debarment
should not be imposed.

(c) Except as otherwise provided by law, a debarment may be

removed or the period thereof may be reduced in the
discretion of the debarring agency upon the submission of a
good faith application under oath, supported by documentary
evidence, setting forth substantial and appropriate grounds
for the granting of relief, such as newly discovered
material evidence, reversal of a conviction or judgment,
actual change of ownership, management or control, or the
elimination of the causes for which the debarment was
imposed.

(d) A debarment may include all know affiliates of a person,

provided that each decision to include an affiliate is made
on a case by case basis after giving due regard to all
relevant facts and circumstances. The offense, failure or
inadequacy of performance of an individual may be imputed to
a person with whom he is affiliated, where such conduct was
accomplished within the course of his official duty or was
effected by him with the knowledge or approval of such
person.

7. Subject to the conditions hereinafter described, the rules

and regulations required by this Order shall authorize the
department or agency to suspend a person in the public interest
for any cause specified in paragraph 4 of this Order, or upon a
reasonable suspicion that such cause exists.
 6 IM P89-2
Attachment 4

8. The rules and regulations concerning suspension required by

this Order shall include in substance the following conditions:

(a) Suspension shall be imposed only upon approval of the

executive head of the department or agency and upon approval
of the Attorney General, except as otherwise provided by
law.

(b) The existence of any cause for suspension shall not require
that a suspension be imposed, and a decision to suspend
shall be made at the discretion of the executive head of the
department and of the Attorney General, and shall be
rendered in the best interest of the State.

(c) Suspension shall not be based upon unsupported accusation,

but upon adequate evidence that cause exists or upon
evidence adequate to create a reasonable suspicion that
cause exists.

(d) In assessing whether adequate evidence exists, consideration

shall be given to the amount of credible evidence which is
available, to the existence or absence of corroboration as
to important allegations, and to inferences which may
properly be drawn from the existence or absence of
affirmative facts.

(e) Reasonable suspicion of the existence of a cause described

in subparagraphs (a), (b), (c), (d), (e), (f), and (g) of
paragraph 4 of this Order may be established by the
rendering of a final judgment or conviction by a court of
administrative agency of competent jurisdiction, by grand
jury indictment, or by evidence that such violations of
civil or criminal law did in fact occur.

(f) A suspension invoked by an agency for any of the causes

described in subparagraphs (a), (b), (c), (d), (e), (f),
(g), (h), (i), (j), (k), and (l) of paragraph 4 of this
Order may be the basis for the imposition of a concurrent
suspension by another agency, which may impose such
suspension without the approval of the Attorney General.

9. The rules and regulations concerning suspension required by

this Order shall include in substance the following provisions
regarding procedures, period of suspension and scope of
suspension:

(a) A department or agency may suspend a person or his

affiliates, provided that within 10 days after the effective
date of the suspension, the agency provides such party with
a written notice: (i) stating that a suspension has been
imposed and its effective date, (ii) setting forth the
reasons for the suspension to the extent that the Attorney
 7 IM P89-2
Attachment 4

General determines that such reasons may be properly

disclosed, (iii) stating that the suspension is for a
temporary period pending the completion of an investigation
and such legal proceedings as may ensue, and (iv) indicating
that, if such legal proceedings are not commenced or the
suspension removed within 60 days of the date of such
notice, the party will be given either a statement of the
reasons for the suspension and an opportunity for a hearing
if he so requests, or a statement declining to give such
reasons and setting forth the agency's position regarding
the continuation of the suspension. Where a suspension by
one agency has been the basis for suspension by another
agency, the latter shall note that fact as a reason for its
suspension.

(b) A suspension shall not continue beyond 18 months from its

effective date unless civil or criminal action regarding the
alleged violation shall have been initiated within that
period, or unless debarment action has been commenced.
Whenever prosecution or debarment action has been initiated,
the suspension may continue until the legal proceedings are
completed.

(c) A suspension may include all known affiliates of a person,

provided that each decision to include an affiliate is made
on a case by case basis after giving due regard to all
relevant facts and circumstances.

The offense, failure or inadequacy of performance of an

individual may be imputed to a person with whom he is
affiliated, where such conduct was accomplished within the
course of his official duty or was effectuated by him with
the knowledge or approval of such person.

10. The rules and regulations required by this Order shall

contain such provisions as may be necessary to conform existing
practices and procedures under any relevant prequalification
statutes to the procedures governing debarment and suspension
required herein, to the extent that such existing practices and
procedures may concern the disqualification of any person from
State contracting.

11. The rules and regulations required by this Order shall

provide that the exclusion from State contracting by virtue of
debarment, suspension or disqualification shall extend to all
State contracting and subcontracting within the control or
jurisdiction of the department or agency which imposes the
exclusion. However, when it is determined essential to the
public interest by the head of the department or agency, and upon
filing of a finding thereof with the Attorney General, an
exception from total exclusion may be made with respect to a
particular State contract.
 8 IM P89-2
Attachment 4

12. Insofar as practicable, prior notice shall be given to the

Attorney General and the Treasurer of any proposed debarment or
suspension.

13. The Treasurer shall maintain a current list of the names of

all persons suspended or debarred, the effective date and term if
any thereof, and the agency or agencies which impose same. Such
list shall be available for public inspection.

14. Departments and agencies required by this Order to

promulgate rules and regulations governing debarment and
suspension are hereby authorized in connection with any
proceeding thereunder to receive such information regarding the
criminal conduct or criminal record of any person to the extent
that such disclosure is deemed appropriate by the Attorney
General, consistent with existing Federal and State law.

15. Nothing required by this Order shall be construed to limit

the authority of any department or agency to refrain from
contracting within the discretion allowed by law.

Given, under my hand and seal this

29th day of March, in the Year of
(SEAL) Our Lord, one thousand nine hundred
and seventy-six, of the
Independence of the United States,
the two hundredth.

/s/ Brendan Byrne

Governor

Attest:

/s/ John J. Degnan

Executive Secretary to the Governor
 IM P91-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: December 6, 1991

SUBJECT: Reallocation of Funds - Clarification - P6.01, Match

Requirements for Social Services Block Grant Services
Contracts

The purpose of this memorandum is to clarify the need for Departmental

approval to reallocate Social Services Block Grant Funds and the
required percentage of Match for such funds.

A. County Human Services Advisory Council Reallocation Process

Each County Human Services Advisory Council recommends

allocations of the SSBG funds for its county. The Departmental
Component must give prior written approval in situations where
there is a need to reallocate funds to service providers.
Furthermore, if funds are to be reallocated, the Department must
ensure that there is no loss in service dollars previously
generated by Matching funds. Therefore, written approval must
also be given to change the percentage of the Match requirement
applicable to any funds being reallocated.

B. Policy Circular P6.01, Match Requirements

The Department's Policy Circular P6.01, Match Requirements for

Social Services Block Grant Service Contracts, currently requires
a 25% Match on all SSBG service contracts. This policy was
subsequently modified for FYs '85 and '86 for new funding (see
Information Memoranda P84-2 and P85-4) in that each County Human
Services Advisory Council was given the option of a 10% or 25%
Match requirement. Therefore, some contracted services may
contain identified Match dollars governed by both a 25% and a 10%
Match requirement.

Funds that initially required a 25% or 10% Match will retain that
percentage when reallocated. However, when authorization is
received to reallocate funds that include a mix of a 10% and a
25% Match requirement, a blended rate may be developed with the
Department. The following formula will be used to develop the
blended rate:
 Total Current Match Funds Required - Blended Percentage Total
SSBG Funds To Be Allocated.

The blended percentage rate is to be rounded to the nearest whole

percentage point. This new percentage rate will then be the
required Match on the SSBG funds being reallocated. However, the
blended rate may be raised to the full 25% Match rate if the
county so chooses.

Issued by:
 Information Memorandum P94-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Department Manual Holders

DATE: July 1, 1994

SUBJECT: Debarments, Suspensions and Disqualification Pursuant

to Executive Order #34-1976

The purpose of this memorandum is to inform the Departmental

Components of how to initiate the procedure to debar, suspend, or
disqualify a person/Provider Agency according to Executive Order #34-
1976; N.J.A.C. 10:3-1, Debarment, Suspension and Disqualification of
Person(s); and Treasury Circular 93-13-GSA.

