ࡱ> egd{ bjbjzz p:W66666$ZZZPL,ZU$"8(```HUJUJUJUJUJUJU$WZnU6@@@nU66``4U@d6`6`HU@HUKlN`@ax^nL*4UU0ULF-[j-[TNN-[6O`"^nUnUlU@@@@-[ : STATE OF NEW JERSEY DEPARTMENT OF CHILDREN AND FAMILIES ANNEX A SECTION 2 PROGRAM INFORMATION The following sections must be completed for each contract component/program Please be advised that additional requirements or stipulations may be necessary and will be forwarded to you, as applicable, by the DCF Office of Contract Administration (Please Note: Effective 9/2011 Section 2.1 of the Annex A has been removed from the package to facilitate the DCF Resource Directory. This section of the Annex A will be provided to you for completion by DCF Contract Administrators) Annex A SECTION 2 INSTRUCTIONS FOR COMPLETING PROGRAM DESCRIPTION AND SERVICE DELIVERY INFORMATION One set of Section 2 documents is completed for each contracted program/component. Make additional copies as necessary. Each section may also be downloaded from the Office of Contract Administration website at  HYPERLINK "http://www." www.nj.gov/dcf and clicking on the link to Contract and RFP Information. Section 2.1: Program Name and Service Delivery Information Effective 9/1/2011, Section 2.1 has been removed from the Standardized Annex A. DCF has reformatted Section 2.1 in order to facilitate the establishment and ongoing maintenance of a DCF Resource Directory. Your DCF Contract Administrator will email a partially completed Section 2.1 for each contract component at the time of contract renewal. The Section 2.1 form is still a required document and a part of a complete Annex A submission. Please remember to email the completed Section 2.1 to your Contract Administrator(s) as part of your Annex A submission(s). Section 2.2: Program Description Answer and clearly label all questions as outlined. Note: Questions asked may not be all inclusive. You will be notified of any other Required Program Description and Deliverables for your specific program, as applicable, to complete your contract package. Section 2.3: Performance Outcomes This section should be negotiated with the managing Contract Office and program staff, where applicable, prior to inclusion in the contract package. Section 2.4: Program Personnel Information Sheet Note: If the agency is contracted to provide 5 programs, and a social worker works in all of these programs, list this person on the Core Agency Personnel sheet (Section 1.3). If the social worker works in only four out of the five programs, do not include this person on the Core Agency Personnel sheet. This staff person will be listed on each of the four relevant program personnel sheets (Section 2.4) which is part of Section 2. Column 1: List all full-time and part-time positions dedicated to and funded by each program. List the title of each full-time and part-time position in your agency. Check appropriate box. Columns 2 through 5: Complete the remainder of the form by listing for each position, in the appropriate column, the following information: Name of employee Work hours (general-not specific to program) Indicate percentage of employees compensated