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{"sheet":"Vendor Worksheet Instructions","index":0,"n_rows":66,"n_cols":2,"rows_kept":66,"cut":false,"hidden":false,"merged":[[32,1,32,8],[28,1,28,8],[4,0,4,8],[22,1,22,8],[20,1,20,8],[30,0,31,8],[34,1,34,8],[36,1,36,8],[65,0,65,8],[63,0,63,8],[38,1,38,8],[48,1,48,8],[50,1,50,8],[59,1,59,8],[55,1,55,8],[57,1,57,8],[61,1,61,8],[44,1,44,8],[51,1,51,8],[42,1,42,8]]}
["TRI-COUNTIES REGIONAL CENTER"]
["AB 10 MINIMUM WAGE 2016 RATE ADJUSTMENT"]
["WORKSHEET INSTRUCTIONS"]
[]
["These instructions are for the Vendor Worksheet.  After you read these instructions, please go to the “Vendor Worksheet” tab to begin.  You will ONLY be able to fill-in and select from the shaded fields on this worksheet.  The information you submit on this worksheet will be reviewed by the Regional Center.  If additional information is needed the Regional Center will contact you.  After the review, the Regional Center will respond to your request accordingly."]
[]
["SECTION A:  PROGRAM INFORMATION"]
[]
["Row 1","Please enter the Service Provider Name."]
[]
["Row 2","Please enter the six-digit Vendor Number."]
[]
["Row 3","Please select the three-digit Service Code from the drop down menu."]
[]
["Row 4","Please enter the Subcode if applicable."]
[]
["Row 5","Please enter the Staffing Ratio."]
[]
["Row 6","Please enter the number of Enrolled Consumers."]
[]
["Row 7","Please enter the dates for the beginning and end of a review period of 3 consecutive months.  If you have been recently vendored and have less that 3 months of payroll and billing data, please enter the dates for an applicable review period of up to 3 months."]
[]
["Row 8","Please enter the current rate as established by the Department and select the Unit Type, either Daily or Hourly, from the drop-down list."]
[]
["Rows 9 & 10","Rate information will populate automatically here."]
[]
["Row 11","Select the Vendoring Regional Center from the drop-down list."]
[]
["Row 12-14","Select the User Regional Center(s), if applicable, from the drop-down list.  If you need to list additional user regional centers, please add rows by clicking as instructed on the designated button."]
[]
["SECTION B:  EMPLOYEE WAGE INFORMATION"]
[]
["Column A","Please enter the name or initials of the employed staff who were paid during the review period, followed by their position title.  For any employee/position who received two or more different hourly wages during the review period being reported, please list only the most current wage paid with the requested information in columns B through I.  If additional rows are needed, please click on the designated button."]
[]
[null,"DO NOT include staff who are providing these services that are funded by another source, such as through a contract with a school district.  Also, DO NOT include wages paid to consumers while receiving these services or any worker who is paid through other sources such as contract funding."]
[]
["Column B","Please enter the Position Title of the Employee."]
[]
["Column C","Please enter the current Hourly Wage paid to the employee(s) reported during the Review Period."]
[]
["Columns D - G","Wage information will calculate automatically here."]
[]
["Column H","Please enter the Workers' Compensation Insurance Employer Rate as a percentage.  IF greater than 6% must submit supporting documentation with this worksheet."]
[]
["Column I","Please enter your Total Unemploment Insurance contribution rate as a percentage,  including the net Federal and State rates, and the Employment Training Tax of 0.1%.  (Refer to your Form DE-2088 that you receive from the State of California Employment Development Department (EDD) for your contribution rates for Unemployment Insurance and Employment Training Tax.)  IF greater than 6.2% must submit supporting documentation with this worksheet."]
[]
["Column J","Wage information will calculate automatically here."]
[]
["Column K","Please enter the actual Total Hours Worked During the Review Period by each of the reported employee(s)."]
[]
["Column L","Annualized hourly information will calculate automatically here."]
[null,"If less than a 3 month period, Section A Row 7,  Department Staff will adjust the calculation as needed."]
[]
["SECTION C:  RATE ADJUSTMENT CALCULATION"]
[]
["Row 1","Total wages, payroll taxes, workers' compensation, and other mandated employer costs will calculate automatically here."]
[]
["Row 2","Total Actual Number of Units of Services Billed to all Regional Centers during the \n3 month period will calculate automatically here."]
