Division of Criminal Justice Services

Grantee Forms

In this forum, you can locate forms you may need to complete your grant contracting or reporting requirements. Forms are in Microsoft formats. Simply click on the form you need. Your browser should open the associated application, and then you can use File|Save As in the application to transfer the file to your computer's hard drive or to diskette.

Contract Certifications

  1. Debarment (Word)
  2. Drug-Free Workplace (Word)
  3. EEOP Requirements (Word)
  4. Encouraging Use of NYS Businesses in Contract Performance (Word)
  5. Federal Certified Assurances (Word)
  6. Lobbying (Word)
  7. Service-Disabled Veteran-Owned Business Enterprises in Contract Performance (PDF)

Contract Documents

  1. Standard NYS Agreement (PDF)
  2. Appendix A, Standard Clauses for NYS Contracts (PDF)
  3. Appendix A-1, Agency-Specific Clauses (PDF)
  4. Appendix C, Payment and Reporting Schedule (PDF)
  5. Appendix F, Guidelines For The Control and Use of Confidential Funds (PDF)
  6. Appendix G, Procedural Guidelines For The Control of Surveillance Equipment (PDF)
  7. Appendix M, Participation by Minority Group Members and Women with Respect to State Contracts: Requirements & Procedures (Word)

Civil Rights

  1. Civil Rights Compliance Certification Form (Word)
  2. Civil Rights Training Certification Form (Word)

GMS Forms

  1. User Registration Form (Word)
  2. SIGNATORY Registration Form (Word)
  3. IRS Form W-9 (PDF)

Grant Budget/ Amendment Forms

  1. OPDF Amendment Request Form (Word)
  2. OPDF B-1 Performance Milestones and Costs Worksheet (Excel)
  3. OPDF Budget Reallocation Worksheet (Excel)
  4. OPDF Sole Source or Single Source Exemption Request Form (Word)
  5. Performance-Based Grant Amendment Request Form (Excel)

Grantee Fiscal Forms for Reimbursement

  1. Claim for Payment (formerly State Aid Voucher) (2 signed originals required) (PDF)
  2. Detailed Itemization Forms (HTML)
  3. Fiscal Cost Reporting Form (2 signed originals required) (Excel) | (Word)
  4. Local Assistance MWBE 3303 Workforce Employment Utilization Report (Word)
  5. MWBE 3310 Subcontractor Utilization Quarterly Report for Performance Based Contracts (Word)
  6. MWBE 3310 Subcontractor Utilization Quarterly Report for Performance Based Contracts Instructions (Word)
  7. Performance-Based Quarterly Fiscal Cost Reporting Form (2 signed originals required) (Word)
  8. Performance-Based Detailed Itemization Form (Excel)

For Indigent Parolee Program Only:

Ignition Interlock Program Forms

  1. Ignition Interlock Device Sentencing Orders Received and Installation Status Quarterly Form (Excel)
  2. Ignition Interlock Device Sentencing Orders Received and Installation Status Quarterly Form Instructions (PDF)

Time Distribution/Certification

(These forms are intended as samples from which you can create your own customized version)

  1. Certification for Employees who work 100% of their time on a single Federal grant program (Word)
  2. Time Distribution form for employees who work part-time on a Federal grant program, or multiple Federal programs (Excel)