Get documents about "Ny State Legal Forms
W
Description
Ny State Legal Forms document sample
Document Sample
This Workbook contains 7 worksheets for completing the DV Fiscal Reporting Forms.
Click on the buttons below to access each worksheet.
eporting Forms.
OCFS-DV-2652 REPORT OF ACTUAL EXPENDITURES NYS Office of Children and Family Services
PERIOD AGENCY CODE AGENCY NAME EXECUTIVE DIRECTOR DATE
From To
ACCOUNT TOTAL
NUMBER ACCOUNT TITLE COST
(1) (2) (3) (4) (5) (6) (7)
01A Salaries-Administrative -
B -Program Support -
C -Maintenance -
02A Social Security -
B Insurance-Life/Health -
C Pension and Retirement -
D Worker's Comp/UIB/Disability -
E Vacation Accrual/Sick Leave -
03 Transportation -
04 Recreation and Social Activities -
05 Purchase of Services -
06 Food -
07 Clothing -
08 Bedding and Linen -
09 Supplies and Equipment -
10 Rent -
11 Rent-Furnishings and Equipment -
12 Rent-Vehicles -
13 Utilities -
14A Repairs-Plant -
B -Equipment -
15 Repairs & Equipment Vehicles -
Page 3 of 14 Rev. 8-8-03
OCFS-DV-2652 REPORT OF ACTUAL EXPENDITURES NYS Office of Children and Family Services
PERIOD AGENCY CODE AGENCY NAME EXECUTIVE DIRECTOR DATE
From To
ACCOUNT TOTAL
NUMBER ACCOUNT TITLE COST
(1) (2) (3) (4) (5) (6) (7)
16 Telephone -
17 Postage -
18 Dues/Licenses/Permits -
19 Office Supplies -
20 Subscriptions/Publications -
21 Conference Expense -
22 Administrative Expense -
23 Staff Development -
24 Publicity -
25 Audit/Legal & Advisory Fees -
26 Insurance -
27A Interest Expense-Debt Service -
B -Operations -
28 Taxes -
29 Use Charges -
30 Parent Organization Charges -
31 Non Allowable Expense -
TOTAL PROGRAM EXPENSES - - - - - - -
Page 4 of 14 Rev. 8-8-03
OCFS-DV-2651: Residential Program Bed Night Statistics
NYS Office of Children and Family Services
From To
Dates: 01/00/00 01/00/00
Agency Name:
Program Type:
DV Shelter, DV Program, Safe Dwelling, Safe Home Network
Program Licensed Capacity
The licensed capacity of the program. This is on the OCFS
issued operating certificate.
I. Bed Nights Billed to LDSS:
A. Billed for Full Payment. Those bed nights where LDSS was
billed the full DV State Aid Rate.
B. Billed for Partial Payment. Those bed nights where LDSS
was billed a portion of the DV State Aid Rate.
C. Total bed nights billed to LDSS. The total of A and B - - - - -
II. Bed Nights Provided but not Billed to LDSS
III. Total of All Bed Nights Provided (Bill and Not Billed) - - - - -
IV. PROGRAM UTILIZATION #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
The percentage of utilization based on capacity and all bed
nights provided.
