CD12-100, OEC12-17 October 3, 2012
Active Protective Services cases should include the following child care documents in the Assessment and Services Section (Cover Sheet: Blue) of the child’s case record.
- Child Assessment and Service Plan (CS-1) for children who are a legal status 1. The child care section of this form must be completed for children needing/receiving child care.
- Written Service Agreement (CD-14B) for families receiving Family Center Services or “intact” families. The need for child care must be specified on this form.
- Child care approval notice (CD-150). This form is optional for inclusion in the case record as it is sent to the parent.
- Provider child care approval notice (FF-155). This form is optional for inclusion in the case record as it is sent to the child care provider.
NOTE: All authorizations for child care must be entered and approved by a supervisor in the FAMIS/FACES interface to a DSS compliant child care provider. Documents that can be retrieved from FAMIS (i.e. CD-150 and FF-155) are not required to be in the Protective Services file.
For active Income Maintenance cases in the FAMIS, the Child Care case record should include the following documents:
- Request for Application, (FA-100). This form printed and signed during in-person application and recertification interviews.
- Child Care Application/Eligibility Statement (IM-1CC) or Child Care Recertification Review Form, (FA-502). These forms are used for mail in or drop off applications and recertifications.
- Interview Summary (FA-102).
- Communications Transmittal Form (IM-16), as applicable.
- Copies of verification documentation necessary to substantiate the eligibility decision and authorized units of care. This may include, but is not limited to, copies of forms and correspondence such as Employment Information Request (FA-311) and the School Attendance Verification (FA-309) and other third party verification, such as wage stubs and schedules.
- Supporting verification documentation for interim changes.
The case record shall be in the name of the parent or caretaker who is applying for child care services. The parent or caretaker is also responsible for reporting changes to FSD that may affect the eligibility status of the family unit.
NOTE: The IM-3 Changes You Must Report form is no longer required as of September 17, 2012.