[]
["Rows 3 - 9","Please select the individual regional center(s) billed in the Review Period and enter the total units billed in the Review Period for the selected regional center(s).  If you need to list additional regional centers, please click the designated button."]
[]
["Row 10","The rate change will calculate automatically here and populate Row 9 in Section A, Program Information."]
[]
["Please review ALL the information you have entered on the worksheet, and specifically rows 8 - 10 in Section A, and row 10 in Section C.  These rows should have calculated rate information based on the data you have entered.  If there is an error message in these rows, you may need to re-enter the information in Sections B, and/or C."]
[]
["Before submitting, please rename this workbook using your vendor name, vendor number, service code, and sub-code as the name of this file.  Failure to do so results in the submission of an empty workbook."]

{"sheet":"Vendor Worksheet","index":1,"n_rows":113,"n_cols":13,"rows_kept":113,"cut":false,"hidden":false,"merged":[[5,2,5,7],[6,2,6,7],[7,2,7,7],[9,2,9,7],[10,2,10,7],[12,3,12,6],[13,3,13,6],[14,3,14,6],[11,2,11,7],[15,2,15,7],[16,2,16,7],[17,2,17,7],[25,2,28,2],[25,3,28,3],[25,4,28,4],[25,5,28,5],[25,6,28,6],[25,7,28,7],[19,2,19,7],[18,2,18,7],[25,8,28,8],[25,10,28,10],[25,11,28,11],[25,12,28,12],[27,1,28,1],[25,9,28,9]]}
["TRI-COUNTIES REGIONAL CENTER"]
["AB 10 MINIMUM WAGE 2016 RATE ADJUSTMENT"]
["Effective January 1, 2016"]
[]
["SECTION A:  PROGRAM INFORMATION"]
[1,"Service Provider Name"]
[2,"Vendor Number"]
[3,"Service Code "]
[4,"Sub-code (if applicable)"]
[5,"Staffing Ratio"]
[6,"Number of Enrolled Consumers"]
[7,"Review Period: (Enter Beginning & End) - 3 months"]
[8,"Current Rate:",null,"Select Unit Type: "]
[9,"Rate Adjustment:",{"$f":"H56","v":{"$error":"#DIV/0!"}}]
[10,"New Rate:",{"$f":"C13+H56","v":{"$error":"#DIV/0!"}}]
[11,"Select Vendoring Regional Center -  select from drop down menu","TCRC"]
[12,"Select User Regional Centers -  select from drop down menu"]
[{"$f":"A17+1","v":13},"Select User Regional Centers"]
[{"$f":"A18+1","v":14},"Select User Regional Centers"]
[{"$f":"A19+1","v":15},"Select User Regional Centers"]
[]
[]
[]
["SECTION B:  EMPLOYEE WAGE INFORMATION"]
[null,"A","B","C","D","E ","F","G","H","I","J","K","L"]
[null,"Name or Initials of Staff Employee(s)","Position Title","Prior Hourly Wage","New Hourly Wage","Hourly Wage Change","Employer Social Security Tax @ 6.2%","Employer Medicare Tax @1.45%","Workers Compensation as a %","Unemploy. Insurance \nas a %","Wage Adjustment plus Mandated Payroll Costs","Hours Worked During \n3 Month Review Period","Cost of Rate Adjustment \n(3 Month Period)"]
[]
["Row","(Please See Instructions for Listing Employees Receiving more than One Wage)"]
["#"]
[1,"Staff 1",null,null,{"$f":"IF(D30>8.99,10,0)","v":0},{"$f":"IF(E30-D30>0,E30-D30,0)","v":0},{"$f":"F30*0.062","v":0},{"$f":"F30*0.0145","v":0},null,null,{"$f":"SUM(F30+G30+H30)+(F30*I30)+(F30*J30)","v":0},null,{"$f":"SUM(K30*L30)","v":0}]
[2,"Staff 2 ",null,null,{"$f":"IF(D31>8.99,10,0)","v":0},{"$f":"IF(E31-D31>0,E31-D31,0)","v":0},{"$f":"F31*0.062","v":0},{"$f":"F31*0.0145","v":0},null,null,0,null,{"$f":"SUM(K31*L31)","v":0}]
[3,"Staff 3",null,null,0,0,0,0,null,null,0,null,0]
[4,"Staff 4",null,null,0,0,0,0,null,null,0,null,0]