The Departmental Component shall notify the Director of the Office of

Legal and Regulatory Liaison (OLRL) and the Manager of the Contract
Policy and Management Unit (CPMU) of a pending recommended action for
debarment, suspension or disqualification. All documentation shall be
forwarded to OLRL as soon as possible for review. OLRL will notify
all appropriate persons of the recommendation, including the
Commissioner and the Attorney General, as appropriate, and obtain all
required signatures to implement the recommendation.

Upon the decision to or not to debar, suspend, or disqualify a

person/Provider Agency, OLRL will notify the Departmental Component
and CPMU of the final decision. If the person/Provider Agency is to
be debarred, suspended or disqualified, OLRL will complete and forward
the required form (GSA-40, New Jersey Debarment Transmittal) to
Treasury notifying them of the action.

CPMU shall notify all Department Manual holders explaining who has
been debarred, suspended or disqualified and the reason for such.

Issued by:
 Information Memorandum P94-2

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: November 1, 1994

SUBJECT: State of New Jersey Policy on Sexual Harassment

The purpose of this memorandum is to inform manual holders of the

Statewide policy on sexual harassment which became effective on
September 1, 1993. The policy applies to all State departments,
colleges and authorities and covers independent contractors, vendors
and all other parties engaged in a business relationship with the
State of New Jersey. The intent of the policy is to allow all
employees (male or female) to work in an environment free from actions
which could be considered harassing or coercive regarding sexual
conduct.

The procedure for reporting any allegations of sexual harassment of

Department employees by employees outside the purview of the
Department shall be to contact the appropriate Departmental Component
Affirmative Action Officer. Any incident of sexual harassment of a
Provider Agency's employees by a Department employee should be
directed to the appropriate Department of Human Services Affirmative
Action Officer (see Attachment 1).

The Department recommends that all Provider Agencies develop an

internal policy concerning sexual harassment.

A copy of the Governor's policy on sexual harassment is attached to

this Information Memorandum.

Issued by:
 IM P94-2
Attachment 1

AFFIRMATIVE ACTION OFFICE

TELEPHONE NUMBERS

DEPARTMENT OF HUMAN SERVICES

Department of Human Services (DHS) (609)-292-7380

DEPARTMENTAL COMPONENTS

Division of Developmental Disabilities (DDD) (609)-984-5350

Division of Family Development (DFD) (609)-588-2108

Division of Mental Health Services (DMHS) (609)-777-0665

Division of Youth & Family Services (DYFS) (609)-984-4330

Commission f/t Blind and Visually Impaired (CBVI) (201)-648-3158

Division of Medical Assistance & Health Services (609)-588-2605

All other Departmental Components (609)-292-7380

 Information Memorandum P99-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: May 1, 1999

SUPERCEDED: Information Memorandum P97-2, promulgated February

1, 1997.

SUBJECT: Applicability of the Federal Davis-Bacon Act and

the New Jersey Prevailing Wage Act

The purpose of this information memorandum is to provide

assistance in understanding the federal Davis-Bacon Act and the
New Jersey Prevailing Wage Act as each applies to funding
allocated through the Department's Contracts. Any Department of
Human Services Contract in excess of $2,000 for the construction,
alteration, demolition (applies to State funding only), repair or
renovations to any property or premises, may, depending on the
funding source (State, local or federal) and contractual
circumstances, be subject to the requirements of the Davis-Bacon
Act and/or the New Jersey Prevailing Wage Act.

The federal Davis-Bacon Act and the State Prevailing Wage Acts
are discussed below:

1. Davis-Bacon Act -(40 U.S.C. §276a-276a-5)

All contracts or subsequent subcontracts for construction,

alteration, renovation, or repair, including painting and
decorating, of a public building or public work, or building
or work, financed by federal funds which meets the $2,000
threshold are required to pay the federal prevailing wage
rate for each class of laborer or mechanic employed.
Regulations applicable to grant-enabling statutes
incorporating the Act can be found in 29 Code of Federal
Regulations (CFR), Parts 1,3,5 and 7. These regulations
stipulate that grant funds appropriated under statutes
imposing the Davis-Bacon Act requirements shall not be paid
to a grantee (the Department) until contractors or
subcontractors performing work under the grant certify that
they will comply with the Act's requirements. The Act also
applies to any contract or subcontract for similar work on
public grants from a federal agency, or where the federal
government acts as guarantors of mortgages. The only
exception is for the transportation of materials and
supplies by persons who are not employed directly at the
work site, but are employed solely to make deliveries to the
work site.
 IM P99-1

Provider Agencies must ensure that contracts or subcontracts

for any construction/alteration projects contain the wage
determinations issued and that the appropriate clauses
required by the Davis-Bacon regulations (29 CFR, section
5.5) are present. It should be made clear in any
announcements of projects or RFPs that federal grant funds
are being used and that Davis-Bacon will apply even if the
federal government is not a party to the contract or
subcontract. The prevailing wage must be paid regardless of
any contractual relationship that may exist between a
contractor or a subcontractor. Although the Department is
not responsible to review sub-contracts for compliance, it
has the right to require a prevailing wage.

Sanctions for post-certification violations include

suspension of payment, advances, or guarantees of grant
funds, and the forced restitution of wages that should have
been paid and the removal of offending contractors or
subcontractors from active employment lists.

Failure to comply can bring penalties that can be severe.

The contractor or subcontractor and their sureties are
liable for any excess costs for completing the work; the
Department may withhold accruals to ensure payment of
prevailing wages to the workers; the contract or subcontract
may be terminated and/or the contractor or subcontractor may
be debarred for a period of three years.

2. New Jersey Prevailing Wage Act -(N.J.S.A. 34:11-56.27 et

seq.)

Current law requires that workers who are compensated

pursuant to a public works contract must be paid the
prevailing wage when a public body is a party to said
contract. If the public body is not a signatory party of
the contract, the Prevailing Wage Act does not apply. The
fact that the source of funds for the contract comes from a
public body is immaterial in determining the applicability
of the New Jersey Prevailing Wage Act.

The penalties of paying less than the prevailing wage, where

applicable, may include the termination of a contract or
part thereof. The State maintains the right to proceed or
prosecute the contracted work to completion with the
contractor's surety liable for excess costs. The Act also
provides for criminal sanctions including fines and/or
imprisonment. In addition, administrative assessments may
be levied by the New Jersey Commissioner of Labor.

Language concerning the Davis-Bacon Act and the New Jersey

Prevailing Wage Act has been included in the Department of Human
Services' Standard Language Document for Social Service and
Training Contracts. When applicable, all Provider Agency

2
 IM P99-1

Contracts must contain the federal Davis-Bacon Contract Provision

(See attachment #1) and a State specific clause stating that the
prevailing wage rate, as designated by the New Jersey
Commissioner of Labor, must be paid to all workers employed
through any subsequent Contracts or subcontracts. These notices
must be present even if the State or federal Act does not apply
to a given construction/alteration project. General federal wage
determinations are kept up-to-date by modifications published in
the Federal Register. State wage determinations can be obtained
by contacting the NJ Department of Labor, Office of Wage and Hour
Compliance, Public Contracts Unit by calling (609) 292-2259.

Issued by:

3
 IM P99-1
Attachment #1

Davis-Bacon Act Contract Provisions

All Federal and federally assisted contracts subject to the Davis-Bacon and related acts must include the
standard contract clauses included in Department of Labor regulations (29 CFR §5.5). These clauses are
reprinted below [§5.5(a)(1)- §5.5(c)].

§5.5 Contract provisions and related matters

(a) The agency head shall cause or require the contracting officer to insert in full in any contract in excess of
$2,000 which is entered into for the actual construction, alteration and/or repair, including painting and
decorating, of a public building or public work, or building or work financed in whole or in part from federal
funds or in accordance with guarantees of a federal agency or financed from funds obtained by pledge of any
contract of a federal agency to make a loan, grant or annual contribution (except where a different meaning is
expressly indicated), and which is subject to the labor standards provisions of any of the acts listed in §5.1, the
following clauses (or any modifications thereof to meet the particular needs of the agency, Provided, That such
modifications are first approved by the Department of Labor):

(1) Minimum wages. (i) All laborers and mechanics employed or working upon the site of the work (or under
the United States Housing Act of 1937 or under the Housing Act of 1949 in the construction or development of
the project), will be paid unconditionally and not less often than once a week, and without subsequent deduction
or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of
Labor under the Copeland Act (29 CFR Part 3)), the full amount of wages and bona fide fringe benefits (or cash
equivalents thereof) due at time of payment computed at rates not less than those contained in the wage
determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any
contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics.

Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the
Davis-Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics,
subject to the provisions of paragraph (a)(1)(iv) of this section; also, regular contributions made or costs incurred
for more than a weekly period (but not less often than quarterly) under plans, funds, or programs which cover the
particular weekly period , are deemed to be constructively made or incurred during such weekly period. Such
laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for
the classification of work actually performed, without regard to skill, except as provided in §5.5(a)(4). Laborers
or mechanics performing work in more than one classification may be compensated at the rate specified for each
classification for the time actually worked therein: Provided, That the employer's payroll records accurately set
forth the time spent in each classification in which work is performed. The wage determination (including any
additional classification and wage rates conformed under paragraph (a)(1)(ii) of this section) and the Davis-Bacon
poster (WH-1321) shall be posted at all times by the contractor and its subcontractors at the site of the work in a
prominent and accesible place where it can be easily seen by the workers.

(ii)(A) The contracting officer shall require that any class of laborers or mechanics which is not listed in the
wage determination and which is to be employed under the contract shall be classified in conformance with the
wage determination. The contracting officer shall approve an additional classification and wage rate and fringe
benefits therefor only when the following criteria have been met:
(1) Except with respect to helpers as defined in 29 C.F.R. §5.2(n)(4), the work to be performed by the
classification requested is not performed by a classification in the wage determination; and
 IM P99-1

(2) The classification is utilized in the area by the construction industry; and
(3) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage
rates contained in the wage determination.
(4) With respect to helpers as defined in 29 C.F.R. §5.2(n)(4), such a classification prevails in the area in which
the work is performed.

(B) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their
representatives, and the contracting officer agree on the classification and wage rate (including the amount
designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting
officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S.
Department of Labor, Washington, D.C. 20210. The Administrator, or an authorized representative, will approve,
modify, or disapprove every additional classification action within 30 days of receipt and so advise the
contracting officer or will notify the contracting officer within the 30- day period that additional time is necessary.

(C) In the event the contractor, the laborers or mechanics to be employed in the classification or their
representatives, and the contracting officer do not agree on the proposed classification and wage rate (including
the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions,
including the views of all interested parties and the recommendation of the contracting officer, to the
administrator for determination. The administrator, or an authorized representative, will issue a determination
within 30 days of receipt and so advise the contracting officer within 30-day period that additional time is
necessary.

(D) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs
(a)(1)(ii)(B) or (C) of this section, shall be paid to all workers performing work in the classification under this
contract from the first day on which work is performed in the classification.

(iii) Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a
fringe benefit which is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the
wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof.
(iv) If the contractor does not make payments to a trustee or other third person, the contractor may consider as
part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona
fide fringe benefits under a plan or program, Provided, That the Secretary of Labor has found, upon the written
request of the contractor, that the applicable standards of the Davis-Bacon Act have been met. The Secretary of
Labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the
plan or program.
(2)Withholding. The (write in name of federal agency or the loan or grant recipient) shall upon its own action or
upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld
from the contractor under this contract or any other federal contract with the same prime contractor, or any other
federally assisted contract subject to Davis-Bacon prevailing wage requirements, which is held the same prime
contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and
mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full
amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any
apprentice, trainee, or helper, employed or working on the site of the work (or under the United States Housing
Act of 1937 or under Housing Act of 1949 in the construction or development of the project), all or part of the
wages required by the contract, the (agency) may, after written notice to the contractor, sponsor, applicant, or
owner, take such action as may be necessary to cause the suspension of any further payment, advance, or
guarantee of funds until such violations have ceased.
2
 IM P99-1

(3) Payrolls and basic records. (i) Payrolls and basic records relating thereto shall be maintained by the
contractor during the course of the work and preserved for a period of three years thereafter for all laborers and
mechanics working at the site of the work (or under the United States Housing Act of 1937, or under the Housing
Act of 1949, in the construction or development of the project). Such records shall contain the name, address, and
social security number of each such worker, his or her correct classification, hourly rates of wages paid (including
rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types
described in section 1(b)(2)(B) of the Davis Bacon Act), daily and weekly number of hours worked, deductions
made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the
wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits
under a plan or program described in section 1(b)(2)(B) of the Davis- Bacon Act, the contractor shall maintain
records which show that the commitment to provide such benefits is enforceable, that the plan or program is
financially responsible, and that the plan or program has been communicated in writing to the laborers or
mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such
benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence
of the registration of apprenticeship programs and certification of trainee programs, the registration of the
apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs.
(ii)(A) The contractor shall submit weekly for each week in which any contract work is performed a copy of all
payrolls to the (write in name of appropriate federal agency) if the agency is a party to the contract, but if the
agency is not such a party, the contractor will submit the payrolls to the applicant, sponsor, or owner, as the case
may be, for transmission to the (write in name of agency). The payrolls submitted shall set out accurately and
completely all of the information required to be maintained under §5.5(a)(3)(i) of regulations, 29 CFR Part 5.
This information may be submitted in any form desired. Optional Form WH-347 is available for this purpose and
may be purchased from the Superintendent of Documents (Federal Stock Number 029-005-00014-1), U.S.
Government Printing Office, Washington, D.C. 20402. The prime contractor is responsible for the submission of
copies of payrolls by all subcontractors.

(B) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or
subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract
and shall certify the following:
(1) That the payroll for the payroll period contains the information required to be maintained under §5.5(a)(3)(i)
of Regulations, 29 CFR Part 5 and that such information is correct and complete;
(2)That each laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract
during the payroll period has been paid the full weekly wages earned, without rebate, either directly or indirectly,
and that no deductions have been made either directly or indirectly from the full wages earned, other than
permissible deductions as set forth in Regulations, 29 CFR Part 3;
(3) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or
cash equivalents for the classification of work performed, as specified in the applicable wage determination
incorporated into the contract.

(C) The weekly submission of a properly executed certification set forth on the reverse side of Optional Form
WH-347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph
(a)(3)(ii)(B) of this section.

(D) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or
criminal prosecution under Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code.

3
 IM P99-1

(iii) The contractor or subcontractor shall make the records required under paragraph (a)(3)(i) of this section
available for inspection, copying, or transcription by authorized representatives of the (write the name of the
agency) or the Department of Labor, and shall permit such representatives to interview employees during working
hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available,
the federal agency may, after written notice to the contractor, sponsor, applicant, or owner, take such action as
may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore,
failure to submit the required records upon request or to make such records available may be grounds for
debarment action pursuant to 29 CFR §5.12.
(4)Apprentices and trainees---(i) Apprentices. Apprentices will be permitted to work at less than the
predetermined rate for the work they performed when they are employed pursuant to and individually registered in
a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training
Administration, Bureau of Apprenticeship and Training, or with a state apprenticeship agency recognized by the
bureau, or if a person is employed in his or her first 90 days of probationary employment as an apprentice in such
an apprenticeship program, who is not individually registered in the program, but who has been certified by the
Bureau of Apprenticeship and Training or a state apprenticeship agency (where appropriate) to be eligible for
probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in
any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force
under the registered program. Any worker listed on a payroll at an apprentice wage rate, who is not registered or
otherwise employed as stated above, shall be paid not less than the applicable wage rate on the wage
determination for the classification of work actually performed. In addition, any apprentice performing work on
the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable
wage rate on the wage determination for the work actually performed. Where a contractor is performing
construction on a project in a locality other than that in which its program is registered, the ratios and wages rates
(expressed in percentages of the journeyman's hourly rate) specified in the contractor's or subcontractor's
registered program shall be observed. Every apprentice must be paid at not less than the rate specified in the
registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate
specified in the applicable wage determination. Apprentices shall paid fringe benefits in accordance with the
provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits,
apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable
classification. If the administrator determine that a different practice prevails for the applicable apprentice
classification, fringes shall be paid in accordance with that determination. In the event the Bureau of
Apprenticeship and Training or a state apprenticeship agency recognized by the Bureau, withdraws approval of an
apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable
predetermined rate for the work performed until an acceptable program is approved.
(ii) Trainees. Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the
predetermined rate for the work performed unless they are employed pursuant to and individually registered in a
program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor
Employment and Training Administration. The ratio of trainees to journeymen on the job site shall not be greater
than permitted under the plan approved by the Employment and Training Administration. Every trainee must paid
at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a
percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid
fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention
fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the
Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with
the corresponding journeyman wage rate on the wage determination which provides for less than full fringe
benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and
participating in a training plan approved by the Employment and Training Administration shall be paid not less
4
 IM P99-1

