drug abuse treatment cost analysis program

DRUG ABUSETREATMENT COST

ANALYSIS PROGRAM(DATCAP)

Program Version

COST INTERVIEW GUIDEDRUG ABUSE TREATMENT MODULE

The material contained in this version of the DATCAP instrument was originallydeveloped by Michael T. French, Ph.D., and his colleagues. Faculty and researchstaffs at numerous institutions have contributed to various versions of the DATCAPinstrument with subsequent revisions.

The DATCAP instrument is in the public domain: copying, using, or reproducingits contents does not require the permission of Dr. French or participatingorganizations. Nonetheless, proper training on the usage of the instrument as wellas on the interpretation of the cost estimates is strongly recommended.

The following information should be included when citing this source:

French, M.T. (1998) Drug Abuse Treatment Cost Analysis Program (DATCAP):Program Version, Sixth Edition, University of Miami, Coral Gables, Florida.

All questions and inquiries should be directed to:

Michael T. French, Ph.D.Research Associate ProfessorUniversity of MiamiHealth Services Research Center1400 NW 10th Avenue, Suite 1105AMiami, FL 33136(305) 243-3490 (phone)(305) 243-2149 (fax)

e-mail:[email protected]

SIXTH EDITIONAugust, 1998

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PRELIMINARY INFORMATION

NAME OF INTERVIEWER(S): _____________________________________________________________

NAME OF RESPONDENT(S): _____________________________________________________________

INTERVIEW OR COMPLETION DATE: _____________________________________________________________

PROGRAM NAME: _____________________________________________________________

STUDY MODALITY & LOCATION: _____________________________________________________________

_____________________________________________________________

_____________________________________________________________OTHER MODALITIES& LOCATIONS: _____________________________________________________________

_____________________________________________________________

_____________________________________________________________

SETTING: _____________________________________________________________(e.g., community-based, hospital-based)

FINANCIAL STRUCTURE: _____________________________________________________________(e.g., private for-profit, public not-for-profit)

NAMES, TITLES, AND TELEPHONE NUMBERS OF ALL PROGRAM EMPLOYEES WHO ATTENDEDTHE INTERVIEW SESSION AND/OR HELPED COMPILE THE INFORMATION:

NAME TITLE PHONE #

__________________________________ __________________________________ ___________________

__________________________________ __________________________________ ___________________

__________________________________ __________________________________ ___________________

__________________________________ __________________________________ ___________________

__________________________________ __________________________________ ___________________

THE DATA IN THIS MODULE CORRESPOND TO FISCAL YEAR: _____________ TO _____________ (MM/DD/YY)

Throughout the data collection process, please answer all questions as they pertain to the treatmentprogram for the above fiscal year (henceforth referred to as “the fiscal year”).

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TABLE OF CONTENTS

INTRODUCTION..........................................................................................................................1

PROGRAM DEFINITION.............................................................................................................2

A. PROGRAM REVENUE .........................................................................................3B. CLIENT INFORMATION.....................................................................................5C. PERSONNEL ..........................................................................................................6D. SUPPLIES AND MATERIALS..............................................................................9E. CONTRACTED SERVICES.................................................................................10F. BUILDINGS AND FACILITIES..........................................................................11G. EQUIPMENT .......................................................................................................24H. MISCELLANEOUS RESOURCES AND COSTS...............................................31I. RESOURCES AND COSTS NOT RECORDED ELSEWHERE.........................33

COMMENTS AND SUGGESTIONS .......................................................................................34

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INTRODUCTION

The Drug Abuse Treatment Cost Analysis Program (DATCAP) is a data collection instrumentand cost interview guide designed to be used for all types of treatment providers. The programversion can be customized for use by a variety of treatment programs, such as mental healthclinics, day treatment centers for alcoholism, outpatient drug abuse treatment programs, andwork site employee assistance programs. The guide is intended to collect and organize detailedinformation on the resources used in treatment operations and their associated dollar costs.Resource categories include client, personnel, supplies and materials, contracted services,buildings and facilities, equipment, and miscellaneous items. The guide also collects informationon program revenues and client caseflows.

