copy of excel 2003 of opplan 2013 4 13 12 by 0XJKdI

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									     2013 OPERATIONAL PLAN - ver 4_13_12
      DEMOGRAPHICS
14    RESIDENTIAL PROGRAMS
20    DAY PROGRAMS
23    OTHER COST CENTERS
      RESIDENTIAL SUMMARY
      DAY SUMMARY
      SUMMARY
      A&G WORKSHEET
      EMPLOYEE BENEFITS


      INFORMATION




                                           9/14/2012 6:48 PM
                INITIAL DEMOGRAPHIC INFORMATION
GENERAL INFORMATION
        Fiscal Year                                      2013
        Agency Name
        Provider Number
        Primary Region
        Person Completing Form
        Phone Number
        E-mail Address
        Budget Form Date (mm/dd/yy)




Adj #   Adjustment Reason                         Date




                                                                9/14/2012 6:48 PM
Residential Service Schedule

Agency Name                                   0
                                                  1       2       3       4       5       6       7       8       9       10             11            12
Region
Cost Center #



Cost Center Name
Type ------Required!
                                  Total
Direct Support FTEs                       -
Salaries                                  -           -       -       -
Employee Benefits                         -           -       -       -
Nonsalary                                 -           -       -       -
Admin&General                             -           -       -       -
Subtotal Expenses                         -           -       -       -       -       -       -       -       -       -        -              -             -
Non-reimburseable costs                   -
Program Total                             -           -       -       -       -       -       -       -       -       -        -              -             -
Other Revenue Towards DDS
Purchased Openings (Non
Annualized).                              -                                                   -       -       -       -        -              -             -
Total Program Cost                        -           -       -       -       -       -       -       -       -       -        -              -             -

Vendor Service Authorization
Revenue                                   -           -       -       -       -       -       -       -       -       -        -              -             -


Revenue For Non-DDS
Participants. Including revenue
for Respite Participants.                 -           -       -       -       -       -       -       -       -       -        -              -             -
Days Open Per Year                        -           -       -       -       -       -       -       -       -       -        -              -             -
Total Number of Contract
Service Authorizations (CSA)              -           -       -       -       -       -       -       -       -       -        -              -             -
Total Number of Vendor Service
Authorizations (VSA)                      -           -       -       -       -       -       -       -       -       -        -              -             -
Total Number of Non-DDS
Funded Individuals                        -           -       -       -       -       -       -       -       -       -        -              -             -
Total Potential Days for All
Openings                                  -           -       -       -       -       -       -       -       -       -        -              -             -
Total Potential Days for CSA              -           -       -       -       -       -       -       -       -       -        -              -             -
Total Annual Cost For CSA                 -
Per Diem Rate

Children Room and Board                   -
Start Up (New CLAs)                       -
Cash Advance (New CLAs)                   -
Total DDS Costs                           -




                                                                                                                                   9/14/2012 6:48 PM
Residential Service Schedule

Agency Name                                   0
                                                  13       14       15       16       17       18       19       20       21       22       23         24           25
Region
Cost Center #



Cost Center Name
Type ------Required!
                                  Total
Direct Support FTEs                       -
Salaries                                  -
Employee Benefits                         -
Nonsalary                                 -
Admin&General                             -
Subtotal Expenses                         -            -        -        -        -        -        -        -        -        -        -        -          -            -
Non-reimburseable costs                   -
Program Total                             -            -        -        -        -        -        -        -        -        -        -        -          -            -
Other Revenue Towards DDS
Purchased Openings (Non
Annualized).                              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Program Cost                        -            -        -        -        -        -        -        -        -        -        -        -          -            -

Vendor Service Authorization
Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -          -            -


Revenue For Non-DDS
Participants. Including revenue
for Respite Participants.                 -            -        -        -        -        -        -        -        -        -        -        -          -            -
Days Open Per Year                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Contract
Service Authorizations (CSA)              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Vendor Service
Authorizations (VSA)                      -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Non-DDS
Funded Individuals                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for All
Openings                                  -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for CSA              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Annual Cost For CSA                 -
Per Diem Rate

Children Room and Board                   -
Start Up (New CLAs)                       -
Cash Advance (New CLAs)                   -
Total DDS Costs                           -




                                                                                                                                                     9/14/2012 6:48 PM
Residential Service Schedule

Agency Name                                   0
                                                  26       27       28       29       30       31       32       33       34       35       36         37           38
Region
Cost Center #



Cost Center Name
Type ------Required!
                                  Total
Direct Support FTEs                       -
Salaries                                  -
Employee Benefits                         -
Nonsalary                                 -
Admin&General                             -
Subtotal Expenses                         -            -        -        -        -        -        -        -        -        -        -        -          -            -
Non-reimburseable costs                   -
Program Total                             -            -        -        -        -        -        -        -        -        -        -        -          -            -
Other Revenue Towards DDS
Purchased Openings (Non
Annualized).                              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Program Cost                        -            -        -        -        -        -        -        -        -        -        -        -          -            -

Vendor Service Authorization
Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -          -            -


Revenue For Non-DDS
Participants. Including revenue
for Respite Participants.                 -            -        -        -        -        -        -        -        -        -        -        -          -            -
Days Open Per Year                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Contract
Service Authorizations (CSA)              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Vendor Service
Authorizations (VSA)                      -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Non-DDS
Funded Individuals                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for All
Openings                                  -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for CSA              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Annual Cost For CSA                 -
Per Diem Rate

