DEPARTMENT OF HEALTH SERVICES Division of Enterprise Services F-80891A (07/08)
STATE OF WISCONSIN Contract Administration 4.0 Attachment #2a
EXPECTED CONTRACTS INSTRUCTIONS (F-80891)
DIVISION TYPE OF CONTRACT PROGRAM NAME CONTRACT PERIOD PROFILE ID NUMBER PROFILE NAME AGENCY NAME AGENCY NUMBER AGENCY TYPE CURRENT CONTRACT LEVEL CONTRACT CHANGE AMOUNT NEW CONTRACT LEVEL Check the box for the contracting division. Check the box for the type of contract. The choices are New, Extended Time, or Amended. Check "Amended", if the list of contracts is for change in dollar amounts. Enter the name of the program providing funds. Enter the beginning and ending date of the contract period (mm/dd/ccyy). Enter the CARS PROFILE ID (Maximum 6 characters). Enter the name of the CARS PROFILE (Maximum 25 characters). Enter the name of the agency. Enter the CARS agency number (Maximum 10 characters). Enter the one or two digit CARS agency type code (Maximum 2 characters). Complete this column (Column B) only if this is a change to an existing PROFILE contract level. Enter the amount of the current contract level. Use whole dollars. Complete this column (Column B) only if this is a change to an existing PROFILE contract level. Enter the amount of increase or (decrease) to current contract level. Use whole dollars. Enter the total contract level for this PROFILE which will appear on the CARS system after this document is keyed. If this is a new PROFILE for an existing contract or a new contract, this will be the only column with an entry. If this is an emended level or a PROFILE, this column equals Column A plus Column B. Use whole dollars. Enter the total of each column. Enter the name of the person preparing this form. Enter the telephone number of the preparer of this form. Enter the date this form was prepared (mm/dd/ccyy). Enter the signature of the authorized Division representative. Enter the telephone number of the authorized Division representative. Enter the date the form was signed by the authorized Division representative (mm/dd/ccyy).
TOTALS PREPARED BY TELEPHONE NUMBER DATE PREPARED DIVISION APPROVAL TELEPHONE NUMBER DATE APPROVED