Two types of costs are estimated: accounting and economic costs. Accounting costs are the valueof those resources that the treatment program has to pay for directly through “out-of-pocket”expenditures. Economic costs are the full value of all resources (i.e., opportunity costs)regardless of whether a direct expenditure is involved. In general, economic costs are equal toaccounting costs plus the incremental value of those resources that are partially subsidized orused free of charge by the treatment program. For resources that involve a direct expenditure, itis preferable to collect cost data from expenditure reports as opposed to budgets, since budgetsdo not always coincide with actual resource use. Indirect costs or the market value of resourcesthat are subsidized or used free of charge will be estimated in two ways: 1) by multiplying theshare of a resource used by the treatment program by the estimated market value of that resource,and 2) by estimating the cost the program would have incurred if the subsidized or free resourcehad not been available without payment. Resource use and cost information will be collected forboth the clients and the treatment provider to estimate social costs of treatment services.

After compiling all the necessary resource use and cost data, the DATCAP will generate totalannual cost estimates for each individual cost category, for the treatment program’s studymodality as a whole, and for the average client. Using client caseflow data, the DATCAP willalso generate average cost estimates that represent the cost to provide uninterrupted treatmentservices to one client for one week. In addition, based on length-of-stay projections, DATCAPwill compute the average cost for a single treatment episode.

The purpose of this interview guide is to collect resource use and cost information pertaining tothe operations of one modality or program at the treatment organization. Please answer thequestions that follow for the “study modality” or program noted on page 2 only; do not groupmodalities or programs. The information collected and generated through the DATCAPinstrument, or through any other part of this study, will be held in confidence and will not bereported in a way that could directly identify the modality or program unless approved by you.Despite this assurance, if there is any information that you consider especially sensitive, pleasealert the interviewer or note your concern on the form. Thank you very much for yourparticipation.

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PROGRAM DEFINITION

For the purposes of data collection with the DATCAP instrument, the “program” or “studymodality” will be defined based primarily on therapeutic criteria rather than financial convenienceor other principles. The data collection process will begin by asking to describe the organizationfrom both a financial and service delivery perspective. A recognizable program term or servicedelivery unit (SDU) and domain, such as outpatient non-methadone services, will then be agreedupon. After a workable definition for the program is determined, the corresponding resource useand cost information will be collected according to the economic principles of opportunity cost.It is expected that organizations will display variation in how a program is defined and howresources are assigned. For example, some programs will deliver services at a single facility witha mutually exclusive accounting system. Other programs will have multiple facilities withintermingled financial structures. While it may be organizationally convenient to treat anoutpatient methadone clinic and a short-term residential facility as one program if they belong tothe same cost center, the therapeutic processes are clearly different and a combined approachwould be virtually useless for program evaluation purposes. In general, we will delineateprograms along the following therapeutic lines: outpatient non-methadone, intensive outpatientor day treatment, outpatient methadone, short-term residential, long-term residential, therapeuticcommunity, residential detoxification, psychiatric hospital detoxification, and prison-basedtreatment.

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SECTION A: PROGRAM REVENUE

A1. What was the total revenue received from all sources by the treatment program, for thefiscal year?

Total program revenue for the fiscal year..............................$____________________

A2. What was the treatment program’s revenue, by source, for the fiscal year?