[5,"Staff 5",null,null,0,0,0,0,null,null,0,null,0]
[{"$f":"A34+1","v":6},"Staff 6",null,null,{"$f":"IF(D35>8.99,10,0)","v":0},{"$f":"IF(E35-D35>0,E35-D35,0)","v":0},{"$f":"F35*0.062","v":0},{"$f":"F35*0.0145","v":0},null,null,{"$f":"SUM(F35+G35+H35)+(F35*I35)+(F35*J35)","v":0},null,{"$f":"SUM(K35*L35)","v":0}]
[7,"Staff 7",null,null,{"$f":"IF(D36>8.99,10,0)","v":0},0,0,0,null,null,0,null,0]
[8,null,null,null,0,0,0,0,null,null,0,null,0]
[9,null,null,null,0,0,0,0,null,null,0,null,0]
[{"$f":"A38+1","v":10},null,null,null,{"$f":"IF(D39>8.99,10,0)","v":0},{"$f":"IF(E39-D39>0,E39-D39,0)","v":0},{"$f":"F39*0.062","v":0},{"$f":"F39*0.0145","v":0},null,null,{"$f":"SUM(F39+G39+H39)+(F39*I39)+(F39*J39)","v":0},null,{"$f":"SUM(K39*L39)","v":0}]
[" ",null,null,null,null,null,null,null,"Totals",null,{"$f":"SUM(K30:K39)","v":0},{"$f":"SUM(L30:L39)","v":0},{"$f":"SUM(M30:M39)","v":0}]
[null," "]
[]
[]
[]
["SECTION C:  RATE ADJUSTMENT CALCULATION"]
[1,null,null,null,null,null,"Total Cost of the Minimum Wage Adjustment for the Review Period:",{"$f":"IF(M40>0,M40,\"0.0\")","v":"0.0"}]
[2,null,null,null,null,null,"Actual Number of Units of Services Billed to all Regional Centers for the Review Period:",{"$f":"SUM(H49:H55)","v":0}]
[]
[3,"Select Regional Center from Drop Down Menu:","TCRC",null,null,null,"Enter Total No. of Units for Review Period"]
[4,"Select Regional Center:",null,null,null,null,"Enter Total No. of Units for Review Period"]
[5,"Select Regional Center:",null,null,null,null,"Enter Total No. of Units for Review Period"]
[6,"Select Regional Center:",null,null,null,null,"Enter Total No. of Units for Review Period"]
[7,"Select Regional Center:",null,null,null,null,"Enter Total No. of Units for Review Period"]
[8,"Select Regional Center:",null,null,null,null,"Enter Total No. of Units for Review Period"]
[9,"Select Regional Center:",null,null,null,null,"Enter Total No. of Units for Review Period"]
[10,"Rate Change (Section C, Row 1: Total Cost of Minimum Wage Adjustment/Section C, Row 3: Annualized Number of Units of Service)",null,null,null,null,null,{"$f":"ROUND(H46/H47,2)","v":{"$error":"#DIV/0!"}}]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Daily","Daily"]
["Hourly","Hourly"]
["Monthly","Monthly"]
["Other","Other"]
[]
["ACRC","ACRC"]
["CVRC","CVRC"]
["ELARC","ELARC"]
["FDLRC","FDLRC"]
["FNRC","FNRC"]
["GGRC","GGRC"]
["HRC","HRC"]
["IRC","IRC"]
["KRC","KRC"]
["NBRC","NBRC"]
["NLACRC","NLACRC"]
["RCEB","RCEB"]
["RCOC","RCOC"]
["RCRC","RCRC"]
["SARC","SARC"]
["SCLARC","SCLARC"]
["SDRC","SDRC"]
["SGPRC","SGPRC"]
["TCRC","TCRC"]
["VMRC","VMRC"]
["WRC","WRC"]

{"sheet":"Certification Instructions","index":2,"n_rows":25,"n_cols":1,"rows_kept":25,"cut":false,"hidden":false,"merged":[[24,0,24,8],[21,0,21,8],[4,0,4,8],[6,0,6,8],[8,0,8,8],[12,0,12,8],[18,0,18,8],[16,0,16,8],[10,0,10,8],[14,0,14,8]]}
["TRI-COUNTIES REGIONAL CENTER"]
["AB 10 MINIMUM WAGE 2016 RATE ADJUSTMENT"]
["SUMMARY & CERTIFICATION INSTRUCTIONS"]
[]
["These instructions are for the Vendor Summary & Certification.   After you read these instructions, please go to the “Vendor Summary & Certification” tab.  Please review the Program Information and enter the service address associated with the information submitted on this workbook.  If your program has a different mailing address than the service address, please enter this information."]