Children Room and Board                   -
Start Up (New CLAs)                       -
Cash Advance (New CLAs)                   -
Total DDS Costs                           -




                                                                                                                                                     9/14/2012 6:48 PM
Residential Service Schedule

Agency Name                                   0
                                                  39       40       41       42       43       44       45       46       47       48       49         50           51
Region
Cost Center #



Cost Center Name
Type ------Required!
                                  Total
Direct Support FTEs                       -
Salaries                                  -
Employee Benefits                         -
Nonsalary                                 -
Admin&General                             -
Subtotal Expenses                         -            -        -        -        -        -        -        -        -        -        -        -          -            -
Non-reimburseable costs                   -
Program Total                             -            -        -        -        -        -        -        -        -        -        -        -          -            -
Other Revenue Towards DDS
Purchased Openings (Non
Annualized).                              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Program Cost                        -            -        -        -        -        -        -        -        -        -        -        -          -            -

Vendor Service Authorization
Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -          -            -


Revenue For Non-DDS
Participants. Including revenue
for Respite Participants.                 -            -        -        -        -        -        -        -        -        -        -        -          -            -
Days Open Per Year                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Contract
Service Authorizations (CSA)              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Vendor Service
Authorizations (VSA)                      -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Non-DDS
Funded Individuals                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for All
Openings                                  -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for CSA              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Annual Cost For CSA                 -
Per Diem Rate

Children Room and Board                   -
Start Up (New CLAs)                       -
Cash Advance (New CLAs)                   -
Total DDS Costs                           -




                                                                                                                                                     9/14/2012 6:48 PM
Residential Service Schedule

Agency Name                                   0
                                                  52       53       54       55       56       57       58       59       60       61       62         63           64
Region
Cost Center #



Cost Center Name
Type ------Required!
                                  Total
Direct Support FTEs                       -
Salaries                                  -
Employee Benefits                         -
Nonsalary                                 -
Admin&General                             -
Subtotal Expenses                         -            -        -        -        -        -        -        -        -        -        -        -          -            -
Non-reimburseable costs                   -
Program Total                             -            -        -        -        -        -        -        -        -        -        -        -          -            -
Other Revenue Towards DDS
Purchased Openings (Non
Annualized).                              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Program Cost                        -            -        -        -        -        -        -        -        -        -        -        -          -            -

Vendor Service Authorization
Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -          -            -


Revenue For Non-DDS
Participants. Including revenue
for Respite Participants.                 -            -        -        -        -        -        -        -        -        -        -        -          -            -
Days Open Per Year                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Contract
Service Authorizations (CSA)              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Vendor Service
Authorizations (VSA)                      -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Non-DDS
Funded Individuals                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for All
Openings                                  -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for CSA              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Annual Cost For CSA                 -
Per Diem Rate

Children Room and Board                   -
Start Up (New CLAs)                       -
Cash Advance (New CLAs)                   -
Total DDS Costs                           -




                                                                                                                                                     9/14/2012 6:48 PM
Residential Service Schedule

Agency Name                                   0
                                                  65       66       67       68       69       70       71       72       73       74       75         76           77
Region
Cost Center #



Cost Center Name
Type ------Required!
                                  Total
Direct Support FTEs                       -
Salaries                                  -
Employee Benefits                         -
Nonsalary                                 -
Admin&General                             -
Subtotal Expenses                         -            -        -        -        -        -        -        -        -        -        -        -          -            -
Non-reimburseable costs                   -
Program Total                             -            -        -        -        -        -        -        -        -        -        -        -          -            -
Other Revenue Towards DDS
Purchased Openings (Non
Annualized).                              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Program Cost                        -            -        -        -        -        -        -        -        -        -        -        -          -            -

Vendor Service Authorization
Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -          -            -


Revenue For Non-DDS
Participants. Including revenue
for Respite Participants.                 -            -        -        -        -        -        -        -        -        -        -        -          -            -
Days Open Per Year                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Contract
Service Authorizations (CSA)              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Vendor Service
Authorizations (VSA)                      -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Number of Non-DDS
Funded Individuals                        -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for All
Openings                                  -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Potential Days for CSA              -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Annual Cost For CSA                 -
Per Diem Rate

Children Room and Board                   -
Start Up (New CLAs)                       -
Cash Advance (New CLAs)                   -
Total DDS Costs                           -




                                                                                                                                                     9/14/2012 6:48 PM
Residential Service Schedule

Agency Name                                   0
                                                  78       79       80
Region                                                                       NR        NR        NR        NR        SR        SR        SR        SR        WR        WR        WR          WR
Cost Center #                                                                CLA       CRS       IHS       CCH       CLA       CRS       IHS       CCH       CLA       CRS       IHS       CCH



Cost Center Name
Type ------Required!
                                  Total
Direct Support FTEs                       -                                        0         0         0         0         0         0         0         0         0         0         0          0
Salaries                                  -                                        0         0         0         0         0         0         0         0         0         0         0          0
Employee Benefits                         -                                        0         0         0         0         0         0         0         0         0         0         0          0
Nonsalary                                 -                                        0         0         0         0         0         0         0         0         0         0         0          0
Admin&General                             -                                        0         0         0         0         0         0         0         0         0         0         0          0
Subtotal Expenses                         -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Non-reimburseable costs                   -                                        0         0         0         0         0         0         0         0         0         0         0          0
Program Total                             -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Other Revenue Towards DDS
Purchased Openings (Non
Annualized).                              -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0