Federal Sources

a. Medicaid.......................................................................................$______________b. Medicare.......................................................................................$______________c. Civilian Health and Medical Program for the Uniformed

Services (CHAMPUS).................................................................$______________d. Veterans Administration..............................................................$______________e. Food Stamps................................................................................$______________f. Vocational Rehabilitation.............................................................$______________g. Federal Correctional Facilities......................................................$______________

Substance Abuse Prevention and Treatment (SAPT )Block Grants

Pregnant Women Set Aside......................$______________Prevention Set Aside................................$______________Other........................................................$______________

Please Specify:_______________________$_____________________________________$______________

h. Total SAPT Block Grant.............................................................$______________i. Community Services Block Grants..............................................$______________j. Other Federal Grants....................................................................$______________k. Other Federal Sources..................................................................$______________

Please Specify:______________________$____________________________________$______________

State Sources

l. Single State Agency......................................................................$______________m. State Correctional Facilities..........................................................$______________n. Other State Sources (e.g., MediCAL)...........................................$______________

Please Specify: ______________________$______________

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______________________$____________________________________$______________

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SECTION A: PROGRAM REVENUE

Local Sources

o. Single County Authority..............................................................$______________p. County Government....................................................................$______________q. City Government.........................................................................$______________r. Other Local Sources.....................................................................$______________

Please Specify: ______________________$____________________________________$____________________________________$______________

Private Sources

s. Private Insurance..........................................................................$______________t. Client Fees....................................................................................$______________u. Foundations..................................................................................$______________v. Corporations................................................................................$______________w. Individual Donations....................................................................$______________x. Other Private Sources...................................................................$______________

Please Specify: ______________________$____________________________________$____________________________________$______________

Total program revenue for the fiscal year............................$_____________________(Note: Must be equal to the value reported in Question A1.)

A3. What was the total revenue received from all sources by the treatment program in theprevious fiscal year?

Total program revenue in the previous fiscal year..............$_____________________

A4. What is the expected total revenue received from all sources by the treatment program forthe next fiscal year?

Expected total program revenue for the next fiscal year....$_____________________

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SECTION B: CLIENT INFORMATION

What was/will be the program’s...a. b. c.

This Previous NextFiscal Fiscal FiscalYear Year Year

B1. number of new admissions or episodes(excluding readmissions)…

B2. number of readmissions... __________________________________

B3. total admissions... __________________________________

B4. total number of active clients... __________________________________

B5. licensed capacity at the end of... __________________________________

B6. actual physical capacity at the end of... __________________________________

B7. average daily census during... __________________________________

B8. median length of stay for a (typical) client (weeks)... __________________________________

B9. average client-to-counselor/therapist caseload (ratio)... |___:___| |___:___| |___:___|

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SECTION C: PERSONNEL

C1. List all positions of the program staff and full-time equivalents, as well as their average annualfull-time salary, for the fiscal year.

PositionNumber of

FTEsAverage

Full-TimeSalary

Total Salaryfor Position

% of TimeDevoted to

Direct PatientCare or

AdministrationX $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $

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PositionNumber of

FTEsAverage

Full-TimeSalary

Total Salaryfor Position

% of TimeDevoted to

Direct PatientCare or

Administration

Total personnel cost ..................................................................... _____________________________$

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C2. Do these salaries include employee benefits?

NO........................................................................................................................................1YES (Skip to C4)..................................................................................................................2

C3. How much was dedicated to employee benefits, as a percentage of base salary, and indollar terms, during the fiscal year?

FICA ...................................................................................._______%..$_____________Federal and State Unemployment Insurance........................_______%..$_____________Health Insurance..................................................................._______%..$_____________Pension and Retirement........................................................_______%..$_____________Workers Compensation Insurance........................................_______%..$_____________Disability.............................................................................._______%..$_____________Other Employee Benefits Costs..........................................._______%..$_____________Other Costs..........................................................................._______%..$_____________

Total cost for employee benefits....................................... %...$_____________

Please specify calculations used to obtain these figures:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C4. What was the total overtime cost during the fiscal year?

Total overtime cost..............................................................................$_______________


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C5. What was the total of any other personnel cost during the fiscal year?

Total other personnel cost......................................................................$_____________


C6. What volunteer labor services did the treatment program receive during the fiscal year?What would be the estimated cost of these volunteer services if the program had to payfor them?

