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Office of Mental Health

Document Requirements for New OMH Local Assistance Contracts
with Amendment Number "0"

(e.g. Contract C00XXXX/0 from the Contract Summary Report by Contract)

Item Non-Residential
Funds
Residential
Funds
Shelter Plus Care Funds Legislative Special Projects

Contract Face Pages 1 & 2 PDF Document

X X X X
Contract Signature Page PDF Document X X X X
Master Contract for Grants/Standard Terms and Conditions PDF Document X X X X
Attachment  A-1 (OMH Specific Clauses) PDF Document X X X X
Attachment A-1(a) MWBE and EEO Requirements PDF Document X X X X
Attachment A-2 (Federally Funded Grants) PDF Document X1 X1 X1  
Attachment A-2(a) Shelter Plus Care Regulations PDF Document     X  
Attachment B-4 (Net Deficit Budget) PDF Document X2 X2 X2 X2
Attachment C (Work Plan) PDF Document X X X X
Attachment D (Payment and Reporting Schedule) PDF Document X X X X
Attachment E (Certification of Licensed Programs - to be completed by OMH) PDF Document X3 X3    
Attachment F (Business Associate Agreement) PDF Document X X X X
Residential Program Rider PDF Document   X    
HCBS Waiver Program Rider PDF Document X4      
Assisted Outpatient Treatment Rider PDF Document X5 X5    
Community Projects Rider PDF Document       X
Certification Appendix (Disclosure & Accountability Certification) (Less than or equal to $50,000) OR; PDF Document       X
Certification Appendix (Disclosure & Accountability Certification) (Greater than $50,000) PDF Document       X
Vendor Responsibility Questionnaire Leaving OMH site X X X X
Proof of NYS Workers’ Compensation  (or exemption) PDF Document X X X X
Proof of NYS Disability Benefits Insurance (or exemption) PDF Document X X X X
NY Charities Registration (or exemption) PDF Document X X X X
Federal Certification Form 1 PDF Document X6   X6  
Federal Certification Form 2 PDF Document X6   X6  

1 Required if Federal funds are included in contract.
2 Budget is submitted electronically through Consolidated Fiscal Reporting System (CFRS); do not submit paper copy.
3 Required if contract includes licensed programs. Only for Multi-year Contracts. Not required for Fixed Term Contracts.
4 Required for contracts with OMH Children’s HCBS Waiver Programs only.
5 For outpatient treatment programs involving court ordered population only.
6 Original signed Federal certification forms are required if Federal funds are included in the contract.

September 2016