Total Program Cost                        -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0

Vendor Service Authorization
Revenue                                   -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0


Revenue For Non-DDS
Participants. Including revenue
for Respite Participants.                 -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Days Open Per Year                        -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Total Number of Contract
Service Authorizations (CSA)              -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Total Number of Vendor Service
Authorizations (VSA)                      -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Total Number of Non-DDS
Funded Individuals                        -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Total Potential Days for All
Openings                                  -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Total Potential Days for CSA              -            -        -        -         0         0         0         0         0         0         0         0         0         0         0          0
Total Annual Cost For CSA                 -                                        0         0         0         0         0         0         0         0         0         0         0          0
Per Diem Rate                                                                      0         0         0         0                   0         0         0                   0         0          0
                                                                                                                 0                                       0                                        0
Children Room and Board                   -                                        0         0         0         0         0         0         0         0         0         0         0          0
Start Up (New CLAs)                       -                                        0         0         0         0         0         0         0         0         0         0         0          0
Cash Advance (New CLAs)                   -                                        0         0         0         0         0         0         0         0         0         0         0          0
Total DDS Costs                           -                                        0         0         0         0         0         0         0         0         0         0         0          0




                                                                                                                                                                       9/14/2012 6:48 PM
Day Service Schedule

Agency Name                                         0

                                                        1       2       3       4       5       6       7       8       9       10            11             12
DDS Region
Cost Center #

Cost Center Name
Model Type -----REQUIRED!               Total

Direct Support FTEs                             -           -       -       -       -       -       -       -       -       -        -             -              -
Salaries                                        -           -       -       -       -       -       -       -       -       -        -             -              -
Employee Benefits                               -           -       -       -       -       -       -       -       -       -        -             -              -
Nonsalary                                       -           -       -       -       -       -       -       -       -       -        -             -              -
Admin & General                                 -           -       -       -       -       -       -       -       -       -        -             -              -
Subtotal Expenses                               -           -       -       -       -       -       -       -       -       -        -             -              -
Non-Reimburseable Costs                         -
Program Total                                   -           -       -       -       -       -       -       -       -       -        -             -              -


Other Revenue Towards DDS
Purchased Openings (Non Annualized).            -           -       -       -       -       -       -       -       -       -        -             -              -
Sales Revenue                                   -           -       -       -       -       -       -       -       -       -        -             -              -
Total Day Costs                                 -           -       -       -       -       -       -       -       -       -        -             -              -

Vendor Service Authorizations Revenue           -           -       -       -       -       -       -       -       -       -        -             -              -
Revenue For Non-DDS Participants                -           -       -       -       -       -       -       -       -       -        -             -              -
Days Open Per Year                              -           -       -       -       -       -       -       -       -       -        -             -              -
Total number of Contract Service
Authorizations (CSA)                            -           -       -       -       -       -       -       -       -       -        -             -              -
Total number of Vendor Service
Authorizations (VSA)                            -           -       -       -       -       -       -       -       -       -        -             -              -
Total number of Non-DDS Funded
Individuals                                     -           -       -       -       -       -       -       -       -       -        -             -              -

Total Annual Cost for CSA                       -




                                                                                                                                         9/14/2012 6:48 PM
Day Service Schedule

Agency Name                                         0

                                                        13       14       15       16       17       18       19       20       21       22       23             24            25
DDS Region
Cost Center #

Cost Center Name
Model Type -----REQUIRED!               Total

Direct Support FTEs                             -            -        -        -        -        -        -        -        -        -        -        -              -             -
Salaries                                        -            -        -        -        -        -        -        -        -        -        -        -              -             -
Employee Benefits                               -            -        -        -        -        -        -        -        -        -        -        -              -             -
Nonsalary                                       -            -        -        -        -        -        -        -        -        -        -        -              -             -
Admin & General                                 -            -        -        -        -        -        -        -        -        -        -        -              -             -
Subtotal Expenses                               -            -        -        -        -        -        -        -        -        -        -        -              -             -
Non-Reimburseable Costs                         -
Program Total                                   -            -        -        -        -        -        -        -        -        -        -        -              -             -


Other Revenue Towards DDS
Purchased Openings (Non Annualized).            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Sales Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total Day Costs                                 -            -        -        -        -        -        -        -        -        -        -        -              -             -

Vendor Service Authorizations Revenue           -            -        -        -        -        -        -        -        -        -        -        -              -             -
Revenue For Non-DDS Participants                -            -        -        -        -        -        -        -        -        -        -        -              -             -
Days Open Per Year                              -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Contract Service
Authorizations (CSA)                            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Vendor Service
Authorizations (VSA)                            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Non-DDS Funded
Individuals                                     -            -        -        -        -        -        -        -        -        -        -        -              -             -

Total Annual Cost for CSA                       -




                                                                                                                                                           9/14/2012 6:48 PM
Day Service Schedule

Agency Name                                         0

                                                        26       27       28       29       30       31       32       33       34       35       36             37            38
DDS Region
Cost Center #

