Skip to Main Content

Office of Mental Health

New York State Consolidated Budget and Claiming Manual Subject: CQR-3 LGU Fiscal Summary Section: 24
For the Periods:
January 1, 2009 to December 31, 2009
July 1, 2009 to June 30, 2010
Issued: September 9, 2009

View Adobe Acrobat Version | Download Adobe Acrobat Reader

The CQR-3 LGU Fiscal Summary schedule is completed by Local Governmental Units (LGUs) located outside of the City of New York. 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 LGU.

Additionally, the CQR-3 is used to establish the basis for reimbursing small counties 75% of the first $100,000 in net operating costs incurred under Regular Local Assistance funding (funding code 001). Small counties are defined as counties with populations less than 200,000.

Note: The NYS Office of Mental Health (OMH) does not require the submission of the CQR-3 schedule. The OMH Aid to Localities Financial System (ALFS) will generate the CQR-3 schedule for each LGU.

General Instructions

  1. Separate OASAS-specific and/or OMRDD-specific CQR-3 schedules must be prepared.
  2. Mid-year and year-end CQR-3 schedules are completed. Mid-year CQR-3s cover the first six (6) months of the fiscal reporting period and year-end CQR-3s cover the full 12 month fiscal reporting period.
  3. The source(s) of the fiscal information summarized on the CQR-3 is as follows:

    Mid-Year Claims: Use the funding code and funding code index information reported on page CQR-1.2 of the Agency Quarterly Fiscal Summaries (CQR-1s) submitted by county operated and local contract funded not-for-profit service providers.

    Year-end Claims: Use the funding code and funding code index information reported on the Aid to Localities and Direct Contracts Program Funding Source Summaries (DMH-3s) submitted by county operated and local contract funded not-for-profit service providers.

  4. Additional CQR-3 continuation schedules are required if:
    1. there are more than seven (7) funded service providers and/or
    2. more than five (5) unique funding code and funding code index combinations.
  5. The overall flow of the CQR-3 schedule is as follows:
    • Column 2 displays the sum of columns 3–7 (or more if required) exclusive of line 28.
  6. Do not include OASAS and OMRDD direct contract funded programs' fiscal information on the CQR-3 schedule.

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. 01/01/XX to 12/31/XX).

Quarter Reported *
Indicate the specific claim period the CQR-3 covers (i.e. 1st quarter, 2nd quarter, mid-year or final).

County Name and Code *
Enter the name and associated two (2) digit code for the county where the reported programs operated and/or were funded through a local county contract. Please see Appendix C of this manual and the Consolidated Fiscal Reporting and Claiming Manual (CFR Manual) for a list of New York State counties and their associated county codes.

Prepared by *
Enter name of person that prepared the CQR-3 and can answer questions about the information contained in the document.

Title *
Enter the title of the person that prepared the CQR-3 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 LGU that has reviewed and approved the expenses, revenues, net operating costs and funding code information reported on the CQR-3.

* Complete this at the top of each page of the CQR-3.

Title *
Enter the title of the person that reviewed and approved the CQR-3.

Date Approved *
Enter the date the LGU reviewed CQR-3 was approved.

Funding Code Information (Columns 3-7) *

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 24.1, General Instructions, item 4 for information on the use of CQR-3 continuation sheets.

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.

Line Instructions

Lines 1-21 – Agency Identification Information

Lines 1, 4, 7, 10, 16 and 19 – Agency Name
Enter the names of the organizations operating the reported programs.

Lines 1, 4, 7, 10, 16 and 19 – Agency Code
Enter the five (5) digit codes assigned to the organizations operating the reported program(s).

* Complete this at the top of each page of the CQR-3.

Columns 3-7 – Lines 1-21 - 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 24.1, General Instructions, item 4 for information on the use of CQR-3 continuation sheets.

Lines 1, 4, 7, 10, 16 and 19 – Total Expenses
For each service provider reported, enter the total expenses for the reporting period in the appropriate funding code/index columns.

Lines 2, 5, 8, 11, 14, 17 and 20 – Revenues
For each service provider reported, enter the total revenues for the reporting period in the appropriate funding code/index columns.