time that is dedicated to the program (Example: If the employee is a social worker who works for 4 of the 5 agencys funded programs, then the employees time should be apportioned, as such) Qualifications, including degrees, licenses, certificates, etc. that the employee possesses and which are pertinent to his/her position; and The functional job duties of the employee Note: Staff listed on the personnel information forms (Section 1.3 and Section 2.4) must also be represented on the Annex B budget presentation, when applicable. Section 2.5: Level of Service Form A monthly contracted level of service chart is to be completed for each program/component, if applicable. One program might require several LOS forms to be completed which can be downloaded from the website. This will be indicated to you by the Contract Administrator and/or in the renewal/award letter. The information on this form is usually utilized as a reference/source document when completing reporting forms during the contract term, when required by DCF. Service Type: Per service dictionary, contact your contract administrator (i.e. individual counseling, residential placement, legal assistance, transportation) Description of Unit Measurement: Indicate what is being used as the measurement for monthly Contracted Level of Service (CLOS), (i.e. beds, rides, sessions, hours) Number of Contracted Slots/Units: Numbers should reflect unduplicated service counts. Unduplicated service counts refers to the practice of counting a customer receiving services only once within a service cycle. Refer to Annex B2 and or Renewal/Award Letter for this number. (i.e. # of beds, # of rides, # of sessions, # of hours) Annualized Units: Equivalent to the Annual Total under Column 3 on chart Column 1: Select Month from drop down menu. Month 1 should reflect 1st month of Contract. Column 2: Indicate Actual Number of Expected Days of Service or Units Per Month. Column 3: Indicate total Contracted LOS per month, this could be Days of Service multiplied by Number of Contracted Slots/Units per month or equivalent to number listed in Column 2. Annual Totals: This number will equal the annualized number of units to be contracted per program type.      PAGE \* MERGEFORMAT 1  PAGE \* MERGEFORMAT 8 8:BDOWcdes{ 8 < ^ _ ǼxocWcWcocGh;*56CJaJmHnHuhuPh 6CJ aJ huPh%6CJ aJ h6CJ aJ huPhCJ$aJ$h%CJ$aJ$huPh%6>*CJ$aJ$huP6>*CJ$aJ$huPh5e6CJ$aJ$huPh%6CJ$aJ$huPh%CJ aJ hH(h%CJHaJHh5eCJHaJHhuPCJHaJHhuP5>*CJHaJHhuPhuPCJ8aJ8huPCJ aJ 89:BCDNOWcde^ _ ` a K L M gd% @gd;*$a$gd$a$gd%$a$gduP_ ` a b o  * I J K L M U ^ _ ` { | ;͔ͯͣvg[RF:hKtsCJOJQJaJhCJOJQJaJhPhP_Hh%CJOJQJaJhH(h%CJOJQJaJhPCJOJQJaJhH(h%CJHaJH hH(h%huPhuP56mHnHuh5e56mHnHuhH(hK56mHnHuhH(h*6f56mHnHuhH(h;*56mHnHu%hH(huP56CJaJmHnHuhuP56CJaJmHnHuM U _ ` | * + deCDv$a$gd$a$gd*p $h^ha$gd3^z$a$gdK$a$gdPgdPdgdP| , < Y z * ϼϧ~qbWOChH(hK5>*^Jh;*^J_HhH(hB]^J_HhH(hB]B*^J_Hph3fhH(hd30J^J_H/jhH(hd3>*B*U^J_Hph3f hH(hd3>*B*^J_Hph3f)jhH(hd3>*B*U^J_Hph3fhH(h"+^J_HhKts^J_HhH(hxs^J_HhP^J_HhKtsh%CJOJQJaJhKtshPCJOJQJaJ* + 7 9 = > ? ] | f ;]^_`cde׶׶㪞מ~re~\hH(ho%^JhhCJ^JaJhH(h%5>*^JhH(h%^JhH(h;*^J_HhH(hD&mHnHuhH(hsmHnHuhH(h1VmHnHuhH(h;*mHnHuh5emHnHuhH(hemHnHuhH(h?EmHnHuhH(hKmHnHuhhCJaJmHnHuDRZvwx l*+| ռխzqeqXqQHhH(h;b^J hH(hE h3^zhE CJ^JaJhH(hE 5>*^JhH(hE ^JhH(hE 5CJaJhKts6^J_HhP6^J_Hh5e6^J_HhH(hE 6^J_HhhCJ^J_HaJhH(hiY5>*^JhhCJ^JaJhH(h%5>*^Jhh%^JhH(h%^Jh3^zho%CJ^JaJvw*+x0Z["#S$a$gd3^z $ !a$gd3^z$ !