than the applicable wage rate on the wage determination for the classification of work actually performed. In
addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program
shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In
the event the Employment and Training Administration withdraws approval of a training program, the contractor
will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work
performed until an acceptable program is approved.
(iii) Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this part
shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as
amended, and 29 CFR Part 30.
(iv)*
(5) Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR
Part 3, which are incorporated by reference in this contract.
(6) Subcontracts. The contractor or subcontractors shall insert in any subcontracts the clauses contained in 29
CFR §5.5(a)(1) through (10) and such other clauses as (write in the name of the federal agency).
may be appropriate or as instructions require, and also a clause requiring the subcontractors to include these
clauses in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any
subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR §5.5.
(7) Contract termination: debarment. A breach of the contract clauses in 29 CFR §5.5 may be grounds for
termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR §5.12.
(8) Compliance with Davis-Bacon and Related Act requirements. All rulings and interpretations of the Davis-
Bacon and Related Acts contained in 29 CFR Parts 1,3, and 5 are herein incorporated by reference in this contract.
(9) Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract
shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accordance
with the procedures of the Department of Labor set forth in 29 CFR Parts 5,6,and 7. Disputes within the meaning
of this clause include disputes between the contractor (or any of its subcontractors) and contracting agency, the
U.S. Department of Labor, or the employees or their representatives.
(10) Certification of eligibility.. (i) By entering into this contract, the contractor certifies that neither it (nor he
or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be
awarded government contracts by virtue of Section 3(a) of the Davis-Bacon Act or 29 CFR §5.12(a)(1).

(ii) No part of this contract shall be subcontracted to any person or firm ineligible for award of a government
contract by virtue of Section 3(a) of the Davis-Bacon Act or 29 CFR §5.12(a)(1).
(iii) The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001.
(b) Contract Work Hours and Safety Standards Act. The agency head shall cause or require the contracting
officer to insert the following clauses set forth in paragraphs (b)(1),(2),(3), and (4) of this section in full in any
contract subject to the overtime provisions of the Contract Work Hours and Safety Standards Act.

______________
*§ 5.5 (a)(4)(iv) removed. See June 26, 1992.
Federal Register.

These clauses shall be inserted in addition to the clauses required by §5.5(a) or §$4.6 of Part 4 of this title. As
used in this paragraph, the terms "laborers" and "mechanics" include watchmen and guards.
(1) Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which
may require or involve the employment of laborers or mechanics shall require or permit any such laborer or

5
 IM P99-1

mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours
in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and
one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek.
(2) Violation; liability for unpaid wages: liquidated damages. In the event of any violation of
the clause set forth in paragraph (b)(1) of this section the contractor and any subcontractor responsible therefore
shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United
States (in the case of work done under contract for the District of Columbia or a territory, to such District or to
such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each
individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in
paragraph (b)(1) of this section, in the sum of $10 for each calendar day on which such individual was required or
permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages
required by the clause set forth in paragraph (b)(1) of this section.
(3) Withholding for unpaid wages and liquidated damages. The (write in the name of the federal agency or the
loan or grant recipient) shall upon its own action or upon written request of an authorized representative of the
Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed
by the contractor or subcontractor under any such contract or any other Federal contract with the same prime
contractor, or any other federally assisted contract subject to the Contract Work Hours and Safety Standards Act,
which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any
liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause
set forth in paragraph (b)(2) of this section.
(4) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in
paragraph (b)(1) through (4) of this section and also a clause requiring the subcontractors to include these clauses
in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or
lower tier subcontractor with the clauses set forth in paragraphs (b)(1) through (4) of this section.
(c) In addition to the clauses contained in paragraph (b), in any contract subject only to the Contract Work Hours
and Safety Standards Act and not to any of the other statutes cited in §5.1, the agency head shall cause or require
the contracting officer to insert a clause requiring that the contractor or subcontractor shall maintain payrolls and
basic payroll records during the course of the work and shall preserve them for a period of three years from the
completion of the contract for all laborers and mechanics, including guards and watchmen, working on the
contract. Such records shall contain the name and address of each such employee, social security number, correct
classifications, hourly rates of wages paid, daily and weekly number of hours worked, deductions made, and
actual wage paid. Further, the agency head shall cause or require the contracting officer to insert in any such
contract a clause providing that the records to be maintained under this paragraph shall be made available by the
contractor or subcontractor for inspection, copying, or transcription by authorized representatives of the (write the
name of agency) and the Department of Labor, and the contractor or subcontractor will permit such
representatives to interview employees during working hours on the job.

6
 Information Memorandum P99-2

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: May 1, 1999

SUBJECT: Subcontracts

This Information Memorandum applies to all Public and Private

Provider Agencies that contract with the Department of Human
Services and award subcontracts as a means of providing third
party social services and training to individuals/families as
specified in the Contract. The intent of this information
memorandum is to provide subcontracting requirements that must be
followed by Provider Agencies to ensure that the Department of
Human Services receives quality services as contractually agreed
upon by the Provider and Department.

As stated in the Department’s Standard Language Document for

Social Service and Training Contracts, the Provider Agency may
not subcontract any of the services that it has committed to
perform or provide pursuant to the Contract without the prior
written consent of the Department. Such consent to subcontract
shall not relieve the Provider Agency of its full
responsibilities under the Contract. Consent to the
subcontracting of any part of the services shall not be construed
to be an approval of said subcontract or any of its terms, but
shall operate only as an approval of the Provider Agency’s
request for the making of a subcontract between the Provider
Agency and its chosen subcontractor. The Provider Agency shall
be responsible for all services performed by the subcontractor
and all such services shall conform to the provisions of the
Contract.

If a Provider Agency chooses to subcontract, it must ensure that

subcontractors comply with all applicable federal, State and
local laws, rules and regulations, including the Department’s
Standard Language Document and the Department’s Contract Policy
and Information Manual and Contract Reimbursement Manual. The
subcontract shall not be in conflict or less restrictive than any
of the Department of Human Services' policies or procedures. The
Provider shall outline in the Annex A of the Department Contract
 IM P99-2

a description of how the Provider intends to monitor any

subcontract it signs to ensure compliance with the Departmental
Contract.

The Provider shall also ensure that:

1. the subcontract document shall include, at a minimum:

a. terms and conditions written so that they do not

contradict or compromise any of the language in the
Department/Provider Agency Contract;

b. a program (service) description, including level of

service; and

c. a budget or rate(s).

2. the subcontract contains provision(s) for adequate

insurance, and a written assurance that the subcontractor
will indemnify, defend and hold harmless the State of New
Jersey and its employees from and against all claims,
demands, suits, actions recoveries, judgments and costs and
any other expenses therewith. The State of New Jersey shall
also be named as an additional insured on the
subcontractor's insurance coverage.

3. necessary licenses and credentials required by the

Departmental component are maintained by the
subcontractor(s).

4. the subcontractor maintains the confidentiality of all

subcontract client records and reports pertaining to the
client(s) served (N.J.S.A. 30:4-24.3); this includes any
medical condition(s) of the client(s), or any subject of a
personal or intimate nature regarding the client(s).

5. the Department and Provider Agency have access to all

subcontract documents applicable to the Departmental
Contract.

6. interim service and financial reports necessary to support

the contractual conditions and obligations of the
Department/Provider Agency Contract are complete and
received from the subcontractor(s) in a timely manner.

7. all subcontractors follow the audit requirements specified

in Department of Human Services’ Audit Requirements, Policy
Circular P7.06, as from time to time amended.

2
 IM P99-2

8. the fully executed subcontract and any copies required shall

be received by the Departmental Components within thirty
(30) Days of the subcontract begin date. The thirty (30)
Day time frame shall be applicable for any subsequent
subcontract amendments or modifications.

Submission of a fully executed subcontract shall be evidence that

the Provider has reviewed the subcontract and determined that it
complies with all of the requirements of this Information
Memorandum.

Issued by:

3
 Information Memorandum P99-3

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

To: Manual Holders

Date: April 25, 2005

Subject: Access to the Department of Human Services (DHS) Contract

Policy and Information Manual and Contract Reimbursement
Manual on the DHS Website.

Supersedes: Depository Libraries Availability of the Contract Policy and

Information Manual and Contract Reimbursement Manual, dated
May 1, 1999 and IMP97-5, Contract Manuals for Licensed Public
Accountants, dated December 15, 1997.