Volunteer/Volunteer Services

TotalAnnualHours

Estimated RatePer Hour Estimated Cost

1. $ $2. $ $3. $ $4. $ $5. $ $6. $ $

Total volunteer labor cost.....................................................................$ _______________


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SECTION D: SUPPLIES AND MATERIALS

D1. Please list the total cost of supplies and materials for the fiscal year.

a. Drugs and Pharmacy (e.g., Methadone).........................................$_____________b. Medical Supplies............................................................................$_____________c. Office Supplies...............................................................................$_____________d. Housekeeping Supplies..................................................................$_____________e. Linen and Bedding..........................................................................$_____________f. Dietary-Food..................................................................................$_____________g. Dietary-Other Supplies..................................................................$_____________h. Minor Equipment (value < $500 for each item)............................$_____________i. Computer Software........................................................................$_____________j. Postage...........................................................................................$_____________k. Other Supplies...............................................................................$_____________

Please Specify: ______________________$____________________________________$____________________________________$______________

Total cost of supplies and materials......................................................$_____________

D2. Please estimate the market value (or cost) of supplies and materials used by the treatmentprogram free of charge for the fiscal year?

a. Drugs and Pharmacy (e.g., Methadone).........................................$_____________b. Medical Supplies............................................................................$_____________c. Office Supplies...............................................................................$_____________d. Housekeeping Supplies..................................................................$_____________e. Linen and Bedding..........................................................................$_____________f. Food...............................................................................................$_____________g. Dietary-Other Supplies..................................................................$_____________h. Minor Equipment (value < $500 for each item)............................$_____________i. Computer Software........................................................................$_____________j. Postage...........................................................................................$_____________k. Other Supplies...............................................................................$_____________

Please Specify: ______________________$____________________________________$____________________________________$______________

Estimated total cost of free supplies and materials.............................$_____________

D3. What is the total cost of all supplies and materials?..................................$_____________

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SECTION E: CONTRACTED SERVICES

If the treatment program has a contract with a company/corporation/internal department to providea service, then enter the corresponding cost information in questions E1 through E11. If thetreatment program has a contract with a person/individual to provide a service, then enter thecorresponding cost information in Question E12.

What was the cost of the following contracted services during the fiscal year?

E1. Laboratory Services...................................................................................$_____________E2. Repair and Maintenance............................................................................$_____________E3. Security Services.......................................................................................$_____________E4. Housekeeping Services..............................................................................$_____________E5. Advertising Services..................................................................................$_____________E6. Pest Control Services................................................................................$_____________E7. Transportation Services............................................................................$_____________E8. Wellness and Fitness.................................................................................$_____________E9. Smoking Cessation....................................................................................$_____________E10. Parenting and Day Care.............................................................................$_____________E11. Other Contracted Services.........................................................................$_____________

Please Specify: ______________________$____________________________________$____________________________________$______________

E12. List consultants and contracted personnel, the number of hours they worked, and theiraverage hourly wage rate, for the fiscal year. (Exclude costs included in questions E1through E11, or personnel costs included in question C1.)

Consultants orContracted Personnel

Number ofHours/Year

Avg. HourlyWage Rate

TotalCost

X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $

Total cost of contracted services...............................................................$__________________

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SECTION F: BUILDINGS AND FACILITIES

F1. What buildings and facilities were used by the treatment program during the fiscal year?Include any building or facility that was used by the program staff or clients even if it wasnot used directly for treatment services.

BuildingNumber: Building Name:

1. _____________________________________________________

2. _____________________________________________________

3. _____________________________________________________

4. _____________________________________________________

5. _____________________________________________________

6. _____________________________________________________

7. _____________________________________________________

8. _____________________________________________________

9. _____________________________________________________

10. _____________________________________________________

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Complete the following set of questions (F2 through F12) for each building or facilitylisted in F1.