^a$gd3^z $ !a$gd*p$ & F !8^8a$gd3^z$ !h^ha$gd3^z $h^ha$gd3^z$a$gdP [am"#ks/6RSTW %Dú}pg]TKBhH(h`3^JhH(hEz^JhH(hE5^JhH(hE55^JhH(hx^Jh3^zhxCJ^JaJhH(h"+^JhH(hi(!<^JhH(hT^JhhCJ^JaJhH(hT5>*^Jh@5CJaJhPh@5CJaJhPhJ5CJaJhPhE 5CJaJ hH(hE hH(h;bhH(h;b6^JST:;./:; $h^ha$gd3^zD9:;[bOȸȚ}sjaWhH(h]5^JhH(ht`^JhH(hi^JhH(hi5^JhH(h"+^JhH(h"+5^JhH(htb5^JhH(h`35^Jh3^zhE5CJ^JaJ hH(hJ hH(h`3hH(htb^JhH(h^JhH(hx^JhH(h5^JhH(hE55^JhH(hE5^JhH(hEz^J ./78al~9:;Jae嵬|tptptptplht`hQjhQU hH(hxs hH(hihP hH(htbhH(hEz5hh@^J htb^JhH(h t^JhH(h"+^JhH(htb^JhH(h!W<5^JhH(htb5^JhH(h]H*^JhH(ho>(!<^JhH(h]^J* $h^ha$gd3^z$a$gdI9$a$̽ hH(hxshQhZh13,CJaJh13,h@mHnHujht`UmHnHuhEfOmHnHujht`Uht`hH61h/R!:pP/ =!"#$% 6&P1h:p@/ =!"#$% DyK www.yK http://www./^ 02 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH D`D CDNormalCJ^J_H9aJmH sH tH \@\ w Heading 2$$dh@&a$5CJOJQJ^J_HaJJ@J w Heading 3$$@&a$5^J_HaJDA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List jj w Table Grid7:V04 @4 w0Footer  !.). w Page Number<@"< (t$Header  !^J_HL>@2L %Title$ H"a$5CJ^J_HaJ@OB@ %p26$d1$7$8$a$^J_HRY@RR ! Document Map-D M OJQJ^JH@bH 9 Balloon TextCJOJQJ^JaJ6U`q6 (; Hyperlink >*B*ph>o> t`0 Footer CharCJ^J_H9aJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] M&:&8: 02PRTTTVVY_ | *  DM vSX*,2JLY!!@ @H 0(  0(  B S  ?~  <Y]z>*urn:schemas-microsoft-com:office:smarttags PersonName %33x OVWdes{8<]]^`HIJJKKMU^_`,<*+||ddvw   ) ) "#9:;;aekNmR<g_'`-&"^$,-k2ٰC5ʪ6&"ճ>(k@>ܲ.<Vu*_?)l&+=s`,|'`,|y-Y6k20Ax5=s^$>ZsUu*_0?)lV                                            >        䁮,        䁮,        dn                 bW                          䁮,         @ V ea;e+-dg)p9%AAY;\ii wp9Axaz:~RQ6E#?FrH\6{!J%4%Va2 ~V Kv g y+b;bc ]"+2;A4^qMnk-B{S t`xBREnGn/!^x!i""(t$%o%M>&&&'0(0(9(X()+*;*"+<+13,?*-c-B.N.`[0"2d3Kr3e4$5E5 *7f[7)G8'9G9J:4<!W<w]= >o>td?fm? H@vAZ$BYBRCCDDDE?E\FFdF}4G]H_,I5IuI0JG]J<$Kw M MEfOPRRS TqT'=UygU.V1V7bVemWUKXXiYjYHbZ<[B]UI]t`6btb[cd{cAd5eWae*6fQfFgKgZg.ijj|k@lw|l+n.o6oc*p*p:q]tq.rKts t8tLOtvmvwN[yEz3^zhzj|A)}0}q=}]S} ~)tZ.1Q:Lf1Us,FeG*I{ gdH(oC(;wD&7`3uPH2J/+N@ YHTR& MTk4Uv>kL wE[fV_psb$I9>u~"Sf@*7.,VqmyHH-al ^V5=m|5]22#`i'2jurnl'N4 GRNwBX\J$1e ,H`QM5 pTq#CR\~yIez#(5 WxsI~s&4@J]4KQW(I }E 9{;}(O@0@Unknown G* Times New Roman5Symbol3. * Arial5MangalC& UniversArial5. *aTahoma;Wingdings?= * Courier NewA$BCambria Math"1(hggG % %!4 2qHX ?w*!xx Contract Number: _____________imageAuthorized UserT             Oh+'0   @ L X dpx Contract Number: _____________image Normal.dotmAuthorized User2Microsoft Office Word@F#@J0Y@`x@`x՜.+,D՜.+,t0 hp  ,NJ Division of Youth and Family Services%  Contract Number: _____________ Title 8@ _PID_HLINKSATP http://www./  !"#$%'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSUVWXYZ[]^_`abcfRoot Entry F0[axhData 1Table&[WordDocumentp:SummaryInformation(TDocumentSummaryInformation8\CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q