The purpose of this Information Memorandum is to advise Prospective Provider

Agencies and Individual Providers, as well as Contracted Provider Agencies,
audit firms and the public that the DHS Contracting Manuals, the Contract
Policy and Information Manual and the Contract Reimbursement Manual, are now
accessible for viewing and downloading from the DHS Website.

These Manuals can be accessed from the Office of Contract Policy and
Management (OCPM) webpage at: http://dhs.state.nj.us/humanservices . The
Contracting Manuals’ link is available from the webpage sidebar.

The $60.00 fee previously required for securing copies of the manuals and any
updates is no longer applicable nor required because of the availability of
the manuals on the web.

The Departmental Components will no longer be distributing manuals nor

updates. The Departmental Components may, at their discretion, from time to
time, notify provider agencies under contract of any department component-
specific policies. Otherwise, public notification of any changes to the
manuals is provided through web access (Changes/revisions to the manuals are
marked with an asterisk (*) during each calendar year).

The Manuals including all updates, will continue to be available at the NJ

State Depository Libraries in hard copy.

The DHS version of the manuals is the legally binding version.

Issued by:
 Policy Guideline PG00-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

To: Manual Holders

Date: August 1, 2000

Subject: Auditors Access to Client Records

Scope:

This interpretation applies to all Departmental Components.

Situation:

A DYFS Provider Agency refused to allow auditors to review client

records, using the Division of Mental Health Services regulation
N.J.A.C. 10:37-6.79, Confidentiality of Records, as the basis for the
refusal.

Policy Query:

Does an audit firm have the right to access client records during the
course of its work on a Provider Agency’s single or other legitimate
audit? Does Division of Mental Health Services regulation N.J.A.C.
10:37-6.79, Confidentiality of Records, preclude access to client
records by a CPA during the course of an audit?

Policy Interpretation:

In order to produce a complete and accurate audit, auditors must be

provided access to all Departmental Component client records in the
course of the audit to test compliance with laws, regulations and
contract specifications. CPAs are held to a code of ethics requiring
that information obtained through an audit be kept confidential.

The Division of Mental Health Services (DMHS) regulation, N.J.A.C.

10:37-6.79, Confidentiality of Records, generally prohibits the
release of client records except as indicated in the regulation. The
intent of the N.J.A.C. 10:37-6.79, Confidentiality of Records, is not
to prohibit auditors from reviewing client records in the course of
their audit. The Division, the State and the federal government
require audits; and consequently, section 6.79 (a) 1.iv.(1) of the
regulation allows disclosure of records to auditors who have been
designated as monitoring and site review staff by DMHS. When
 2 PG00-1

required, the auditor must present appropriate identification to

providers’ representatives or state officials.

In addition, P8.01, Access to Records and Facilities, Retention of

Contract Records, Confidentiality, states in section II.B.2. that
client records relating to the Contract must be made available in
order to permit audit examination. Section II.D.1. of the policy
indicates further that such audits shall be conducted in accordance
with generally accepted standards of privilege and confidentiality.

The development of this interpretation was in conjunction with the

Department of Human Services Office of Auditing, Office of Legal and
Regulatory Liaison and the Division of Mental Health Services.

Issued by:
 Information Memorandum P02-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: March 1, 2002

SUBJECT: Staff Attendance at Conferences or Other Events Sponsored by

Department of Human Services’ Provider Agencies.

The purpose of this Information Memorandum is to inform Provider

Agencies and Departmental Components of Department of Human Services
guidelines regarding Department staff attendance at Provider Agency
sponsored events.

DEFINITIONS

In addition to defined terms included in the Glossary of the Manual,

the following terms, when capitalized, shall have meanings as stated:

Approval means written permission from the Departmental Component’s

Ethics Liaison Officer to attend and/or participate in an Event; to
accept an honorarium or fee; and/or to accept Direct or Indirect
Benefits in connection with attendance.

Department Head means the administrative or executive head of the

State Official’s agency or his or her designee. The Commissioner of
Human Services has designated Departmental Component Ethics Liaison
Officers to grant the approval defined above.

Direct Benefit means acceptance by a State Official from the sponsor

of an Event or any other person of travel, meals, accommodation,
waiver of conference or Event fee or any other costs associated with
attending the Event for which no payment is made by the State but is
not intended to mean nominal refreshments such as nonalcoholic
beverages and snacks (bagels, doughnuts, pastries and cookies).

Event means a meeting, conference, seminar, speaking engagement,

symposium, training course, ground-breaking, ribbon cutting, meal,
open house, cocktail party, fundraiser, holiday party, social
function, or similar event that takes place away from the State
Official’s work location, is sponsored or co-sponsored by a non-
 2 IM PO2-1

government source and the invitation for which is extended to the

State Official because of his/her official position.

Indirect Benefit means acceptance by a State Official from the Event

sponsor or any other person of reimbursement for costs of travel,
meals, accommodation, event fees, or any other costs associated with
attending the Event for which no reimbursement is made by the State
but is not intended to mean nominal refreshments such as nonalcoholic
beverages and snacks (bagels, doughnuts, pastries and cookies).

Interested Party means 1. Any person, or employee, representative or

agent thereof, who is or may reasonably be anticipated to be subject
to the regulatory, licensing or supervisory authority of the State
Official’s agency; 2. Any supplier, or employee, representative or
agent thereof; 3. Any organization that advocates or represents the
positions of its members to the State Official’s agency; and/or, 4.
Any organization a majority of whose members are as described in
paragraphs 1 through 3 above.

Person means any individual, association, organization, firm,

partnership or corporation.

State Official means any State Officer or employee or special State

Officer or employee as defined in the Conflicts of Interest Law,
N.J.S.A. 52:13D-13(b) and (e).

GUIDELINES

Pursuant to N.J.A.C. 19:61-6, Department of Human Services staff may

not accept free slots to an Event unless there is a specific
stipulation in the Contract stating that a Departmental Component is
entitled to an identified number of complimentary seats. If a
Contract does not require a Provider Agency to provide complimentary
seats for staff to attend an Event, the acceptance of such an offer
would constitute the acceptance of a prohibited “Direct or Indirect”
Benefit. N.J.A.C. 19:61-6.4 prohibits State employees from accepting
a “Direct or Indirect Benefit” from a Contract Provider Agency, an
individual representing that Contract Provider Agency, or any other
Interested Party.

Departmental Components and Provider Agencies may negotiate

complimentary arrangements through Contract and discretionary grant
awards (in writing) to meet specific Departmental Component goals and
objectives. When appropriate, subsequent Contracts or grant award
notifications should stipulate (in writing) that the Contract or grant
funding is conditioned upon the allocation of a given number of
complimentary slots to the Department.
 3 IM PO2-1

If complimentary arrangements are not incorporated into the Contract

or grant award, the Department of Human Services Staff may attend the
Event if the staff person or division pays the registration fee.
Employees may not accept discounted rates that are offered exclusively
to their State entity. Departmental Components may accept discounted
rates only when the discount is offered equally to all State entities.

Department staff must secure prior approval from their Department Head
(i.e. supervisor, manager, Director, Assistant Commissioner, Chief of
Staff, Commissioner or designee) to attend any such Event. The prior
written approval of the Departmental Component’s Ethics Liaison
Officer to attend an Event shall be requested by completing the
attached Request for Approval for Attendance at Event form.
(Attachment 1)

If a State Official is making a speech, participating in a panel

discussion at the Event or is an accompanying resource person for the
speaker and/or panel participant, the State Official and resource
person may accept a Direct or Indirect Benefit (such as a meal) if
this Benefit is identical to the Benefits provided to other speakers
or panel participants. This applies to Events designed to provide
training, dissemination of information, or the exchange of ideas.
Approvals granted by the Ethics Liaison Officer under this exception
will be forwarded to the Executive Commission on Ethical Standards for
review.

Departmental Component Contract administrators should contact their

Departmental Component Ethics Liaison Officer if they have any
questions concerning this matter.

Attachment

Issued by:
 IM P02-1
Attachment 1
Request For Approval For Attendance At An Event
(Instructions on Reverse Side)

Department: ________________________ Division: _________________________________

Name: ________________________ Title: _________________________________

Office Address: _____________________________________________________________________

Voice Telephone Number: _____________ Fax Telephone Number: _____________________

Event*: _____________________________________________________________________________

*Event means a meeting, conference, seminar, speaking engagement, symposium, training

course, ground-breaking, ribbon-cutting, meal, open house, cocktail party,
fundraiser, holiday party, social function, or similar event that takes place away
from the State official’s work location, is sponsored or co-sponsored by a non-
government source and the invitation for which is extended to the State official
because of his/her official position.