Cost Center Name
Model Type -----REQUIRED!               Total

Direct Support FTEs                             -            -        -        -        -        -        -        -        -        -        -        -              -             -
Salaries                                        -            -        -        -        -        -        -        -        -        -        -        -              -             -
Employee Benefits                               -            -        -        -        -        -        -        -        -        -        -        -              -             -
Nonsalary                                       -            -        -        -        -        -        -        -        -        -        -        -              -             -
Admin & General                                 -            -        -        -        -        -        -        -        -        -        -        -              -             -
Subtotal Expenses                               -            -        -        -        -        -        -        -        -        -        -        -              -             -
Non-Reimburseable Costs                         -
Program Total                                   -            -        -        -        -        -        -        -        -        -        -        -              -             -


Other Revenue Towards DDS
Purchased Openings (Non Annualized).            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Sales Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total Day Costs                                 -            -        -        -        -        -        -        -        -        -        -        -              -             -

Vendor Service Authorizations Revenue           -            -        -        -        -        -        -        -        -        -        -        -              -             -
Revenue For Non-DDS Participants                -            -        -        -        -        -        -        -        -        -        -        -              -             -
Days Open Per Year                              -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Contract Service
Authorizations (CSA)                            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Vendor Service
Authorizations (VSA)                            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Non-DDS Funded
Individuals                                     -            -        -        -        -        -        -        -        -        -        -        -              -             -

Total Annual Cost for CSA                       -




                                                                                                                                                           9/14/2012 6:48 PM
Day Service Schedule

Agency Name                                         0

                                                        39       40       41       42       43       44       45       46       47       48       49             50            51
DDS Region
Cost Center #

Cost Center Name
Model Type -----REQUIRED!               Total

Direct Support FTEs                             -            -        -        -        -        -        -        -        -        -        -        -              -             -
Salaries                                        -            -        -        -        -        -        -        -        -        -        -        -              -             -
Employee Benefits                               -            -        -        -        -        -        -        -        -        -        -        -              -             -
Nonsalary                                       -            -        -        -        -        -        -        -        -        -        -        -              -             -
Admin & General                                 -            -        -        -        -        -        -        -        -        -        -        -              -             -
Subtotal Expenses                               -            -        -        -        -        -        -        -        -        -        -        -              -             -
Non-Reimburseable Costs                         -
Program Total                                   -            -        -        -        -        -        -        -        -        -        -        -              -             -


Other Revenue Towards DDS
Purchased Openings (Non Annualized).            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Sales Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total Day Costs                                 -            -        -        -        -        -        -        -        -        -        -        -              -             -

Vendor Service Authorizations Revenue           -            -        -        -        -        -        -        -        -        -        -        -              -             -
Revenue For Non-DDS Participants                -            -        -        -        -        -        -        -        -        -        -        -              -             -
Days Open Per Year                              -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Contract Service
Authorizations (CSA)                            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Vendor Service
Authorizations (VSA)                            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Non-DDS Funded
Individuals                                     -            -        -        -        -        -        -        -        -        -        -        -              -             -

Total Annual Cost for CSA                       -




                                                                                                                                                           9/14/2012 6:48 PM
Day Service Schedule

Agency Name                                         0

                                                        52       53       54       55       56       57       58       59       60       61       62             63            64
DDS Region
Cost Center #

Cost Center Name
Model Type -----REQUIRED!               Total

Direct Support FTEs                             -            -        -        -        -        -        -        -        -        -        -        -              -             -
Salaries                                        -            -        -        -        -        -        -        -        -        -        -        -              -             -
Employee Benefits                               -            -        -        -        -        -        -        -        -        -        -        -              -             -
Nonsalary                                       -            -        -        -        -        -        -        -        -        -        -        -              -             -
Admin & General                                 -            -        -        -        -        -        -        -        -        -        -        -              -             -
Subtotal Expenses                               -            -        -        -        -        -        -        -        -        -        -        -              -             -
Non-Reimburseable Costs                         -
Program Total                                   -            -        -        -        -        -        -        -        -        -        -        -              -             -


Other Revenue Towards DDS
Purchased Openings (Non Annualized).            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Sales Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total Day Costs                                 -            -        -        -        -        -        -        -        -        -        -        -              -             -

Vendor Service Authorizations Revenue           -            -        -        -        -        -        -        -        -        -        -        -              -             -
Revenue For Non-DDS Participants                -            -        -        -        -        -        -        -        -        -        -        -              -             -
Days Open Per Year                              -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Contract Service
Authorizations (CSA)                            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Vendor Service
Authorizations (VSA)                            -            -        -        -        -        -        -        -        -        -        -        -              -             -
Total number of Non-DDS Funded
Individuals                                     -            -        -        -        -        -        -        -        -        -        -        -              -             -

Total Annual Cost for CSA                       -




                                                                                                                                                           9/14/2012 6:48 PM
Day Service Schedule

Agency Name                                         0

                                                        65       66       67       68       69       70       71       72       73       74       75         76
DDS Region
Cost Center #

Cost Center Name
Model Type -----REQUIRED!               Total

Direct Support FTEs                             -            -        -        -        -        -        -        -        -        -        -        -          -
Salaries                                        -            -        -        -        -        -        -        -        -        -        -        -          -
Employee Benefits                               -            -        -        -        -        -        -        -        -        -        -        -          -
Nonsalary                                       -            -        -        -        -        -        -        -        -        -        -        -          -
Admin & General                                 -            -        -        -        -        -        -        -        -        -        -        -          -
Subtotal Expenses                               -            -        -        -        -        -        -        -        -        -        -        -          -
Non-Reimburseable Costs                         -
Program Total                                   -            -        -        -        -        -        -        -        -        -        -        -          -


