Child Care Assistance Program. In-Home & Approved Home Child Care Provider Registration Packet

Transcription

1 Child Care Assistance Program In-Home & Approved Home Child Care Provider Registration Packet How to determine if you are an In-Home or Approved Home provider: In-Home: These providers must care for at least 3 or more children, in the child s private residence. 1. Are you caring for at least 3 or more children? Yes, next question. No, you will need to apply to become an Approved Home provider. Please contact the Child Care Program Office at: Once you receive your Approval Certificate, you may submit the attached application. It may take 30 days or longer for your Approved provider application to be processed by the State of Alaska. 2. Will you be watching the children in their own home? Yes, next question. No, If you will be watching children in YOUR home (the providers home) you will need to apply to become an Approved Home provider. Please contact the Child Care Program Office at: Once you receive your Approval Certificate, you may submit the attached application. It may take 30 days or longer for your Approved provider application to be processed by the State of Alaska. 3. Have you ever been under investigation by Office of Children s Services (or the former Division of Child and Family Services) for any reason, regardless of whether the investigation is related to activities within the daycare or the provider s own family? Yes, you are not eligible to receive payments from the Child Care Assistance Program. No, Please submit a copy of your Interested Persons Report from the Alaska State Troopers Office to the Child Care Manager for approval. Once you have cleared the background check process, you may proceed with completing and submitting this application. Approved Home: These providers must care for children in their own private residence, not where the children being cared for live. 1.) Will you be caring for children in your own home? Yes, you will need to apply to become an Approved Home provider. Please contact the Child Care Program Office at: Once you receive your Approval Certificate, you may submit the attached application. It may take 30 days or longer for your Approved provider application to be processed by the State of Alaska. No, You must provide care in your own home if you do not meet the criteria above to be an In- Home provider. 2.) Will you be caring for only one or two children? Yes, you will need to apply to become an Approved Home provider. Please contact the Child Care Program Office at: Once you receive your Approval Certificate, you may submit the attached application. It may take 30 days or longer for your Approved provider application to be processed by the State of Alaska. No, You must provide care in your own home if you do not meet the criteria above to be an In- Home provider.

2 Thank you for your interest in becoming a provider on our Child Care Assistance Program. In order to receive payment from CITC providers must first become Approved through the State Child Care Program Office, at: 3601 C Street, Ste 140; Anchorage, AK Please contact them directly at: for requirements and application process. Once you have obtained your Approval Certificate you may complete and submit this application to become registered with the CITC Child Care Assistance Program. Providers wanting to be approved for In-Home child care must first submit a State Troopers Background check to our office and receive approval and then complete the attached provider packet. Once you have been approved, you will then need to purchase a State of Alaska Business License (the fee is $50-100). Please be aware that In-Home provider must meet the In-Home Provider Requirements. Please acknowledge being a provider means you are considered an independent contractor (CITC is not your employer) and you are required to report all income to the Internal Revenue Service for tax purposes so please keep copies of your check stubs. At the end of the calendar year, our accounting department will mail a 1099 form to all providers (excluding corporations) earning over $600 per year. Child Care Authorizations and payments will be issued based on how the IRS W-9 Form is completed. Please be aware that we utilize a Debarment Process (see Policy & Procedures) for parents and/or providers who do not follow the Child Care Policies & Procedures. This process will always be used for those parents whom fail to pay their child care debt, also for those whom are found to have committed fraud while on the Child Care Assistance Program. REMINDER: Parents must renew their child care assistance by the end date written on the bottom of the CITC Child Care Authorization. If they have not submitted a Child Care Renewal packet, child care costs incurred after the end date of the last authorization will not be covered by our program. The renewal periods are now dome semi-annually each September and March. We do not send reminders, so it is the parent s responsibility to remember these dates. To receive payment from our program, you must submit a CITC Facility Attendance and Billing Report for each family on your last working day of the month. Due to the increase in clientele, please refrain from calling the Child Care Assistance Program inquiring when your payment will be issued unless it has been over 30 days since your billing was submitted to our office. All checks are processed and mailed within 30 days from the date we receive the billing report if we have all necessary documentation from the parent. Pay stubs or timesheets are required on a monthly basis from the parent before we can process your billing. From the date we receive your billing, the parent has 60 days to submit the required documents or they will be responsible for payment. Directions for completing a Facility Attendance and Billing Report can be found on the back of the form. Billings must be legible and accurate for easy processing. Please note all child care costs not authorized on the Child Care Authorization is the parent s responsibility for payment as well as any portion of the bill that is not paid by CITC