BUILDING 1

F2. Where is the building located? What is its mailing address?

Name of Facility:__________________________________________________________Street: __________________________________________________________________City and Zip Code:________________________________________________________

F3. Was this building used by the treatment program during the previous fiscal year?

NO ..................................................................................................................................1YES ..................................................................................................................................2

F4. Is this building expected to be used by the treatment program during the nextfiscal year?

NO ..................................................................................................................................1YES ..................................................................................................................................2

F5. How large was the total usable space in this building during the fiscal year?

Total usable space........................................................................._______________ sq. ft.

F5a.................How much of the total usable space in this building was used by thetreatment program?

Percentage of total usable building space................................_______________ %

F6. If the program space noted in F5a was used full-time during the fiscal year (i.e., 40 hoursper week or 2080 hours per year), write 100 in the space below. Otherwise, estimate thepercentage of time it was used?

Percentage of time used......................................................................._______________ %

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F7. How was this building used by the treatment program during the fiscal year? (Mark all that apply)

a. Direct Client Services..................................................................................................1b. Staff Offices................................................................................................................2c. Intake Processing.........................................................................................................3d. Administration............................................................................................................4e. Storage.........................................................................................................................5f. Research......................................................................................................................6g. Education.....................................................................................................................7h. Other Uses..................................................................................................................8

Please Specify: __________________________________________________________________________________________________________

F8. During the fiscal year, did the treatment program lease or rent Building 1?

Leased/Rented (Continue)........................................................................................1Other Arrangement (Skip to F11)....................................................................................2

F9. What was the lease or rent amount for this building in the fiscal year?

Lease or rent amount.....................................................................$_____________ per year

F10. Is the lease or rent amount noted in F9 the fair market value?

NO (Skip to F10a.)............................................................................................................1YES (Skip to F12)...............................................................................................................2

F10a. Please estimate the fair market value based on a lease or rental price per squarefoot of space.

Fair market value...............................................................$_____________ per year

Please specify calculations/sources used to obtain these figures:_________________________________________________________________________________________________________________________________________________________________________________________________________

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F10b. If it is not possible to estimate the fair market lease or rent amount, please give usthe name, address, and phone number of a local real estate agent/company whomay be able to provide an estimate.

Real Estate Agent/Company: _____________________________________________Address: _____________________________________________________________Phone Number: ________________________________________________________(Skip to Question F12)

F11. What would be the lease or rent amount if the program had to pay for the space in thisbuilding instead of owning the building or using it free of charge?

Estimated lease or rent amount........................................................$_____________ per year

Please specify calculations used to obtain these figures:_______________________________________________________________________________________________________________________________________________________________________________________________________________

F11a. If it is not possible to estimate the fair market lease or rent amount, please give usthe name, address, and phone number of a local real estate agent/company whomay be able to provide an estimate.


F12. Annual opportunity cost of Building 1........................................................$_______________

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Complete the following set of questions (F2 through F12) for each building or facilitythat was listed in F1.

BUILDING 2




NO ..................................................................................................................................1YES ..................................................................................................................................2


NO ..................................................................................................................................1YES ..................................................................................................................................2


Total usable space...............................................................................____________ sq. ft.

F5a. How much of the total usable space in this building was used by thetreatment program?



Percentage of time used..................................................................................__________%

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Please Specify: __________________________________________________________________________________________________________










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BUILDING 3




NO ..................................................................................................................................1YES ..................................................................................................................................2


NO ..................................................................................................................................1YES ..................................................................................................................................2







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Please Specify: __________________________________________________________________________________________________________










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BUILDING __




NO ..................................................................................................................................1YES ..................................................................................................................................2


NO ..................................................................................................................................1YES ..................................................................................................................................2







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Please Specify: __________________________________________________________________________________________________________

F8. During the fiscal year, did the treatment program lease or rent Building __?









