C 4026 Form – Fill Out and Use This PDF

The C-4026 Contract Approval Form serves as a critical document within the framework of contract management, specifically designed to streamline and document the process of contract approval. This form facilitates a structured approach by encompassing a variety of details such as contractor information, contract description, financial implications, and a comprehensive approval process by designated authorities within an organization. For individuals or entities preparing to initiate or amend a contractual agreement, ensuring the accurate completion of the C-4026 form is a vital step towards securing a formal nod. Click the button below to start filling out your form with confidence.

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C 4026 Form PDF Details

Navigating the intricacies of contract management within the sphere of the Department of Health and Human Services (DHHS) necessitates a thorough understanding of various procedural documents, among which the C-4026 Contract Approval Form plays a pivotal role. This form serves as a foundational document designed to streamline the approval process for contracts by collecting essential information about the contractor, including contact details, organizational type, and financial identifiers such as the Federal Tax ID number or Social Security Number. Additionally, it outlines the contract's scope, duration, and total or amendment amount, alongside specifying approval stages required from various DHHS divisions and personnel. Its structured format ensures that all contractual activities, whether new, renewed, or amended, undergo a systematic review process, incorporating checks for budget availability, compliance with procurement policies, and alignment with organizational objectives. Moreover, the form’s adaptability to amendments makes it a versatile tool for managing contract modifications efficiently, mitigating risks associated with funding and compliance. Therefore, understanding the C-4026 form's attributes and its proper utilization is crucial for contractors and DHHS personnel alike, facilitating clear communication, transparency, and effective contract management within the healthcare sector.

Question	Answer
Form Name	C 4026 Form
Form Length	5 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 15 sec
Other names	NCAS, North_Carolina, Sys, contract approval template

Form Preview Example

C-4026 C O N T R A C T

A P P R O V A L F O R M

NCAS #

DHHS Sys #

C O N T R A C T O R

I N F O R M A T I O N

Div. Contract #

Name:

Division Contract Administrator:

Address: (to which checks will be mailed) Street, City, State Zip

Type:

Section:

Contractor Signature Authority:

Federal Tax Id # or SSN:

Group #:

Fiscal Year: mo/mo: Select toSelect

Email:

Contractor Administrator:

Tel #:

Fax #:

C O N T R A C T I N F O R M A T I O N

Description:

Contract Dates

Status:

Amd #

Old DHHS #

Options:

Sub Contract:

Item# GN: Select

Company #

Account #

Center #

Amount

If Processing an Amendment:		TOTAL OR AMENDMENT AMOUNT

OPCS #:			Current Contract Total:
Amd Contract Dates:	to		New Contract Total:

A P P R O V A L S f o r I N T E N T T O C O N T R A C T

	Contract Admin Initials -	--Section Chief Signature		Date
2.			Approve
	Division Contract Office and telephone number	Date

	Division Budget Office	Date
4.
	Division Personnel Mgr, if required	Date
5.
	Center of Excellence Chair	Date
6.
	Director/Designee	Date
7.
	DIRM, if required	Date

Funds Budgeted

Funds Proposed

Funds Not Available

Funds Proposed, Requires Realignment BR# _____________

Approve

8.			Approve
	Public Affairs, if required	Date
9.			Approve
	DHHS Budget & Analysis, if required	Date
10.			Approve
	DHHS Personnel Director, if required	Date
11.			Approve

DHHS Office of Procurement & Contract Services, if required & Date Comments:

P&C Number

Conditional Approval based on Funds Proposed

DIVISION BUDGET OFFICER - FINAL SIGNATURE APPROVAL---REQUIRED ONLY IF FUNDS PROPOSED

Date:

Contract Approval Form Instructions

(See next section for Contract Amendment Instructions.)

The Contract Approval Form is a one-page document and printed on pink paper. Use the tab key to reach each field that requires completion. Click the arrow beside the box to view choices in drop down box. Click on the appropriate choice and use the tab key to move to the next box.

NCAS Number	Enter the North Carolina Accounting System (NCAS) number.

DHHS System #	Enter the eight digit DHHS Contract System number.

