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Office of Mental Health

Document Requirements for Amendment OMH Local Assistance Contracts
with Amendment Numbers Greater Than "0"

(e.g. Contract C00XXXX/1 from the Contract Summary Report by Contract)

Item Non-Residential
Residential Funds Shelter Plus Care

Contract Face Pages 1 & 2

Contract Signature Page X X X
Attachment B-4 Net Deficit Budget (Amendment) X1 X1 X1
Attachment  C (Work Plan) X X X
Attachment D (Payment and Reporting Schedule) X X X
Residential Program Rider   X  
HCBS Waiver Program Rider PDF Document X2    
Assisted Outpatient Treatment Rider X3 X3  
Vendor Responsibility Questionnaire Leaving OMH site X X X
Proof of NYS Workers’ Compensation (or exemption) X X X
Proof of NYS Disability Benefits Insurance (or exemption) X X X
NY Charities Registration (or exemption) X X X
1 Budget is submitted electronically through Consolidated Fiscal Reporting System (CFRS); do not submit paper copy.
2 Required for contracts with OMH Children’s HCBS Waiver Programs only.
3 For outpatient treatment programs involving court ordered population only.

March 2015