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Contracts Forms

This page provides a convenient way for Division of Public Health employees to access needed Contracts Unit materials. Each "package" below contains the forms, instructions, and documents you need to begin and complete the various contracts submission processes. The forms have been modified from those found on the DHHS Center of Excellence website to include DPH specifications.

All forms required for submission from a package are indicated in the "Required" column by either a "Yes" or "No" value. In addition, any required form includes "(req)" in its file name. However, there may be other forms you want to include for your particular contract. Please refer to the checklist in each contract package for more detailed instructions.

For clarification or if you have questions, please contact the appropriate person from the Staff Directory.

To view the files listed below, the free viewers for Word and Excel may be helpful if you don't have Word and/or Excel installed on your machine.

Forms

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AGREEMENT ADDENDUM

Form Name Format, Size Last Modified Required
AA Process Guide July 2016 PDF, 585 KB 06/21/16 No
Agreement Addendum Template Fiscal Year 2016-2017 DOCX, 34 KB 07/14/15 Yes
Agreement Addendum Template Fiscal Year 2017-2018 DOCX, 38 KB 06/21/16 Yes
Agreement Addendum Guidelines PDF, 26 KB 08/12/13 No
ATC Expenditure Control Schedule Calendar 2016 PDF, 42 KB 01/08/16 No
Consolidated Agreement Fiscal Year 2016-2017 PDF, 213 KB 02/08/16 No
Cover Memo for Consolidated Agreement Fiscal Year 2016-2017 PDF, 64 KB 02/08/16 No
Federal Award Supplement Form FY16 v1.2 DOCX, 295 KB 5/31/16 Yes
Federal Award Supplement Form FY17 v1.2 DOCX, 295 KB 5/31/16 Yes
Federal Award Supplement Form FY18 v1.2 DOCX, 295 KB 5/31/16 Yes
LHD Legal Names List FY 2017 (These are the LHD names to use for all FY17 Agreements. These are the names on the FY17 Consolidated Agreement.) DOCX, 26 KB 12/02/15 No
LHD Legal Names List FY 2018 (These are the LHD names to use for all FY18 Agreements. These are the names on the FY18 Consolidated Agreement.) DOCX, 23 KB 12/02/16 No
Omni Circular Rollout for FY17 Agreement Addenda DOCX, 30 KB 12/01/15 No
Quality Assurance Checklist DOCX, 25 KB 08/22/14 Yes
Timeline for Major Distribution FY18 PDF, 134 KB 06/21/16 No

ARCHIVE

Contract

Form Name Format, Size Last Modified Required
Contract Budget and Narrative Requirements DOC, 25 KB 12/14/06 Yes
Contract Justification Memorandum Grant DOC, 164 KB 10/29/10 Yes
Contract Justification Memorandum Guidelines DOC, 75 KB 01/27/11 No
Contract Profile Sheet DOC, 65 KB 10/05/09 Yes
Indirect Costs DOC, 31 KB 01/28/03 No
Performance Criteria Checklist DOC, 32 KB 07/01/05 No

Contract Amendment

Form Name Format, Size Last Modified Required
Contract Amendment Profile Sheet DOC, 55 KB 10/05/09 Yes
Contract Budget and Narrative Requirements DOC, 25 KB 12/14/06 Yes
Justification Memorandum Amendment (HT -- Please see note in red above.) DOC, 99 KB 12/08/10 Yes
Justification Memorandum Amendment Guidelines DOC, 46 KB 01/27/11 No
Three Column Budget XLS, 31 KB 03/07/12 Yes

Intra-Departmental Memorandum Of Agreement (IMOA)

Form Name Format, Size Last Modified Required
Contract Justification Memorandum Grant DOC, 164 KB 10/29/10 Yes
Contract Justification Memorandum Guidelines DOC, 75 KB 01/27/11 No

Memorandum of Agreement (MOA)

