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MEETING YOUR CONTRACTURAL OBLIGATIONS In order for you to receive reimbursement and be in compliance with the Federal and State Regulations under which the Texas Fluoridation ?roject operates, we are enclosing a supply of three (3) forms which must be completed and returned to this office at the appropriate times. These forms are: 1. Fluoridation Proqram Progress Report (Por.m DH91a) This form is to be completed and returned every three months until your fluoridation installation is complete and operating. Its purpose is simply to officially inform this office of your project's status. The first progress report form will be due three (3) months from the beginning date of your contract. Because most installations are complete within six (6) months, it is likely that the need to furnish this report will occur only once or twice. 2. Nonexoendable Personal ProDertv (Por.m GC-11) This form serves to list only the fluoridation equipment items which individually cost you in excess of $1,000. In theory, we could demand that those items be returned as state property if at some point they were no longer being used to fluoridate your water supply. This form need only be submitted once-- after you have received and paid for all of your fluoridation equipment. 3, Request for Reimbursement (For.m GC-10) This form must be completed and returned each time you request reimbursement. You may bill this program for reimbursement of the actual expenses you have paid as often as monthly, or only once--when all your expenses have been paid, and you are ready to totally close out the contract. A completed example of each of the forms is attached. If you wish/. we will be happy to furnish you with a copy of the Federal and State Regulations with which you will be complying by completing and returning the required forms. Send all reports to: BUREAU OF DENTAL HEALTH SERVICES TEXAS DEPARTMENT OF HEALTH 1100 WEST 49TH STREET AUSTIN, TX 78756-3199