State of Hawaii

State Procurement Office

Procurement of Health and Human Services (SPOH)  

Chapter 103F, HRS

 

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SPO > SPOH > For Private Providers > Forms for Private Providers/Applicants

Forms and Instructions

for Private Providers/Applicants
Last updated: 12 February, 2007

 

Instructions for Downloading

RFP

Protest 

 

  

Below are the State Procurement Office forms and instructions for private providers to use when responding to solicitations of health and human services by the State.  Most are in MS Word or MS Excel format as well as in the printer-friendly PDF should your word processor or spreadsheet program be unable to read Word or Excel files. 

Instructions for Downloading and Viewing Forms & Instructions

MS Word or MS Excel files:

  • Right click (click with your right mouse button) on the "xls" or "doc" after the form name. 

  • Choose "save target as."

  • Note: If you do not use your right mouse button when clicking on the ".xls" or ".doc" the document may take a long time to open or may cause your computer to lock up. 

PDF Files:

To view or print, just click.

PDF forms marked "fillable" may be completed on your computer after downloading: 

  • Right click (click with your right mouse button).

  • Choose 'Save target as."

  • Open the form in Adobe Reader.

  • Move your curser over the form until the curser turns into an "I" beam and type.

You will need Adobe Reader to view and print PDF files. Get Adobe Reader.

Form #

Form Title

Instructions & Samples
Registration

 Note: Effective January 23, 2006, registration with the State Procurement Office and completion of registration form SPO-H 100A is no longer required.  All applicants must be registered and in good standing with the DCCA Business Registration Division, as applicable, at the time of contracting.  To see if a provider is in good standing you may check online at: http://www.ehawaii.gov/dcca/cogs/exe/cog.cgi

Proposal Application Forms

for the Competitive Method (RFP) of Procurement

SPO-H-200

(Revised 9/06)

Proposal Application Identification Form

(formerly the POS Application Title Page)
(doc)   (pdf) (fillable)

 Instructions (PDF)

SPO-H-200A

(Revised 9/04)

 

 Proposal Application (doc)      Refer to the RFP
SPO-H-250

Proposal Application Short Form 1 (doc)

 Refer to Section 3 of the RFP
 
Don't forget to click with your right mouse button if you are downloading a ".doc" or ".xls" file.  See instructions above.

Budget Application Forms

for the Competitive Method (RFP) of Procurement
SPO-H-201 Cost Principles 
(This is not a form for you to fill out but you will need this when completing budget forms.  It will help you to determine allowable and unallowable costs) (PDF - 85kb)
View/download all budget instructions/samples (PDF- 107kb) or separately (below)
Download all the budget forms in one file (xls) or separately (below).
Form # Form Title Instructions & Samples

SPO-H-205

(10/98)

Budget
  (xls)         (pdf)

Instructions
view (html)

print (pdf)

Sample (pdf)

SPO-H-205A

(10/98)

Organization-Wide Budget By Source of Funds 
(xls)           ( pdf)

Instructions

view (html)

print (pdf)

Sample (pdf)

 

SPO-H-205B

(10/98)

Organization-Wide Budget by Programs (xls)

Instruction (pdf)

Sample (pdf)

 
Don't forget to click with your right mouse button if you are downloading a ".doc" or ".xls" file.  See instructions above.
Form # Form Title Instructions & Samples

SPO-H-206A

(10/98)

Budget Justification - Personnel - Salaries & Wages 
(xls)      (pdf)

Instructions(pdf)

Sample (pdf)

 

SPO-H-206B

(10/98)

Budget Justification - Personnel: Payroll Taxes, Assessments & Fringe Benefits  
(xls)     (pdf)

Instructions(pdf)

Sample (pdf)

 

SPO-H-206C

(10/98)

Budget Justification - Travel-Inter-Island (xls)            

Instructions

view (html)

print (pdf)

Sample (pdf)

SPO-H-206D

(10/98)

Budget Justification - Travel-Out of State (xls)      (pdf)

Instructions(pdf)

Sample (pdf)

 

SPO-H-206E

(10/98)

Budget Justification - Contractual Services-Administrative  
(xls)     (pdf)

Instructions(pdf)

Sample (pdf)

 

SPO-H-206F

(10/98)

Budget Justification - Contractual Services-Subcontracts  
(xls)     (pdf)

Instructions(pdf)

Sample (pdf)

 
Don't forget to click with your right mouse button if you are downloading a ".doc" or ".xls" file.  See instructions above.
Form # Form Title Instructions & Samples

SPO-H-206G

(10/98)

Budget Justification - Depreciation  
(xls)     (pdf)

Instructions(pdf)

sample (pdf)

 

SPO-H-206H

(10/98)

Budget Justification - Program Activities  
(xls)     (pdf)

Instructions(pdf)

Sample (pdf)

 

SPO-H-206I

(10/98)

Budget Justification - Equipment Purchases (xls)     (pdf)

Instructions(pdf)

Sample (pdf)

 

SPO-H-206J

(10/98)

Budget Justification - Motor Vehicle
(xls)     (pdf)

Instructions(pdf)

Sample (pdf)

 
Need Tax Clearance Forms?
Tax Clearance Application & Instructions (A link to the Department of Taxation website to ensure you get the most current forms)
Protests and Requests for Reconsideration

All protest forms are in PDF and are fillable.

Chapter 3-148, HAR, "Protests and requests for reconsideration"

Protest Procedures, flowchart and protest forms for protestors (pdf) (rev. 3/05) Contains protest procedures, flowchart, and all protestor forms in one document - everything  listed below regarding protests.

Protest Flowchart (pdf)  (rev. 4/03) 

 

Get all protest forms for protestors at once or each form separately (below.) 

SPO-H-801

(Revised 4/03)

Notice of Protest (PDF)

SPO-H-804

(4/03)

 Request for Clarification (PDF)

SPO-H-805

(4/03)

Response to Request for Clarification (PDF)

SPO-H-806

(Revised 4/03)

Formal Protest (PDF)

 

SPO-H-808

(4/03)

Reply (PDF)

SPO-H-810

(Revised 4/03)

Request for Reconsideration (PDF)
Application for Treatment Purchase of Services (Notice to Providers of Treatment Services)
SPO-H-400  
(Revised 7/06)

Annual Solicitation for  Treatment Purchase of Services Statement of Qualifications  

*Note: To view/print PDF documents*, a copy of the freeware Adobe  Reader® is needed.  Download the latest version here.

Please direct questions to:

Mara Smith at 808.587.4704 or mara.smith@hawaii.gov or

Corinne Higa at 808.587.4706 or corinne.y.higa@hawaii.gov

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State Procurement Office ~ 1151 Punchbowl Street, #230A ~ Honolulu, HI  96813 ~ Fax:  808.587.4703