Volume IV - Agency Plan Infomration

Volume IV: Section 1 - Agency Plan Introduction

The Community Agency Plan System (CAPS) collects agency plan information each fiscal year. The Grant Agreement provides the basis for Departmental financial participation in grant-in-aid programs and formalizes the contractual relationship between the Department and the community agency. The agency plan is the part of the Grant Agreement which identifies the services to be provided, the target population, and the geographic areas to be served.

The Comprehensive Community Service Networks are the primary contact in the agency plan process.

This volume sets the guidelines for the creation of the Agency Plan Program Service and Funding Plan (2.0/2.1), Personnel Information (2.3), and Operating Fund Projected Revenue and Expenses (4.0/4.1) data on diskette by agencies using their own system for reporting.

These guidelines must be used in conjunction with the Agency Plan instructions packet issued yearly.

Volume IV: Section 2 - Agency Plan File Creation Requirements

Submit Agency Plan information only when requested by the Department. It must be accompanied by signed paper documents.

Data records must be created in compliance with the record formats as described in Volume IV - Section 4.

Agency Plan information file must be submitted via FTP Data Transmission.

  • AGYTRAN.FLE - Program Service and Funding Plan (2.0/2.1)
  • AGYPRSL.FLE - Personnel Information (2.3)
  • AGYFUND.FLE - Operating Fund Projected Revenue and Expenses (4.0/4.1)

Volume IV:  Section 3 - Fee for Services Record Formats

the file format can be found on the following web site https://intranet.dhs.illinois.gov/oneweb/page.aspx?item=141809

1.1 Provider Record Format
1.2 Provider Trailer Record Format
1.3 Client Financial Information Record Format
1.4 Client Financial Information Trailer Record Format
1.6 Billing Record Fromat
1.7 Voucher Record Format

Volume IV: Section 4 - Agency Plan Data Submission Requirements

4.1 Program Service and Funding Plan Record Format (2.0/2.1)

  1. 4.1 Program Service and Funding Plan Record Format (2.0/2.1)
  2. 4.2 Personnel Information Record Format (2.3)
  3. 4.3 Operating Fund Projected Revenue & Expense Record Format (4.0/4.1)

4.1 Program Service and Funding Plan Record Format (2.0/2.1)

Note: For numeric fields, "V" is the assumed decimal position. The actual decimal point is not in the field.

ITEM/FIELD NAME FROM TO SIZE FIELD DESCRIPTION
Agency FEIN 1 9 9 Federal Employer Identification Number
Site Number 10 11 2
  • Required for MH program codes. 
  • Not used for DD program codes and must equal spaces.
Unit Number 12 13 2
  • For MH program codes, if not used report 00.
  • For DD program codes, if not used report spaces.
Program Service Code 14 16 3 The specific program service for which grant funds are being received.
Fiscal Year 17 20 4
  • Must be numeric - from Agency Plan 1.0. Format: CCYY
  • Example: 2000
Agency Name 21 50 30 Legal name of the agency
Network 51 54 4
  • The Mental Health or Developmental Disabilities network responsible for this particular program at the agency.
  • MENTAL HEALTH
  • MHCA - Metro C & A MHCE - Central
  • MHCS - Chicago Suburban
  • MHMN - Metro North
  • MHMS - Metro South
  • MHMW - Metro West
  • MHNC - North Central
  • MHNW - Northwest
  • MHSO - Southern
  • MHSM - Metro East Southern
  • DEVELOPMENTAL DISABILLTIES
  • CE - Central
  • MCCN - North Chicago Metro
  • MCCS - South Chicago Metro
  • MCNS - North Suburban
  • MCSS - South Suburban
  • NC - North Central
  • NW - Northwest
  • SO - Southern
Program Fund Ind 55 55 1
  • Valid Values are:
  • 1 - DHS Grant Funded
  • 2 - DFI/CFI
  • 3 - Contract Funded
  • 4 - Special Programs
  • 5 - Non-DHS Funded
Program Service Name 56 85 30 The name commonly used for the program service by the agency.
Program Service Capacity 86 92 7 Must be numeric
Number Of Days Open 93 95 3 Must be numeric
Days & Time of Program Operation
  • There are 7 occurrences.
  • Sunday thru Saturday
  • X = Applies
  • Space = Does not apply
Days Open 96 96 1 lst occurrence - Sunday
Evenings Open 97 97 1 lst occurrence - Sunday
24 Hours Open 98 98 1 lst occurrence - Sunday
Answering Service 99 99 1 lst occurrence - Sunday
100 103 4 2nd occurrence - Monday
104 107 4 3rd occurrence - Tuesday
108 111 4 4th occurrence - Wednesday
112 115 4 5th occurrence - Thursday
116 119 4 6th occurrence - Friday
120 123 4 7th occurrence - Saturday
Length of Program Service Day 124 127 4 Must be numeric 99V99
Geographic Impact Planning Area There are 6 occurrences.
County 128 130 3 1st occurrence
Township 131 132 2 1st occurrence
Percentage 133 135 3 1st occurrence
136 143 8 2nd occurrence
144 151 8 3rd occurrence
152 159 8 4th occurrence
160 167 8 5th occurrence
168 175 8 6th occurrence
Filler 176 183 8 Must equal spaces
Geographic Impact Planning Area There are 8 more occurrences.
County 184 186 3 1st occurrence
Township 187 188 2 1st occurrence
Percentage 189 191 3 1st occurrence
192 199 8 2nd occurrence
200 207 8 3rd occurrence
208 215 8 4th occurrence
216 223 8 5th occurrence
224 231 8 6th occurrence
232 239 8 7th occurrence
240 247 8 8th occurrence
Filler 248 284 37 Must equal spaces
Primary Service Population
MI 285 287 3 Must be numeric
DD 288 290 3 Must be numeric
Other 291 293 3 Must be numeric
Age Groups
0 - 3 294 296 3 Must be numeric
4 - 12 297 299 3 Must be numeric
13 - 17 300 302 3 Must be numeric
18 - 22 303 305 3 Must be numeric
23 - 64 306 308 3 Must be numeric
65+ 309 311 3 Must be numeric
Key Statistic 312 312 1
  • E = Direct Serv Employee Hours
  • R = Nights of Service
  • C = Client Hours
  • O = Other
Projections - Column A - Total Projected Service Units

