(a.k.a. 711 Form)
Some service programs may be required to complete a 711 form rather than a 600/610 form. The specific form used is based on what SPC code is identified for the specific service provided. The State has determined which SPCs require a 711 form and which require a 600/610 form. The County Contract Manager will communicate which reporting process is required for each program through its annual contracts. Note that the Contract Manager may require a 600/610 form despite the program being one that has a 711 form-appropriate SPC code.
The 711 Form may be used only for these types of services.
| SPC Code | Description | Reporting Units |
|---|---|---|
| 107 | Specialized Transportation & Escort Trips | One-Way Trip |
| 403 | Recreation & Alternative Activities | Staff Hours |
| 408 | Community Prevention | Staff Hours |
| 501 | Crisis Intervention | Staff Hours |
| 601 | Outreach | Staff Hours |
| 602 | Information & Referral | Contacts |
| 603 | Intake Assessment | Contacts |
| 605 | Advocacy & Defense Resources | Staff Hours |
| 606 | Health Screening & Accessibility | Staff Hours |
| 701 | Training & Development | Staff Hours |
| 702 | Agency / Systems Management | Staff Hours |
If you have questions about this report, please call your designated data entry contact.
