DOC-1026 Unit Service - Monthly Report.pdf

This is a Unit Service Monthly Report form (DOC-1026, RFB# CJO-6268, Attachment C) used by the Wisconsin Department of Corrections, Division of Community Corrections, operating under Wisconsin Statutes Section 301.08. The form is designed for provider agencies to request reimbursement for services delivered to eligible correctional offenders, with the original distribution going to the DCC Central Business Office.

The document serves as a reimbursement request mechanism where provider agencies report units of service provided to correctional offenders, including unit descriptions, number of units delivered, cost per unit, and total amounts. Agencies must submit this report within 30 days after the final day of the reporting month and are also required to submit a corresponding Offender Monthly Report within the same timeframe. The form includes certification language requiring agencies to attest that claimed services are accurate, have not been previously reimbursed, and represent actual services delivered in compliance with Wisconsin Department of Corrections laws, rules, and regulations. The reimbursement structure is based on a unit-of-service model with variable pricing depending on the specific services provided.