DOC-1026 Unit Service - Monthly Report.pdf

This document is a Unit Service Monthly Report form (DOC-1026) from the Wisconsin Department of Corrections, Division of Community Corrections, referencing Wisconsin Statutes Section 301.08. The form is designated as RFB# CJO-6268 Attachment C and is used by provider agencies to request reimbursement from the state for services delivered to eligible correctional offenders. The form requires completion by authorized agency representatives and includes fields for agency identification, tax ID, purchase order numbers, program details, and contact information.

The form is designed for providers to report units of service provided to correctional offenders, with sections for unit descriptions, quantities, cost per unit, and total amounts for reimbursement calculation. Providers must certify that claimed services are accurate, have not been previously reimbursed, and represent actual services delivered under Wisconsin Department of Corrections laws and regulations. The form requires submission within 30 days after the final day of the reporting month, along with a corresponding Offender Monthly Report. All entries must be signed and dated by the provider agency contact, with distribution going to the DCC Central Business Office for processing and reimbursement.