For MH program codes, if you choose to report only the annual total, report the annual total of all 12 months in positions 313 - 319. If you choose to report monthly, follow the description below.

For DD program codes, you must report monthly; follow the description below.
July 313 319 7 Must be numeric
August 320 326 7 Must be numeric
September 327 333 7 Must be numeric
October 334 340 7 Must be numeric
November 341 347 7 Must be numeric
December 348 354 7 Must be numeric
January 355 361 7 Must be numeric
February 362 368 7 Must be numeric
March 369 375 7 Must be numeric
April 376 382 7 Must be numeric
May 383 389 7 Must be numeric
June 390 396 7 Must be numeric
Projections - Column B - Registered Individuals Required for both MH and DD program codes.
July 397 403 7 Must be numeric
August 404 410 7 Must be numeric
September 411 417 7 Must be numeric
October 418 424 7 Must be numeric
November 425 431 7 Must be numeric
December 432 438 7 Must be numeric
January 439 445 7 Must be numeric
February 446 452 7 Must be numeric
March 453 459 7 Must be numeric
April 460 466 7 Must be numeric
May 467 473 7 Must be numeric
June 474 480 7 Must be numeric
Annual Number of Unduplicated Registered Individuals 481 487 7
  • Must be numeric
  • Required for both MH and DD program codes.
Projections - Column C - Average Units Per Registered Individual
  • For MH program codes, leave this area spaces - do not report.
  • For DD program codes, follow the description below.
July 488 494 7 Must be numeric 9(5)V99
August 495 501 7 Must be numeric 9(5)V99
September 502 508 7 Must be numeric 9(5)V99
October 509 515 7 Must be numeric 9(5)V99
November 516 522 7 Must be numeric 9(5)V99
December 523 529 7 Must be numeric 9(5)V99
January 530 536 7 Must be numeric 9(5)V99
February 537 543 7 Must be numeric 9(5)V99
March 544 550 7 Must be numeric 9(5)V99
April 551 557 7 Must be numeric 9(5)V99
May 558 564 7 Must be numeric 9(5)V99
June 565 571 7 Must be numeric 9(5)V99
Projections - Column D - Contacts Non-registered Required for both MH and DD program codes.
July 572 578 7 Must be numeric
August 579 585 7 Must be numeric
September 586 592 7 Must be numeric
October 593 599 7 Must be numeric
November 600 606 7 Must be numeric
December 607 613 7 Must be numeric
January 614 320 7 Must be numeric
February 621 627 7 Must be numeric
March 628 634 7 Must be numeric
April 635 641 7 Must be numeric
May 642 648 7 Must be numeric
June 649 655 7 Must be numeric
1st Quarter - Projected Operating Expenses 656 662 7 Must be numeric
2nd Quarter - Projected Operating Expenses 663 669 7 Must be numeric
3rd Quarter - Projected Operating Expenses 670 676 7 Must be numeric
4th Quarter - Projected Operating Expenses 677 683 7 Must be numeric
Total Grant Disbursements 684 692 9 Must be numeric
Projected Revenue 693 699 7 Must be numeric, signed
Projected Surplus/Deficit 700 706 7 Must be numeric, signed
Cost of Production 707 713 7 Must be numeric, signed
Total Expenses - Net Cost of Production 714 720 7 Must be numeric, signed
Total Unit/Client Cost 721 727 7 Must be numeric, signed S9(5)V99
MH/DD Unit/Client Cost 728 734 7 Must be numeric, signed S9(5)V99
Filler 735 741 7 Must equal spaces
File Creation Date - Year, Month, Day 742 749 8
  • Date on which the file was created for submission.
  • Format: CCYYMMDD
Software Indicator 750 753 4
  • Must equal 9.99
  • (Indicates Own Software)
Program Service Address - Street 754 793 40 Street address of the program service
Program Service Address - City 794 813 20 City of the program service
Program Service Address - State 814 815 2 State abbreviation of the program service
Program Service Address - Zip Code 816 820 5 Zip code and zip code suffix of the program service
Program Service Address - Zip Code Suffix 821 824 4 Zip code and zip code suffix of the program service
Filler 825 825 1 Must equal spaces

