Service Delivery Forms

Contracting & Procurement Forms

Number Name Purpose
1513 Disclosure of Ownership and Control Interest Statement Documents ownership and financial interest information.
2030 Budget for Purchase of Services Contracts Budget for Cost Reimbursement contracts.
2030 CLIVE Budget for Title IV-E County Contract Budget for Title IV-E Legal services contracts.
2030 CLIVE-IR Budget for Title IV-E County Budget for Title IV-E Legal services with parental representation contracts.
2030 CWIVE Budget for Title IV-E County Contract Budget for Title IV-E Child Welfare services contracts.
2031 Signature Authority Designation Signature authority designation.
2044MOU DFPS Memorandum of Understanding Routing Form Proper routing and signature authority of MOUs.
2282G DFPS Grant Contract Template DFPS template for grant contracts.
2282V DFPS Vendor Contract Template DFPS template for vendor contracts.
2970C Disclosure and Consent to Release of Information Regarding Criminal or Abuse/Neglect History For Applicants, Employees or Volunteers of DFPS Contractors and Subcontractors Release of information regarding criminal history or DFPS abuse and neglect history.
2971C Request for Criminal History and DFPS History Check Application for requesting criminal history and DFPS abuse or neglect history.
4514MOU Memorandum of Understanding (MOU) DFPS template to draft MOU.
4530 DFPS Cybersecurity Training Certification Certifies completion of training required for access to DFPS systems and databases.
4734 Federal Funding Accountability and Transparency Act (FFATA) Certifications The form is required for any DFPS subrecipient contracts and any other sub-awards granted under a federal cooperative agreement or grant.
4735 Out of State Contractor Certifications Certifies compliance with business entities laws of the state where the contractor does business and that the contractor is not delinquent in state or federal taxes.
5622CSC RCC Child Specific Contract Special Conditions Required Special Conditions for DFPS vendor Child Specific Contracts.
5622G DFPS Grant Supplemental and Special Conditions Required attachment for DFPS grant contracts.
5622RCC-CPA RCC Supplemental, Special, and Programmatic Conditions for CPA Required Special Conditions for RCC CPA contracts.
  RCC Performance Measures for CPA Required performance measures for RCC CPA contracts.
5622RCC-GRO RCC Supplemental, Special, and Programmatic Conditions for GRO Required Special Conditions for RCC GRO contracts.
  RCC Performance Measures for GRO Required performance measures for RCC GRO contracts.
5622RCC-IPTP RCC Supplemental, Special, and Programmatic Conditions for IPTP Required Special Conditions for RCC IPTP contracts.
  RCC Performance Measures for IPTP Required performance measures for RCC IPTP contracts.
5622V DFPS Vendor Supplemental and Special Conditions Required Special Conditions for DFPS vendor client service contracts.
5622VRG Regional Contracts Supplemental and Special Conditions Required Special Conditions for DFPS regional client service contracts.
5622VPADPAL Post Adoption & PAL Contracts Supplemental and Special Conditions Required Special Conditions for DFPS PAD & PAL client service contracts.
5645CBC DFPS Special Attachment for Single Source Continuum Contracts

Required attachment, to DFPS Contract Templates for DFPS Single Source Continuum Contracts in addition to the 5622.
5645G DFPS Grant Uniform Terms and Conditions Uniform Terms and Conditions for grant contracts.
5645V DFPS Vendor Uniform Terms and Conditions Uniform Terms and Conditions for vendor contracts.
5645INT DFPS Interagency and Interlocal Uniform Terms and Conditions Uniform Terms and Conditions for Interagency and Interlocal contracts.
74-157 Payee Change Request Change existing information for one payee number.
74-176 Direct Deposit Authorization For vendor to receive direct deposit.
9007CR Internal Control Structure Questionnaire and Instructions (ICSQ) for Cost Reimbursement Contracts Contractor's disclosure of internal controls to safeguard assets. Instructions included.
9007ICC Internal Control Certification (ICC) For contractors to certify there have been no internal control changes.
9007CIVE_S Internal Control Structure Questionnaire (ICSQ) for Title IV-E County Between $10,000 and $24,999 Contractor's disclosure of internal controls. Instructions included.
9007CIVE Internal Control Structure Questionnaire (ICSQ) for Title IV-E County > $25,000 Contractor's disclosure of internal controls. Instructions included.
9007CPG Internal Control Structure Questionnaire (ICSQ) for Community and Parent Groups Contractor's disclosure of internal controls. Instructions included.
9007FFS Internal Control Structure Questionnaire (ICSQ) for Fee for Service Contracts Contractor's disclosure of internal controls. Instructions included.
9007Claims Internal Control Structure Questionnaire (ICSQ) for Claims Processing Contractor's disclosure of internal controls. Instructions included.
9007RCC Internal Control Structure Questionnaire (RCC) Contractor's disclosure of internal controls. Instructions included.
9025a Related Party Leases/Rental Worksheet Form used by Residential Child-Care Contracts to determine and manage Contractor Related party leases/rental agreement(s).
9105 Risk Analysis Questionnaire (RAQ) Questionnaire for provider to assist staff with the completion of the Risk Assessment Instrument (RAI).
9105PEI PEI Risk Analysis Questionnaire (RAQ) PEI questionnaire for provider to assist staff with the completion of the Risk Assessment Instrument (RAI).
PCS-102RCC PCS Background Checks Residential Child Care Background Checks only.
AP-152 Application for Texas Identification Number/Additional Mailing Address Application for identification number.