F-20942a - Total Expenses All Sources By Target Group And Standard Program Cluster

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DEPARTMENT OF HEALTH SERVICES
STATE OF WISCONSIN
Division of Enterprise Services
Completion of this form meets the requirements of
F-20942A (05/2009)
the State / County contract specified under
s. 46.031 (2g), Wis. Stats.
TOTAL EXPENSES ALL SOURCES
BY TARGET GROUP AND STANDARD PROGRAM CLUSTER
NAME – Agency Contact
Telephone – Agency Contact
REPORT YEAR __________
TARGET GROUPS
Physical
TOTAL
And
Delinquent
Abused And
Children
Adults
Expenses
Develop-
Alcohol /
Sensory
and Status
Neglected
And
And
Columns
mental
Mental
Other Drug
STANDARD PROGRAM CLUSTER
Disability
Offender
Children
Families
Elderly
(1) Thru (8)
Disability
Health
Abuse
(4)
(5)
(6)
(7)
(8)
(1)
(2)
(3)
100 Child Day Care - Crisis Respite
104 Supportive Home Care
107 Specialized Transportation and Escort
200 Access, Outreach And Prevention
300 Community Living / Support Services
400 Investigations and Assessments
500 Community Support Programs
600 Work-Related and Day Services
615 Supported Employment
700 Community Residential Services
800 Community Treatment Services
900 Inpatient and Institutional Care
Including IMD
950 Juvenile Corrections
TOTAL
SUBTOTALS
Adult – Age: 18 years and over
Child – Age: Under 18 years

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