Child Care Provider Guide

Size: px
Start display at page:

Download "Child Care Provider Guide"

Transcription

1 DEPARTMENT OF HUMAN SERVICES: children, adults and families division Child Care Provider Guide DHS Child Care Program Independent. Healthy. Safe.

2 Frequently used phone numbers: Name and Address Local Phone Number Toll-free Number Direct Pay Unit (DPU) PO Box Salem, OR (Salem) Automated information system to check on payments Background Check Unit (BCU) PO Box Salem, OR Child Care Division (CCD) PO Box Salem, OR (Salem) (Salem) (Salem) Oregon Center for Career Development Portland State University Oregon Registry PO Box 751 Portland, OR (Portland) Ext for Spanish Child Care Resource and Referral Network Child Care Resource and Referral US Department of Agriculture Sponsors (USDA Food Program) AFSCME Council 75 Local Tandem Ave NE Salem, OR SEIU Local Commercial St. SE Salem, OR (Salem) See pages for Directory See page 70 for Directory (Salem) The Oregon Department of Human Services (DHS) will not discriminate against anyone. This means DHS will help all who qualify. DHS will not deny help to anyone based on age, race, color, national origin, gender, sexual orientation, religion, political beliefs or disability. You can file a complaint if you think DHS singled you out because of any of these things.

3 Table of contents General information...1 Why should you read this booklet?... 1 How does the DHS Child Care Program work?... 1 DHS and the IRS... 2 Unions... 2 Registering with the Child Care Division... 3 Who will DHS pay?... 4 What can DHS tell you about families?... 4 What you should ask parents... 5 What providers and parents must do... 5 Sample Child Care Provider Letter (DHS 7494E)... 7 How to become a listed provider for the DHS Child Care Program...9 What does it mean to be listed?...9 How do I get listed?...9 What are the provider requirements?...10 Help with basic health and safety standards...11 Provider training...12 How to fill out the Child Care Provider Listing form (DHS 7494)...13 Sample Child Care Provider Listing form (DHS 7494)...16 Background checks...18 Who must be on the listing form to get a background check?...18 What happens when the background check is completed?...19 If I am denied, how do I request a hearing?...20 The billing process: how to bill for care...21 About the billing forms...21 Reading the child care billing form...22 More on definitions of provider type...22 More on child age categories...23 How do I report hours of care on the billing form?...24 Missing, lost or destroyed billing forms...25 Billing for absent days...26 Sample DHS Child Care Billing form...27 Copays...28 What is a copay?...28 What happens if the family does not pay the copay?...29 Continued on next page

4 Table of contents continued DHS payments...31 When will I get my payment?...31 Checking on your payment...31 How much will DHS pay?...32 How is the payment calculated?...33 About enhanced rates...35 How do I get a higher rate for children with special needs?...36 If a family needs extra hours of care...36 DHS child care maximum rates...39 Child age categories...39 Provider type definitions...39 DHS Child care maximum rates (effective 10/1/2007) Troubleshooting, overpayments and reporting changes...45 Troubleshooting What do I do when things go wrong?...45 Provider payment reviews and overpayments...45 Intentional Program Violations (IPVs)...46 What if I disagree with a DHS decision? (Hearing rights)...47 Reporting changes...48 Filling out the Provider Report form (DHS 7496)...48 Sample Provider Report form...50 Preventing Child Abuse: the provider s role...51 Providers are mandatory reporters...51 Importance of reporting abuse...51 Recognizing child abuse...52 How do I make a report?...55 Department of Human Services offices for child abuse reporting Preventing disease: the provider s role...61 Preventing the spread of infectious disease...61 Required immunizations for children in care...63 Recommended Childhood Immunization Schedule for Resources and other information...65 Child Care Resource and Referral offices Nutrition education and meal reimbursements U.S. Department of Agriculture (USDA) Sponsor List...70 Child care payment worksheet Sample Oregon Department of Revenue brochure ( ) Sample Attendance sheet...74 Web sites...75

5 General information General information What is the Department of Human Services (DHS) Child Care Program? The DHS Child Care Program helps parents or caretakers pay for child care so they can work, or so they can prepare for employment. Why should you read this booklet? If you provide care for families who get child care benefits from DHS, this booklet is for you. It explains what you need to know to become a listed provider and get payment from the DHS Child Care Assistance Program. We want to make these programs work for you and the families we serve. If this booklet does not answer your questions, look on page 45 (Troubleshooting What do I do when things go wrong?) to find where to call for help. You may also visit our Web site at: How does the DHS Child Care Program work? The parent applies for child care assistance, or subsidy, at a local DHS office in their area. DHS determines if they qualify, the number of hours of childcare needed, and the portion the family is expected to pay (the copay). The amount of the subsidy is based on the family s income, family size, the type of child care they receive, and how many hours of care they need. If the parent qualifies, they select a child care provider. Providers must be listed with the Direct Pay Unit (DPU) before a payment can be issued. (See What does it mean to be listed? on page 9.) Once the provider is approved, DHS pays them a portion of the cost of care, through the DPU in Salem. This amount is called the subsidy. Most parents are also required to pay a portion of the cost, called the copay, directly to the provider. 1

6 General information continued DHS and the IRS Child care providers are self-employed. Most child care providers are self-employed. That means you are responsible for the children in your care, keeping records, and paying taxes on your income. You must keep records of the children s attendance and all payments received from the family and from DHS. For your convenience, a tear-out sample attendance log is available on page 73. DHS makes child care subsidy payments on behalf of the family DHS is not your employer. What DHS tells the Internal Revenue Service (IRS) DHS keeps track of all payments made to child care providers. We report what we pay you to the IRS. We will send you a statement (IRS 1099-Misc) in January, showing how much we paid you during the previous year. You must report this income for tax purposes. Consult a tax advisor if you need information about how to include this income on your tax forms. Why DHS needs your Social Security number or Federal Tax ID number The Internal Revenue Service (IRS) requires DHS to obtain your Social Security Number (SSN) or Federal Tax ID Number to report what we pay you. The name you give DHS must match your name with the IRS. We check your name and number with the IRS. If your name and number are not valid, you may be subject to an IRS fine and you will not get checks from DHS. You may also have to pay back any money received from DHS. Unions There are two unions that represent child care providers: AFSCME Council 75, Child Care Providers Together represents family providers who are registered and certified with the Child Care Division (CCD) of the Oregon Department of Employment. SEIU Local 503 OPEU represents family providers who receive a DHS subsidy who are exempt (not CCD registered or certified). 2

