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.
View the file
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 Days | Filtered Total Cost |
| 0 | $ - 0 |
| Provider Name | Home Based Service Type | FAC ID | Child Last Name | Child First Name | Child DOB | RICHIST Case ID | RICHIST Child ID | Case Name (Family Name) | Service Authorization # | Service Start Date (For Billing Period) | Service End Date (For Billing Period) | Rate | Total 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 Days | Total Cost | Service Delivery Status |
| 0 | 0 | $ - 0 | Srvc Ended – Successful Completion | |||||||||||||||||
| 0 | 0 | $ - 0 | Srvc Ongoing | |||||||||||||||||
| 0 | 0 | $ - 0 | Srvc Ongoing |
DropDowns
| CSEC Mentor | Emergency Shelter | Foster Care - Non Relative | One to One | Census-HomeBased | Srvc Ongoing |
| CSEC Team | Foster Care - Private Agency | Census-Placement | Srvc Ended – Successful Completion | ||
| Enhanced Family Support Services | Group Homes | Census-FosterCare | Srvc Ended – Out of Home Placement | ||
| Familias Unidas | High End Residential Treatment | Census-One on One | Srvc Ended – Detained/Sentenced | ||
| Family Centered Treatment | Independent Living Contracted | Srvc Ended – Aged Out of Program | |||
| Family Preservation | Purchase of Service Foster Care | Srvc Ended – Family Moved | |||
| Family Preservation - Adoption Support | Purchase of Service Group Homes | Srvc Ended – Refused Svc/Engagement | |||
| Family Preservation - Visitation | Residential Treatment Center | Srvc Ended – Runaway/Absent from Care | |||
| Family Stablization Program | Semi- Independent Living | Srvc Ended – Client Closed to DCYF | |||
| Foster Parent Support Services | Srvc Ended – Client Deceased | ||||
| Functional Family Therapy | Srvc Ended – Court Order | ||||
| Homebuilders | Srvc Ended – Service Inappropriate | ||||
| MST - Contracted | Srvc 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 .