Other Revenue Towards DDS
Purchased Openings (Non Annualized).            -            -        -        -        -        -        -        -        -        -        -        -          -
Sales Revenue                                   -            -        -        -        -        -        -        -        -        -        -        -          -
Total Day Costs                                 -            -        -        -        -        -        -        -        -        -        -        -          -

Vendor Service Authorizations Revenue           -            -        -        -        -        -        -        -        -        -        -        -          -
Revenue For Non-DDS Participants                -            -        -        -        -        -        -        -        -        -        -        -          -
Days Open Per Year                              -            -        -        -        -        -        -        -        -        -        -        -          -
Total number of Contract Service
Authorizations (CSA)                            -            -        -        -        -        -        -        -        -        -        -        -          -
Total number of Vendor Service
Authorizations (VSA)                            -            -        -        -        -        -        -        -        -        -        -        -          -
Total number of Non-DDS Funded
Individuals                                     -            -        -        -        -        -        -        -        -        -        -        -          -

Total Annual Cost for CSA                       -




                                                                                                                                                   9/14/2012 6:48 PM
Day Service Schedule

Agency Name                                         0


DDS Region                                              NR            NR            NR           NR            SR            SR            SR           SR            WR            WR              WR           WR
Cost Center #                                           DSO           GSE           ISE          SHE           DSO           GSE           ISE          SHE           DSO           GSE             ISE          SHE

Cost Center Name
Model Type -----REQUIRED!               Total

Direct Support FTEs                             -             0.00          0.00          0.00         0.00          0.00          0.00          0.00         0.00          0.00          0.00            0.00         0.00
Salaries                                        -                 0             0           0              0             0             0           0              0             0             0             0              0
Employee Benefits                               -                 0             0           0              0             0             0           0              0             0             0             0              0
Nonsalary                                       -                 0             0           0              0             0             0           0              0             0             0             0              0
Admin & General                                 -                 0             0           0              0             0             0           0              0             0             0             0              0
Subtotal Expenses                               -             -             -               0          -             -             -               0          -             -             -                 0          -
Non-Reimburseable Costs                         -                 0             0           0              0             0             0           0              0             0             0             0              0
Program Total                                   -             -             -               0          -             -             -               0          -             -             -                 0          -


Other Revenue Towards DDS
Purchased Openings (Non Annualized).            -                 0             0           0              0             0             0           0              0             0             0             0              0
Sales Revenue                                   -                 0             0           0              0             0             0           0              0             0             0             0              0
Total Day Costs                                 -                 0             0           0              0             0             0           0              0             0             0             0              0

Vendor Service Authorizations Revenue           -                 0             0           0              0             0             0           0              0             0             0             0              0
Revenue For Non-DDS Participants                -                 0             0           0              0             0             0           0              0             0             0             0              0
Days Open Per Year                              -                 0             0           0              0             0             0           0              0             0             0             0              0
Total number of Contract Service
Authorizations (CSA)                            -                 0             0           0              0             0             0           0              0             0             0             0              0
Total number of Vendor Service
Authorizations (VSA)                            -                 0             0           0              0             0             0           0              0             0             0             0              0
Total number of Non-DDS Funded
Individuals                                     -                 0             0           0              0             0             0           0              0             0             0             0              0

Total Annual Cost for CSA                       -                 0             0           0              0             0             0           0              0             0             0             0              0




                                                                                                                                                                                                  9/14/2012 6:48 PM
Other Schedule

Agency Name                                0

                                               1       2       3       4       5       6       7       8        9                  10
Region
Cost Center #
Cost Center Name




Type -------REQUIRED!          Total

Direct Support FTEs                    -
Salaries                               -
Employee Benefits                      -
Nonsalary                              -
Admin&General                          -
Subtotal Expenses                      -           -       -       -       -       -       -       -       -         -                  -
Non-Reimburseable Costs                -
Program Total                          -           -       -       -       -       -       -       -       -         -                  -



Other Revenue Towards Total
Openeings (Non Annualiized)            -
Total Cost                             -           -       -       -       -       -       -       -       -         -                  -
Days Open Per Year
Total Vendor Service
Authorizations (VSA)                   -
Total number of Non-DDS
Funded Individuals                     -
Total Potential Days                   -           -       -       -       -       -       -       -       -         -                  -

Total Potential Days for VSA           -           -       -       -       -       -       -       -       -         -                  -
Total Annual Cost of VSA               -




                                                                                                               9/14/2012 6:48 PM
Other Schedule

Agency Name                                0

                                               11       12       13       14       15       16       17       18       19       20       21         22          23
Region
Cost Center #
Cost Center Name




Type -------REQUIRED!          Total

Direct Support FTEs                    -
Salaries                               -
Employee Benefits                      -
Nonsalary                              -
Admin&General                          -
Subtotal Expenses                      -            -        -        -        -        -        -        -        -        -        -        -          -            -
Non-Reimburseable Costs                -
Program Total                          -            -        -        -        -        -        -        -        -        -        -        -          -            -



Other Revenue Towards Total
Openeings (Non Annualiized)            -
Total Cost                             -            -        -        -        -        -        -        -        -        -        -        -          -            -
Days Open Per Year
Total Vendor Service
Authorizations (VSA)                   -
Total number of Non-DDS
Funded Individuals                     -
Total Potential Days                   -            -        -        -        -        -        -        -        -        -        -        -          -            -