7 For more information, you may contact the unions by telephone or visit their Web sites at: AFSCME Council SEIU Local x454 Registering with the Child Care Division Should I be registered? Many family child care providers are required by law to register with the Child Care Division (CCD) of the Oregon Employment Department. You may be required to register even if you don t provide child care for a DHS family. If you provide child care in your home, you are required by law to register with CCD, unless you: Provide care in the child s home; Are related to the children in care by blood, marriage or adoption; Care for children from only one family at a time; Care for three children or fewer; Care for children fewer than 70 days per year; Are younger than age 18. To register, providers must meet certain requirements and maintain minimum health and safety standards set by CCD. There is an application processing fee, but the fee may be reduced if the provider s income is below the federal poverty level. While many of the registration requirements are similar to DHS listing requirements (see page 10), registration is separate from listing and is not carried out by DHS. It is the provider s responsibility to comply with the law. If you have questions about CCD registration or need an application, you may contact your local Child Care Resource and Referral office (see local listings on pages 66-68), or call the Child Care Division at (Salem) or (outside of Salem). You may also access their Web site at: 3

8 General information continued Who will DHS pay? Families may use any child care provider they choose. However, DHS can only pay providers who meet the listing and provider requirements on pages Also, the provider cannot be: A parent or stepparent of the child being cared for; A parent of the child s brother or sister, if all are living in the same household; On the same Temporary Assistance for Needy Families (TANF) grant as the child; In the same DHS filing group as the child; Younger than age 18. Additionally, child care providers who have been previously denied by DHS and are now in approved status are not eligible to be paid for child care provided while they were in denied status. What can DHS tell you about families? The law allows DHS to give limited information about families we serve once we have verified with the parent or through the listing process that you are the provider for that family. We can tell you: Which program the family is on; The family s case number; The number of authorized hours for child care; The amount DHS will pay you; The amount the family must pay you; The reason for any delay in paying DHS share of a bill. If DHS can t verify that you are the provider, have the family call their caseworker. 4

9 What you should ask parents Before you provide care, you should have: A Child Care Provider Listing form (DHS sample on page 16); or A Child Care Provider Letter (DHS 7494E - sample on page 7); or A billing form (sample on page 27); or Direct approval from a DHS caseworker to be sure the family is eligible for help with their child care payment. If DHS does not give you one of the above, the family could be responsible to pay for the child care provided. You should also ask families for other information you need to know, such as: What days and hours will the children be in care? What is the family s address and telephone number? What is the work telephone number for reaching a family member? Who else can you call in an emergency? What is their phone number? Who is allowed to pick up the children? When will the family pay their share of the bill? What is the family s case number? What providers and parents must do Providers must: Fill out DHS forms completely and accurately and return them promptly; Meet the provider and listing requirements (see pages 9-11); Treat DHS families the same as other families for whom they provide care. (This means providing the same services, not charging higher rates for DHS families than other families, etc.); Provide healthy, safe and dependable child care; Register with the Child Care Division, if required to do so by law. 5

10 General information continued Parents must: Give providers any provider forms they receive from their worker; Send their income information to DHS on time; Pay their share of the child care bill; Give adequate notice before changing providers; Inform their provider when their eligibility for assistance changes. To learn more about the DHS Child Care Program, visit our Web site at: 6

11 Date: Family s Name: Case Number: Estimated Copay: Estimated Hours of Care: Provider s Name: Dear Child Care Provider: This letter verifies that the Department of Human Services (DHS) will help pay child care for the family named above, beginning X-X-XX. This replaces the Child Care Provider Listing form for providers already approved by DHS. You should receive a child care billing form within one week. If you don t, please call the Direct Pay Unit (DPU) at ( in Salem). DHS does not usually pay the total child care expense. Most families are required to pay a portion of the bill, known as the copay. The amount of the copay will be shown on the billing form. In addition, the family is responsible for any difference between the rate you charge and the maximum rate DHS will pay. To find out what the maximum rate is for your area, or to answer other questions you may have about DHS child care programs, please refer to the Child Care Provider Guide. If you don t have the Provider Guide, you can request one by calling DPU at the number given above. The Provider Guide and rate information is also available on-line at Thank you for providing this very important service. Sincerely, SAMPLE DHS 7494E 7

12 8

13 How to become a listed provider for the DHS Child Care Program What does it mean to be listed? To be eligible for payment from DHS, the provider must be listed. To be listed with DHS, providers need to fill out a separate application, called a Child Care Provider Listing form (DHS 7494). DHS listing is separate from the process of becoming registered or certified with the Child Care Division (CCD). The listing form asks for information about you. It also contains an agreement you must sign to be eligible for payment. It includes a list that describes minimum standards for a safe facility. By signing this form, you agree to meet all the program requirements. You also authorize background checks for you and everyone who will have access to the children in care (see page 18). The background checks include both criminal and Child Protective Services records. How do I get listed? To be listed, the provider fills out a Child Care Provider Listing form (DHS 7494: see sample on page 16). You get this form from the family. The family gets this form from their DHS worker when they are eligible for child care assistance. This form tells you the family is eligible for help for the first month. It is important that you complete this form and send it in to the DHS Direct Pay Unit (DPU) within 10 days. DPU s address is on the form. The listing form must be received and processed before a billing form can be sent to you. You will need to receive a billing form so you can be paid. To make sure you meet the requirements, carefully read What are the provider requirements? on pages Also read the section on Background checks beginning on page 18 of this guide. We must have information about all persons subject to the records check and their signatures. If the listing form is not complete, it may be returned to you, and processing will be delayed. You may contact the Direct Pay Unit at if you have questions about completing the form. 9