Form Name Format, Size Last Modified Required
Contract Justification Memorandum Grant DOC, 164 KB 10/29/10 Yes
Contract Justification Memorandum Guidelines DOC, 75 KB 01/27/11 No

Training

Contracts Training

Form Name Format, Size Last Modified Required
101 Contracts Training Basics for Beginners Fall 2015 PDF, 489 KB 10/16/15 No
101 Resource Packet October 2010 DOC, 386 KB 10/01/13 No
Budget Workshop Fall 2013 (at the prompt open as a read-only file) PPT, 630 KB 12/13/13 No
Questions and Answers from 101 Contracts Training October 2010 DOC, 36 KB 11/05/10 No
Questions and Answers from October 2008 Training Sessions DOC, 45 KB 12/17/08 No

UNC Fringe Benefits and Resources

Form Name Format, Size Last Modified Required
DHHS Approved UNC Fringe Benefits FY 15/16 XLS, 56 KB 09/30/15 No

BUDGET REALIGNMENT FORM

Form Name Format, Size Last Modified Required
Budget Realignment XLS, 35 KB 04/01/10 No

CASH ADVANCE

Form Name Format, Size Last Modified Required
Cash Advance DOCX, 25 KB 12/01/15 Yes
Cash Advance Request DOCX, 83 KB 03/29/16 Yes
Cash Advance Request Requirements DOC, 27 KB 01/10/01 No

CHANGE REQUEST

Form Name Format, Size Last Modified Required
Change Request Memo DOC, 115 KB 04/08/16 Yes
Change Request Procedure DOC, 24 KB 03/31/15 No

DIRECTIVES

Form Name Format, Size Last Modified Required
Contract Fringe Benefit Rates and Sole Source Contracts Memo PDF, 142 KB 08/20/10 No
Reimbursement of Indirect Costs PDF, 23 KB 11/30/07 No

DUAL EMPLOYMENT

Form Name Format, Size Last Modified Required
OSC HR/Payroll Dual Employment Agreement external link PDF N/A Yes

EXPENDITURE REPORTS - CURRENT AND LATE

Form Name Format, Size Last Modified Required
ARRA Contract Expenditure Report XLS, 42 KB 09/25/09 Yes
Contract Expenditure Report XLS, 39 KB 10/10/08 Yes
H1N1 Contract Expenditure Report XLS, 42 KB 09/16/09    Yes
Late Contract CER Payment Request DOCX, 83 KB 03/29/16 No

OMNI CIRCULAR AND INDIRECT COST

Form Name Format, Size Last Modified Required
DPH FA Indirect Cost Rate Worksheet DOCX, 23 KB 10/10/16 Yes
Federal Funds IDC Decision Tree DOCX, 53 KB 10/10/16 No
State Funds IDC Decision Tree DOCX, 40 KB 10/10/16 No

OPEN WINDOW WORKSHEETS

Form Name Format, Size Last Modified Required
CAF DOC, 28 KB 04/27/16 Yes
Federal Award Worksheets for FA Contracts DOC, 60 KB 08/26/15 No
Federal Award Worksheets for POS Contracts DOC, 50 KB 08/26/15 No
How to Fill Out the Open Window Budget Form DOC, 443 KB 10/18/16 No
Open Window Audit Determination (FA/POS) Form XLSX, 14 KB 10/10/16 No
Open Window Budget Worksheet XLS, 1,007 KB 10/18/16 No
Open Window Contract Entry Guide PDF, 8 MB 08/23/12 No
Open Window Justification Worksheet DOC, 102 KB 10/23/12 No
Open Window IT Questionnaire DOCX, 35 KB 10/10/16 No
Open Window Measures Worksheet DOC, 46 KB 12/05/14 No
Open Window Writing Style Guide PDF, 46 KB 07/11/11 No
Scope of Work DOC, 33 KB 12/10/14 No
Three Column Budget XLS, 31 KB 03/07/12 No

