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Office of Mental Health

New York State Consolidated Budget and Claiming Manual Subject: CQR-2 NYC Fiscal Summary Section: 23
For the Periods:
January 1, 2009 to December 31, 2009
July 1, 2009 to June 30, 2010
Issued: September 9, 2009

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The CQR-2 NYC Fiscal Summary schedule is completed by the NYC Department of Health and Mental Hygiene (NYC DOHMH). It summarizes mid-year and year-end fiscal activity for service providers receiving Aid to Localities (State Aid) funding from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) and the NYS Office of Mental Retardation and Developmental Disabilities (OMRDD) through a local contract with the NYC DOHMH. Additionally, the CQR-2 is used to establish accountability for advance payments made to local contract funded service providers by the NYC DOHMH.

Note: The NYS Office of Mental Health (OMH) does not require the submission of the CQR-2 schedule.

General Instructions

  1. Separate OASAS-specific and/or OMRDD-specific CQR-2 schedules must be prepared.
  2. The mid-year CQR-2 reports fiscal data for the first six (6) months of the fiscal reporting period. The year end CQR-2 reports fiscal data for the full 12 months of the fiscal reporting period.
  3. Additional CQR-2 continuation schedules are required if:
    1. there are more than five (5) funded service providers and/or
    2. more than five (5) unique funding code and funding code index combinations.
  4. The overall flow of the CQR-2 schedule is as follows:
    • Column 2 displays the sum of columns 3–7 (or more if required) exclusive of line 30.

Heading Instructions
State Agency *
Indicate whether the reported programs are for either OASAS services or OMRDD services.

Fiscal Period *
Enter the beginning and ending dates of the complete 12 month fiscal reporting period (i.e. 07/01/XX to 06/31/XY).

Quarter Reported *
Indicate the specific intra-year claim period the CQR-1 covers (i.e. 1st quarter, 2nd quarter, mid-year, etc.).

* Complete this at the top of each page of the CQR-2.

Prepared by *
Enter name of person that prepared the CQR-2 and can answer questions about the information contained in the document.

Title *
Enter the title of the person that prepared the CQR-2 and can answer questions about the information contained in the document.

Telephone *
Enter the preparer's telephone number.

LGU Approval By *
Enter the name of the individual representing the NYC DOHMH that has reviewed and approved the expenses, revenues, net operating costs and funding code information reported on the CQR-2.

Title *
Enter the title of the person that reviewed and approved the CQR-2.

Date Approved *
Enter the date the LGU reviewed CQR-2 was approved.

Funding Code Information (Columns 3-7) *
For each reported service provider, enter the applicable three (3) digit funding code(s) used during the reporting period.

OASAS Note: Funding codes used for OASAS funded county operated and not-for-profit service providers must also include the alphabetic funding source index. The funding code and funding code index combinations used must be consistent with those used in the service provider's most recently approved budget.

County operated and local contract funded not-for-profit service providers can find the correct funding code and funding code indexes to use on the most recently issued OASAS Approval Letter for the fiscal reporting period.

Only one (1) unique funding code or funding code/funding code index combination can be used on each line.

* Complete this at the top of each page of the CQR-2.

Line Instructions

Lines 1-20 – Agency Identification Information

Lines 1, 5, 9, 13 and 17 – Agency Name
Enter the names of the organizations operating the reported programs.

Lines 2, 6, 10, 14 and 18 – Agency Code
Enter the five (5) digit codes assigned to the organizations operating the reported program(s).

Lines 4, 8, 12, 16 and 20 – NYC Contract Number
Enter the NYC DOHMH contract number associated with the agencies entered on lines 1, 5, 9, 13 and 17.

Column 3-7 – Lines 1-20 - Service Provider Funding Code Information
Note: There will be more than seven (7) columns if more than five (5) unique funding code and funding code indexes are used. Please see page 23.1, General Instructions, item 3 for information on the use of CQR-2 continuation sheets.

Lines 1, 5, 9, 13 and 17 – Total Expenses
For each service provider reported, enter the total expenses for the reporting period in the appropriate funding code/index columns.

Lines 2, 6, 10, 14 and 18 – Revenues
For each service provider reported, enter the total revenues for the reporting period in the appropriate funding code/index columns.

Lines 3, 7, 11, 15 and 19 – Net Operating Costs
For each service provider reported, enter the total net operating costs for the reporting period in the appropriate funding code/index columns.

Lines 4, 8, 12, 16 and 20 – Advances
For each service provider reported, enter the total advance payments provided for the reporting period in the appropriate funding code/index columns.

