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Wisconsin Department of Health Services

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DMHSAS / DHCAA Memo Series 2009-03

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Expenditure and Revenue Reports
Update to DLTC Memo 2008-8, DMHSAS Memo 2008-8 and DCFS Memo 2008-3

STATE OF WISCONSIN

Department of Health Services
Division of Long Term Care
Division of Mental Health and Substance Abuse Services
Department of Children and Families
Division of Safety and Permanence

DLTC/DHS Memo Series 2009-04 /ACTION
DMHSAS/DHS Memo Series 2009-03 /ACTION
DSP/DCF Memo Series 2009-04/ACTION

Re: Expenditure and Revenue Reports

Update to DLTC Memo 2008-8, DMHSAS Memo 2008-8 and DCFS Memo 2008-3

February 20, 2009

To:

Area Administrators/ Human Services Area Coordinators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Licensing Chiefs/Section Chiefs
Tribal Chairpersons/Human Services Facilitators

From:

Fredi-Ellen Bove, Interim Administrator
Division of Long Term Care

John Easterday, Administrator
Division of Mental Health and Substance Abuse Services

Cyrus Behroozi, Administrator
Division of Safety and Permanence

Instructions

The 942 and the HSRR are fiscal reports completed by county agencies on an annual basis and have been renamed/renumbered F-20942 and F-22540, respectively.

Starting with the reports for CY 2008 county agencies will no longer be required to report funds used in the operation of the Aging and Disability Resource Centers (ADRCs) on the F-20942 and the F-22540.

In addition the F-22540 form has been changed to a data entry screen found at https://health.wisconsin.gov/hsrs (this form will not be available at this site until  March 30, 2009). This is a secured website, similar to the F-20942, that requires a HSRS login ID and password for access. For further information on this change see instructions below under Report Format and Due Dates.

For county agency staff interested in filling out the forms before entering the data on the web, the form F-22540 can be found at http://www.dhs.wisconsin.gov/forms1/F2/f22540a.xls and the form F-20942 can be found at http://www.dhs.wisconsin.gov/forms1/f2/f20942a.pdf.

Report Formats and Due Dates

The F-20942 data entry screen can also be found at https://health.wisconsin.gov/hsrs. It is a secured website that requires a HSRS login ID and password for access. If you have problems, call the HSRS SOS Desk at 608 266-9198. This report must be submitted by April 30th of each year for the previous calendar year period.

The HSRR report form F-22540 data entry screen can be found at https://health.wisconsin.gov/hsrs and must be submitted by May 15th of each year for the previous calendar year period. It is a secured website that requires a HSRS login ID and password for access. It is suggested that someone who already has a HSRS login ID in your agency enter the data. If you wish to request a HSRS login ID, complete the DWSW-10-E COMPUTER ACCESS REQUEST form available at http://dcfweb/forms/doc/dwsw_10_e.doc.

Thank you for your cooperation and assistance. If you have any questions regarding these reports or the instructions, please contact:

Regional Office Contacts:    Area Administrators

Central Office Contact for the F-20942 form:

SOS Desk, DES, Room B150
Department of Health Services
PO Box 7851
Madison, WI 53707-7851

Telephone: (608) 266-9198

Email: dhssoshelp@wisconsin.gov

Central Office Contact for the HSRR F-22540 form:

Chris Hendrickson
DES, Room 618
Department of Health Services
PO Box 7850
Madison, WI 53707-7850

Telephone: (608) 261-7812

Email: Chris.Hendrickson@Wisconsin.gov

MEMO WEB SITES:

DLTC / DMHSAS Memo Series

Department of Children and Families Memo Series

 

Attachments

Attachment 1: Human Services Reporting System Form F-20942 (PDF, 44KB)

Attachment 2: Human Services Revenue Report (HSRR) Form F-22540 (PDF, 28KB)

Attachment 3: Target Group Definitions (PDF, 36KB)

cc
Division of Health Care Access and Accountability
Department of Corrections

Last Revised:  July 16, 2010