Welcome to the Missouri Department of Health and Senior Services (DHSS) online administrative and data collection form. Subrecipient contractors/providers are required to submit one online administrative form per calendar year per federal taxpayer identification number (nine digit number), regardless of the number of contracts or agreements with DHSS or the number of business locations.
Section I contains questions related to the Business Management Assessment (BMA). The information submitted in Section I, in conjunction with audit reports, if applicable, is used as a tool in managing the department’s funds and to comply with the department’s monitoring requirements. DHSS program managers may use the information obtained in this assessment to determine monitoring plans for the upcoming year. Program staff will continue to individually review the programmatic components of the contracts/agreements, which may include reviewing invoices and applicable source documentation during desk audits or on-site visits.
Section II collects information as required by the Federal Funding Accountability and Transparency Act (FFATA).
Section III collects contact information for the Health Insurance Portability and Accountability Act (HIPAA).
IMPORTANT NOTE: The form works best when using the Microsoft Internet Explorer browser rather than other browsers such as Chrome, Firefox, Opera, Safari, etc.
Please note there is not a Save feature for the administrative data collection form. Once you start entering information into the online form, it must be completed. If you have to close out and come back at a later time/date you will have to start the process over again. Information needed to complete the process:
- your organization’s federal taxpayer ID#;
- your organization’s DUNS number and Parent DUNS number if there is one (you may find your DUNS number by going to http://www.dnb.com/duns-number/lookup.html;
- access to any written policies and procedures; and,
- a copy of your most recently completed audit or financial review.
If applicable, a copy of your organization’s most recent audit or financial review must be forwarded to DHSS, except Single Audits for organizations with $750,000 or more in federal expenditures. Single Audit reports must be uploaded to the Federal Audit Clearinghouse at https://harvester.census.gov/facweb/ as required by 2 CFR 200 (Uniform Grants Guidance).
Copies of audit reports other than Single Audits, plus any additional attachments may be sent:
- via the preferred method, email, to firstname.lastname@example.org;
- or by fax to 573-526-6049;
- or by regular mail to
Missouri Department of Health and Senior Services
Division of Administration
PO Box 570
Jefferson City, MO 65102-0570
If you have a federal indirect cost (IDC) rate, please email a copy of the negotiated IDC rate agreement to email@example.com. For information regarding negotiated indirect cost rates, please refer to 2 CFR 200, Appendix III, IV, or V as applicable.
Some questions on the form have “help” links to assist you in selecting the response that best fits your organization. If you have additional questions regarding the completion of this form, you may contact the DHSS Division of Administration at 573-751-6104. Thank you for your time in completing the form.
Please make sure that you have enough time to complete the form prior to starting. It may take several minutes to complete. Prolonged periods of inactivity will cause your login to expire.