3 REGISTRATION AND RATE SHEET Provider Name Facility Name Mailing Address Physical Address City, State, Zip Code (907) Telephone Number Fax Number Address City, State, Zip Code Tax ID or Social Security Number Check provider type and attach required documents listed: Approved (by the State Child Care Program Office) - Approval Certification, Alaska Business License, Picture ID In-Home (Provides care in the child s home) Background Check, TB clearance, State of AK Business License, Picture ID (additionally, I certify I will have enough children in care to meet Alaska Minimum Wage Law requirements). In Home Provider s Only: Have you ever been under investigation of Office of Children s Services (Formerly Division of Family and Children s Service DFYS) Yes No Please list the days & hours you provide care: Do you charge State Rates? Yes No ~ If No, please complete the chart below: Complete only if your rates are different than the State Rates and/or the age range is different from below for the following categories. Age Range: Infant 0 18 Months Toddler Months Child 37 Months 6 yrs. Full-time Enrollment: $ $ $ $ 5 full-time days a week Part-time Enrollment: $ $ $ $ 5 part-time days a week Full-time Daily Rate: $ $ $ $ 5+ to 10 hours a day Part-time Daily Rate: $ $ $ $ 0-5 hours per day Hourly Rate: $ $ $ $ School Age 7 12 years Do you provide Child Care for children with Special Needs? Yes No Do you charge for holidays and/or closures? (NOTE: CITC does not pay In-Home and Approved Home providers for holiday or other closures). If so, please list: Provider Signature Date

4 PROVIDER RESPONSIBILITIES I have received and agree to comply with the CITC Child Care Policies & Procedures. I understand that as a provider, I function as an independent contractor, so I must comply with all applicable federal, state and local laws and regulations. I agree to provide a current: Approval Certification, Municipal Child Care License, State of Alaska License, or Military License in order to offer child care services. I understand that I will not receive payment for child care services if I do not have the required licenses or approval certification on file with the CITC Child Care Assistance Program. Should my license expire or be revoked I understand that the CITC Child Care Authorization will become null and void. I agree to provide child care services to the parent when they have a valid Child Care Authorization, and I certify that the parent(s) will have open access to the facility whenever their children are in my care. I certify that space is available to meet the parent s work and/or training schedule listed on the Child Care Authorization, and I understand that I must arrange for alternative child care during an unscheduled facility closure. I will submit my billing form within the fiscal year: October 1, 2014 to September 30, 2015 or it will not be eligible for payment. I agree to submit a true and correct Facility Attendance & Billing Report. I understand that all absences must be indicated and that the payment will be calculated on the basis of authorized days of care provided in the Child Care Authorization. I understand that I will not receive payment for child care before the effective date or after the expiration or revocation date. I understand that payment for services provided to the parent(s) outside the days and times written on the Child Care Authorization are the responsibility of the parent(s) and will not be included on the Facility Attendance & Billing Report. I understand that as primary provider, I will be paid for the subsidy amount billed as long as it does not exceed what is authorized on the authorization: the monthly maximum subsidy rate. As secondary provider (authorized only when the primary provider is temporarily unavailable), payment is limited to the amount remaining after deducting the payment to the primary provider from the monthly maximum subsidy rate. I understand that the parent(s) are responsible for paying any balance due. I will charge the CITC parent(s) the same rate that I charge non-subsidized parents for the same service. I also agree not to discriminate against a parent on the basis of race, color, national origin, age, or sex. I agree to submit any rate changes to the parent(s) and to CITC 30-calendar days before the effective date of change. I understand the Child Care Assistance Program has 30 calendar days to process payment for billings that are fully completed (with parents signature). I understand that payment is contingent upon the parent s compliance with program policies. I understand the Child Care Assistance Program will NOT accept any inquiries in regards to payment prior to 30 calendar days. I understand that I may not bill CITC s Child Care Assistance Program and the Municipality of Anchorage Daycare Assistance Program, or other agencies offering child care assistance, for the same children during the same period of time or I will be held responsible for repayment to the CITC Child Care Assistance Program and may be debarred from the program. IMPORTANT: I understand that monthly authorizations revert to attendance when authorized absences are exceeded or if a parent s eligibility for assistance has changed, payment is then based on days of actual attendance. Attendance basis does not allow payment for absences or holidays; it is the responsibility of the parent. Provider Signature Date Printed Name of Facility/Child Care Provider

