RFP 6124 Att I - Quarterly Report.xlsx

XLSX spreadsheet 22 KB Posted

Attached to
Request for Proposals - Agency with Choice Services
Solicitation number
S-10000-00013757
Issued by
Oregon

About this file

This document is a Quarterly Reporting Form for an Agency with Choice (AwC) program, involving the Oregon Department of Justice (OR DOJ). The form is designed to track quarterly data for service delivery, specifically related to Direct Support Workers (DSWs) and individuals receiving services. The template requires reporting on key metrics including the number of new and current individuals served, DSWs employed, language capabilities of support workers, and individual records such as Medicaid ID, complaints, inspections, and contact logs. The document appears to be part of a broader procurement process, referencing RFP 5340 for acquisition and renovation of licensed residential facilities and homes.

The quarterly reporting form provides a structured mechanism for tracking program performance and service delivery details, with spaces for noting total numbers of individuals and DSWs, language matching capabilities, and additional administrative documentation. While specific financial terms are not detailed in this document, it suggests a comprehensive oversight approach for a state-managed service program. The form includes provisions for attachments of individual records and requires approval, indicating a rigorous documentation and compliance process managed by the Oregon Department of Justice.

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Text version

Sheet1

ATTACHMENT I - Agency with Choice Quarterly Report

INSTRUCTION:

Please complete this form for each Quarter of each year:March, June, Sept,December

Agency with Choice Name:
Name of Administrator :
Indicate what Quarter:
DataNumber of IndividualsNotes (as necessary)
Number of new Individuals this quarter
Number of current Individuals this quarter
Number of new DSW working for AwC Individual
Number of current DSW working for AwC Individuals
Number of DSW that speak Individual's primary language
TOTAL Number of DSW0
TOTAL Number of Indiviudals0
Is it attached to this form?Notes (as necessary)
Quarterly reporting
Individual records that include but not limited to:
Individual Medicaid ID
Complaints
Inspections
improvement plans
Contact Logs
Other:
Number of Individual records attached
Additional Notes:
May-25
Approved by OR DOJ on _/__/__

RFP 5340 ACQUISITION / RENOVATION OF LICENSED RESIDENTIAL FACILITIES AND HOMES

&P of &N

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