Event Sponsor: ______________________________________________________________________

Is the Sponsor an Interested Party*? _______________Yes ______________No

*Interested Party means: 1. Any person, or employee, representative or agent thereof,

who is or may reasonably be anticipated to be subject to the regulatory, licensing or
supervisory authority of the State Official’s agent; 2. Any supplier, or employee,
representative or agent thereof; 3. Any organization that advocates or represents the
positions of its members to the State official’s agency; or, 4. Any organization a
majority of whose members are as described in paragraphs 1 through 3 above.

Location of the Event*: _____________________________________________________________

Date of the Event*: _________________________________________________________________

Is overnight accommodation required? ___________ Yes ____________________ No

Estimated cost: _______________________________
Is the Department or Division to pay cost? ___________ Yes ____________ No
Is the sponsor to pay cost? ________________ Yes _______________ No
Is the employee to pay cost? _______________ Yes _______________ No

Reason for attendance: _____________________________________________________________

_____________________________________________________________________________________

Will the sponsor offer an honorarium or fee to the employee? ______Yes_____No

Amount of honorarium? $__________________

__________________________________________ __________________________
Employee Signature Date
____________________________________________________________
Attendance Approved: _______ Yes _______No
Acceptance of honorarium approved: __________ Yes _________ No

Conditions: _________________________________________________________________________

__________________________________________ ___________________________
Signature Date
 2 IM PO2-1
Attachment 1

Request For Approval For Attendance At An Event

Instructions

1. All sections must be completed and cost information must be provided whether
the sponsor, the Department of Human Services or one of it divisions or the
employee is paying for the Event.
2. If the Event is sponsored by one or more private entities or the event is
co-sponsored by one or more private entities and a government entity an Event’s
form must be completed.
3. Approval must be given by the Ethics Liaison Officer prior to attendance at the
Event.
4. If the Event is solely sponsored by a federal, state, county or municipal
government entity, approval to attend is not required. A government entity
includes Rutgers University and all State colleges.
5. Approval to attend an Event shall be requested in writing on this form in
advance of the Event.

Guidelines for Attending Events

1. If the event is solely sponsored by a federal, state, county or municipal

government entity, approval to attend is not required. A government entity
includes Rutgers University and all State Colleges.

2. Nominal refreshments such as non-alcoholic beverages and snacks such as bagels,

doughnuts, pastries, and cookies may be accepted by an employee, the employee
need not pay personally or seek State payment for same.

3. If a State official is making a speech, participating in a panel discussion at

the Event or is an accompanying resource person for the speaker and/or
participant, the State official and resource person may accept a Direct or
Indirect benefit (such as a meal), if this benefit is identical to the benefits
provided to other speakers or panel participants. This applies to Events and
to the benefits provided to other speakers or panel participants. This applies
to Events designed to provide training, dissemination of information, or the
exchange of ideas.*

*Note: Since this is an exception to the rule which says a State official shall
not receive any Direct or Indirect Benefit from any source, approvals which are
granted by the Ethics Liaison Officer under this exception, must be forwarded
to the Ethics Commission for review.

4. Special Note: If you attend an Event where the refreshments turn out to be more
than nominal, such as a full-course dinner or a buffet or where entertainment
is provided, and you feel that it would be questionable to accept the benefit,
you may do one of several things:

a. You may offer to pay for the value of the benefit offered at the Event
itself. If you do so, please make sure that you pay by check or credit
card only so that you have a record of having paid.

b. You may wait until the next day, especially if you are unsure of whether
payment is necessary and call the sponsor of the Event, ascertain the
cost, and send a check or pay by credit card after the Event.

c. We have been advised by the Ethics Commission that it is unwise to pay by

cash. If you have no other choice, either get a receipt for the
transaction or send a confirming letter the next day.
 Information Memorandum P02-2

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: March 1, 2002

SUBJECT: Business Registration

The purpose of this Information Memorandum is to inform Provider

Agencies and Departmental Components about the State’s annual business
reporting requirements once a Provider Agency has filed their
incorporation papers with the State of New Jersey.

According to P.L. 2001, c. 134 (N.J.S.A. 52:32-44 et seq.) all profit

and non-profit corporations (domestic and foreign), as well as, all
limited partnerships, limited liability companies, and limited
liability partnerships must submit annual reports and associated fees
(annual business registration) each year commencing with the year
after their date of incorporation.

Unincorporated businesses, businesses owned by individuals or general

partnerships do not have to file for incorporation or register their
business annually.

Please note that no State agency (the Department) can contract with a
Provider Agency if the Provider has not filed for its incorporation
papers or filed its annual business registration commencing with the
year after becoming incorporated. Furthermore, no Provider Agency
that has a Contract with the Department shall enter into any
subcontract unless the subcontractor can demonstrate that it is
incorporated or its annual business registration is current.

Background

Annual business reporting is a prerequisite for maintaining active

business status. Annual reports contain vital business census data;
addresses, officer/director information, etc., which is used to update
the State’s public records system. This public information represents
the core of the State’s corporate/business status reporting system.
The commercial, financial and legal sectors rely heavily on this
reporting system for service of process and credit checks; while the
data collected assists in providing a uniform and reliable source of
contact information. In addition, this business information
integrates with all of the Treasurer’s public records systems and
 IM P02-2
2

serves as a mechanism for updating corporation office and agent

registration changes. It is important that businesses comply with
annual business report requirements given the overall significance the
information provides to the State’s public records system.

In accordance with State law, incorporated businesses that fail to

file annual reports for two consecutive years will have their business
registration revoked. If an entity’s business registration is
revoked, it may be reinstated by submitting the appropriate forms and
fees (see chart on last page).

Division of Revenue

The Division of Revenue automatically mails blank annual business

report forms approximately two (2) months prior to the due date. The
due date is the month of the business entity’s initial incorporation
or registration.

If your business does not receive an annual business reports form or

you need a reinstatement package; you may obtain the necessary form(s)
or package from the Annual Reports Unit of the Division of Revenue.
The reinstatement package includes all required blank forms,
instructions and fees due. The reinstatement package can be obtained
via the mailing address, telephone number, FAX number or Internet
address noted below.

NJ Treasury Department
Division of Revenue
PO Box 302
Trenton, NJ 08625
ATTN: Annual Reports, Forms Requests

Voice: (609) 292-9292

FAX: (609) 984-6849
Internet: www.state.nj.us/njbgs

IMPORTANT

For all form or reinstatement package requests, remember to provide:

the name of the business, a return address, and the business
registration number (10 digit ID), included on the Certificate of
Incorporation.

NOTE: For-Profit corporations must obtain a tax clearance certificate

before filing for reinstatment, this is also included in the
reinstatment package.
 IM P02-2
3

NOTE: Corporations subject to the Corporation Business Tax (CBT) must

now submit their tax payments and annual report concurrently, using an
integrated voucher called the CAR100. The CAR100 is part of the
corporate tax return package. It is important to note that the annual
report due date for subject corporations has been changed to coincide
with the corporate business tax due date (fiscal month plus 3.5
months). The Treasury’s Division of Revenue mails annual report forms
out to registered businesses approximately 2 months prior to the due
date. The due date is the month of the entity’s initial incorporation
or registration date. Corporations that have been on file with the
State of New Jersey for six (6) months or less are not required to
file an annual report.

Issued by:
 IM P02-2
Attachment 1

Reinstatement Fees

Business Type Annual Report Fees Reinstatement Fees

For-profit Corp All Delinquent Annual $70.00 ($50.00 for

Reports (variable); reinstatement, $20.00
Current Annual Reports filing tax clearance)
($40.00) plus $200.00 late
filing fee

Nonprofit Corp Current Annual Report $100.00

($15.00)

Limited Partnership All Delinquent Annual $50.00 for

Reports (variable); reinstatement filing
Current Annual Report plus $200.00 late
($40.00) filing fee

Limited Liability All Delinquent Annual $50.00 for

Partnership Reports (variable); reinstatement filing
Current Annual Reports plus $200.00 late
($40.00) filing fee

Limited Liability All Delinquent Annual $50.00 for

Company Reports (variable); reinstatement filing
Current Annual Reports plus $200.00 late
($50.00) filing fee
 Information Memorandum PO4-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: February 9, 2004

SUBJECT: Revised Audit Requirements, Policy Circular P7.06,

Section III, A. and B.