5 PROGRAM STANDARDS FOR APPROVED AND IN-HOME PROVIDERS ONLY I am 18 years old or older. I agree to never leave the child(ren) unsupervised, or I will arrange care with a qualified substitute provider who meets the mandatory program standards listed here. Smoke alarms & fire extinguishers are in place and in good working order where I provide child care. There are two separate exits in the home where I provide care, one of which may be a window large enough for an adult to exit. I understand as an approved provider I may not provide care for more than 4 unrelated children, 5 total including my own; or as an approved relative provider I may provide care for up to 5 children (includes own children)-no more than two children may be under the age of 30 months in either instance. As an Approved Relative Provider I must be related to all children in care; and the child in care is a grandchild, great grandchild, niece, nephew, great niece, great nephew, or sibling. I understand that I must live in a separate residence from children I provide child care services to. I may not bill child care services for children who reside in my home, even if a Child Care Authorization was issued inadvertently. I will inform the child care staff if I have a relinquished child care license/ approval certificate, been refused a license/ approval certificate, or had a suspended or revoked license/ approval certificate in the past 10 years. I understand I am not eligible for payment from this program, if I ve had my Child Care License / Approval Certificate revoked or am currently or have been previously under investigation from the Office of Children s Services, regardless of whether the investigation is related to activities within the daycare or the provider s own family. I certify that each resident in my facility, including myself, is not prohibited from providing child care as described in the Alaska Regulations. I prohibit any person (including convicted sex offenders or persons convicted of a crime of violence) or animal known to be dangerous to ever be around the child(ren) in my care. All hazards (medicine, poisons, sharp objects, guns, etc.) are not accessible to children where I provide child care. I provide a smoke-free, drug-free, and alcohol-free environment in my child care home including in my vehicle when transporting children. All children in my care have age appropriate immunizations. I have no known infections or communicable diseases that may be a risk to children. I will provide a healthy, safe, and clean environment. The parent has completed an Emergency Child Record for each child, which I keep in my possession for emergency purposes. Medicine will be only given to children with permission from the parent. Physical punishment of children in my care is prohibited. I will allow parent s access to their children in my home at all times. I will allow CITC Child Care staff to conduct unannounced home visits where I provide child care services. I will follow safe practices in transporting children, using seatbelts and safety seats as required. As an approved provider I will maintain a first aid kit and follow the procedures required by the State Child Care Program; I will also obtain Cardiopulmonary Resuscitation (CPR) certification within 6 months of approval. I understand that if I am an In-Home provider, I must have three or more children in my care to meet Alaska State Minimum Wage Law requirements to be eligible for approval as a provider. Please list all persons in your household. If you need more space, please use the back of this form. Name Birth Date Name Birth Date I certify that the items above have been met, and I agree to continue these requirements as long as I provide child care services. If I fail to meet these standards at any time, I will be removed from the CITC Child Care Assistance Program. Provider Signature Date

6 IN-HOME PROVIDER REQUIREMENTS If you choose to provide care within a child s own home there are certain requirements* you must meet before you can receive payment from our program. Please be aware that you may not provide child care services and receive payment from our program until you have been authorized and receive a Child Care Authorization. If you are caring for a child without authorization, the parent is responsible for paying you. You must first acquire an Interested Person s Report for us to review and authorize you to become a provider. After we have approved you, you may then fill out our application and submit the required documents listed below: Picture ID (Driver s license or State ID) TB Clearance State of Alaska Business License or a copy of the receipt and license application We require the above listed items before a Child Care Authorization will be issued authorizing you to provide child care services. The Child Care Authorization explains how much we pay with the effective start and end dates. As an authorized In-Home provider there are some things to keep in mind while you are on our program. Most importantly, federal law requires that In-Home providers earn enough wages to meet Alaska State Minimum Wage Law requirements and be able to pass a background check. In some cases, providers may not be able to meet these criteria and families will have to select a provider who is approved to receive payment from the Child Care Assistance Program to receive child care assistance. Additionally, the child care staff will be conducting unannounced home visits several times throughout the year. This means we will be visiting the home in which you provide child care services without notifying you or the parent. If we find conditions are not safe or unhealthy for the child(ren) or any suspicious behavior you and/or the parent may be terminated from our program. For instance, if we attempt to visit the home and are frequently unsuccessful, that would be a cause for concern. Please be aware you are not able to provide child care for other children whom do not live in the home. If you stop providing child care services in the home we have listed on file, please notify us immediately so we do not attempt to conduct a home visit. *In order to qualify as a child care provider you must not have committed any of the following prohibited offenses: 7 AAC (1) within the previous 10 years, charged with, convicted of, found not guilty by reason of insanity for, or adjudicated as a delinquent for, a misdemeanor crime of assault, reckless endangerment, misconduct involving a controlled substance, or perjury, as defined in AS 11 or the laws or another jurisdiction; OR 7 AAC (2) at any time charged with, convicted of, found not guilty by reason of insanity for, or adjudicated as a delinquent under, the following statutes or similar provisions of another jurisdiction: (i) an offense against the family and vulnerable adults under AS 11.51; (ii) perjury under AS ; (iii) a serious offense as defined in AS ; (iv) an offense under AS (c). A serious offense includes a felony offense, a crime involving domestic violence, sexual assault in the first fourth degree, sexual abuse of a minor in the first fourth degree, incest, unlawful exploitation of a minor, indecent exposure in the first or second degree, contributing to the delinquency or a minor, unlawful marrying, endangering the welfare of a vulnerable adult in the first or second degree, disorderly conduct (specifically and only AS (a)(7) the offender intentionally exposes the offender s buttock or anus to another with reckless disregard for the offensive or insulting effect the act may have on that person ), distribution of child pornography, prostitution, promoting prostitution in the first third degree, former AS , or assault to commit rape under former AS ; or former AS , , , or (crimes against morality and decency), if committed before January 1, Revised 8/12

