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Dane County Department of Human Services Provider Hub

711 Form Monthly Reporting

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 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

107

Specialized Transportation & Escort Trips

403

Recreation & Alternative Activities

408

Community Prevention

501

Crisis Intervention

601

Outreach

602

Information & Referral

603

Intake Assessment

605

Advocacy & Defense Resources

606

Health Screening & Accessibility

701

Training & Development

702

Agency / Systems Management