14 How to become a listed provider for the DHS Child Care Program continued What are the provider requirements? A family chooses the provider they wish to care for their children. DHS pays the provider on behalf of the family. In order for DHS to make the payment directly to the provider, the provider agrees to meet certain requirements. This includes passing criminal history and Child Protective Service record checks. The provider also agrees to meet basic health and safety standards. The provider s signature on the Child Care Provider Listing form affirms that they agree to meet the requirements listed below. In the area of basic requirements the provider must: Be age 18 or older. Be in such physical and mental health as will not adversely affect a child in care. Be the person who provides the care. Notify DHS (and CCD if you are a licensed provider) before using a substitute caregiver. (Substitute caregivers must be listed on a Child Care Provider Listing form.) Not be the parent or stepparent of the child, or of the child s sibling (if all live in the same household), or on the same TANF grant as the child. Be registered or certified with CCD, if required by law. Pass a background check. (This includes the provider and all other persons required to be on the listing form.) Cooperate with any investigation and allow DHS to inspect the site of care during the hours child care is provided. In the area of health and safety the provider must: Meet the DHS health and safety minimum standards on the listing form and agree to continue to meet those standards. Supervise children in care at all times. Review immunization schedule with parents and keep immunization records up-to-date. Take steps to prevent the spread of infectious diseases. Report suspected child abuse to a DHS Child Protective Services office (Child Welfare) or a law enforcement agency. 10

15 Report to DPU within 10 days any arrests, convictions or involvement with Child Protective Services (Child Welfare) of themselves or people living with them. Prevent people who may harm children from gaining access to children in care. Allow custodial parents to have immediate access at all times to their children who are in care. In the area of billing and record keeping, the provider must: Give DHS their correct, valid SSN or IRS identification number. Charge the family the same rate (or less than) they normally charge other families. Bill for the amount of care they actually provided. Keep billing records and daily attendance records that show the in and out times each day for each child in care. The records must be kept for at least one year. Allow DHS to review attendance records upon request. A sample attendance log is provided on page 73. Report to DPU within 10 days any changes in the provider s names, phone number or address, or any changes in who is working in the facility or moving in or out of the home. Not bill a DHS family for the provider s obligations. For example, providers must not bill a DHS family for any amount DHS collects from the provider to recover an overpayment, or for any amount paid by DHS to a creditor of the provider due to a lien, garnishment or other legal process. Help with basic health and safety standards Limited assistance is available for meeting the basic health and safety standards for providers who care for DHS client families. For example, DHS can provide help with barriers for protecting children from wood stoves or electrical outlets. If you do not meet the standards, mark the appropriate box on the Child Care Provider Listing form (DHS 7494). You will receive information about who to contact for help. You can still qualify to provide care while you are working with us to meet the standards. 11

16 How to become a listed provider for the DHS Child Care Program continued Provider training Orientation training is encouraged for all providers. Beginning July 1, 2010, orientations will be mandatory for all license-exempt providers in order to receive payment from DHS. Orientation contains important information on: The payment process; Program rules; Child care provider rights and responsibilities; Enhanced rate training options; Food program resources through the U.S. Department of Agriculture; and other resources and reimbursements available through public and private sources. If you would like more information on this and other child care provider training opportunities, contact the Child Care Resource and Referral Network. To find the agency nearest you, see the directory of local agencies on page You may also contact the Resource and Referral Network office in Salem at You can get help to meet the basic health and safety standards to provide child care. 12

17 How to fill out the Child Care Provider Listing form (DHS 7494) Please also read Instructions to Provider on the first page of the Child Care Provider Listing form (sample on page 16). Pages Write your name or the name of your business as it appears on Internal Revenue Service (IRS) records. If the name does not match IRS records, you could receive a fine from the IRS and stop getting payments from DHS Write your Social Security number, or your IRS identification number, if you have one. (The IRS identification number can be a personal tax ID number or employer ID number.) You must give your correct, valid Social Security number or IRS identification number to receive payment. Write your name (or the name of your facility if it is a center or certified family home). This is what will be printed on the check. Write the address where child care is provided. This may be different from your mailing address or the address where you live. We need the address where care is provided to determine your DHS rate area. Write in your telephone number. Write the address where you actually live. Do not leave this area blank unless you are registered or certified by the Child Care Division (CCD). Write the name of your first language (for example, English, Spanish, etc.) Write your mailing address. We will send your checks and letters to this address. Note: You must be registered with the post office to receive mail at that address. The post office will not deliver checks in your name if your name is not registered with them at that address Write the name and birth date (if known) of each child you are caring for from this family. Mark yes or no to show if you are related to any of the children. If related, indicate how. For example, grandmother, uncle, etc. 13

18 How to become a listed provider for the DHS Child Care Program continued You are not eligible for payment from DHS if you are: The child s parent or stepparent; Younger than age 18; Not related to the child, but you live with the child s parent and have a child together, or you are expecting a child, with that parent. 10. Check this box if you provide care for the child in the child s own home. 11. Check this box if you are currently certified to provide foster care. If so, you must also attach a letter from your certifier approving you to do child care in addition to foster care or you will not be approved to provide child care. 12. If you are registered or certified by the Child Care Division, write your CCD provider number, and skip to number 15, the Provider Agreement. Otherwise, continue with number 13 through Review the health and safety standards information sheet. Check yes if you meet all the health and safety standards listed on that sheet. Check no if you do not meet all those standards yet, and we will contact you on how to get help meeting the standards. You must meet the standards within 30 days or your listing will not be approved. 14. You must provide information on all people who are required to have background checks, unless your facility has been registered or certified by the Child Care Division. You must answer all of the questions asked, for the provider and all people you list. One of the questions asks if the person has any criminal arrests, convictions or Child Protective Services involvement. If you or any of the people you listed on the form marked yes to that question, you will need to attach a separate sheet of letter-size paper explaining the history, including each incident, date and location. If you do not list everyone who is required, that will make you not eligible for payment, and you may have to repay payments you have already received. Each person listed must sign to authorize background records checks or the form will be returned. 14

19 Background checks are required for all of the following who are 16 years old or older: You, the provider; Employees or staff who work in the child care facility (in facilities with more than one caregiver); Substitute caregivers who will provide care when the primary caregivers are unavailable; All members of the household where the care is being provided (including the parent, if the parent and provider live together); All frequent visitors, or people who may have unsupervised access to the child in care, in the place in which care is provided. 15. Read the provider requirements carefully on pages of this guide. DHS will not pay providers who do not agree to meet them. Sign your name, date the form and print your name where indicated. Your signature on the listing form means that you agree to meet all of the requirements and the information given is true and complete. After you sign and date the form, send it to the DHS Direct Pay Unit (DPU) as soon as possible at the address on the form. All providers paid by DHS must meet the provider requirements. This includes criminal history and Child Protective Service records checks. 15