[]
["Please enter the requested Contact Information for the individual responsible for completing this workbook.  This information will include Contact Name, Contact Phone Number, Email Address, and Executive Director/Owner."]
[]
["Please review the current rate, proposed rate change, and the proposed new rate, which are calculated based on the information you have entered on the worksheet.  If there is an error message in the rate information, go back and review the information in the worksheet. "]
[]
["Please ensure you click on the \"I AGREE\" checkbox prior to saving or sending the workbook."]
[]
["We ask that you save this workbook using your vendor name, vendor number, service code, and sub-code in the title of the file name.  For example, \"ACME SLS - H12345 - 896 PS.xlsm\", then email the workbook to TCRC at \"minwage@tri-counties.org\" by hitting the “SUBMIT” button on the bottom of the Vendor Summary & Certification worksheet.  Please ensure you keep copies for your records."]
[]
["We ask that you only submit this workbook ONCE for each sub-code.  If you do not get a receive reply from us please e-mail minwagequestions@tri-counties.org, and we will follow up with you.  PLEASE DO NOT SUBMIT THE SAME WORKSHEET MULTIPLE TIMES!"]
[]
["PLEASE NOTE:  By hitting the “SUBMIT” button on the bottom of the “Vendor Summary & Certification” worksheet, you certify that the information provided to the Regional Center or DDS is specific to payroll costs necessary to meet the requirements of the minimum wage increase effective January 1, 2016.  You additionally certify to the best of your knowledge and belief that the information submitted is true and correct, and subject to verification by all record keeping and audit processes, procedures, and guidelines under the Lanterman Act and Title 17 of the California Code of Regulations (CCR)."]
[]
["You must retain ALL backup documentation which supports the information being submitted in this workbook.  The backup information for the information provided on this workbook is subject to all record keeping and audit processes, procedures, and guidelines under the Lanterman Act and Title 17, CCR.  "]
[" "]
["EMAIL ADDRESS:"]
["minwage@tri-counties.org"]
[]
["MAILING ADDRESS:"]
["TCRC WILL NOT ACCEPT ANY WORKSHEETS RECEIVED VIA FAX OR SCANNED/HARDCOPY VERSIONS."]

{"sheet":"Vendor Summary & Certification","index":3,"n_rows":43,"n_cols":4,"rows_kept":43,"cut":false,"hidden":false,"merged":[[42,0,42,8],[25,2,25,5],[26,2,26,5],[33,0,33,8],[40,0,40,3],[40,5,40,7],[37,0,37,8],[38,0,38,8],[6,2,6,5],[11,2,11,5],[12,2,12,5],[13,2,13,5],[14,2,14,5],[16,2,16,5],[17,2,17,5],[18,2,18,5],[23,2,23,5],[24,2,24,5],[19,2,19,5]]}
["TRI-COUNTIES REGIONAL CENTER"]
["AB 10 MINIMUM WAGE 2016 RATE ADJUSTMENT"]
["SUMMARY & CERTIFICATION SHEET"]
[]
["PROGRAM INFORMATION"]
[]
["Service Provider Name:",null,{"$f":"'Vendor Worksheet'!C6:H6","v":0}]
["Vendor Number:",null,{"$f":"'Vendor Worksheet'!C7:H7","v":0}]
["Service Code:",null,{"$f":"'Vendor Worksheet'!C8:H8","v":0}]
["Subcode (if applicable):",null,{"$f":"'Vendor Worksheet'!C9","v":0}]
[]
["Service Address:"]
[]
[]
[]
[]
["Mailing Address:"]
["(if different than service address)"]
[]
[]
[]
["CONTACT INFORMATION"]
[null,null,"Individual Responsible for Completing Worksheet:"]
["Contact Name:"]
["Contact Phone Number:"]
["Email Address:"]
["Executive Director/Owner:"]
[]
["Current Rate:",null,{"$f":"'Vendor Worksheet'!C13","v":0}]
["Proposed Rate Change:",null,{"$f":"'Vendor Worksheet'!C14","v":{"$error":"#DIV/0!"}}]
["Proposed New Rate:",null,{"$f":"'Vendor Worksheet'!C15","v":{"$error":"#DIV/0!"}}]
["Unit Type:",null,{"$f":"'Vendor Worksheet'!H13","v":0}]
[]
["By checking the box below, I certify that the information provided to the Department is specific to payroll costs necessary to meet the requirements of the minimum wage increase effective January 1, 2016.  I additionally certify to the best of my knowledge and belief the information submitted is true and correct, and subject to verification by all record keeping and audit processes, procedures, and guidelines under the Lanterman Act and Title 17 of the California Code of Regulations.  "]
[]
[null,null,null,"   I AGREE"]
[]
["To submit this completed 'Vendor Summary & Certification' and 'Vendor Worksheet' electronically please save the document as instructed on the Certification Instructions, then click on the following 'SUBMIT' button."]