Division Contract ID #	Enter the Contract Number assigned by the Division Contract Office.

Division Contract Administrator	Enter the Division Contract Administrator name and telephone number.

Contractor Signature Authority	Enter the Contractor’s signature authority name.

	CONTRACTOR INFORMATION

Name	Enter the official name of the Contractor.

Address	Enter the mailing address, including a nine-digit zip code of the Contractor for check mailing.

Type	Click arrow to view drop down box choices and click the appropriate organizational status of the
	Contractor. See the DHHS Procurement and Contract Services Policies/Manual for definitions.

Section	If the organizational type is NC Community College, UNC System, University In-state or Out-of-
	state click arrow to view drop down box and click the appropriate Section performing the service.
	See the DHHS Procurement and Contract Services Policies/Manual for definitions.
Federal Tax ID No. or	Enter the Contractor’s Federal Tax Identification Number or for Personal Services Contract, enter
SSN	the Employee Social Security Number.
Group Number	Enter group number assigned to the Contractor’s appropriate check mailing address in NCAS.

Fiscal Year	Click arrow to view choices. Click appropriate choice to identify the Contractor’s fiscal year.
	(Contractor’s IRS audit cycle.) This does not necessarily coincide with the dates of the contract
	period.
Email	Enter the email address of the Contractor Administrator.

Contractor Administrator	Enter the name of the person responsible for policy/terms of the contract for the Contractor.

Telephone #, Fax #	Enter the telephone number (area code) and fax number of the Contractor Administrator.

	CONTRACT INFORMATION

Description	Enter a one line description of what activity is to be performed/accomplished.

Contract Dates	Enter the beginning and ending dates of the contract such as 07/01/05- 06/30/06 (using a format:
	MM/DD/YYYY, MM-DD-YYYY, MM/DD/YY, or MM-DD-YY).
Status	Click arrow to view choices. Click appropriate choice to enter if document to be processed is a new
	contract, renewal contract or an amendment.
Amendment #	Leave blank if processing a new or renewal contract. See amendment instructions below.

Old DHHS System #	Enter the previous eight (8) digit Contract Number assigned by the DHHS Contract System.

Options	Click arrow to view choices. Click appropriate choice to identify how the Contractor was selected.

Subcontract	Click arrow to view choices. Click appropriate choice to identify if any services are not being
	performed by the Contractor.

Audit	Click arrow to view choices. Select appropriate choice to identify the contract determination.

Item #	Click arrow to view choices. Select appropriate choice to identify the applicable coding for NCAS.
	Use 96102 contractual services; 96162 personal services contracts, 97145 lease or rental; 93959
	maintenance (service) agreements or 91806 for consultant services.
Company, Account # ,	Enter the applicable company, account and center along with the amounts for each center. The
Center and Amount	amount should include applicable required Contractor match. This information dictates the NCAS
	encumbrance.