20 How to become a listed provider for the DHS Child Care Program continued DHS SAMPLE DHS

21 SAMPLE DHS

22 Background checks To be eligible for payment from DHS, providers and other people in the house or facility who will have access to the children in care must pass a background check. This check is conducted by the DHS Background Check Unit and includes a criminal history check and a Child Protective Services (CPS) history check. If DHS finds the provider or other person on the listing form do not meet the requirements, the provider is not eligible for payment. Providers must give complete information for all persons subject to a background check. Each of these individuals must sign the form to authorize their background check. A provider who gives misleading, false or incomplete information can be denied eligibility for payment by DHS and may have to repay any payments they received from DHS. They may also be subject to legal action. A provider with a current registration or certification by the Child Care Division (CCD) who has already passed a background check may be required to have another background check by DHS. Who must be on the listing form to get a background check? For license-exempt child care facilities, providers must provide on the Child Care Provider Listing form (DHS 7494) the names of the site director, and everyone who works in the facility who will have access to the children in care. This includes substitute caregivers. For child care homes, providers must provide on the Child Care Provider Listing form (DHS 7494) the names of everyone age 16 and older who lives in the house, is a substitute caregiver, or is a frequent visitor to the house during the hours care is provided, and who may have unsupervised access to the children in care. Note: The parents of the children in care must also be included on the listing form, if they live with the provider. The Department may find a child care provider ineligible for payment based upon the Child Protective Service (CPS) or criminal history of any of the people subject to a background check. This decision is based on prior conduct that indicates that one of those individuals is likely to engage in 18

23 conduct that may jeopardize the safety of, or have a detrimental effect on, a child in the care of the provider. To make its determination, the Department may use any available information including the CPS records of the Department, an investigation of a complaint, or information provided by another agency. A single incident may be sufficient history for denial of eligibility. This disqualification is determined by weighing the content and source of the reports, the time elapsed since the reports, the number of reports and referrals, the person s participation in rehabilitation, training or counseling, and the likelihood of the person s abuse of drugs or alcohol. After reviewing the circumstances, DHS may also determine the provider is still eligible for payment even though there is a founded or valid report. That decision would be based on a fitness determination that repeated behavior is unlikely and that the presence of the individual likely would not jeopardize the safety of a child in the provider s care. A copy of the rules containing the list of crimes and potential disqualification periods can be found on the Criminal History Check rules Web site at: Persons who have lived outside of Oregon in the last 18 months for 60 consecutive days or more, or who have convictions or arrests for crimes in other states, will be required to submit fingerprint cards for a national check in order to complete the background check process. What happens when the background check is completed? Once the background check is complete the provider will receive a Notice of Fitness Determination. The notice will indicate one of the following: Approved Based on the background check, you have been approved to receive payment to provide care to DHS clients. Once approved, any changes in your status must be reported to DPU, including changes to your name, address, people who must be included on your listing form, or if you or people on your listing form become subject of criminal charges, or an investigation of abuse or neglect. Failed Based on the information you provided, it is not possible to complete your background check at this time, due to missing or inaccurate 19

24 information about you or someone on your listing form. For example, you could be failed for not providing a Social Security Number, or not disclosing or providing explanation for an arrest or involvement with an abuse or neglect investigation. If you receive a notice you have failed, you will need to reapply, being very careful to provide all required information. Denied Based on the background check, you have been denied to receive payment for providing care for DHS clients, due to the nature of the criminal history or history of abuse and neglect of one or more of the individuals on the listing form. You may request a hearing if you disagree with this decision. If the problem is the history of someone in the household where care is provided, other than the provider, the denied provider can reapply only if they have changed the location where care is provided, or if the individual whose background check resulted in a denial is no longer living in or visiting that location. If the listing was denied, DHS will also send a notice to the family to let them know the listing was denied, and that they must find another provider if they want to continue to receive child care help through DHS. If I am denied, how do I request a hearing? To request a hearing, providers may submit a written request to: DHS Background Check Unit (BCU), PO Box 14870, Salem, OR You can get a hearing request form from your nearest DHS office, or on the Child Care Program Web site at For more information on hearing rights, see What if I disagree with a DHS decision?, on page

25 The billing process: how to bill for care About the billing forms Once you are a listed provider, your billing forms should arrive by mail around the beginning of each month. Each child care billing form has its own voucher number and can be used only once for the time period stated on the form. DHS will make only one payment per billing form. The form cannot be changed to bill for a different time period. A sample billing form is on page 27. Instructions for filling out the Child Care Billing form follows this section. The billing form tells you: The time period covered by the billing form; The copay amount (if any) that will be deducted; The names of the eligible children in the family and their age categories; The maximum authorized child care hours. At the end of the period authorized on the billing form, fill out the billing form and send it to the Direct Pay Unit (DPU) for processing and payment. Do not bill for future days you expect to provide care; only for care that has already been provided. Be sure to send the billing form in promptly each month. Billing forms expire 90 days after they are issued 21

26 The billing process: how to bill for care continued Reading the child care billing form See the sample billing form on page Section one of the child care billing form tells you: The voucher number and the date it was issued; The program the family is on, the local DHS branch number, the family s case number and the worker s identification; The family s case name; The provider s DHS provider number and the provider type (see definitions below). Program Branch Date issued VOUCHER # /01/2006 M AC SC Worker ID JONES, JOHN Q Case number ABCZ FAM Provider type Provider # More on definitions of provider type On your Child Care Billing form, your provider type tells you if you are coded to receive the standard, enhanced or licensed rate. The definitions below explain which rate you will receive for that billing based on your provider type: Provider type: You will receive: FAM...Standard Family Rate NQC...Standard Center Rate QFM...Enhanced Family Rate QEC...Enhanced Center Rate RFM...Licensed Registered Family Rate CFM...Licensed Certified Family Rate CNT...Licensed Certified Center Rate 2. If you have a new address or phone number, do not write it on the form. Please call DPU at (or in Salem) or send in the Provider Report (DHS 7496). A tear-out Provider Report form is on page

