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DSS FISCAL MANUAL Section III - Developing Cost on the DSS-1571 Report

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Section III-C Purchased Services Reporting DSS-1571 Part IV

The DSS-1571, PART IV contains a six-block heading, a client service information section, and payment data showing to which costs were paid by the provider and the total cost of each client's units of service received. A fund column is provided to identity a specific fund source.

The following manuals should be referenced for information regarding eligibility category codes, service codes, and units of service:

l. Eligibility Category Codes - Category codes are no longer needed for Part IV reporting effective July 1, 1993.

2. Service Codes - The Services Information System (SIS) User's Manual.

Contract Reporting Procedures:

When entering into a contract for services, one of the following methods of reporting must be used:

a. If the person providing the service (contracted worker) is stationed on-site in the DSS facility and completes a Day Sheet that is keyed into SIS, the following reporting procedures are applicable:

b. If the person providing the service (contract worker) is stationed on-site in the DSS facility but does not complete a Day Sheet, the following reporting procedures are applicable:

c. If the person providing the service (contracted worker) is housed outside of the DSS facility, the following reporting procedures are applicable:

Contract Reporting Requirements:

When entering into a contract, the following method of reporting must be used:

Child Day Care (State Subsidy, CCDF Payments, etc.) is not reported on the DSS-1571 report.

Who submits?

1. The DSS-1571, Part IV is transmitted by counties to the State to cover the provision of purchased services.

2. Providers under contracts should submit the Part IV (or an invoice which contains all necessary information) to the county monthly, in time for the county to use that information to complete a DSS-1571 Part IV. All Part IV’s should be submitted together with the regular county submission.

3. For counties that began participating in the Food Stamp Workfare program after July 1, 1986, reports of payments for work related expenses are to be reported as follows:

4. Purchased Attorney Services

If the attorney's services are purchased, costs should be reported as follows:

5. Consumer Contributions (formerly Service Cost –Sharing)

6. LINKS Purchased Service must be reported on the DSS-1571 Part IV. Enter a fund I.D. "K".

7. The following codes should be used, depending upon which funding source you wish to obtain reimbursement from.

8. Child Support Fee Collecting

The following instructions describe what is reported on the Part IV.

County/Provider ID

Month of Service

Name

Method of Service Provision

Recipient Name - List the name of each recipient by last name, first name (or initial), and middle initial. (Note: For alcohol and drug programs, the recipient's case file number must be entered instead of his/her name).

Recipient Identification Number and Service Code

Enter the eleven digit client identification number, or MPI number, category code, and service code of the reported client. A service code must be shown for each client reported regardless of whether they are eligible or ineligible.

Authorized Rate

Units Provided

Invoice for Service Payments

Fees

Federal

State

County

Fund ID Codes

Program

100.00

   

1

Refugee Assistance

 

75.00

25.00

2

SSBG State

75.00

 

25.00

3

SSBG & State In-Home

66.00

 

34.00

3

IV-D

87.50

 

12.50

4

SSBG In-Home

   

100.00

6

HCCBG 60 & Up

87.50

 

12.50

7

STIH Adult 60 and over/Prep & Del

87.50

 

12.50

8

State In-Home under 60

   

100.00

9

Adoption Access Case Management

   

100.00

9

County Only/Non-DSS

   

100.00

9

Work First Block Grant Non Reim

87.50

 

12.50

A

Sp Federal Adult under 60

   

100.00

B

HCCBG

 

87.50

12.50

D

Sp State Adult under 60 State

 

87.50

12.50

F

Sp State Adults 60 and over State

75.00

 

25.00

G

Permanency Planning

75.00

 

25 .00

H

Adult Protective Services-SSBG

   

100.00

J

Adoption Access

80.00

20.00

 

K

LINKS

75.00

 

25.00

L

TANF to SSBG

87.50

 

12.50

M

Sp Federal Adults 60 and over

 

100.00

 

N

CPS State

 

87.50

12.50

P

State In Home 17 and Under

75.00

 

25.00

P

Transportation

100.00

   

Q

TANF CPS & FC/Adoption

50.00

 

50.00

R

IV-E Optional Foster Care

50.00

 

50.00

S

F.S. Emp. & Tr. Supp. Services

100.00

   

T

Work First Service 100 %

 

100.00

 

U

Smart Start

     

W

Work First Block Grant (Various)

100.00

   

V

Family Reunification Fund

50.00

 

50.00

X

IV-E Optional Adoption

   

100.00

X

Adolescent Parenting Non Reim

Please Note: The above Part IV Fund ID codes are not the same codes as the program codes that are listed in the SIS Manual Appendix C.

Please Note: Not all Part IV codes are available to be used. Please review your “Dear County

Directors” letters that were mailed to the county directors and the letters are also located on the North Carolina Department of Health and Human Services, Office of Controller’s website.

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  For questions or clarification on any of the policy contained in these manuals, please contact your local county office.  


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