Total Potential Days for VSA           -            -        -        -        -        -        -        -        -        -        -        -          -            -
Total Annual Cost of VSA               -




                                                                                                                                                  9/14/2012 6:48 PM
Other Schedule

Agency Name                                0

                                               24       25       26       27       28       29       30       31       32       33       34       35              36           37
Region
Cost Center #
Cost Center Name




Type -------REQUIRED!          Total

Direct Support FTEs                    -
Salaries                               -
Employee Benefits                      -
Nonsalary                              -
Admin&General                          -
Subtotal Expenses                      -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Non-Reimburseable Costs                -
Program Total                          -            -        -        -        -        -        -        -        -        -        -        -        -               -            -



Other Revenue Towards Total
Openeings (Non Annualiized)            -
Total Cost                             -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Days Open Per Year
Total Vendor Service
Authorizations (VSA)                   -
Total number of Non-DDS
Funded Individuals                     -
Total Potential Days                   -            -        -        -        -        -        -        -        -        -        -        -        -               -            -

Total Potential Days for VSA           -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Total Annual Cost of VSA               -




                                                                                                                                                           9/14/2012 6:48 PM
Other Schedule

Agency Name                                0

                                               38       39       40       41       42       43       44       45       46       47       48       49              50           51
Region
Cost Center #
Cost Center Name




Type -------REQUIRED!          Total

Direct Support FTEs                    -
Salaries                               -
Employee Benefits                      -
Nonsalary                              -
Admin&General                          -
Subtotal Expenses                      -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Non-Reimburseable Costs                -
Program Total                          -            -        -        -        -        -        -        -        -        -        -        -        -               -            -



Other Revenue Towards Total
Openeings (Non Annualiized)            -
Total Cost                             -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Days Open Per Year
Total Vendor Service
Authorizations (VSA)                   -
Total number of Non-DDS
Funded Individuals                     -
Total Potential Days                   -            -        -        -        -        -        -        -        -        -        -        -        -               -            -

Total Potential Days for VSA           -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Total Annual Cost of VSA               -




                                                                                                                                                           9/14/2012 6:48 PM
Other Schedule

Agency Name                                0

                                               52       53       54       55       56       57       58       59       60       61       62       63              64           65
Region
Cost Center #
Cost Center Name




Type -------REQUIRED!          Total

Direct Support FTEs                    -
Salaries                               -
Employee Benefits                      -
Nonsalary                              -
Admin&General                          -
Subtotal Expenses                      -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Non-Reimburseable Costs                -
Program Total                          -            -        -        -        -        -        -        -        -        -        -        -        -               -            -



Other Revenue Towards Total
Openeings (Non Annualiized)            -
Total Cost                             -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Days Open Per Year
Total Vendor Service
Authorizations (VSA)                   -
Total number of Non-DDS
Funded Individuals                     -
Total Potential Days                   -            -        -        -        -        -        -        -        -        -        -        -        -               -            -

Total Potential Days for VSA           -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Total Annual Cost of VSA               -




                                                                                                                                                           9/14/2012 6:48 PM
Other Schedule

Agency Name                                0

                                               66       67       68       69       70       71       72       73       74       75       76       77              78           79
Region
Cost Center #
Cost Center Name




Type -------REQUIRED!          Total

Direct Support FTEs                    -
Salaries                               -
Employee Benefits                      -
Nonsalary                              -
Admin&General                          -
Subtotal Expenses                      -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Non-Reimburseable Costs                -
Program Total                          -            -        -        -        -        -        -        -        -        -        -        -        -               -            -



Other Revenue Towards Total
Openeings (Non Annualiized)            -
Total Cost                             -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Days Open Per Year
Total Vendor Service
Authorizations (VSA)                   -
Total number of Non-DDS
Funded Individuals                     -
Total Potential Days                   -            -        -        -        -        -        -        -        -        -        -        -        -               -            -

Total Potential Days for VSA           -            -        -        -        -        -        -        -        -        -        -        -        -               -            -
Total Annual Cost of VSA               -




                                                                                                                                                           9/14/2012 6:48 PM
          Administrative & General Worksheet
Agency                                     0

1         Salary and Wages                    FTE   A&G
     a.    Administration
     b.    Business
     c.    Secretarial/Clerical
     d.    Other
     e.    Total Salary & Wages (a thru d)                -
2         Non-Salary
     a.    Accounting & Auditing
     b.    Legal Fees
     c.    Office Supplies (including postage)
           Occupancy Costs (utilities,                        Total Agency Expense excluding
     d.    telephone, repairs, rent, taxes)                   Revenue and A&G                                     -
     e.    Dues & Membership Fees
     f.    Management Services                                Total Agency A&G Percentage                       0.00%
     g.    Consultant Services
                                                              Total DDS Expense excluding Revenue
           Data Processing
    h.                                                        and A&G                                             -
     I.  Staff Development & Seminars
     j.  Temporary Help (Non-Payroll)                         Total DDS A&G Percentage                          0.00%
    k.   Depreciation & Amortization
     l.  Insurance                                            Net A&G Allocated                                   0.00
    m.   Employee Mileage
    o.   Vehicle Cost
    p.   Lease Equipment & Maintenance
    q.   Other
     r.  Total Non-Salary (2a-2p)                         -
3        Employee Benefits
4        Interest Expense
5       Subtotal Gross A&G Costs                          -
6       A&G Expense Recovery
     a. Less Non-Reimbursable Costs
        Less Other Operating and Non-                         Difference A&G Worksheet and Allocated
     b. Operating Revenue                                     A&G costs                                            -
     c. Total                                             -
7         Total Net A&G Expense                           -