27 3. This is the time period the billing form covers. Do not change the dates. It will make your billing form invalid. If you need a billing form for a different time period, contact DPU at (or in Salem) to find out what to do. 4. This paragraph tells you what the family s copay is. You should collect this amount from the family. Check the box if you wish to report that the family has not yet paid their copay to you. This only applies to the copay amount. (See What happens if the family does not pay the copay? on page 29.) Do not check the box unless you want to report the copay has not been met. Do not check the box if the family has paid the copay, even if they still owe you for other charges, such as amounts over the DHS rate. 5. If any important information about your Child Care Billing needs to be added, it will be added here (for example, identifying that it is a re-issued billing rather than the original). 6. This section shows the eligible child s name, the age category of the child and the maximum authorized hours for each child. This is also where you bill for the child care you provided. (See How do I report hours of care on the Child Care Billing form? on page 24.) More on child age categories On your Child Care Billing form, the age category of each child tells you the age rate DHS will pay you. The definitions below explain the DHS age categories: Infant...Newborn to 1 year Toddler...1 year (12 months) to 3 years Preschool...3 years to 6 years School...6 years or older (Unless the child has a special circumstance, Employment Related Day Care (ERDC) pays child care for children through age 11. Temporary Assistance for Needy Families (TANF) pays child care through age 12.) Special needs...a child from newborn to 18 years old who needs more costly care due to a physical, behavioral or mental disability. 7. You should not send in your billing form before the end of the month, unless you no longer provide care for the family. Please mark the appropriate box and write in the last date you provided care. 23

28 The billing process: how to bill for care continued 8. This is where you, the child care provider, will sign. 9. This is where the family signs. You must have the signature of one of the parents on the case, unless you no longer provide care for that family. How do I report hours of care on the Child Care Billing form? Send in the billing form for payment at the end of the authorized period, after you have provided all of the care for the month. Even if you did not provide care for the month, you should still send in the billing form. Write zero (0) for the hours of care, and for the total charge. Mark the appropriate box on the billing form (section 7 of the sample billing form on page 27.) Check either hourly or monthly to show whether you are charging by the hour or by the month. (Select only one.) Fill in the number of hours of care you provided that you are billing for, rounding up to the nearest whole hour. (For example: 136½ hours = 137.) Fill in your total charge in dollars and cents. (For example: $400.00). Bill DHS at your normal rates, for the total actual amount of care you provided. (Note: This may not be the same as the authorized maximum for the child.) Example 1: The child is authorized for up to 140 hours a month, but you only provided care for 105 hours. Do not write 140: write 105. If the child receives less than the maximum authorized amount of care, DHS will pay only for the actual hours provided. Example 2: Perhaps the child is authorized for 120 hours of care, but you provided 150 hours. Write in 150 hours. DHS will not pay for more than the maximum hours authorized, but you should still record it. The family would then be responsible for the amount over the maximum hours authorized. Charge only for care that was provided. Do not bill for hours a child was in school. You may bill for up to five absent days per month under certain circumstances. (See What if the child is absent for the entire month? on page 26.) Do not deduct the family s copay amount from the amount you are billing. It will be deducted from your payment automatically. 24

29 Mark any of the appropriate boxes that apply to you. This includes reporting a copay not met. (See What happens if the family does not pay the copay? on page 29.) Have the parent sign and date the form. (If you no longer provide care for this family and are unable to contact them for a signature, check the box that says you do not provide child care for this family any more and write in the last day of care you provided. The family s signature will not be required.) You, the provider, must sign and date the form. Complete the billing form prior to having the family sign it. This allows the parent to understand what is being billed. Neither the parent nor the provider should sign a blank billing form. Be sure to keep a copy of your completed billing form for your records. Send the original to the Direct Pay Unit (DPU) for processing. Mail the billing form to DPU for processing and payment to the address at the top of the form. Notify DPU when you stop providing care for a family or you change your address or phone number. Missing, lost or destroyed billing forms What if I don t get a billing form? If you don t get a billing form, you can ask the family about it, call the Direct Pay Unit, or talk to the family s DHS worker to find out why. (See What can DHS tell you about families? on page 4.) If DHS does not send you a billing form or tell you that the child care will be paid by DHS, the family is responsible to pay for the cost of care provided. How do I replace a lost or destroyed billing form? A lost or destroyed billing form can be replaced by calling DPU at (or in Salem). 25

30 The billing process: how to bill for care continued Billing for absent days Providers who meet the following criteria may bill DHS for up to five absent days per month when: The care was authorized by DHS and scheduled by the parent, but the child was absent and the provider could not fill the time slot with another child; and It is the provider s policy to bill all of their families for absent days; and The scheduled hours are logged on the provider s attendance log as an absent day. DHS will not pay for more than five consecutive absent days of scheduled care even if it extends from one month to the next. What if the child is absent for the entire month? If you did not provide any care for the month, and you are not billing for absent days (see above), mark a zero (0) in the Total Charge box, mark the box that explains why you are sending in the billing form, sign the form and send it to DPU. As a provider, you must keep attendance records of the hours and days you care for children for at least one year. 26

31 SAMPLE

32 Copays What is a copay? Most working families receiving child care help from DHS must pay part of the cost of their child care each month. The family s required share of the cost is called their copay. The family s copay amount is based on their income and size of their family. The family pays their copay amount directly to their primary provider, plus any amount the provider charges above the DHS payment limits. The billing form shows the copay amount the family is responsible for paying, which will be deducted from the DHS allowed rate. DHS pays the provider the difference the allowed rate minus the family s copay amount. There is a Child Care Payment Worksheet (DHS 7492W) for your use on page 71. You can use this worksheet to determine how much the parent will need to pay you after DHS pays their portion of the child care. Both you and the family will know the copay amount in advance. If a family has more than one provider, usually only one will collect the copay from the family. The family pays the copay to the primary provider. This is usually the provider who does most of the child care. The family tells their worker who their primary provider is. It is the provider s responsibility to collect the copay or make other arrangements with the parent. If you are the primary provider, it is very important that you and the parent talk about their copay. It is up to you and the parent to decide how and when to collect the copay and other amounts DHS does not pay. In working out the family s payment schedule, it may help to find out when the family gets paid. Some providers and parents agree to barter instead of paying the copay. For example, the parent might provide care for the provider s children. If you decide to do this, make sure your agreement is in writing. Give the parent a receipt, whether you re paid in cash or in some other way. The parent may need the receipts if they apply for the Oregon Working Family Child Care Credit. Please see page for information from the Oregon Department of Revenue. 28

