Financial Support Unit
Aid to Counties Toolkit
- Abbreviated Instructions for Staff Entering Expenditures on ATC Website (PDF) Updated 10/23
- New ATC Website
- Aid to County "ATC" Change Request Form (electronic document)
- Aid to County Payment Schedule 2024 (PDF) - Updated 1/3/24
Administrative Monitoring
- Current Tool (PDF) Updated 08/29/23
- DPH Financial Checklist (PDF)
- Billing Review Tool (PDF)
Budget Preparation Maintenance of Effort and Reports
- Agency Reports and Considerations for Health Directors
- Revenue Tracking
- Expenditure
- Payroll
- MOE-Blank
Consolidated Agreement and Program Agreement Addenda
- Consolidated Agreement FY 23-24 (PDF) - Added 02/09/23
- Cover Memo: Consolidated Agreement FY 23-24 (PDF) - Added 02/09/23
- Links to Agreement Addenda
Forms and Tools
- Brief Form Bill or Not Bill Insurance (DOCX)
- Confidential Contact Explanation Card (DOCX)
- Confidential Contact Explanation Card (Spanish) (DOCX)
- Income Eligibility Form
- Registration Checklist Sample 1
- Registration Checklist Sample 2
- Sample Third Party Confirmation Letter
- Third Party Form
- Third Party Form (Spanish)
Fee Development and Fee Setting
Registration and Financial Eligibility
- Alias Names Policy Sample
- Approved Income Documents - Sources of Income
- County Health Department Personal Data Continuation Sheet (alias names form)
- County Health Department Personal Data Continuation Sheet (alias names form) (Spanish)
- Income Eligibility Form
- Sample checklist for Registration and Eligibility
- Terms and Conditions/Receipt of Notice of Privacy Practices
Billing and Collection of Revenue
- Collecting Co-Payments and Applying Sliding Fee Scales - Job Aid for Front Desk Staff
- Sample Fee, Eligibility, and Billing Policy - Updated 10/2023
- Sliding Fee Scales
- Third Party
- Bad Debt Set-Off Clearinghouse