SUPERSEDES: Policy Circular P7.06, Section III A. and B., Promulgated

June 1, 2001.

The purpose of this Information Memorandum is to inform Provider

Agencies, their Independent Auditors and Departmental Components of
revisions to Policy Circular P7.06, Audit Requirements. The purpose
of the revision is to align Departmental audit requirements with those
recently promulgated by the Federal Office of Management and Budget
(Circular A-133) and New Jersey Office of Management and Budget
(Circular 04-04-OMB).

The following policy changes regarding audits of Departmental

Recipients are effective for fiscal years ending after December 31,
2003:

III. POLICY

A. All provider agencies which expend $500,000 or more in Federal or

State awards within their fiscal year, in which the Department is
the largest funding source (cognizant), must have an annual
single audit performed in accordance with Federal OMB Circular A-
133, New Jersey OMB Circular 04-04-OMB and Departmental policy.

B. All provider agencies which expend $100,000 or more in combined

Federal and State awards but less than $500,000 in Federal or
State awards within their fiscal year, in which the Department is
cognizant, must have an annual organization-wide financial
statement audit performed in accordance with Government Auditing
Standards (Yellow Book) and Departmental policy.

As a reminder, audit reports meeting the above requirements are due

within 120 days of the agency’s fiscal year-end and a copy should be
sent directly to the Office of Auditing in addition to forwarding to
the cognizant Departmental Component.
 Information Memorandum PO4-1

Departmental Component Contract administrators should contact the DHS

Office of Auditing if they have any questions concerning this matter.

Issued by:

2
 Information Memorandum P05-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

To: Manual Holders

DATE: August 11, 2005

SUBJECT: Cognizant Contracting

The purpose of this Information Memorandum is to clarify and affirm

the policies and procedures that will supplant certain portions of the
Cognizant Division Contracting policy P1.25 which has been rescinded.
Information herein is a reiteration of related existing policy in the
Contract Policy and Information Manual (CPIM).

Any contracts that include more than one DHS Departmental Component
may have their respective responsibilities stated in an
Interdivisional Agreement. If such an agreement is developed, all of
the involved Departmental Components must be included. Development of
an agreement is at the discretion of the involved Departmental
Components; however, if a provider requests development of such an
agreement, it may be considered by the involved Departmental
Components.

The involved Departmental Components shall determine which is the lead

Departmental Component and also the functions that will be assumed by
all DHS participants. The Lead Departmental Component may be changed
from time to time as deemed necessary by the involved Departmental
Components.

The provider agency’s fiscal year is to be used as the contract term

unless dictated by the funding source or when the term length of the
contract is atypical. Such exceptions must be stated in writing to the
provide agency.

The allowable General and Administrative costs must be identified for

the provider agency by the Departmental Components. The basis for the
G&A percentage must be stated in the contract.

For efficiency and convenience to the provider agency, only the DHS
standardized contract forms are to be used in processing contracts.
Any exceptions are listed on the Documents and Conditions Required for
Processing, Executing and Documenting a DHS Third Party Contract form,
P1.01.
 IM P05-1

Each Departmental Component shall maintain its own set of contract

documents. It is recognized that this can be a duplication of
paperwork for the provider, however, each Departmental Components has
its own file requirements and is responsible for internal controls.

Issued by:

2
 Information Memorandum P07-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: November 21, 2007

SUBJECT: Affirmative Action Requirements

SUPERCEDES: Information Memorandum P91-2, dated December 6, 1991

The purpose of this information memorandum is to inform Provider

Agency, Individual Providers and Departmental Component staff of
Affirmative Action legislation requirements that must be met by
organizations that contract with the Department of Human Services. In
accordance with N.J.S.A. 10:5-31 et seq., N.J.A.C. 17:27, the
Department of Human Services, as a public agency that awards social
service and training contracts and Individual Provider agreements,
must ensure that all contracting entities comply with the Affirmative
Action requirements of P.L. 1975, C. 127. The Department, as directed
by the State of New Jersey Department of the Treasury, Division of
Contract Compliance and Equal Employment Opportunities in Public
Contracts will include specific Affirmative Action language in the
Standard Language Document (SLD) for social services and training and
Individual Provider’s Contracts and provide Affirmative Action forms
to Provider Agencies and Individual Provider’s to obtain the necessary
State certification. The Departmental Components shall be responsible
for distributing the required State Affirmative Action initial
certification application (Attachment 3)to eligible Providers.

After the initial application process, the Division of Contract

Compliance will forward the renewal application to the Provider Agency
and/or Individual Provider. It is the Provider’s responsibility to
submit the forms to the Division of Contract Compliance and forward a
copy to the contracting Departmental Component. Upon receiving the
Certification of Employee Information Report the Provider
Agency/Individual Provider shall issue the Certificate to the
contracting Departmental Component.

The Department upon awarding any social services or training Contract

and Individual Provider Agreements must determine if either of the
following documents is on file at the Provider Agency:

1. A FEDERAL AFFIRMATIVE ACTION PLAN APPROVAL which is a valid

letter from the Office of Federal Contract Compliance Programs
(see Attachment 1). A photocopy of the Letter of Approval shall
be submitted to the Departmental Component with the completed
contract proposal package, but no later than seven Days after the
 Information Memorandum P07-1
actual signing and dating of the Contract by the Provider Agency
and/or Individual Provider.

OR

2. A CERTIFICATE OF EMPLOYEE INFORMATION REPORT which is a

certificate from the State Treasurer's Office (see Attachment 2).
A photocopy of a current certificate shall be submitted to the
Departmental Component with the completed contract proposal
package, but no later than seven Days after the actual signing
and dating of the Contract by the Provider Agency and/or
Individual Provider. If neither of the above documents is
available, then:

An AFFIRMATIVE ACTION EMPLOYEE INFORMATION REPORT (Form AA-302) (see

Attachment 3) enclosed with the contract proposal package shall be
completed. The AA-302 is a carbonized form consisting of four copies
which shall only be given to Providers that have been or will be
awarded a Contract.

The Provider Agency shall forward the completed copies as follows:

1) The white and canary copies shall be submitted to the State
Department of the Treasury's Division of Contract Compliance
address shown below.

State of New Jersey

Department of the Treasury
Division of Contract Compliance & Equal Employment
Opportunities in Public Contracts
P.O. Box 209
Trenton, NJ 08625-0209

2) The pink copy shall be sent to the contracting Departmental

Component as part of the completed contract proposal package.

3) The gold copy shall be retained and filed by the Provider Agency
in the Contract file.

If the Provider Agency does not submit either the Federal Affirmative
Action Plan Approval letter or a current Certificate of Employee
Information Report within the required time frame, the Departmental
Component may extend the compliance time period to fourteen total Days
after the actual signing and dating of the Contract by the Provider
Agency. If the appropriate documentation cannot be produced within
the seven Day extension, the Departmental Component must declare the
Provider Agency as being non-responsive and stop all Contract
proceedings.

The Departmental Component may award a Contract in an emergency

situation without following the Affirmative Action procedures outlined
above. This may occur only if the Departmental Component documents
that an actual or imminent emergency exists which requires the
 Information Memorandum P07-1
Departmental Component to immediately award a Contract for service(s)
because a delay would endanger the health, safety or welfare of the
Department's clients.

The Departmental Component shall maintain a copy of the appropriate

Affirmative Action document on file for review by the State Treasury
Department's Division of Contract Compliance until expiration. The
Federal Affirmative Action Plan Approval letter expires one year from
the date on the letter. The Certificate of Employee Information
Report has an expiration date on the certificate.

Any questions or comments concerning the Affirmative Action

requirements should be referred to the State Treasury Department's
Division of Contract Compliance at (609)-292-5475.

Issued by:
 Information Memorandum P09-1
Attachment A

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: July 20, 2009

EFFECTIVE: This Information Memorandum will become effective

immediately.

SUBJECT: New Site for the Publication of the Department of

Human Services’ (DHS) Notice of the Availability
of Grant Funds

SUPERCEDES: Policy Circular P1.04, Request for Proposal,

Procedures Section, Paragraph 1, subsection a.,
paragraph 1.

