STATE OF WISCONSIN
Department of Health and Family Services
Division of Children and Family Services

       DCFS Memo Series 2004 - 16
         August 12, 2004

Re:   CY 2004 INDEPENDENT
         LIVING PROGRAM
         REPORTING FORMS

To:

Area Administrators/Assistant Area Administrators
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:

Kitty Kocol
Administrator

 

Attached are updated forms for reporting independent living (IL) data effective January 1, 2004. The first report period in which these forms will be utilized is January 1 through December 31, 2004. The annual report due date is 
February 28, 2005.

Forms CFS-873, Independent Living Participant Data, and CFS-873A, Independent Living Participants Annual Summary Data, have been revised to include all of the proposed National Youth Transition Database items identified in the Federal draft format, "List of NYTD Data Items December 2003." Although not yet in final form, it is anticipated that by late 2004 or 2005 most, if not all, of these items will be implemented as the Federal reporting requirements for State Independent Living Programs funded by the Chafee Foster Care Independence Act of 1999. These forms will be the only method for reporting Wisconsin IL data at this time, as WiSACWIS will not be modified until the Federal IL reporting requirements are finalized.

Effective immediately, Forms CFS-976, Independent Living 90-day Follow-Up, and CFS-976A, Independent Living Follow-Up Annual Summary Data, will no longer be required. Please do not submit any 2004 data to the State using Forms 976 and 976A.

Forms 873 and 873A can be accessed alphabetically or numerically at http://dhfs.wisconsin.gov/forms/index.htm. Formerly, these forms were only available in PDF format, but now they are available in Word format where they can be saved to your own system, completed and sent to the State electronically. Also available is a data definitions form, Independent Living Participant Data Form CFS-873 Data Definitions. This form is not available online but can be obtained in Word format by contacting Paula Brown, Independent Living Coordinator.

CENTRAL OFFICE CONTACT:

Paula Brown
Independent Living Coordinator
(608) 267-7287
brownpl@dhfs.state.wi.us

Attachments:
CFS-873, Independent Living Participant Data form (PDF)
CFS-873, Independent Living Participant Data form (WORD)
CFS-873A, Independent Living Participants Annual Summary Data form (PDF)
CFS-873A, Independent Living Participants Annual Summary Data form (WORD)
Independent Living Participant Data Definitions  

cc:

Independent Living Coordinators


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