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F12. Annual opportunity cost of Building ____..................................................$_______________

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SECTION G: EQUIPMENT

G1. What was the cost of all leased or rented equipment during the fiscal year?

Cost of leased or rented equipment.......................................................$ ________________

G2. What equipment was purchased by the treatment program during the fiscal year?(Include only individual items of equipment [e.g., methadone dispensing machine] andcategories of equipment [e.g., desks] worth more than $500.)

Equipment Units Cost/Unit Total Cost

Office Furniture

Chairs X $ = $Desks X $ = $Filing Cabinets X $ = $Tables X $ = $

X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $

a. Total office furniture cost.........................................................................$ ________________

Computers

Hardware X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $

b. Total computer cost...................................................................................$ ________________

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Electronic

TVs X $ = $VCRs X $ = $Phones X $ = $Projectors X $ = $Copy Machines X $ = $Security Systems X $ = $

X $ = $X $ = $X $ = $X $ = $X $ = $

c. Total electronic equipment cost...............................................................$ ________________

Medical Equipment

Methadone Dispensing Systems X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $

d. Total medical equipment cost.......................................................................$ _____________

Recreational & Child Care

Fitness Equipment X $ = $Playground Equipment X $ = $

X $ = $X $ = $X $ = $X $ = $X $ = $

e. Total recreational and child care cost...........................................................$ _____________

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Residential

Beds X $ = $Appliances X $ = $

X $ = $X $ = $X $ = $X $ = $X $ = $

f. Total residential cost........................................................................................$ ___________

Vehicles

Courtesy Vans X $ = $Staff Vehicles X $ = $

X $ = $X $ = $X $ = $

g. Total vehicle cost.............................................................................................$ ____________

Other Equipment

Air Conditioners X $ = $Stereo Systems X $ = $TV Monitors X $ = $Safes X $ = $Refrigerators X $ = $Stoves X $ = $Microwaves X $ = $

X $ = $X $ = $X $ = $X $ = $X $ = $X $ = $

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h. Total other equipment cost............................................................................$ _____________

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G3. What other equipment did the program have on hand for use at the treatment programduring the fiscal year? Please provide a description of the equipment and the presentcondition of the equipment. (Include only individual items of equipment [e.g., methadonedispensing machine] and categories of equipment [e.g., desks] worth more than $500.)

Current Condition

Office Furniture UnitsPurchase

YearPurchase

Price Excellent Fair PoorChairs $

Desks $

Filing Cabinets $

Tables $

$

$

$

$

$

$

$

$

$

$

Computers(make & model)

Speed(mhz)

RAM(mb)

HDSize(mb)

PurchaseYear Units

PurchasePrice

OtherFeatures

$$$$$$$$$$

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$$$


ElectronicMake &Model

PurchaseYear Units

PurchasePrice Features

TVs $VCRs $FAX Machines $Projectors $Phones $Copy Machines $Security Systems $

$$$$$$$$$$$$$$$$$$$$$$$$$$

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$$$$


MedicalMake &Model

PurchaseYear Units


AutomaticDispensers $X-Ray Machines $

$$$$$$$

Vehicles ConditionYear Make Model Miles Features Excellent Fair Poor

Recreational andChild Care

Make &Model

PurchaseYear Units


Exercise Equipment $Playground Equipment $

$

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$$$

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ResidentialMake &Model

PurchaseYear Units


Beds $Appliances $

$$$$$$

OtherEquipment

Make &Model

PurchaseYear Units


Air Conditioners $Stereo Systems $TV Monitors $Safes $Refrigerators $Stoves $

$$$$$$$$$$$$$$$$$$$

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Estimated total annual cost of existing equipment............................$_______________

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SECTION H: MISCELLANEOUS RESOURCES AND COSTS

H1. What was the cost of the specific miscellaneous items listed below used by the treatmentprogram during the fiscal year?