                                                                                                       9/14/2012 6:48 PM
             Summary of Employee Benefits

Agency                                                      0
                                                                Amount
         1   Social Security (FICA)
         2   Unemployment
         3   Workers Compensation
         4   Insurance (Health, Dental, Disability, Life)
         5   Retirement
         6   Other
         7   Total Benefits                                        -


             Salaries from Summary                                 -
             Salaries from A&G                                     -
             Total Salaries                                        -

             Percentage of Benefits                              0.00%

             Benefits Allocated Service Cost Centers               -
             Benefits Allocated A&G Cost Center                    -

             Difference between expense and allocated              -




                                                                         9/14/2012 6:48 PM
Community Living Arrangement Schedule
Agency Name                                     0
Region                                              NR        NR        NR         NR   SR         SR        SR         SR
Type                                                CLA       CRS       IHS       CCH   CLA       CRS       IHS        CCH
                                    Total
Direct Support FTEs                         -             -         -         -     -         -         -         -        -
Salaries                                    -             -         -         -     -         -         -         -        -
Employee Benefits                           -             -         -         -     -         -         -         -        -
Nonsalary                                   -             -         -         -     -         -         -         -        -
Admin & General                             -             -         -         -     -         -         -         -        -
Subtotal Expenses                           -             -         -         -     -         -         -         -        -
Non-Reimburseable Costs                     -             -         -         -     -         -         -         -        -
Program Total                               -             -         -         -     -         -         -         -        -
Other Revenue Towards DDS
Purchased Openings (Non
Annualized)                                 -             -         -         -     -         -         -         -        -
Total Cost                                  -             -         -         -     -         -         -         -        -
Vendor Service Authroizations
Revenue                                     -             -         -         -     -         -         -         -        -
Revenue For Non-DDS Participants.
Including revenue for Respite
Participants.                               -             -         -         -     -         -         -         -        -
Total Number of Contract Service
Authorizations (CSA)                        -             -         -         -     -         -         -         -        -
Total Number of Vendor Service
Authorizations (VSA)                        -             -         -         -     -         -         -         -        -
Total Number of Non-DDS Funded
Individuals                                 -             -         -         -     -         -         -         -        -
Total Potential Days for All
Openings                                    -             -         -         -     -         -         -         -        -
Total Potential Days for Contract
Service Authorizations                      -             -         -         -     -         -         -         -        -
Total Annual Cost of Contract
Service Authorizations                      -             -         -         -     -         -         -         -        -

Children Room and Board                     -             -         -         -     -         -         -         -        -
Start Up (New CLAs)                         -             -         -         -     -         -         -         -        -
Cash Advance (New CLAs)                     -             -         -         -     -         -         -         -        -
Total DDS Cost                              -             -         -         -     -         -         -         -        -
Total Cost CLA & CRS for Region                                     -                                   -
Total Cost for Region                                                               -                                      -

                                                                                                            9/14/2012 6:48 PM
WR        WR        WR        WR        TOTAL     TOTAL          TOTAL        TOTAL      TOTAL
CLA       CRS       IHS       CCH       CLA       CRS           CLA & CRS      IHS       CCH



      -         -         -         -         -         -             -              -         -
      -         -         -         -         -             -             -          -             -
      -         -         -         -         -             -             -          -             -
      -         -         -         -         -             -             -          -             -
      -         -         -         -         -             -             -          -             -
      -         -         -         -         -             -             -          -             -
      -         -         -         -         -             -             -          -             -
      -         -         -         -         -             -             -          -             -



      -         -         -         -         -             -             -          -             -
                                                                                                   -
      -         -         -         -         -             -             -          -             -

      -         -         -         -         -             -             -          -             -



      -         -         -         -         -
                                              -             -             -          -
                                                                                     -             -
                                                                                                   -

      -         -         -         -         -             -             -          -             -

      -         -         -         -         -             -             -          -             -

      -         -         -         -         -             -             -          -             -

      -         -         -         -         -             -             -          -             -

      -         -         -         -         -             -             -          -             -

      -         -         -         -         -             -             -          -             -
                                                                                                   -
      -         -         -         -         -             -             -                        -
      -         -                             -             -             -                        -
      -         -                             -             -             -                        -
      -         -         -         -         -             -             -          -             -
                -
                                    -