Total or Amendment	Enter the total amount of the contract.
Amount

		APPROVALS FOR INTENT TO CONTRACT

	Signatures	Prior to the effective date, obtain all appropriate approvals. See the DHHS Procurement and Contract Services
		Policies/Manual for details regarding the meaning of each approval.
	Contract Administrator/	The Contract Administrator should initial and forward to Section Chief. If approved, the Section Chief should
	Section Chief Signature	sign beside Contract Administrator’s initials, enter the current date, and forward the package to the Division
		Contract Office. If not approved, return the package to the Contract Administrator.
	Division Contract Office	If approved, the Division Contract Manager should sign, enter the phone number, enter the current date, and
		forward the package to the Division Budget Officer. If not approved, return the contract package to the
		Section Chief.
	Division Budget Office	The Division Budget Officer determines if the proposed funding is available, if the funding has appropriate
		obligations/spending periods, and if proposed uses are allowable. The Budget Officer is responsible for
		designating the specific funding codes for the funds used for the contract or contract amendment. If approved,
		the Division Budget Officer should forward to the Division Director. If not approved, return the package to the
		Contract Office.
		Funds Budgeted – The contract amount is budgeted in the correct account and center. The Budget Officer
		should sign the bottom line at this time if “Funds Budgeted” is checked.
		Funds Proposed – The contract amount is in the proposed budget pending action by the General Assembly.
		Funds Proposed, Require Realignment – Funds are available but not in the proper line item; a budget revision
		is necessary to budget the contract amount in the correct account and center. Enter the budget revision
		number.
		Funds Not Available – For current year contracts, available funds cannot be identified in the proposed budget.
		For future year contracts, funds are not in the proposed budget, or if in the proposed budget, funding for the
		contract does not appear likely to be approved, or has been disapproved, by the General Assembly.
	Division Personnel	The Division Personnel Manager must review and approve all Personal Services contracts and contract
	Manager	amendments.
	COE Chair	The COE Chair is required to sign and date the contract approval form, representing committee review and
		approval. “Approval” indicates the contract includes the elements of PBC.
	Division Director	All prior approvals must be in place prior to Director’s approval. The Director returns the approved or
		unapproved contract or contract amendment to Contract Manager. The Division Director is the final approval
		authority for the following types of contracts, except Information Technology services: (a) non-consulting
		contract with DHHS agency or corresponding local agency, regardless of the amount (b) direct client services
		or grant in contract form less than $200,000, per 12 month period, with private non-profit organization (c) non-
		direct, non-consulting services less than $200,000, per 12 month period, with North Carolina State owned
		university, community college, or local government entity (d) all Personal Services contracts and contract
		amendments $10,000 and above and/or exceeds the established rate.
	DIRM	If required, DIRM must review and approve all contracts and contract amendments containing an Information
		Technology (IT) component, regardless of the amount or funding source. If you are unsure whether any
		portion of the contract or contract amendment does or does not meet the criteria referenced in the “Checklist
		Detail”, please contact the DIRM Contracts Office at DIRM’s main number 919-855-3000 or via email to
		DIRM.ContractOffice@ncmail.net.
	PIO	If required, PIO will review and approve all contracts and contract amendments for media, public relations, or
		associated services, regardless of amount or provider. For guidance, or to clarify if the contract or contract
		amendment contains media services call PIO’s main number 919-733-9190.
	DHHS Budget &	If required, Budget & Analysis will review and approve all contracts and contract amendments: (a) sole source
	Analysis	contract for non-direct services (excluding support services such as pest control, equipment maintenance,
		janitorial, etc.) with for-profit and private non-profit organizations regardless of dollar amount (b) consulting
		contract regardless of amount or provider (c) non-direct services (except support services) with for-profit or
		non-profits equal to or greater than $10,000, regardless of how procured (d) non-direct services (except support
		services) with North Carolina state-owned university, community college, and local government entity equal to
		or greater than $200,000 (e) personal services contracts and contract amendments exceeding the established
		rate.
	DHHS Personnel	If required, the DHHS Personnel Director must review and approve all Personal Services contracts and contract
	Director	amendments $10,000 and above and/or exceeds the established rate.
	DHHS Office of	If required, Office of Procurement and Contract Services will review and approve all contracts and contract
	Procurement and	amendments: (a) sole source contract for non-direct services with for-profit and private non- profit
	Contract Services	organizations regardless of dollar amount (b) consulting contract regardless of amount or provider (c) contract
	Contract Services	with other state agencies (except university contracts) (d) direct medical services equal to or greater than

		$200,000, per 12 month period, with a for-profit organization (e) direct client services or grant in contract form
		equal to or greater than $200,000, per 12 month period, with a non-profit organization (f) contract for non
		direct services with North Carolina state-owned university, community college, local government entity equal
		to or greater than $200,000 (g) contract for non-direct services with for-profit or non-profit equal to or greater
		than $10,000, regardless of how the contract was selected.

Contract Approval Form Instructions - Contract Amendment

Saving the original Contract Approval form to another file will save time in completing the form for an amendment. Items with instructions to “complete as described above” should be the same response as the original contract. Print on pink paper.

NCAS Number	Complete as described above.

DHHS Sys #	Complete as described above.

Division Contract ID #	Complete as described above.

Division Contract Administrator	Complete as described above.