33 What happens if the family does not pay the copay? To stay eligible for child care benefits in the Employment Related Day Care (ERDC) program, the family must pay their copay to the provider, by the end of each month or make other arrangements with the provider. If they don t, you can check the box on the Child Care Billing form that says, Check here ( ) if the parent did not pay this amount or arrange with you to pay it. This reports to DPU that the copay has not been met. You may also write a letter or call DPU to report the copay hasn t been met. You must notify DPU within 60 days from the date we paid you to report a copay that has not been met. Otherwise, the copay will be considered met. If you notify DPU that the copay has not been met, DPU will send a notice to the family that their ERDC program benefits will end. Once the benefits end, DPU cannot continue the family s benefits until they are notified by you in writing or have other proof that the family has paid or made arrangements to pay you their copay. Any billing forms already sent to you will still be processed. (The parent may be eligible for child care benefits from other programs that do not have a copay.) DHS can end the family s benefit for not paying the copay amount stated on the Child Care Billing form. We can t end the family s benefit for failure to pay other costs the parent owes to the provider (for example, the amount the provider charges over the DHS payment limit). Any payments made to the provider by the family are applied to the copay first. If the provider notifies DPU that the family made satisfactory arrangements for the copay, it is up to the provider to collect it. We cannot close the family s benefit again for not honoring the arrangement between the provider and the family. 29

34 30

35 DHS payments When will I get my payment? After you have mailed in your billing form to DPU at the end of the authorized period, your billing form will be processed and entered into the computer within four working days. Your billing form may be sent back to you unprocessed if it is: Incomplete or incorrect; Sent in before the end of the authorized period; Sent in before the care billed has actually been provided. This could delay the processing and payment of your billing. For providers who have requested direct deposit for their payments, DHS will deposit the payment directly to the provider s bank account on the next working day after processing. For providers who receive their payments by check, DHS will send the payment check on the next working day after the form is processed. When DHS sends a payment, we include a notice to the provider showing how much child care was paid for each child. Please keep this notice for your tax records. The family gets a similar notice telling them how much DHS paid. Checking on your payment DPU has an automated system you can call 24 hours a day, every day, for payment information. The system can tell you if your payment: Has already been processed and a check was mailed to you; Has been denied, either due to an issue with the voucher, or because the amount billed was less than the family s copay amount. If the system states that no information is available, that means your billing form has not yet been processed. 31

36 DHS Payments continued Here s how it works: Call in Salem, or statewide. You will hear a menu of options; select the number indicated for the information you want. Be ready with your Social Security Number or Federal Tax ID Number. Be ready with the voucher number for the billing you wish to check on. If the system states that no information is available, that means your billing form has not yet been processed. It may take 3-4 days. If you are a new provider or have not received payments in some time, you may get the message that the system does not recognize your Social Security Number. That means the process of linking you as the provider to the client family may not be complete yet. It takes a few days. Please always press # before you hang up. About rates: How much will DHS pay? DHS has maximum child care rates they can pay providers each month. The rates are based on a statewide market survey of child care providers and the amount most of them charge in their area. These are the maximum rates DHS is allowed to pay a provider. DHS will pay the amount the provider bills, or the maximum allowable DHS rate, whichever is less. The amount paid to a provider is determined by several factors: The ZIP code where the care is provided This determines which area the care is provided in: Group Area A, B or C. (See DHS Child Care Maximum Rates on pages ) The type of provider Family or child care center, and whether they receive the standard, enhanced or licensed rate. (See Reading the Child Care Billing form More on provider type definitions on page 22 and How do I qualify for the enhanced rate? on page 35.) The age category of the child See Reading the Child Care Billing form More on child age categories on page

37 The authorized hours on the billing form This is based on the family s expected work hours or approved activity hours, plus 25 percent for commuting and meal time. This is the maximum total number of child care hours the child can receive from all providers for the time period on the billing form. How the provider billed Whether the provider bills by the hour or by the month, and how many hours were billed. The total charge the provider billed If the provider bills for less than the DHS maximum rate, DHS cannot pay more than the provider bills. The DHS maximum rates Payments will not exceed the DHS maximum rates listed. If parents choose a provider who charges more than the maximum DHS can pay, the parents are responsible for paying anything over the DHS maximum. The family s copay amount This amount is deducted from the DHS allowed amount. There are multiple providers If the combined billings from multiple providers add up to more than the maximum allowable for care, providers may receive a percentage of the allowable amount. Example: if the first provider provided 85 percent of the total hours of care for a child, and the second provided 15 percent of the total hours, then the first provider will be paid 85 percent of the maximum allowable amount, and the second would receive 15 percent of that maximum. How is the payment calculated? DHS will pay: At your hourly or monthly rate, or up to the DHS maximum hourly or monthly rates for your provider type, whichever is less; The actual amount of care you provide, up to the total number of authorized hours, minus the family s copay amount (specified on the billing form). 33

38 DHS Payments continued DHS will not pay: More than you bill; More than the authorized hours; More than the DHS maximum rates. Even if you bill hourly, DHS cannot pay more than the maximum monthly rate; Amounts less than one dollar. Once the allowed amount is calculated for each child, the copay is deducted from the total of the allowed amounts. If you have additional questions about how your payment was calculated, contact the Direct Pay Unit at (or in the Salem area). The following is an example of how a payment is calculated: A family provider who gets the standard rate in Region C is authorized for and bills for 215 hours of care. The provider charges $ monthly rate for an infant in full time care. The parent s copay amount is $ The DHS maximum monthly rate is $ for an infant in Region C for a Standard Family provider (from page 42, DHS maximum rates). Provider billed $400; DHS allowed $374; parent s copay is $136. DHS allows... $374 Family s copay... -$136 DHS pays... $238 Provider billed... $400 DHS paid... -$238 Family owes... $162 The family is responsible for their copay ($136) plus any amount that DHS doesn t pay ($26). ($136 + $26= $162). ***Do not deduct the copay from the amount you are billing. DHS will automatically deduct the copay from the DHS allowed amount. 34

39 About enhanced rates What is the enhanced rate? In order to encourage providers to pursue training in child care subjects, and to reward those who make that effort, DHS is authorized to pay a higher rate, called the enhanced rate, to child care providers who are enrolled in the Oregon Registry. The Oregon Registry is a voluntary, statewide program to document and recognize the professional achievements of people who work in the childhood care and education profession. How do I qualify for the enhanced rate? Family providers and centers who are exempt from Child Care Division (CCD) certification who wish to receive the enhanced rate must meet specific training requirements of the Oregon Registry. You meet training requirements when you: Have completed at least two hours of training on Recognizing and Reporting Child Abuse and Neglect; Are currently certified in infant and child CPR and first aid; Have a current food handler s permit; Agree to complete and submit proof of a minimum of eight hours additional training related to child care issues every two years. To be added to the Oregon Registry, send proof you ve completed the first three requirements, along with a completed Oregon Registry application, to the address on the application. If you meet the Enhanced Rate Training requirements, you automatically meet the training requirements for Step 1 of the Oregon Registry. The enhanced rate will take effect no later than 60 days after your name has been added to the Oregon Registry. It is your responsibility to keep your first aid, CPR and food handler certifications current. For centers exempt from CCD certification, at least one staff member for every 20 children in care will need to meet the above requirements to receive the enhanced rate. 35

