Document Requirements for
NYS Office of Mental Health
Non-Grant Contracts

Contract Document Amendment “0” Amendments Greater than “0”
Non-Grant Contract Face Page X1  
Contract Signature Pages 1 & 2 X1  
State of New York Agreement X  
Appendix A Standard Clauses X  
Appendix A-1 Agency Specific Clauses X  
Appendix A-1(a) EEO and MWBE Requirements X  
Exhibit 1 – MWBE Utilization Plan X2  
Exhibit 2 – MWBE Request for Waiver X2  
Exhibit 2a – Certification of Good Faith Efforts X2  
Exhibit 3 – Contractor Quarterly Compliance Report X2  
Exhibit 4 – EEO Workforce Utilization Report X2  
Appendix B Budget X X
Appendix C Payment and Reporting Schedule X X
Appendix D Work Plan X X5
Appendix F Business Associate Agreement X  
Appendix I Consultant Disclosure Instructions with Form A and B X  
Attachments To Be Returned With The Contract:    
     -   Attachment J1 Affirmation of Understanding X  
     -   Attachment J2 Disclosure of Prior Non-Responsibility Determinations X  
     -   Attachment J3 Certification of Compliance with State Finance Law X  
     -   Attachment J4 Termination for Non-Compliance X  
Appendix X Modification Agreement Form X3 X3
Rider-Provisions for Contractors Receiving Aid-to-Localities Funding (ATL Rider) X  
Vendor Responsibility Questionnaire X X
Proof of NYS Workers’ Compensation (or exemption) X X
Proof of NYS Disability Benefits Insurance (or (or exemption) X X
NY Charities Registration (or exemption) X X
Federal Certification Form 1 X4 X4
Federal Certification Form 2 X4 X4

1 Prefilled by OMH and included with letter.
2 Required if MWBE goals are assigned. Goals are identified in the Appendix A-1(a).
3 Include blank copy with Amendment 0.
4 Original signed Federal certification forms are required if Federal funds are included in the contract.
5 Only required if amendment includes change in scope of work.