Contractor Signature Authority	Complete as described above.

		CONTRACTOR INFORMATION

		Complete as described above.
		CONTRACT INFORMATION

Description	Enter a brief description of the purpose of the amendment including what is being amended and
	why the contract is being amended.

Contract Dates	Enter the original beginning and ending date of the contract (using a format: MM/DD/YYYY,
	MM-DD-YYYY, MM/DD/YY, or MM-DD-YY). If the amendment is for revision of dates do
	not enter the revised dates in this area. See Amended Contract Dates below.
Status	Click arrow to view choices. Click amendment.

Amendment #	Enter the amendment number such as 1, 2, or 3, etc. in the next space.

Old DHHS System #	Complete as described above.

Options	Complete as described above.

Subcontract	Complete as described above.

Audit	Click arrow to view choices. Select appropriate choice to identify the contract determination. If
	the choice is being revised, include appropriate contract language revision and a new completed
	contract determination.
Item #	Complete as described above.

Company, Account # ,	Enter the applicable company, account and center along with the increase or decrease amounts for
Center and Amount	each center. The amount should include applicable required Contractor match. This information
	dictates the NCAS encumbrance. Enter the company, account and center from the original
	contract if there is no change in amounts. Leave amounts blank if there is no change in funding
	amounts.
Total or Amendment	Enter the net amount of the increase or decrease. Leave blank if there is no change in funding
Amount	amounts.

Current Contract Total	If funds are being increased/decreased, enter the amount of the current contract. Leave blank if
	processing an amendment for Year 2 or 3. Leave blank if processing a no cost amendment.

OPCS Approval Number	Enter the number assigned by the DHHS Office of Procurement and Contract Services for
	approval of the original contract such as SS544-05.

New Contract Total	If funds are being increased/reduced for the current period of the contract, add/subtract the
	amendment amount to/from the current contract total and enter the new contract total. Leave
	blank if processing an amendment for Year 2 or 3. Leave blank if processing a no cost
	amendment.
Amended Contract Dates	If applicable, enter the beginning date of the original contract and the new ending date (using a
	format: MM/DD/YYYY, MM-DD-YYYY, MM/DD/YY, or MM-DD-YY). Leave blank if the
	effective period of the contract is not being changed.