Columns 3-7 – Lines 3-24 – Page Total Information
Note:
There will be more than seven (7) columns if more than five (5) unique funding code and funding code indexes are used. Please see page 23.1, General Instructions, item 3 for information on the use of CQR-2 continuation sheets.

  1. Total Expenses
    Enter the sum of the amounts reported on lines 1, 5, 9, 13 and 17 for each funding code and funding code index combination used.
  2. Revenues
    Enter the sum of the amounts reported on lines 2, 6, 10, 14 and 18 for each funding code and funding code index combination used.
  3. Net Operating Costs
    Enter the sum of the amounts reported on lines 3, 7, 11, 15 and 19 for each funding code and funding code index combination used.
  4. Advances
    Enter the sum of the amounts reported on lines 4, 8, 12, 16 and 18 for each funding code and funding code index combination used.

Columns 3-7 – Lines 25-31 – NYC Total Information (Last page(s) of CQR-2 only)
Note: There will be more than seven (7) columns if more than five (5) unique funding code and funding code indexes are used. Please see page 23.1, General Instructions, item 3 for information on the use of CQR-2 continuation sheets.

  1. Total Expenses
    On the last set of CQR-2 continuation sheets, enter the sum of the amount(s) reported on line 21 of each CQR-2 for each funding code and funding code index combination used.
  2. Revenues
    On the last set of CQR-2 continuation sheets, enter the sum of the amount(s) reported on line 22 of each CQR-2 for each funding code and funding code index combination used.
  3. Net Operating Costs
    On the last set of CQR-2 continuation sheets, enter the sum of the amount(s) reported on line 23 of each CQR-2 for each funding code and funding code index combination used.
  4. Advance Amount
    On the last set of CQR-2 continuation sheets, enter the sum of the amount(s) reported on line 24 of each CQR-2 for each funding code and funding code index combination used.
  5. Total Net/Advances
    On the last set of CQR-2 continuation sheets, enter the sum of the amounts reported on lines 27 and 28 of each CQR-2 for each funding code and funding code index combination used.
  6. Reimbursement Rate
    On the last set of CQR-2 continuation sheets, enter the applicable reimbursement rate for each funding code and funding code index combination used.
  7. State Aid Total
    On the last set of CQR-2 continuation sheets enter the State Aid amount calculated by applying the reimbursement rate entered on line 30 to the amount entered on line 29 for each funding code and funding code index combination used.

Column 2 State Agency Total Information - Lines 1-20

Lines 1, 5, 9, 13 and 17 – Total Expenses
For each service provider reported, enter the sum of the expenses reported on these lines in columns 3-7.

Lines 2, 6, 10, 14 and 18 – Revenues
For each service provider reported, enter the sum of the revenues reported on these lines in columns 3-7.

Lines 3, 7, 11, 15 and 19 – Net Operating Costs
For each service provider reported, enter the sum of the net operating costs reported on these lines in columns 3-7.

Lines 4, 8, 12, 16 and 20 – Advances
For each service provider reported, enter the sum of the advances reported on these lines in columns 3-7.

Column 2 – Page Total Information - Lines 21-24

  1. Total Expenses
    Enter the sum of the amounts reported on lines 1, 5, 9, 13 and 17 of column 2.
  2. Revenues
    Enter the sum of the amounts reported on lines 2, 6, 10, 14 and 18 of column.
  3. Net Operating Costs
    Enter the sum of the amounts reported on lines 3, 7, 11, 15 and 19 of column 2.
  4. Advances
    Enter the sum of the amounts reported on lines 4, 8, 12, 16 and 18 of column 2.

Column 2 – NYC Total Information - Lines 25-31 (Last page(s) of CQR-2 only)

  1. Total Expenses
    On the last set of CQR-2 continuation sheets, enter the sum of the amounts reported on line 21 of each CQR-2 submitted.
  2. Revenues
    On the last set of CQR-2 continuation sheets, enter the sum of the amounts reported on line 22 of each CQR-2 submitted.
  3. Net Operating Costs
    On the last set of CQR-2 continuation sheets, enter the sum of the amounts reported on line 23 of each CQR-2 submitted.
  4. Advance Amount
    On the last set of CQR-2 continuation sheets, enter the sum of the amounts reported on line 24 of each CQR-2 submitted.
  5. Total Net/Advances
    On the last set of CQR-2 continuation sheets, enter the sum of the amounts reported on lines 27 and 28 of each CQR-2 submitted.
  6. Reimbursement Rate
    Make no entry.
  7. State Aid Total
    On the last set of CQR-2 continuation sheets, enter the sum of the amounts reported on line 31 of each CQR-2 submitted.

Comments or questions about the information on this page can be directed to the Community Budget & Financial Management (CBFM) Group.