Lines 3, 6, 9, 12, 15, 18 and 21 – 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.

Columns 3-7 – Lines 22-24 – Page Total Information

  1. Total Expenses
    Enter the sum of the amounts reported on lines 1, 4, 7, 10, 16 and 19 for each funding code and funding code index combination used.
  2. Revenues
    Enter the sum of the amounts reported on lines 2, 5, 8, 11, 14, 17 and 20 for each funding code and funding code index combination used.
  3. Net Operating Costs
    Enter the sum of the amounts reported on lines 3, 6, 9, 12, 15, 18 and 21 for each funding code and funding code index combination used.

Columns 3-7 – Lines 25-31 – County Total Information (Last page(s) of CQR-2 only)

  1. Total Expenses
    On the last set of CQR-3 continuation sheets, enter the sum of the amount(s) reported on line 22 of each CQR-3 for each funding code and funding code index combination used.
  2. Revenues
    On the last set of CQR-3 continuation sheets, enter the sum of the amount(s) reported on line 23 of each CQR-3 for each funding code and funding code index combination used.
  3. Net Operating Costs
    On the last set of CQR-3 continuation sheets, enter the sum of the amount(s) reported on line 24 of each CQR-3 for each funding code and funding code index combination used.
  4. Reimbursement Rate
    For each funding code and funding code index combination used in columns 3-7, enter the applicable reimbursement rate for that funding code and funding code index combination on the last set of CQR-3 continuation sheets.
  5. State Aid Subtotal
    For each funding code and funding code index combination used in columns 3-7, enter the State Aid amount calculated by applying the reimbursement rate entered on line 28 to the amount entered on line 27 of the last set of CQR-3 continuation sheets.
  6. Extra $25,000
    In the column used for funding code 001 on the last set of CQR-3 continuation sheets, LGUs with a population of 200,000 or less should calculate an additional 25% reimbursement of the net operating costs reported on line 27 up to the approved OASAS or OMRDD limit.
  7. State Aid Total
    On the last set of CQR-3 continuation sheets, enter the sum of the amounts reported on lines 30 and 31.

Column 2 State Agency Total Information - Lines 1-20

Lines 1, 4, 7, 10, 16 and 19 – Total Expenses
For each service provider reported, enter the sum of the expenses reported on these lines in columns 3-7.

Lines 2, 5, 8, 11, 14, 17 and 20 – Revenues
For each service provider reported, enter the sum of the revenues reported on these lines in columns 3-7.

Lines 3, 6, 9, 12, 15, 18 and 21 – Net Operating Costs
For each service provider reported, enter the sum of the net operating costs reported on these lines in columns 3-7.

Column 2 – Page Total Information - Lines 22-24

  1. Total Expenses
    Enter the sum of the amounts reported on lines 1, 4, 7, 10, 16 and 19 of column 2.
  2. Revenues
    Enter the sum of the amounts reported on lines 2, 5, 8, 11, 14, 17 and 20 of column 2.
  3. Net Operating Costs
    Enter the sum of the amounts reported on lines 3, 6, 9, 12, 15, 18 and 21 of column 2.

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

  1. Total Expenses
    On the last set of CQR-3 continuation sheets, enter the sum of the amounts reported on line 22 of each CQR-3 submitted.
  2. Revenues
    On the last set of CQR-3 continuation sheets, enter the sum of the amounts reported on line 23 of each CQR-3 submitted
  3. Net Operating Costs
    On the last set of CQR-3 continuation sheets, enter the sum of the amounts reported on line 24 of each CQR-3 submitted.
  4. Reimbursement Rate
    Make no entry.
  5. State Aid Subtotal
    On the last set of CQR-3 continuation sheets, enter the State Aid amount calculated for each funding code and funding code index combination used in columns 3-7 by applying the reimbursement rate entered on line 28 to the amount entered on line 27.
  6. Extra $25,000
    On the last set of CQR-3 continuation sheets, LGUs with population of 200,000 or less should calculate an additional 25% reimbursement of the net operating costs reported on line 27 under funding code 001.
  7. State Aid Total
    On the last set of CQR-3 continuation sheets, enter the sum of the amounts reported on lines 30 and 31.

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