4.2 Personnel Information Record Format (2.3)

ITEM/FIELD NAME FROM TO SIZE FIELD DESCRIPTION
Filler 1 4 4 Must equal spaces
Fiscal Year 5 8 4 Must be numeric - from Agency Plan 1.0 Format: CCYY
Site Number 9 10 2 Required for MH program codes. Not used for DD program codes and must equal spaces.
Unit Number 11 12 2

For MH program codes, if not used report 00.

For DD program codes, if not used report spaces.
Program Service Code 13 15 3 The specific program service for which grant funds are being received.
Filler 16 16 1 Must equal space
Program Service Name 17 46 30 The name commonly used for the program service.
Filler 47 48 2 Must equal spaces
Network 49 52 4
  • The Mental Health or Developmental Disabilities network responsible for this program.
  • MENTAL HEALTH
  • MHCA - Metro C & A MHCE - Central
  • MHCS - Chicago Suburban
  • MHMN - Metro North
  • MHMS - Metro South
  • MHMW - Metro West
  • MHNC - North Central
  • MHNW - Northwest
  • MHSO - Southern
  • MHSM - Metro East Southern
  • DEVELOPMENTAL DISABILLTIES
  • CE - Central
  • MCCN - North Chicago Metro
  • MCCS - South Chicago Metro
  • MCNS - North Suburban
  • MCSS - South Suburban
  • NC - North Central
  • NW - Northwest
  • SO - Southern
FTE Hours Per Week 53 55 3 Must be numeric 99V9
Percent MH/DD Funded 56 58 3 Must be numeric
Administration
CEO/Pres/Exec Dir 59 64 6 Must be numeric 999V999
FTEs 65 70 6 Must be numeric 999V999
Assistant FTEs 71 76 6 Must be numeric 999V999
Bookkeeper FTEs 77 82 6 Must be numeric 999V999
Business Manager FTEs 83 88 6 Must be numeric 999V999
Public Relations FTEs 89 118 30
Other Description 119 124 6 Must be numeric 999V999
Other FTEs 125 132 8 Must be numeric
Total Salary
Program Service
Pgm Svc Manager FTEs 133 138 6 Must be numeric 999V999
139 145 7 Must be numeric
Pgm Svc Mngr Salary 146 151 6 Must be numeric 999V999
152 158 7 Must be numeric
LPHA FTEs 159 164 6 Must be numeric 999V999
165 171 7 Must be numeric
LPHA Salary 172 177 6 Must be numeric 999V999
178 184 7 Must be numeric
QMHP FTEs 185 190 6 Must be numeric 999V999
191 197 7 Must be numeric
QMHP Salary 198 203 6 Must be numeric 999V999
204 210 7 Must be numeric
QMRP FTEs 211 216 6 Must be numeric 999V999
217 223 7 Must be numeric
QMRP Salary 224 253 30
254 259 6 Must be numeric 999V999
MHP FTEs 260 266 7 Must be numeric
MHP Salary 267 274 8 Must be numeric
RSA FTEs
RSA Salary
Dir Serv Worker FTEs
Dir Serv Wrkr Salary
Other Description
Other FTEs
Other Salary
Total Salary
Support Services
Consultant Ftes 275 280 6 Must be numeric 999v999
Consultant Salary 281 287 7 Must be numeric
288 293 6 Must be numeric 999v999
Housekeeping Ftes 294 300 7 Must be numeric
301 330 30
Housekeeping Salary 331 336 6 Must be numeric 999v999
337 343 7 Must be numeric
Other Description 344 351 8 Must be numeric
Other FTEs
Other Salary
Total Salary
Agency Name 352 381 30 Legal name of the agency
Filler 382 439 58 Must equal spaces
File Creation Date Date on which the file was created for submission.
Year 440 443 4 Format: CCYYMMDD
Month 444 445 2
Day 446 447 2
Software Indicator 448 451 4 Must equal 9.99 (Indicates Own Software)
Filler 452 500 49 Must equal spaces