40 DHS Payments continued If you need an application or have questions about the training requirements, or you want information about where to find training in your area, call the Oregon Registry at , or in Portland, or go to their Web site at You may also call your local Child Care Resource and Referral (CCR&R). (See pages for the telephone number of the CCR&R in your area.) How do I get a higher rate for children with special needs? Special needs rate A higher rate is available for care of children or youth with disabilities, if they require a higher level of care for their age due to a physical, behavioral or mental disability. The need must be verified, and the provider must state that the child needs a higher than normal level of care. To do that, the provider signs the Special Needs Child Care Rate Request form (DHS 7486). The family gets this form from their DHS worker. High Needs Program If a child or youth requires a much higher level of care in the childcare setting, a supplemental payment may also be available. This is called the High Needs Program and involves an assessment of the child. The assessment is done, at no cost to the family or the provider, by a specialist from the DHS Inclusive Child Care Program. If a provider identifies a child or youth who requires a much higher level of care, they should discuss this with the family and contact the DHS caseworker or the Inclusive Child Care Program at (or in Portland) or send an to [email protected]. Once a referral is made, an individual assessment is done to determine if a supplemental payment is appropriate. If a family needs extra hours of care DHS may also be able to help pay for hours when the child care needed is greater than work hours plus 25 percent. If the family needs more than 215 hours of care per month to continue working or participating in a DHS-approved activity, the family s worker can authorize payment up to 50 percent more than the DHS monthly maximum limit. To see if they qualify, the family can call their DHS worker. 36

41 The amount is calculated based on the number of hours needed and is limited to approved situations. If approved, the child care billing form will show from hours in the authorized hours area. **Here s how the payment is calculated for extra hours: The computer takes the total number of hours entered by the DHS worker (from hours) and divides it by 215 to come up with a percentage. Then it multiplies the percentage by the maximum rate for the child. For example: The family needs 264 hours of child care in a month. The computer divides 264 hours by 215 = 1.23 and multiplies this number by the maximum rate for that child. This increases the maximum by 23 percent. If the provider does not provide 216 hours of care or more, they will receive up to the normal maximum rate for their area. A higher rate is available for children or youth who require a higher level of care for their age due to a physical, behavioral or mental disability. 37

42 38

43 DHS child care maximum rates The tables on pages show the maximum DHS child care rates for each group area (market area). If the family is receiving help through a DHS Child Welfare program, these rates may not apply. Contact the family s worker for more information. For more information about payments, see How much will DHS pay? on page 32, and How is the payment calculated? on page 33. These are the child age categories and provider type definitions used on the rate charts on the following pages: Child age categories Infant...Newborn to 1 year Toddler...1 year (12 months) to 3 years (36 months) Preschool...3 years to 6 years School...6 years or older (Unless the child has a special circumstance, Employment Related Day Care (ERDC) pays child care for children through age 11. Temporary Assistance for Needy Families (TANF) pays child care through age 12.) Special needs...a child age newborn to 18 years who needs more costly care due to a physical, behavioral or mental disability. Provider type definitions Provider type: You will receive: FAM...Standard Family Rate NQC...Standard Center Rate QFM...Enhanced Family Rate QEC...Enhanced Center Rate RFM...Licensed Registered Family Rate CFM...Licensed Certified Family Rate CNT...Licensed Certified Center Rate 39

44 DHS Maximum rates continued DHS child care current maximum rates (effective since 10/1/2007) Group Area A STANDARD RATE MAXIMUMS (Not Licensed) Standard Family Rate Standard Center Rate Hourly Monthly Hourly Monthly Infant $2.64 $493 $3.53 $675 Toddler $2.64 $466 $3.41 $671 Preschool $2.64 $440 $2.89 $529 School $2.64 $436 $3.23 $524 Special Needs $2.64 $493 $3.53 $675 ENHANCED RATE MAXIMUMS (Not Licensed) Enhanced Family Rate Enhanced Center Rate Hourly Part-time Monthly Hourly Part-time Monthly Infant $2.85 $399 $532 $3.83 $574 $765 Toddler $2.85 $378 $504 $3.65 $570 $760 Preschool $2.85 $356 $475 $3.27 $449 $599 School $2.85 $353 $470 $3.66 $445 $593 Special Needs $2.85 $399 $532 $3.83 $574 $765 LICENSED RATE MAXIMUMS Registered Family Rate Certified Family Rate Certified Center Rate Hourly Part-time Monthly Hourly Part-time Monthly Hourly Part-time Monthly Infant $3.00 $420 $560 $4.25 $645 $860 $4.50 $675 $900 Toddler $3.00 $398 $530 $4.00 $559 $745 $3.90 $671 $894 Preschool $3.00 $375 $500 $4.00 $516 $688 $3.85 $529 $705 School $3.00 $371 $495 $4.00 $450 $600 $4.30 $524 $698 Special Needs $3.00 $420 $560 $4.25 $645 $860 $4.50 $675 $ ZIP Codes for Group Area A: Portland, Eugene, Corvallis, Bend, Monmouth and Ashland areas:

