Data, Forms & Reports - Administration
Budget
Budget Services Reports
- FY21 Expenditure Tracking
- FY20 Expenditure Tracking
- FY19 Expenditure Tracking
- FY18 Expenditure Tracking
Financial Services Forms
- DA-56 NON-EMPLOYEE Travel Expense Report (Effective July 1, 2021)
- DA-57 Monthly Expense Report Form (Effective July 1, 2021)
- DA-56 NON-EMPLOYEE Travel Expense Report (Effective March 1, 2021)
- DA-57 Monthly Expense Report Form (Effective March 1, 2021)
- DA-58 Coding Detail Form
- DA-101 Receivable Write-off Form (previously DH-101)
- DH-11 Document Invoice Form
- DH-59 Invoice Routing Form
- DH-100 E-Deposit Security Request Form
- Budget Load Form
- Budget Move Form
- E&E Journal Voucher Request Form
- Fund Switch Template
- LDPR New-Change Request Form
- Payroll JV request form
- State of Missouri Tax Exempt Letter
- Vendor Input
Financial Services Reports
- Contract Tracking Number Report
- Daily Contract Status Report
- Detailed Network Allocation Reports
- Direct Bill Listing
- Document Services Sweep Analysis
- Fixed Asset Managers (FAMs)
- Fringe Benefit Rate Reports
- FSRs/Billings Monthly Reports
- Fund Reports
- Payment Processing Reports
Fiscal Notes
- Fiscal Note Worksheet FY21
- Overview Questions FY21
- Staff Review Form FY21
- Statement of No Change FY21
Fixed Assets
- DH-60 Non-Expendable Property Transfer/Reassignment
- DH-85 Non-Expendable Property Removal Request
- DH-86 Listing of Loaned Equipment
- DH-87 Request for Listing of DHSS Fixed Assets/Telecommuter Equipment
- DH-88 Fixed Asset/Property Tab Substitution/Waiver Request
- SS1 Report of State Owned Surplus Property
- SS2 Redistribution Authorization
- Fixed Asset/Property Tag Assignment
General
General Services/Warehouse
- DA-48 Request for Forms (.pdf) (previously DH-48)
- DH-61 Work Order
- DH-84 Vehicle Expense Form
- DA-90 Move Request (previously DH-90)
- Cisco Phones and Vacant Positions Guidance
- New Employee - New Phone Request
- Non-Expendable Property Transfer/Reassignment DH-60
- Production Request Form (previously State Print Req)
- Wireless Service Requests
Grant Applications
- DA-42 Request for Approval for Application Letter (previously DH-42)
- SF-424 Application
- SF-424A Application Budget
- SF-424 R&R
- Assurance Forms
- Certification Forms
- Fringe Rate Estimates FY22
- Fringe Rate Estimates FY21
- Indirect Cost Rate Agreement FY22
- Indirect Cost Rate Agreement FY21
- Indirect Cost Rate Agreement FY20
- Network Access and General Application Support - effective 7-1-2019
- Network Access and General Application Support - effective 7-1-2020
- OMB Checklist
- Request for Carryover of Grant Funds
- Request for No-Cost Extension
- Set Up of Grants Prior to Receipt of Official Notice of Grant Award
- W9 for State of Missouri
Grants Management
- DA-40 Financial Monitoring Tool
- COFAR FAQ on UGG
- Grants Management Roles and Responsibilities
- Grants Manual 2018
- Referral Checklist Template (DA-103)
- Risk Assessment-Matrix
- Risk Assessment-Matrix Instructions
- Risk Assessment Sample Risk Categories Criteria
Letterhead/Fax Cover/Memo
Letterhead
Eastern District
Northeastern District
Northwestern District
Southeastern District
Southwestern District
Cameron Area Office
Cape Girardeau Office
Columbia Area Office
Joplin Area Office
Fax Cover
Eastern District
Northeastern District
Northwestern District
Southeastern District
Southwestern District
Cameron Area Office
Cape Girardeau Office
Columbia Area Office
Joplin Area Office
Purchasing and Contract Forms
Contract Language and Attachments with OMB Updates MAIN
- Anti-Discrimination Against Israel Act Certification Exhibit
- Attachment A - Certifications with OMB updates
- Attachment B - Subrecipient Conditions with OMB updates
- Attachment C - Subrecipient Annual Financial Report (MO580-3091)
- Business Associate Provisions Attachment
- Business Entity Certification, Enrollment Documentation, and Affidavit of Work Authorization Attachment
- Standard Contract Language with OMB updates
- Terms and Conditions
Forms & Templates
- DH-10 Purchasing Request
- MO 580-3094 Invoicing Tool for Calculating Indirect
- Invitation for Bid Shell Document
Participation Agreements
- DH-74A Participation Agreement for Professional and Special Services Provider
- DH-74A Terms and Conditions
- Brain Injury Waiver Participation Agreement
- Missouri Women, Infants and Children (WIC) Program Retailer Authorization Agreement
- Summer Food Service Program Inspections Participation Agreement
- Tuberculosis Diagnostic Services Participation Agreement
- Environmental Child Care Sanitation Inspections Participation Agreement – Serving Outside County
- Environmental Child Care Sanitation Inspections Participation Agreement – Own County Only
- Onsite Wastewater Treatment System Construction Review and Permitting Participation Agreement
- 580-3166 STEMI Agreement
- 580-3167 Stroke Agreement
- 580-3200 Trauma Agreement