A sample DBF-14 is attached with the mandatory fields numbered.  It is attachment #1.  Attachment 1a is instructions for completing the DBF-14.

All DBF-14's submitted for the GAFP Program, must have the original invoice attached.  The invoice must be itemized showing the items or services that are to be paid.  Budget and Finance (B&F) will no longer accept Xerox copies of any invoice or receipt.  This is due to numerous double payments that have occurred from a DBF-14 being submitted twice, once with the original and again with copies. 

Please refer to the sections below for clarification regarding specific payments though the GAFP Program.

CLOTHING ALLOWANCE

When submitting a DBF-14 to pay the vendor directly, such as Kmart, JC Penney, etc., the original itemized receipt must be attached along with two (2) copies.  B&F will not accept copies in lieu of the original, even if it is stamped "only original invoice available."  The same rule applies if you are reimbursing the guardian for clothing.  You must provide the original, itemized receipt, but in this case, the receipt must show that the guardian has paid in full, thus justifying the reimbursement.  Reimbursement amounts are as follows:

When submitting a DBF-14 to reimburse Wal-Mart you must attach specific information.  See attachment #2 for the complete instructions.

• Child age 0 to 5                       $150 yearly reimbursement
• Child age 6-12                         $200 yearly reimbursement
• Child age 13 and over             $250 yearly reimbursement

When paying an attorney directly for legal fees on a DBF-14, you must attach an original bill from the Attorney stating the service provided and the amount due.  If reimbursing the guardian for legal fees, you must have a receipt from the attorney showing that the guardian has paid in full, or copies of the front and back of the check that was used to pay the attorney.  In this case, copies of the check are sufficient and the original check does not need to be sent.  Reimbursement for legal fees is as follows:

• Up to $500 per child.

Most childcare services provided through the GAFP Program will be handled through the Income Maintenance Childcare system, occasionally a DBF-14 is submitted for childcare services.  If paying the childcare provider directly, the childcare provider must provide a bill stating the number of days attended and the total amount owed.  If we are reimbursing the guardian for childcare services, a receipt showing the guardian has paid in full and/or a copy of the front and back of the check must be provided.

Effective September 30, 2001, the GAFP Program will only pay childcare expenses up to the state maximums for child care providers.  We will no longer reimburse additional charges such as co-payments, summer day care camps, etc.

MILEAGE

If reimbursing for approved mileage, the guardian must provide a statement showing where they went, the number of miles for each trip and a total amount to be reimbursed.

Effective August 30, 2001, the GAFP Program will only reimburse mileage for extraordinary medical/emergency situations only.  It must be in excess or 45 miles one way in "have to" situations, such as seeing a specialist.  Mileage is reimbursed at the state reimbursement rate.

RESPITE

When paying a respite provider directly, the original bill form the respite provider, showing the number of days provided and total amount due, must be attached to the DBF-14.  It must be directly from the respite provider with his/her name and address on it, the name of the children and the name of the guardian.  If reimbursing the grandparent for respite, you must have a receipt from the respite provider showing the guardian has paid it in full.

Respite providers are reimbursed $20 per unit with a minimum of 12 hours and a maximum or 24 hours per child.  This amount cannot exceed 12 units per family per 12 months, for a total of $240 per year.

An example of a respite care invoice is included as attachment #3.  Individual counties may have already drafted one of their own. 

DBF-14 CODING

• For all GAFP DBF-14's enter ER100 in the field labeled Contract/ Registration Number.

• For all GAFP DBF-14's where payment is made directly to the guardian, enter the guardian's name in the Check Payable To field and guardian's social security number in the Vendor Fed Tax ID or SS# field. 

• For all GAFP DBF-14's, always use the same guardian and SSN for recurring payments.

• For all GAFP DBF-14's, always list the DCN of the guardian and the individual children reimbursement is being requested on in the description of item or service field.

• For child care expenses enter the following codes on the DBF-14:

• For all other expenses enter the following codes on the DBF-14:

If you have any questions regarding this e-mail memorandum, please contact Gail Zielonka, Temporary Assistance Unit, at (573) 751-9488.

• Discuss this memorandum with all appropriate staff.

• Effective immediately, a DBF-14 submitted for the GAFP Program must have an original bill or receipt and two (2) copies attached.  B&F will no longer accept copies.

• Effective immediately begin using the appropriate coding for GAFP expenses.

• Questions regarding specific case situations, as related to these procedures, should be cleared through normal supervisory channels.