The purpose of this Information Memorandum is to advise DHS

Contracted Provider Agencies, Individual Providers, Prospective
Provider Agencies and the Citizens of New Jersey that the
Department of Human Services has changed its location for the
public announcements of the availability of grant funds in the
accordance with N.J.S.A.52:14-34.4 et seq. The Department of
Human Services will discontinue publishing in the New Jersey
Register, as of this date, and will utilize the DHS existing web
site as its main publication site. The DHS web site permits for
reasonable access and competition for all.

To access the Department of Human Services’ Webpage for viewing

and downloading Public Notices and Request for Proposals, please
utilize the following URL address:
www.state.nj.us/humanservices/providers/grants/nofa/index.html.

Each DHS departmental component publishing a Public Notice and

Request for Proposal on the DHS web site will also publish on
their web site.

Twice a year the Office of Contract Policy and Management will

publish in the New Jersey Register a notification of the
availability of grant funds with the DHS URL address for
continued viewing and downloading of Public Notices and Request
for Proposals.(Attachment A)
DEPARTMENT OF HUMAN SERVICES
AGENCY WEBSITE POSTING OF NOTICES OF GRANT AVAILABILITY

Public Notice of Available Grant Funds

Take notice that, in compliance with N.J.S.A. 52:14-34.4 et seq. (P.L.

1987, c. 7), the Department of Human Services hereby publishes notice of
the availability of grant funds on its web site at
http://www.state.nj.us/humanservices/providers/grants/nofa/index.html .
Copies of the notices can be downloaded at the site or by contacting the
issuing DHS contracting unit.
 Policy Guidelines PG 93-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: June 7, 1993

SUBJECT: Loans to Provider Agency Employees

Policy Query: Allowability of Using Contract Funds for Employee Loans

A Provider Agency has instituted a policy/practice allowing

certain agency employees and Board members to make personal
purchases on the agency's corporate credit card established for
Provider Agency use. The Agency, which is required to pay the
account in full each month, allows the employees/Board members to
make monthly payments on these personal purchases, including an
interest charge when payments are made in installments. Is this
an acceptable use of Contract dollars?

Policy Interpretation:

The Department of Human Services contracts with Provider Agencies

to provide certain services to the Department's clients. The
Provider Agency most show effective control over and
accountability for all funds and other assets, as well
as,adequately safeguard all such assets and assure that they are
used solely for the authorized purposes. The Contract
Reimbursement Manual indicates that the portion of the Provider
Agency's operations paid by the Department under a Contract must
relate to services delivered to Contract clients. Accordingly, in
P9.05, Contract Default, a Provider Agency is in Default of the
Contract if there is "use of Contract funds for purposes other
than as approved by the Department and specified in the
Annex(es)." Using Contract funds for personal debts or staff
loans is not an essential requisite of the Contract and,
therefore, is not an allowable use of Contract funds.

Issued by:
 Policy Guidelines P97-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

TO: Manual Holders

DATE: February 1, 1997

SUBJECT: Department Equitable Interest in Contract Purchased Equipment

Policy Query:

How should the Department calculate its equitable interest for

Equipment purchased with Contract funds? Should the calculation be
accomplished before or after other revenues are used to offset Contract
funding?

Policy Interpretation:

Revenue as defined in Section 4.2 of the Department’s Contract

Reimbursement Manual (CRM) is the total income generated by the
Provider Agency by means of its programs and activities. Such income
comes from various sources such as other government contracts and
grants, payments from non-contract clients, foundation grants,
contributions, third party health insurance, fund raising, investment
income and miscellaneous sources and credits.

Department Contract Generated Revenue as defined in the CRM includes

all income generated by the Provider Agency in connection with the
delivery of Contract services such as Department client fees, any
interest, dividends, etc., earned on Department funds, third party
insurance such as Medicare and Medicaid, and Department rental
agreements.

Note: The Department considers all Department and federal funds

expended through a Department Contract as public funding,
such funding shall be recognized as contributory financing
towards the determination of equitable interest (See
Department Policy Circular P4.05).

The Department’s equitable interest for cost related Contracts shall be

determined in the following manner:

1) Equipment purchased using 100% Department funds will have a

Department equitable interest of 100%, as long as there is
documentation to support the purchase.
 2 PG97-1

2) When the Department is not the only funder, then the

Department’s equitable interest in Equipment purchased shall
be the Department’s percentage of Contract participation in
the program for which the Equipment was acquired, plus any
Department Contract Generated Revenue divided by the Provider
Agency’s annual total cost to operate that program.

Example:

The Department’s Contract participation rate is 75%, and the

Provider Agency during the Contract term purchases a $20,000
vehicle and the Department covers the entire purchase price of the
vehicle, what is the State’s equitable interest in the vehicle?
Since the Department provided the entire amount of the purchase,
the Department’s equitable interest in the vehicle is 100%. If
the purchase is made during the Contract year with funds from the
Provider’s total operating budget, the equitable interest would be
75% since the Department furnishes 75% of the Provider’s total
annual budget.

The Department’s percentage of interest (equitable interest) in the

Equipment is the same percentage as the Department’s share of the
Contract Total Cost. The equitable interest for Contract purchased
Equipment shall be calculated using the Reimbursable Ceiling line added
to any Department Contract Generated Revenue divided by the Total Cost
line of the Annex B: Contract Expense Summary form. The calculation
shall be accomplished before the Department Contract Generated Revenues
are used to offset the Total Cost line. The Department’s equitable
interest shall be determined during Contract negotiations or adjusted,
as appropriate, at the time of any Contract Modification, not after the
Contract has expired.

Example:

The Department’s Reimbursable Ceiling line on the Annex B:

Contract Expense Summary form is $50,000, the Department Contract
Generated Funds are $15,000, and non-Department funds are $35,000
equaling the Total Cost line of $100,000, then:

$50,000 + $15,000 = 65% Equitable Interest

$100,000

After the Department’s equitable interest is determined, it shall be

entered on the Provider Agency’s Equipment inventory records and kept
on file at the Provider Agency. The Provider Agency shall list the
Department’s equitable interest on the budget’s Schedule 6: Cost of
Equipment form prior to Contract signature. The Equipment schedule
shall serve as the supporting document to the Contract budget for
identifying the Department’s equitable interest of any purchased
Contract items. If necessary, the equitable interest may be revised,
as appropriate, and noted on a new Schedule 6: Cost of Equipment form
and secured to Attachment A of the P1.10 Contract Modification form.
 3 PG97-1

The revised percentage shall then be used to calculate any future

Department equitable interest in Equipment purchased through the
Contract.

Issued By:
 Policy Guideline PG00-1

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

To: Manual Holders

Date: August 1, 2000

Subject: Auditors Access to Client Records

Scope:

This interpretation applies to all Departmental Components.

Situation:

A DYFS Provider Agency refused to allow auditors to review client

records, using the Division of Mental Health Services regulation
N.J.A.C. 10:37-6.79, Confidentiality of Records, as the basis for the
refusal.

Policy Query:

Does an audit firm have the right to access client records during the
course of its work on a Provider Agency’s single or other legitimate
audit? Does Division of Mental Health Services regulation N.J.A.C.
10:37-6.79, Confidentiality of Records, preclude access to client
records by a CPA during the course of an audit?

Policy Interpretation:

In order to produce a complete and accurate audit, auditors must be

provided access to all Departmental Component client records in the
course of the audit to test compliance with laws, regulations and
contract specifications. CPAs are held to a code of ethics requiring
that information obtained through an audit be kept confidential.

The Division of Mental Health Services (DMHS) regulation, N.J.A.C.

10:37-6.79, Confidentiality of Records, generally prohibits the
release of client records except as indicated in the regulation. The
intent of the N.J.A.C. 10:37-6.79, Confidentiality of Records, is not
to prohibit auditors from reviewing client records in the course of
their audit. The Division, the State and the federal government
require audits; and consequently, section 6.79 (a) 1.iv.(1) of the
regulation allows disclosure of records to auditors who have been
designated as monitoring and site review staff by DMHS. When
 2 PG00-1

required, the auditor must present appropriate identification to

providers’ representatives or state officials.

In addition, P8.01, Access to Records and Facilities, Retention of

Contract Records, Confidentiality, states in section II.B.2. that
client records relating to the Contract must be made available in
order to permit audit examination. Section II.D.1. of the policy
indicates further that such audits shall be conducted in accordance
with generally accepted standards of privilege and confidentiality.

The development of this interpretation was in conjunction with the

Department of Human Services Office of Auditing, Office of Legal and
Regulatory Liaison and the Division of Mental Health Services.

Issued by: