Monthly Child Served Report.xlsm

XLSM spreadsheet 32 KB Posted

Attached to
Statewide HOMEBUILDERS(R) Program
Solicitation number
RFP - 10A - 202605083
Issued by
Maine

About this file

This is a Monthly Child Served Report form used by child welfare service providers to submit census and billing data to the Rhode Island Department of Children, Youth and Families (DCYF). Providers must complete and submit this form by the fifth working day of each month following the service period. The form captures detailed information on individual children served, including demographic data, case identifiers, service authorization details, and service dates. Providers report on multiple service types including foster care (relative and non-relative), residential treatment, emergency shelter, family preservation services, mentoring, and various community-based programs. For each child served during the billing period, providers document total service days, absences due to hospitalization or other reasons, billable days, and current service delivery status (ongoing, successfully completed, or terminated for various reasons).

The form requires providers to calculate total costs based on contracted rates and billable days, with aggregated summaries of filtered days and total costs displayed at the form level. Service delivery status options include ongoing services as well as multiple termination categories such as successful completion, out-of-home placement, detention, aging out of program, family relocation, refusal of services, runaway status, client death, court order, service inappropriateness, and other reasons. The spreadsheet format allows for multiple service types and drop-down menus to ensure consistent data entry and reporting accuracy. This census data serves as the basis for provider invoicing and enables DCYF to track service utilization and outcomes across its contracted home-based and placement-based child welfare service network.

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Other files

File Type Posted
RFP 202605083 Q —
HOMEBUILDERS Proposed Services Response Form-FINAL.docx DOCX document
RFP 202605083 HOMEBUILDERS_FINAL.docx DOCX document
RFQ 15A260626-0326 rev1 Augusta Armory.docx DOCX document
HOMEBUILDERS Provider Packet Report Template.xlsx XLSX spreadsheet
RFP 202605083 HOMEBUILDERS_FINAL.docx.crdownload CRDOWNLOAD file

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Text version

Census-HomeBased

This form is to be submitted by the provider by the 5th working day of each month following the service period. By submitting this form, the provider certifies information is accurate and complete.
Home Based Service Census Form
Provider Name:
Invoice Submission Date:
Invoice Period:
Provider Contact Name:
Provider Contact Phone #:
Provider Contact Email:Filtered DaysFiltered Total Cost
0$ - 0
Provider NameHome Based Service TypeFAC IDChild Last NameChild First NameChild DOBRICHIST Case IDRICHIST Child IDCase Name (Family Name)Service Authorization #Service Start Date (For Billing Period)Service End Date (For Billing Period)RateTotal Service Days (For Billing Period)Days Child Absent (Hosp - Billed)Days Child Absent (Hosp - Unbilled)Days Child Absent from Care (Billed)Days Child Absent from Care (Unbilled)Total Billable DaysTotal CostService Delivery Status
00$ - 0Srvc Ended – Successful Completion
00$ - 0Srvc Ongoing
00$ - 0Srvc Ongoing

DropDowns

CSEC MentorEmergency ShelterFoster Care - Non RelativeOne to OneCensus-HomeBasedSrvc Ongoing
CSEC TeamFoster Care - Private AgencyCensus-PlacementSrvc Ended – Successful Completion
Enhanced Family Support ServicesGroup HomesCensus-FosterCareSrvc Ended – Out of Home Placement
Familias UnidasHigh End Residential TreatmentCensus-One on OneSrvc Ended – Detained/Sentenced
Family Centered TreatmentIndependent Living ContractedSrvc Ended – Aged Out of Program
Family PreservationPurchase of Service Foster CareSrvc Ended – Family Moved
Family Preservation - Adoption SupportPurchase of Service Group HomesSrvc Ended – Refused Svc/Engagement
Family Preservation - VisitationResidential Treatment CenterSrvc Ended – Runaway/Absent from Care
Family Stablization ProgramSemi- Independent LivingSrvc Ended – Client Closed to DCYF
Foster Parent Support ServicesSrvc Ended – Client Deceased
Functional Family TherapySrvc Ended – Court Order
HomebuildersSrvc Ended – Service Inappropriate
MST - ContractedSrvc Ended – Other
MST-PSB
Outreach and Tracking
Parenting w/ Love & Limits
Preserving Family Networks
SafeCare
STAAR
Teen Assertive Community Treatment
Triple P
TST Community Based
TTEAM
Visitation Center
Youth Advocate Program

File details come from the government source that posted it. Updated .