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Treatment Fiscal Forms for Fiscal Year 2012 can be found at:

http://www.maine.gov/dhhs/purchased-services/contract-2012/index.html

Please check with your Agreement Administrator if you are unsure of what forms you need.

Treatment Quarterly Financial Report– Scroll down to section titled Quarterly Financial Reports
Required financial report for treatment services providers. Submit no later than 30 days after the end of each of the quarter of the contract.

Treatment Final Financial Report – Scroll down to section titled Agreement Close- Out Report
Required year-end financial report for treatment services providers. Submit no later than 60 days after the completion date of the contract.

Treatment Budget - Scroll down to section titled Rider “F”, choose Budget Forms- OSA Treatment

Instructions Word
All required budget pages for original, amended and revised budgets for treatment services providers.

Electronic Funds Transfer

Used to have state checks directly deposited in to your account.

New Vendor/Vendor Update

Used to set up vendors for payment on MFASIS accounting system or update existing information. This form should be mailed to your Agreement Administrator for initial processing.

To access documents in PDF format, you need the free Adobe Acrobat Reader. Printouts of these documents are also available upon request.

 

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