RFP 6124 Att I - Quarterly Report.xlsx
XLSX spreadsheet 22 KB Posted
- 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.
View the file
Other files
Show all 24
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: |
| Data | Number of Individuals | Notes (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 DSW | 0 | |
| TOTAL Number of Indiviudals | 0 |
| 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 .