7 EMERGENCY CHILD RECORD For Approved Home and In-Home Providers (For Use By The Child Care Provider Please have the parent complete and keep for your records) Full Name of Child(ren): Birthdate(s): Mother: Home Address: Business Address: How to Reach Parent(s) or Legal Guardian(s) Father: Home Address: Business Address: Home Phone ( ) Business Phone ( ) Home Phone ( ) Business Phone ( ) Names, addresses, and telephone numbers of person(s) who can assume responsibility for my child, if I cannot be reached during an emergency: Persons authorized to take my child(ren) from care: Physician Information Hospital Information Name: Name: Address: Address: Telephone: ( ) Telephone: ( ) Known allergies, including drugs: Consent for Emergency Medical Care I authorize to give permission for appropriate medical or hospital personnel Name of Provider to provide emergency medical or surgical care for in the event that I Name of Child(ren) cannot be contacted immediately. It is understood that a conscientious effort will be made to locate me or my child s other parent or legal guardian before any action will be taken. I understand my obligation to keep my Provider informed of my whereabouts, and I will assume the cost of necessary medical or surgical care. Parent/Guardian Signature Date Witness Signature Date Expiration Date

8 Participant Code of Conduct Purpose To protect rights and safety of CITC participants and staff; and to ensure quality service is provided to meet CITC s mission statement: To work in partnership with our People to develop opportunities that fulfill our endless potential. Policy CITC/ETSD is open to people of all ages and backgrounds. Participants are encouraged to use the resources available within our department. In order to receive quality services, the following actions or behaviors are not allowed within the Employment and Training Department: 1. Failing to comply with a staff member s request to stop an inappropriate behavior, this code of conduct or any other company policy; including, but not limited to: Yelling and using abusive, offensive language or gestures. Physically or verbally disciplining a child in manner that may cause injury to him/her or disrupts other participants. Leaving young children unsupervised or ignoring their disruptive behaviors. 2. Any act that constitutes a criminal offense under federal, state, or local law; including, but not limited to: Intoxication or under the influence of non-prescribed drugs. Bringing guns, knives or other items designed or intended to injure or harm people. Disorderly conduct, including, but not limited to: fighting; engaging in violent or seriously disruptive behavior, threatening or intimidating staff or any other customer. Damaging or destroying CITC property through careless or willful acts. Enforcement These rules will be enforced in a fair and reasonable manner. ETSD staff and security personnel will intervene to stop prohibited activities and behaviors. Failure to comply with the Employment and Training Department s established policies may result in the interruption of services as described below: 1. If on the premises and displaying disruptive behavior, the following will occur: You will be asked to be quiet and/or take a minute to calm down; if this does not occur, it will result in you being asked to leave the premises. 3 incidents will result in having to be escorted to and from appointments by building security. 2. If on the telephone, the following will occur: You will be asked to take a minute to lower your voice and calm down. If the above request fails, the phone call will be terminated and you may call back when you are able to speak in a calm and respectful manner. 3. Continuous disrespect of staff will result in a meeting called to address your behavior to include you, your CITC staff contact and their supervisor(s). 4. Illegal Activity: Law enforcement will be contacted if any participant engages in what is believed to be unlawful or dangerous behavior. Participant Signature Date Staff Signature Date

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