Welcome to the State of California 

Maternal, Child, & Adolescent Health Program:

FY 2010-11 Agreement Funding Application (AFA)

For Local Health Jurisdictions (LHJs) & Community Based Organizations (CBOs)

MO-09-0015 MCAHFI

The MCAH Fiscal function is to establish the legal agreements between the CDPH and agencies that conduct the MCAH-funded programs; perform administrative and fiscal oversight of MCAH legal agreements; provide administrative support to the CDPH MCAH Program and its agencies, and manage the program budgets.

It is important to use the forms, documents, and procedures specific to the fiscal year that you are budgeting or invoicing. Below are forms and documents specific to 2010-11.

Agreement Funding Application (AFA) Components

  • AFA Letter (PDF)Opens a new browser window.
  • AFA Checklist (Word) Opens a new browser window.
  • AFA Update Form (Word)Opens a new browser window.
  • Allocation Tables

  • MCAH / BIH / FIMR / SIDS, June 2010 (PDF)Opens a new browser window.
  • AFLP, June 2010 (PDF)Opens a new browser window.
  • Budget/Invoice Templates

  • AFLP - Quarterly Invoicing, Updated June 2010 (Excel, 5.8MB)Opens a new browser window.
  • AFLP - CBO Quarterly Invoicing, Updated June 2010  (Excel, 5.8MB)Opens a new browser window.
  • AFLP - CBO Monthly Invoicing, Updated June 2010 (Excel, 9.5MB)Opens a new browser window.
  • MCAH - Quarterly Invoicing, Updated June 2010 (Excel, 5.8MB)Opens a new browser window.
  • BIH - Quarterly Invoicing, Updated June 2010 (Excel, 5.8MB)Opens a new browser window.
  • Medi-Cal Factor Tables

  • MCAH Medi-Cal Factor Table, Updated June 2010 (Excel)Opens a new browser window.
  • BIH Medi-Cal Factor Table, Updated June 2010  (Excel)Opens a new browser window.
  • Alternate Medi-Cal Factor Requests (Word)Opens a new browser window.
  • Scope(s) of Work, SOW

  • SOW AFLP, June 2010 (Word)Opens a new browser window.
  • SOW BIH, June 2010 (Word)Opens a new browser window.
  • SOW FIMR , June 2010 (Word)Opens a new browser window.
  • SOW MCAH / SIDS, June 2010 (Word)Opens a new browser window.
  • LMCQI Phase III SOW (Word)Opens a new browser window.
  • Forms

  • Monthly AFLP Advance Payment Agreement (Excel)Opens a new browser window.
  • Quarterly AFLP Advance Payment Agreement (Excel)Opens a new browser window.
  • Advance Payment Request Letter (Word)Opens a new browser window.
  • Exhibit K - AB 629 AFLP Compliance Form (Word)Opens a new browser window.
  • CDPH 1203 - Contractor Equipment Purchased with CDPH Funds (Word)Opens a new browser window.
  • CDPH 1204 - Inventory/Disposition of CDPH Funded Equipment (Word)Opens a new browser window.
  • STD 152 - Property Survey Report (Word)Opens a new browser window.
  • SPMP Questionnaire (Word)Opens a new browser window.
  • Subcontract Agreement Transmittal Form (Word)Opens a new browser window.
  • Travel Reimbursement Information, 01-11 (Word)Opens a new browser window.
  • Sample Invoice Cover Letter (Word)Opens a new browser window.
  • Federal Financial Participation Calculation File, Version 2.04 (Excel)Opens a new browser window.
  • Weekly Time Study Form (Excel)Opens a new browser window.
  • CMU Bulletin 07-04 - HIPAA Data Security Requirements, February 2008 (Word)Opens a new browser window.
  • Prior Year AFA's/RFA's

  • FY 2009-2010 (AFA)
  • FY 2008-2009 (AFA)
  • FY 2007-2008 (AFA)
  • FY 2007-2008 (RFA)
  • FY 2006-2007 (AFA)
  • FY 2005-2006 (AFA)
  • FY 2005-2007 (RFA)
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    Last modified on: 5/17/2011 5:31 PM