PERSONAL SERVICES CONTRACT

Form Name Format, Size Last Modified Required
Employment Relationship Questionnaire DOC, 140 KB 10/05/09 Yes
Contract Justification Memorandum Grant DOC, 164 KB 10/29/10 Yes
Contract Justification Memorandum Guidelines DOC, 75 KB 01/27/11 No
PSC Attachments DOC, 32 KB 10/05/09 Yes
PSC Checklist DOC, 28 KB 10/24/08 Yes
PSC Policy DOC, 28 KB 06/10/09 No

REQUEST FOR APPLICATIONS

Form Name Format, Size Last Modified Required
IT Checklist Detail and Summary DOC, 86 KB 10/28/08 Yes
IT Checklist Detail and Summary Instructions DOC, 35 KB 11/02/04 No
Notice of Funding Availability Reporting Form DOC, 84 KB 10/29/10 Yes
RFA Approval Form DOC, 40 KB 07/07/09 Yes
RFA Approval Form Instructions DOC, 41 KB 10/29/10 No
RFA Checklist DOC, 27 KB 09/09/08 Yes
RFA Justification Memorandum DOC, 60 KB 10/29/10 Yes
RFA Awards Template DOC, 49 KB 08/22/14 Yes
RFA Template DOC, 340 KB 10/18/16 Yes
RFA Questions and Answers Template DOC, 34 KB 10/29/10 Yes

REQUEST FOR APPLICATIONS AGREEMENT ADDENDA

Form Name Format, Size Last Modified Required
RFA Agreement Addenda are under review.      

REQUEST FOR PROPOSALS

Form Name Format, Size Last Modified Required
Contract Justification Memorandum Grant DOC, 164 KB 10/29/10 Yes
Contract Justification Memorandum Guidelines DOC, 75 KB 01/27/11 No
IT Checklist Detail and Summary DOC, 86 KB 10/28/08 Yes
IT Checklist Detail and Summary Instructions DOC, 35 KB 11/02/04 No
RFP Approval Form DOC, 102 KB 07/07/09 Yes
RFP Approval Form Instructions DOC, 51 KB 07/07/09 No
RFP Checklist DOC, 24 KB 02/21/06 Yes
RFP Outline DOC, 25 KB 12/13/04 No

TRAINING

AA/BE/CA/FA Training

Form Name Format, Size Last Modified Required
AA Training FY18 Basic PDF, 655 KB 06/21/16 No
AA Training FY18 Refresher PDF, 555 KB 06/21/16 No
AA Training - AA Supplement Training Nov. 2016 PDF, 747 KB 11/16/16 No
Sample of Budgetary Estimate PDF, 240 KB 07/14/15 No
Sample of Funding Authorization PDF, 88 KB 07/14/15 No
Q&A from FY16 Training Sessions PDF, 16 KB 08/01/14 No
Q&A from FY17 Training Sessions PDF, 103 KB 07/14/15 No
Q&A from FY18 Training Sessions PDF, 126 KB 07/20/16 No

Contracts Training

Form Name Format, Size Last Modified Required
Acronym List DOC, 56 KB 12/11/14 No
Budget Workshop Fall 2016 PDF, 189 KB 10/18/16 No
Contracts 101 Training Basics for Beginners Fall 2016 PDF, 628 KB 11/18/16 No
Contracts Refresher Training PDF, 415 KB 11/18/16 No
Scope of Work and Performance Measures Training Workshop Fall 2014 (at the prompt open as a read-only file) PDF, 685 KB 12/09/14 No
Scope of Work Training Appendix Handout Fall 2014 DOC, 220 KB 12/09/14 No

UNC FRINGE BENEFITS & RESOURCES

Form Name Format, Size Last Modified Required
DHHS Approved UNC Fringe Benefits FY 16/17 XLS, 55 KB 11/21/16 No
UNC NC DHHS IDC Chart PDF, 18 KB 10/10/16 No
UNC System Master Agreement 2015 PDF, 5 MB 10/10/16 No