4.3 Operating Fund Projected Revenue & Expense Record Format (4.0/4.1)

ITEM/FIELD NAME FROM TO SIZE FIELD DESCRIPTION
Filler 1 1 4 Must equal spaces
Fiscal Year 5 8 4 Must be numeric - from Agency Plan 1.0 Format: CCYY
Site Number 9 10 2 Required for MH program codes. Not used for DD program codes and must equal spaces.
Unit Number 11 12 2 For MH program codes, if not used report 00.., For DD program codes, if not used report spaces.
Program Service Code 13 15 3 The specific program service for which grant funds are being received. NOTE: Total columns have a program code of "C" and a program service suffix of the column number.., C02 - Total Agency., C03 - Total Program Not MH/DD Grant Funded ., C04 - Total Program MH/DD Grant Funded., C05 - DD CILA Programs
Filler 16 18 3 Must equal space
Network 19 22 4 The Mental Health or Developmental Disabilities network responsible for this program/column.., MENTAL HEALTH., MHCA - Metro C & A MHCE - Central., MHCS - Chicago Suburban., MHMN - Metro North., MHMS - Metro South., MHMW - Metro West., MHNC - North Central., MHNW - Northwest., MHSO - Southern., MHSM - Metro East Southern., DEVELOPMENTAL DISABILLTIES., CE - Central., MCCN - North Chicago Metro., MCCS - South Chicago Metro., MCNS - North Suburban., MCSS - South Suburban., NC - North Central., NW - Northwest., SO - Southern
Fees For Service
MH/DD Pgm Svc Fnd 23 31 9 Must be numeric
Local Ed Agy/ISBE 32 40 9 Must be numeric
41 49 9 Must be numeric
Dept of Pub Aid 50 58 9 Must be numeric
MH/DD Medicaid Pay 59 67 9 Must be numeric
Other-A 68 88 21
Other-A Desc 89 97 9 Must be numeric
Other-B 98 118 21
Other-B Desc 119 127 9 Must be numeric
Other-C 128 148 21
Other-C Desc 149 157 9 Must be numeric
Other-D 158 178 21
Other-D Desc 179 187 9 Must be numeric
Clnt/Family Pay 188 196 9 Must be numeric
197 205 9 Must be numeric
Oth 3rd Party Pay
Tot Fees For Serv
Grants
MH/DD Pgm Svc Fnd 206 214 9 Must be numeric
215 223 9 Must be numeric
DPA DFI/CFI 224 232 9 Must be numeric
233 253 21 Must be "United Way"
Other-A 254 262 9 Must be numeric
Other-A Desc 263 283 21
Other-B 284 292 9 Must be numeric
Other-B Desc 293 313 21
Other-C 314 322 9 Must be numeric
Other-C Desc
Total Grants
Other Sources
Contribution-Rstr 323 331 9 Must be numeric
332 340 9 Must be numeric
In-Kind Contrib 341 349 9 Must be numeric
350 358 9 Must be numeric
Contrib-Unrstr 359 367 9 Must be numeric
368 376 9 Must be numeric
Investment Income 377 385 9 Must be numeric, signed S9(9)
386 406 21 Must be Local Government Fund
Sale Of Goods/Svc 407 415 9 Must be numeric, signed S9(9)
416 436 21
LEA Transport Pay 437 445 9 Must be numeric, signed S9(9)
Other-A 446 466 21
467 475 9 Must be numeric, signed S9(9)
Other-A Desc 476 484 9 Must be numeric
Other-B 485 493 9 Must be numeric
Other-B Desc
Other-C 494 502 9 Must be numeric
Other-C Desc 503 511 9 Must be numeric
Total Oth Sources
Total Revenue
Total Projected Operating Expense
Depreciation
Tot Proj Oper Exp With Depreciation
Agency Name 512 541 30 Legal name of the agency
Software Indicator 542 545 4 Must be 9.99 (Indicates Own Software)
File Creation Date Date on which the file was created for submission Format: CCYYMMDD
Year 546 549 4
Month 550 551 2
Day 552 553 2
Agency FEIN 554 562 9 Federal Employer Identification Number
11d.Transition Line 563 571 9 Must be numeric
Filler 572 675 104 Must equal spaces