		APPROVALS FOR INTENT TO CONTRACT

	Signatures	Prior to the effective date, obtain all appropriate approvals. See the DHHS Procurement and Contract Services
		Policies/Manual for details regarding the meaning of each approval.
	Contract Administrator/	The Contract Administrator should initial and forward to Section Chief. If approved, the Section Chief should
	Section Chief Signature	sign beside Contract Administrator’s initials, enter the current date, and forward the package to the Division
		Contract Office. If not approved, return the package to the Contract Administrator.
	Division Contract Office	If approved, the Division Contract Manager should sign, enter the current date, and forward the package to the
		Division Budget Officer. If not approved, return the contract package to the Section Chief.
	Division Budget Office	The Division Budget Officer determines if the proposed funding is available, if the funding has appropriate
		obligations/spending periods, and if proposed uses are allowable. The Budget Officer is responsible for
		designating the specific funding codes for the funds used for the contract or contract amendment. If approved,
		the Division Budget Officer should forward to the Division Director. If not approved, return the package to the
		Contract Officer.
		Funds Budgeted – The contract amount is budgeted in the correct account and center. The Budget Officer
		should sign the bottom line at this time if “Funds Budgeted” is checked.
		Funds Proposed – The contract amount is in the proposed budget pending action by the General Assembly.
		Funds Proposed, Require Realignment – Funds are available but not in the proper line item; a budget revision
		is necessary to budget the contract amount in the correct account and center. Enter the budget revision
		number.
		Funds Not Available – For current year contracts, available funds cannot be identified in the proposed budget.
		For future year contracts, funds are not in the proposed budget, or if in the proposed budget, funding for the
		contract does not appear likely to be approved, or has been disapproved, by the General Assembly.
	Division Personnel	The Division Personnel Manager must review and approve all Personal Services contracts and contract
	Manager	amendments.
	COE Chair	The COE Chair is required to sign and date the contract approval form, representing committee review and
		approval. “Approval” indicates the contract includes the elements of PBC.
	Division Director	All prior approvals must be in place prior to Director’s approval. The Director returns the approved or
		unapproved contract or contract amendment to Contract Manager. The Division Director is the final approval
		authority for the following types of contracts, except Information Technology services: (a) non-consulting
		contract with DHHS agency or corresponding local agency, regardless of the amount (b) direct client services
		or grant in contract form less than $200,000, per 12 month period, with private non-profit organization (c) non-
		direct, non-consulting services less than $200,000, per 12 month period, with North Carolina State owned
		university, community college, or local government entity (d) all Personal Services contracts and contract
		amendments $10,000 and above and/or exceeds the established rate.
	DIRM	If required, DIRM must review and approve all contracts and contract amendments containing an Information
		Technology (IT) component, regardless of the amount or funding source. If you are unsure whether any
		portion of the contract or contract amendment does or does not meet the criteria referenced in the “Checklist
		Detail”, please contact the DIRM Contracts Office at DIRM’s main number 919-855-3000 or via email to
		DIRM.ContractOffice@ncmail.net.
	PIO	If required, PIO will review and approve all contracts and contract amendments for media, public relations, or
		associated services, regardless of amount or provider. For guidance, or to clarify if the contract or contract
		amendment contains media services call PIO’s main number 919-733-9190.
	DHHS Budget &	If required, Budget & Analysis will review and approve all contracts and contract amendments: (a) sole source
	Analysis	contract for non-direct services (excluding support services such as pest control, equipment maintenance,
		janitorial, etc.) with for-profit and private non-profit organizations regardless of dollar amount (b) consulting
		contract regardless of amount or provider (c) non-direct services (except support services) with for-profit or
		non-profits equal to or greater than $10,000, regardless of how procured (d) non-direct services (except support
		services) with North Carolina state-owned university, community college, and local government entity equal to
		or greater than $200,000 (e) personal services contracts and contract amendments exceeding the established
		rate.
	DHHS Personnel	If required, the DHHS Personnel Director must review and approve all Personal Services contracts and contract
	Director	amendments $10,000 and above and/or exceeds the established rate.
	DHHS Office of	If required, Office of Procurement and Contract Services will review and approve all contracts and contract
	Procurement and	amendments: (a) sole source contract for non-direct services with for-profit and private non- profit
	Contract Services	organizations regardless of dollar amount (b) consulting contract regardless of amount or provider (c) contract
	Contract Services	with other state agencies (except university contracts) (d) direct medical services equal to or greater than

		$200,000, per 12 month period, with a for-profit organization (e) direct client services or grant in contract form
		equal to or greater than $200,000, per 12 month period, with a non-profit organization (f) contract for non
		direct services with North Carolina state-owned university, community college, local government entity equal
		to or greater than $200,000 (g) contract for non-direct services with for-profit or non-profit equal to or greater
		than $10,000, regardless of how the contract was selected.

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When it comes to fields of this precise PDF, here is what you want to do:

1. The DIRM usually requires certain details to be inserted. Be sure the next blank fields are finalized:

2. Immediately after the prior part is filled out, go on to enter the suitable details in these: Contract Admin Initials , A P P R O V A L S f o r I N T E N, Section Chief Signature, Date, Division Contract Office and, Approve, Funds Budgeted Funds Proposed, Funds Proposed, Funds Not Available, Approve, Approve, Approve, Date, Date, and Date.

Division Contract Office and, Date, and Section Chief Signature of PIO

3. This next section is about Public Affairs if required, DHHS Budget Analysis if required, DHHS Personnel Director if required, Date, Date, Date, Approve, Approve, Approve, Approve, DHHS Office of Procurement , Comments, PC Number, Conditional Approval based on, and DIVISION BUDGET OFFICER FINAL - fill in all these fields.

Be really careful when filling in DHHS Personnel Director if required and PC Number, because this is the part in which most users make a few mistakes.

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C 4026 Form – Fill Out and Use This PDF

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