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Report Forms for Vendors

Listed below are the Excel spreadsheets developed by the Department for reporting performance measures. Each vendor must report their required performance data via electronic mail using one of the following forms. (If you are unsure which form to complete, please call 410-230-3222 for further directions.) To complete a report, each vendor should save a copy of the Excel spreadsheet on your hard drive. Please submit the completed report of performance data to the Office of Research and Planning at DJScontract@djs.state.md.us by the 15th of the month following the report month.



Instructions for Completing Monthly Reports
(word file)


Residential Services

 Structured Shelter Care & Respite

 Group Home, Alternative Living Unit & Independent Living

 Treatment Foster Care & Therapeutic Group Home

 Residential Treatment Center & Out of State

 Substance Abuse Treatment

 Special Education Services

 Residential Secure Treatment Program

 Mental Health and Substance Abuse Monthly Statistical Report
(Revised 1-1-10)



Community-Based Services (non-residential)

 Community-Based Treatment

 Assessment

 Psychiatric Services

 Mental Health Evals for Employees

 Youth Panel

 After Hours Intake

 Community-Based Substance Abuse Treatment

 Detention Response Unit

 Immediate Charging Pilot

 Restitution and Community Services

 Youth Transportation

 Diversion

 Sex Offender Treatment



Invoices

 Advance Payment

 Non-Residential Per Diem

 Non Residential POC

 Residential Per Diem:

    Residential Per Diem Invoice 18 or Less Juveniles.xls
    Residential Per Diem Invoice 19 to 38 Juveniles.xls
    Residential Per Diem Invoice 39 to 75 Juveniles.xls


Minority Business Enterprise (MBE) Forms (Word Docs)

Competitive Procurement:

 Instructions for Completing MBE Forms - Attachments E and F

 Attachment E - Prime Contractor Paid/Unpaid MBE Invoice Report

 Attachment F - Subcontractor Paid/Unpaid MBE Invoice Report

Non-Competitive Procurement:

 Instructions for Completing Per Diem MBE Forms - Attachments E and F

 Attachment E - Prime Contractor Per Diem Provider Paid/Unpaid MBE Invoice Report

 Attachment F - Per Diem Provider Subcontractor Paid/Unpaid MBE Invoice Report



Medical Reports

 Physician Services Report




For additional information please call
410-230-3222