                                                                                               9/14/2012 6:48 PM
Day Service Schedule
Agency Name                                    0
Region                                              NR       NR        NR        NR         SR       SR        SR        SR        WR        WR         WR            WR
Type                                               DSO       GSE       ISE       SHE       DSO       GSE       ISE       SHE       DSO       GSE        ISE           SHE
                                   Total
Direct Support FTEs                        -             -         -         -         -         -         -         -         -         -         -          -             -
Salaries                                   -             -         -         -         -         -         -         -         -         -         -          -             -
Employee Benefits                          -             -         -         -         -         -         -         -         -         -         -          -             -
Nonsalary                                  -             -         -         -         -         -         -         -         -         -         -          -             -
Admin & General                            -             -         -         -         -         -         -         -         -         -         -          -             -
Subtotal Expenses                          -             -         -         -         -         -         -         -         -         -         -          -             -
Non-Reimburseable Costs                    -             -         -         -         -         -         -         -         -         -         -          -             -
Program Total                              -             -         -         -         -         -         -         -         -         -         -          -             -
Other Revenue Towards DDS
Purchased Openings (Non
Annualized)                                -             -         -         -         -         -         -         -         -         -         -          -             -
Sales Revenue                              -             -         -         -         -         -         -         -         -         -         -          -             -
Total Day Cost                             -             -         -         -         -         -         -         -         -         -         -          -             -
Vendor Service Authorizations
Revenue                                    -             -         -         -         -         -         -         -         -         -         -          -             -
Revenue For Non-DDS
Participants                               -             -         -         -         -         -         -         -         -         -         -          -             -
Days Open Per Year                         -             -         -         -         -         -         -         -         -         -         -          -             -
Total number of Contract Service
Authorizations (CSA)                       -             -         -         -         -         -         -         -         -         -         -          -             -
Total number of Vendor Service
Authorizations (VSA)                       -             -         -         -         -         -         -         -         -         -         -          -             -
Total number of Non-DDS Funded
Individuals                                -             -         -         -         -         -         -         -         -         -         -          -             -

Total Annual Cost of Contract
Service Authorizations                     -             -         -         -         -         -         -         -         -         -         -          -             -
Total Cost for Region                                                                  -                                       -                                            -




                                                                                                                                                       9/14/2012 6:48 PM
TOTAL       TOTAL       TOTAL       TOTAL
DSO         GSE          ISE        SHE


        -           -           -           -
        -           -           -           -
        -           -           -           -
        -           -           -           -
        -           -           -           -
        -           -           -           -
        -           -           -           -
        -           -           -           -



        -           -           -           -
        -
        -           -           -           -


        -


        -           -           -           -
        -           -           -           -

        -           -           -           -

        -           -           -           -

        -           -           -           -


        -           -           -           -




                                                9/14/2012 6:48 PM
Summary Schedule
Agency Name                                     -                                           Provider #             -

Contact                                         -                                                           0
Primary Region                                      -   TOTAL       TOTAL       TOTAL         TOTAL       TOTAL             TOTAL
Type                                                    CLA         CRS          IHS           CCH         Day              Other

                                        Total
Direct Support FTEs                                 -           -           -           -             -           -                  -
Salaries                                            -           -           -           -             -           -                  -
Employee Benefits                                   -           -           -           -             -           -                  -
Nonsalary                                           -           -           -           -             -           -                  -
Admin&General                                       -           -           -           -             -           -                  -
Subtotal Expenses                                   -           -           -           -             -           -                  -

Non-Reimburseable Costs                             -           -           -           -             -           -                  -
Program Total                                       -           -           -           -             -           -                  -
Other Revenue Towards DDS
Purchased Openeings (Non
Annualiized)                                        -           -           -           -             -           -                  -
Sales Revenue                                       -                                                             -
Total Cost                                          -           -           -           -             -           -                  -
Vendor Service Authroizations
Revenue                                             -           -           -           -             -           -
Revenue For Non-DDS Participants.
Including revenue for Respite
Participants.                                       -           -           -           -             -           -                  -
Total Number of Contract Service
Authorizations (CSA)                                -           -           -           -             -           -
Total Number of Vendor Service
Authorizations (VSA)                                -           -           -           -             -           -                  -
Total Number of Non-DDS Funded
Individuals                                         -           -           -           -             -           -                  -

Total Potential Days for All Openings               -           -           -           -             -           -                  -
Total Potential Days for CSAs                       -           -           -           -             -           -
Total Annual Cost of CSAs                           -           -           -           -             -           -

Children Room and Board                             -           -
Start Up (New CLAs)                                 -           -
Cash Advance (New CLAs)                             -           -
Total                                               -           -           -           -             -            -                 -

                                                                                                                 9/14/2012 6:48 PM
                                                      Info


This OPPLAN EXCEL sheet was designed to allow streamlined budgeting of provider cost centers.
  Key changes include: The addition of a line item to capture children Room & Board paid by DDS.




Please contact
with questions, comments, suggestions, or problems.




General      1. Make extra copy of file.




Data Entry   1. Data entry fields are bordered in green. All entries should be rounded to the nearest dollar.
             2. List Boxes are used for region and program type. These must be used in order for all calculations and
             distributions to be made




             1. Region and Service Type List Boxes not used.
Common
             2. DDS Contract Revenue does not get entered on any schedule as Revenue. Revenue is for other kinds of
Errors       revenue that relate to the cost center.




                                                   Page 30
                                                                Info


This OPPLAN EXCEL sheet was designed to allow streamlined budgeting of provider cost centers.
   Key changes include: The addition of a line item to capture children Room & Board paid by DDS.
                        Lines for start up and Cash advance
                        DDS agency title.
                        More consistent formatting of numbers.
                        The addition of a date and comment for OPPLAN revisions on the Demographic page.
                        A match for allocation of A&G with the A&G Sheet
Please contact Peter Mason at DDS Central Office (860) 418-6077 peter.mason@ct.gov
with questions, comments, suggestions, or problems.




           1. Make extra copy of file.




           1. Data entry fields are bordered in green. All entries should be rounded to the nearest dollar.
           2. List Boxes are used for region and program type. These must be used in order for all calculations and
           distributions to be made




           1. Region and Service Type List Boxes not used.
           2. DDS Contract Revenue does not get entered on any schedule as Revenue. Revenue is for other kinds of
           revenue that relate to the cost center.




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