NEW YORK STATE OFFICE OF VICTIM SERVICES
Agency / Program Name: ________________________________________________ Phone #:_____________________________
Instructions: Complete and submit this Checklist with your contract materials. Once you have downloaded the documents from the
OVS website, please contact your OVS Auditor and Monitor for further assistance. Use only the forms and instructions provided with
your award letter or that you are directed to on our website. Do not use forms from prior contract periods.
____ Complete Program Information form.
____ Verify that your preprinted agency name is accurate and that your agency’s contract number in the upper right-hand box
agrees with the contract number on the cover page. You will be required to provide this number on other contract forms,
vouchers and future grant reports.
____ Execute three (3) signature pages with original notarized signatures of an authorized officer of your Board of Directors or
county official as appropriate.
____ Required for local government agencies: Provide a copy of the county resolution authorizing the agreement or a copy of the
county charter stating that the county official signing the agreement has the authority to do so.
Agreement, Appendix A and Appendix A-1 (located on OVS website)
____ Read and submit the Agreement, Appendix A, and Appendix A-1 with each original contract packet.
Appendix B (located on OVS website)
____ Before completing Appendix B (Budget), contact your OVS Auditor to discuss your award. Instructions for completion are
on the individual pages of Appendix B.
____ Complete and submit all budget pages OVSGR-BUD 01 through OVSGR-BUD10 and OVSGR-BUD25 with each original
____ Verify that your agency name and the annual award period appear on each budget page.
Appendix C (located on OVS website)
____ Read and submit Appendix C with each original contract packet.
Appendix D (located on OVS website)
____ Before completing Appendix D (Program Goals and Objectives) read the “Monthly Objective Definitions” and contact your
OVS Monitor to discuss your program goals and objectives.
____ Complete an Appendix D form for each location where OVS-funded program services will be provided and submit with each
original contract packet.
____ Vendor Responsibility Questionnaire (located on the OVS website)
___ Completed and attached the VRQ form to all three (3) copies of the renewal submission (or)
___ Updated VRQ information electronically through the OSC VendRep System at
____ Submit three (3) complete unbound contract packets each with original notarized board member or county official signature
____ Complete and return four (4) Claims for Payment with the completed unbound packet.
____ Verify that contract packets are free from any alterations or marks (white-out) to avoid delays in processing and payment.
All required items must be RECEIVED at the OVS address listed below by 2:00 pm on June 18, 2012. LATE SUBMISSIONS
WILL NOT BE ACCEPTED. Submit documents to:
New York State Office of Victim Services
1 Columbia Circle, Suite 200
Albany, New York 12203