["Before submitting, please save your workbook as follows:\n\"VENDOR NAME - VENDOR NUMBER - SERVICE CODE  SUB-CODE.xlsm\"\nPLEASE ONLY SUBMIT WORKSHEETS ONCE!\nIF YOU DO NOT GET A RECEIVED REPLY, PLEASE E-MAIL minwagequestions@tri-counties.org,\nAND WE WILL FOLLOW UP WITH YOU."]
[]
[]
[]
["If the 'SUBMIT' button above does not work for you, save a copy and e-mail the worksheet as an attachment to minwage@tri-counties.org.\nPlease keep a copy for your records."]

{"sheet":"CODES","index":4,"n_rows":24,"n_cols":8,"rows_kept":24,"cut":false,"hidden":false,"merged":[]}
[null,null,null,null,null,"Rate updated automatically by DDS"]
[48,"Client/Parent Support Behavior Interv Training",null,null,null,"096","Geriatric Facility","* Only those based on ARM rates"]
[55,"Community Integration Services",null,null,null,"113","Specialized Residential Facility (Habilitation)","* Only those based on ARM rates"]
[62,"Personal Assistance",null,null,null,"114","Specialized Residential Facility (Health)","* Only those based on ARM rates"]
[77,"Behavior Intervention: Parent Coordinated Homebased",null,null,null,"420","Respite: Family Member "]
[90,"Crisis Intervention Facility / Bed",null,null,null,"465","Respite: Participant Directed "]
[93,"Personal Assistance: Parent Coordinated",null,null,null,"862","Respite: Agency"]
[96,"Geriatric Facility","** Only those NOT based on ARM rates",null,null,"864","Respite: In Home Respite Worker"]
[109,"Supplemental Program Support - Residential",null,null,null,"868","Respite: Out Of Home Respite"]
[110,"Supplemental Program Support - Day program",null,null,null,"904","Family Home Agency","* Only those based on ARM rates"]
[111,"Supplemental Program Support - Miscellaneous",null,null,null,"905","Res Facility - Adult - Owner Operated"]
[113,"Specialized Residential Facility (Habilitation)","** Only those NOT based on ARM rates",null,null,"910","Res Facility - Children - Owner Operated"]
[114,"Specialized Residential Facility (Health)","** Only those NOT based on ARM rates",null,null,"915","Res Facility - Adult - Staff Operated"]
[612,"Behavior Analyst",null,null,null,"920","Res Facility - Children - Staff Operated"]
[615,"Behavior Management Assistant"]
[620,"Behavior Management Consultant",null,null,null,"Must submit request to DDS"]
[635,"Independent Living Specialist",null,null,null,"505","Activity Center  - DTAC"]
[676,"Teacher's Aide",null,null,null,"510","Adult Development Center - ADC "]
[860,"Homemaker Program",null,null,null,"515","Behavior Management Day Program - BMP"]
[875,"Transportation ",null,null,null,"520","Independent Living Services - ILS"]
[880,"Transportation  ",null,null,null,"525","Social Recreation Program"]
[882,"Transportation Aide",null,null,null,"805","Infant Development Program"]
[894,"Supported Living Services - Admin",null,null,null,"952","Supported Employment - Indiv"]
[896,"Supported Living Service",null,null,null,"954","Work Activity Program"]