The New York State Office of Temporary and Disability Assistance (OTDA) has released a new form, Form 4968 Elw. The form is to be used by local social services districts when verifying eligibility for emergency shelter assistance. The new form must be used as of January 1, 2018.Verification will now include an assessment of whether the individual or family has access to housing that is safe, decent, and affordable. This assessment will take into account all available housing options in the individual or family's community, including those that are not considered traditional shelters. The use of Form 4968 Elw is part of Governor Andrew M. Cuomo's ongoing efforts to improve the delivery of essential services to those who need them most. For more information on this and other initiatives please visit www.otda.ny.gov .
Question | Answer |
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Form Name | Form Otda 4968 Elw |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | OTDA 4968 otda form |
OTDA - 4968 ELW (Rev 7/13)
CONTRACTOR QUARTERLY COMPLIANCE REPORT
INSTRUCTIONS: BEGINNING TEN DAYS FOLLOWING THE END OF THE FIRST CALENDAR QUARTER (March 31st, June 30th, September 30th, and December 31st) AFTER A CONTRACT IS AWARDED; QUARTERLY COMPLIANCE REPORTS WILL BE DUE FOR THE PROCEEDING QUARTER’S ACTIVITY.
Expenditure Code: C – Commodities, SC – Services/Consultants, CC
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REPORTING PERIOD: |
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MWBE Goal |
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Contract Number: __ __ __ __ __ __ __ |
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MBE |
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% |
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From:_____/_____/_____ |
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WBE |
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% |
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To: _____/_____/_____ |
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Contractor: |
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M/WBE ________ % |
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A |
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B |
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C |
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Amount of Actual |
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(MBE) Subcontracting |
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Enterprise (WBE) Subcontracting |
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Expenditures in Reporting |
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Expenditures in Reporting Period |
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Expenditures in Reporting Period |
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Period |
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$____________________ |
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$____________________ |
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$____________________ |
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(If none, enter 0) |
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(If none, enter 0) |
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(If none, enter 0) |
D
Dual Minority and
Enterprise (MWBE) Subcontracting
Expenditures in Reporting Period
$____________________
(If none, enter 0)
*CERTIFIED M/WBE VENDOR(S) INFORMATION: ALL AREAS MUST BE FILLED IN, NOTHING SHOULD BE LEFT BLANK*
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Primary Owner’s Name, |
Ethnicity and |
Service |
MBE, WBE or |
Expendit |
Product |
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Payee ID |
Gender (Male |
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Amount |
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Address, City, Zip |
Location |
Dual MWBE |
Code |
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or Female) |
Code |
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Date Paid
NAME AND TITLE OF PREPARER (Print or Type): |
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TELEPHONE NO.: |
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EMAIL ADDRESS: |
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QUARTERLY REPORTS SHOULD BE |
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FOR AGENCY USE ONLY |
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REVIEWED BY: |
DATE: |
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SUBMITTED TO THE OTDA |
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PROGRAM/CONTRACT MANAGER |
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CREDIT WILL NOT BE GIVEN WITHOUT COMPLETE INFORMATION
INSTRUCTIONS:
List all M/WBEs used during the quarter, providing all requested information in appropriate columns. In the event that an M/WBE is used more than one time during a quarter, list the M/WBE only once for each expenditure category. Use the Expenditure Code defined at the top of the form to indicate the category of expenditures for which the M/WBE was used.
TOTALS FOR REPORT PERIOD
Column A |
Total Amount of Actual Expenditures in Report Period: Enter the amount ($) for each Expenditure Code made during |
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report period under this contract. |
Column B |
MBE Subcontracting Expenditures: Enter the amount for each Expenditure Code with registered Minority Owned |
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Business Enterprises made during the report period under this contract. |
Column C |
WBE Subcontracting Expenditures: Enter the amount of expenditures for each Expenditure Code with registered |
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Women Owned Business Enterprises made during the report period under this contract. |
Column D |
MWBE Dual Subcontracting Expenditures: Enter the amount of expenditures for each Expenditure Code with |
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registered Minority and Women Owned Business Enterprises made during the report period under this contract. |
Use the following codes in the Product Code column to indicate the category of work for which the M/WBE was utilized:
PRODUCT CODE KEY:
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A |
Agriculture/Landscaping (e.g., all forms of landscaping services) |
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B |
Mining (e.g., Geological Investigation) |
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C |
Construction |
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C15 |
Building Construction – General Contractors |
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C16 |
Heavy Construction (e.g., highway, pipe laying) |
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C17 |
Special Trade Contractors (e.g., plumbing, heating, electrical, carpentry) |
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D |
Manufacturing (production of goods) |
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E |
Transportation, Communication and Sanitary Services (e.g., Delivery services, warehousing, broadcasting and cable systems) |
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F/G |
Wholesale/Retail Goods (e.g., gravel, hospital supplies and equipment, food stores, computer stores, office supplies) |
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G52 |
Construction Materials (e.g., lumber, paint, lawn supplies) |
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H |
Financial, Insurance and Real Estate Services |
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I Services
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I73 |
Business Services (e.g., copying, advertising, secretarial, janitorial, rental services of equipment, computer programming, |
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security services) |
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I80 |
Health Services |
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I81 |
Legal Services |
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I82 |
Educational Services (e.g., AIDS education, automobile safety, tutoring, public speaking) |
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I83 |
Social Services (e.g., counselors, vocational training, child care) |
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I87 |
Engineering, architectural, accounting, research, management and related services |
ETHNICITY MINORITY GROUP DEFINITION
Black
Hispanic
Persons having origins from any of the Black African racial groups.
Persons of Mexican, Puerto Rican, Dominican, Cuban, Central or South American descent of Either Indian or Hispanic origin, regardless of race.
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Persons having origins from the Far East, Southeast Asia or the Pacific Islands. |
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Persons having origins from the Indian subcontinent. |
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Subcontinent |
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Native |
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Persons having origins in any of the original peoples of North America. |
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American |
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Expenditure: An expenditure is an actual payment which has been made by an agency, either through the Office of the State Comptroller or by the agency's finance office directly, including subcontractor/supplier payments made by a prime contractor and verified by the agency.
Grants: For the purposes of this report, grants are monies dispensed by a contracting governmental agency to a person or institution to accomplish a public purpose authorized by law. According to Article
Subcontract: a) For construction, a subcontract is any portion of the contract or any service performed or supplies provided relative to that contract by any party other than the prime contractor;
b)For commodities and consultant/services, a subcontract is that portion of the total value of a contract portioned out to another consultant/individual or vendor. This is also known as second tier spending;
c)For
d). It is important to provide all information as requested or credit may not be allowed.
e). It is critical that you provide the detailed information requested on the CONTRACTOR QUARTERLY COMPLIANCE REPORT. List each M/WBE firm you have included in the MBE and WBE totals (for prime and subcontract expenditures) in each expenditure category. Missing information may result in the firm/dollars not counting toward agency MWBE participation goals.