a. Electricity.....................................................................................$ ______________b. Gas...............................................................................................$_______________c. Oil.................................................................................................$_______________d. Water and Sewer...........................................................................$_______________e. Garbage.........................................................................................$_______________f. Insurance......................................................................................$_______________g. Licenses........................................................................................$_______________h. Federal Taxes................................................................................$_______________i. State Taxes...................................................................................$_______________j. Local (e.g., Property) Taxes.........................................................$_______________k. Telephone.....................................................................................$_______________l. Printing and Duplicating...............................................................$_______________m. Transportation.............................................................................$_______________n. Publications, Subscriptions, and Books.......................................$_______________o. Staff Training................................................................................$_______________p. Staff Travel...................................................................................$_______________q. Medical Waste Disposal..............................................................$_______________r. Proficiency Test Fees...................................................................$_______________s. Cola Regulation Fees....................................................................$_______________t. Lab Licensing................................................................................$_______________u. Other Miscellaneous ...................................................................$_______________

Please Specify: ______________________$____________________________________$____________________________________$______________

Total cost of miscellaneous resources listed above...........................$_______________

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SECTION H: MISCELLANEOUS RESOURCES AND COSTS

H2. What was the estimated cost of the specific miscellaneous items listed below that were usedby the treatment program free of charge during the fiscal year?

a. Electricity.....................................................................................$_______________b. Gas...............................................................................................$_______________c. Oil.................................................................................................$_______________d. Water and Sewer...........................................................................$_______________e. Garbage.........................................................................................$_______________f. Insurance......................................................................................$_______________g. Licenses and Taxes.......................................................................$_______________h. Federal Taxes................................................................................$_______________i. State Taxes...................................................................................$_______________j. Local (e.g., Property) Taxes.........................................................$_______________k. Telephone.....................................................................................$_______________l. Printing and Duplicating...............................................................$_______________m. Transportation.............................................................................$_______________n. Publications, Subscriptions and Books........................................$_______________o. Staff Training................................................................................$_______________p. Staff Travel...................................................................................$_______________q. Medical Waste Disposal..............................................................$_______________r. Proficiency Test Fees...................................................................$_______________s. Cola Regulation Fees....................................................................$_______________t. Lab Licensing................................................................................$_______________u. Other Miscellaneous....................................................................$_______________

Please Specify: ______________________$____________________________________$____________________________________$____________________________________$____________________________________$______________

Total cost of miscellaneous free resources listed above....................$_______________

H3. Total cost of all miscellaneous resources..................................................$_______________

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SECTION I: RESOURCES AND COSTS NOT RECORDED ELSEWHERE

I1. What other goods and services were purchased by the treatment program during the fiscalyear that are not recorded elsewhere? What was the cost of these goods and services?

Goods and Services Cost

a. _____________________________________________.......$__________________

b. _____________________________________________.......$__________________

c. _____________________________________________.......$__________________

d. _____________________________________________.......$__________________

e. _____________________________________________.......$__________________

f. _____________________________________________.......$__________________

Total cost of goods and services listed above.................................$__________________

I2. What other goods and services were used free of charge by the treatment program during thefiscal year that are not recorded elsewhere? What is the estimated cost of these goods andservices used free of charge?

Goods and Services Cost

a. _____________________________________________.......$__________________

b. _____________________________________________.......$__________________

c. _____________________________________________.......$__________________

d. _____________________________________________.......$__________________

e. _____________________________________________.......$__________________

f. _____________________________________________.......$__________________

Total cost of free goods and services listed above.........................$__________________

I3. Total cost of all goods and services listed in I1 and I2........................$__________________

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COMMENTS AND SUGGESTIONS

Part Q # Comments and Suggestion

_____ _____ ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

_____ _____ ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

_____ _____ ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

_____ _____ ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

_____ _____ ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

_____ _____ ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

_____ _____ ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

_____ _____ ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

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drug abuse treatment cost analysis program

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