Page 5 of 14 Rev. 8-8-03
OCFS-DV-2654 Period Agency Executive Director Date Agency Code
REPORT OF ACTUAL INCOME From To
NYS Office of Children & Family Services 01/00/00 01/00/00 1/0/1900
Source of Revenue EDP Gross Amount Distribution of Gross Income
(List each separately) Code of Income
Section A: GOVT. GRANTS
-
-
-
-
-
-
-
Total A - - - - - - - -
Section B: FEE FOR SERVICE
-
-
-
-
-
-
Total B - - - - - - - -
Section C: OTHER INCOME
-
-
-
-
-
-
Total C - - - - - - - -
GRAND TOTAL - - - - - - - -
Page 6 of 14 Rev. 8-8-03
OCFS-DV-2668-1 Period Agency Agency Executive Director Date Prepared
NYS Office of Children and Family Services From To Code
EMPLOYEE DISTRIBUTION 01/00/00 01/00/00 1/0/1900
BY JOB CLASSIFICATION Highest Lowest
Gross Gross
OCFS Job Classification DSS Annual Annual Agency Total
Code Salary Salary Salary FTE Salary FTE Salary FTE Salary FTE Salary FTE
Administration (1) (2) (3) (4) (4a) (5) (5a) (6) (6a) (7) (7a) (8) (8a)
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
SUB-TOTAL ADMINISTRATION - - - - - - - - - -
Page 7 of 14 Rev. 8-8-03
OCFS-DV-2668-2 Actual Period Agency Agency Executive Director Date Prepared
NYS Office of Children and Family Services From To Code
EMPLOYEE DISTRIBUTION 1/0/1900 1/0/1900 1/0/1900
BY JOB CLASSIFICATION Highest Lowest
Gross Gross
OCFS Job Classification DSS Annual Annual Agency Total
Code Salary Salary Salary FTE Salary FTE Salary FTE Salary FTE Salary FTE
Program Support (1) (2) (3) (4) (4a) (5) (5a) (6) (6a) (7) (7a) (8) (8a)
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
SUB-TOTAL PROG. SUPP. - - - - - - - - - -
Page 8 of 14 Rev. 8-8-03
OCFS-DV-2668-3 Actual Period Agency Agency Executive Director Date Prepared
NYS Office of Children and Family Services From To Code
EMPLOYEE DISTRIBUTION 1/0/1900 1/0/1900 1/0/1900
BY JOB CLASSIFICATION Highest Lowest
Gross Gross
OCFS Job Classification DSS Annual Annual Agency Total
Code Salary Salary Salary FTE Salary FTE Salary FTE Salary FTE Salary FTE
Maintenance (1) (2) (3) (4) (4a) (5) (5a) (6) (6a) (7) (7a) (8) (8a)
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
SUB-TOTAL MAINTENANCE - - - - - - - - - -
Page 9 of 14 Rev. 8-8-03
OCFS-DV-2856 Agency Executive Director Date Prepared
NYS Office of Children and Family Services
SUPPLEMENTAL MEMORANDUM REPORT
CHARGES FROM PARENT ORGANIZATION
Period: From To
01/00/00 01/00/00 1/0/1900
Elements of Cost Included in Charge Description of Method by which Parent Organization Determines Charge
Nature of Expense Amount
TOTAL PARENT
ORGANIZATION CHARGE -
Description of Method by which Parent Organization Charge is Allocated to Program Cost Centers
Allocations to Program Cost Centers (should be the same distribution as reported on OCFS-DV-2652)
TOTAL 0 0 0 0 0 0
- - - - - - -
Page 10 of 14 Rev. 8-8-03
Period Agency Executive Director Date Agency Code
OCFS-DV-3307 From To
PURCHASE OF SERVICES SCHEDULE 01/00/00 01/00/00 1/0/1900
NY Office of Children & Family Services Allocation by Program
EDP Total
TYPE OF SERVICE Code Expense
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Total - - - - - - - -
Page 11 of 14 Rev. 8-8-03
OCFS-DV-3308 Period Agency Executive Director Date Agency Code
REPORT OF ALLOCATION METHODS From To
NY State Office of Children & Family Services 01/00/00 01/00/00 01/00/00
Account Allocation Method Used Total Expense Direct Allocated Distribution of Allocated Expense
Number From DV-2652 Expense Expense Program
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
01A - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
01B - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
01C - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
02A - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
02B - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
02C - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
02D - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
02E - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
03 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
04 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
05 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
06 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
07 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
08 - - - AMT.
Page 12 of 14 Rev. 8-8-03
OCFS-DV-3308 Period Agency Executive Director Date Agency Code
REPORT OF ALLOCATION METHODS From To
NY State Office of Children & Family Services 01/00/00 01/00/00 01/00/00
Account Allocation Method Used Total Expense Direct Allocated Distribution of Allocated Expense
Number From DV-2652 Expense Expense Program
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
09 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
10 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
11 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
12 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
13 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
14A - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
14B - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
15 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
16 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
17 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
18 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
19 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
20 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
21 - - - AMT.
Page 13 of 14 Rev. 8-8-03
OCFS-DV-3308 Period Agency Executive Director Date Agency Code
REPORT OF ALLOCATION METHODS From To
NY State Office of Children & Family Services 01/00/00 01/00/00 01/00/00
Account Allocation Method Used Total Expense Direct Allocated Distribution of Allocated Expense
Number From DV-2652 Expense Expense Program
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
22 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
23 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
24 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
25 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
26 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
27A - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
27B - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
28 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
29 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
30 - - - AMT.
% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
31 - - - AMT.
Page 14 of 14 Rev. 8-8-03
Related docs