45 Group Area B STANDARD RATE MAXIMUMS (Not Licensed) Standard Family Rate Standard Center Rate Hourly Monthly Hourly Monthly Infant $2.20 $400 $2.96 $473 Toddler $2.20 $396 $2.91 $467 Preschool $2.20 $374 $2.34 $356 School $2.20 $352 $2.34 $345 Special Needs $2.20 $400 $2.96 $473 ENHANCED RATE MAXIMUMS (Not Licensed) Enhanced Family Rate Enhanced Center Rate Hourly Part-time Monthly Hourly Part-time Monthly Infant $2.38 $324 $432 $3.17 $380 $506 Toddler $2.38 $321 $428 $3.11 $375 $500 Preschool $2.38 $303 $404 $2.65 $303 $404 School $2.38 $285 $380 $2.65 $293 $391 Special Needs $2.38 $324 $432 $3.17 $380 $506 LICENSED RATE MAXIMUMS Registered Family Rate Certified Family Rate Certified Center Rate Hourly Part-time Monthly Hourly Part-time Monthly Hourly Part-time Monthly Infant $2.50 $341 $455 $3.00 $371 $495 $3.60 $446 $595 Toddler $2.50 $338 $450 $3.00 $345 $460 $3.52 $431 $575 Preschool $2.50 $319 $425 $3.00 $338 $450 $3.12 $356 $475 School $2.50 $300 $400 $2.65 $375 $500 $3.12 $345 $460 Special Needs $2.50 $341 $455 $3.00 $371 $495 $3.60 $446 $595 Zip Codes for Group Area B: Salem, Medford, Roseburg, Brookings and areas outside the metropolitan areas in Eugene and Portland

46 DHS Maximum rates continued Group Area C STANDARD RATE MAXIMUMS (Not Licensed) Standard Family Rate Standard Center Rate Hourly Monthly Hourly Monthly Infant $2.20 $374 $2.64 $421 Toddler $1.98 $352 $2.28 $421 Preschool $1.76 $348 $1.93 $312 School $1.76 $348 $1.93 $312 Special Needs $2.20 $374 $2.64 $421 ENHANCED RATE MAXIMUMS (Not Licensed) Enhanced Family Rate Enhanced Center Rate Hourly Part-time Monthly Hourly Part-time Monthly Infant $2.38 $303 $404 $2.99 $351 $468 Toddler $2.14 $285 $380 $2.55 $344 $458 Preschool $1.90 $281 $375 $2.13 $252 $336 School $1.90 $281 $375 $2.13 $251 $334 Special Needs $2.38 $303 $404 $2.99 $351 $468 LICENSED RATE MAXIMUMS Registered Family Rate Certified Family Rate Certified Center Rate Hourly Part-time Monthly Hourly Part-time Monthly Hourly Part-time Monthly Infant $2.50 $319 $425 $2.50 $375 $500 $3.52 $413 $550 Toddler $2.25 $300 $400 $2.50 $300 $400 $3.00 $404 $539 Preschool $2.00 $296 $395 $2.25 $300 $400 $2.50 $296 $395 School $2.00 $296 $395 $2.40 $300 $400 $2.50 $270 $360 Special Needs $2.50 $319 $425 $2.50 $375 $500 $3.52 $413 $550 42

47 Zip Codes for Group Area C: Balance of State, Other State Zips

48 44

49 Troubleshooting, overpayments and reporting changes Troubleshooting What do I do when things go wrong? There are three kinds of problems that affect payment. To troubleshoot, use the list below to identify the source of the problem and how to resolve it: 1. For questions about the family s eligibility, talk with the family or the local DHS office. Please remember, due to confidentiality laws, the DHS office can only give you information about the family if they know you are the family s child care provider. 2. If you haven t received a listing or billing form, talk with the family, the local DHS office or DPU. You can also call your local Child Care Resource and Referral agency for help. (See the directory on pages ) 3. If you have a problem with or question about a listing or billing form you ve sent in, call DPU at ( if calling from the Salem area). Please allow up to 4 working days for your billing form to be processed. If you are still not sure who to call, contact DPU or the Child Care Resource and Referral agency in your county. Provider payment reviews and overpayments DHS reviews payments made in the child care program, to make sure they are correctly authorized, billed and paid. A small number of child care cases are randomly selected for review each month. These records are compared to providers attendance logs to make sure the payments are correct. If a child care payment you received is selected for a review, you will be asked to send in a copy of the attendance log showing the hours of care you provided for the payment being reviewed. 45

50 Troubleshooting, overpayments and reporting changes continued If you do not return your attendance log, it will be assumed that the amount you received during the period in question was an overpayment that you must repay. If you have been paid for hours when child care was not provided, (not including authorized absent days), and DHS determines this is a result of an honest mistake, you will be notified about the overpayment. Overpayments are usually collected from future provider payments. If the overpayment is determined to be the result of an intentional act to get a larger payment, to get paid for care not provided, or to pay an ineligible provider, that is called an Intentional Program Violation, or IPV. Intentional Program Violations (IPVs) What is an IPV? An IPV is when an overpayment is the result of incorrect information on the part of a client or provider and there is reason to believe it was intentional in other words, that fraud has occurred. IPV disqualifications are determined by the Investigations Unit. If it is determined that you have made an IPV: You will be required to repay the overpayment; Legal action may be taken; You may be subject to penalties; and You may be disqualified for future payments. Providers have a right to a hearing on all overpayment decisions. (See What if I disagree with a DHS decision? on page 47.) Hearings are held on every IPV decision unless you have signed the Agreement to Waive Child Care Provider Hearing for Intentional Program Violations (DHS 649CP). Read the information carefully before you sign this form. Signing the form will result in a disqualification period and does not prevent you from being prosecuted in court, or from the overpayment being collected 46

51 What is the disqualification period for an IPV? A child care provider whose overpayment has been established as an IPV is not eligible for payment for a minimum of six months, and until the full amount of the overpayment has been paid. If the violation is serious enough, the DHS Child Care Program manager can permanently disqualify a provider from receiving payment. What if I disagree with a DHS decision? (Hearing rights) If you disagree with the DHS decision to deny your eligibility for payment or if DHS sends you a notice that you are being charged with an overpayment, you have up to 45 days to submit a written request for a hearing about the overpayment. (This is a separate hearing from the IPV hearing described above.) Someone at the family s DHS branch office can help you fill out an Administrative Hearings Request form (DHS 443) or your written letter of request. Providers who request a hearing for an IPV are not eligible for payment while they are waiting for the hearing decision. If the hearing result determines the provider now is eligible for payment, DHS cannot go back and pay for the time the provider was in denied status. Providers who do not request a hearing within the 45 days, or who lose the right to a hearing, are not eligible to reapply for listing until 180 days following the date of the listing denial notice. However, if the situation has changed that caused the denial, you may contact the Background Check Unit for a review of your circumstances. Providers who are charged with an overpayment and request a hearing will have overpayment amounts deducted from their future child care payments. If the hearing is in your favor, DHS will repay any money we collected for the overpayment. Providers also have the right to ask for a delay in paying DHS back until the hearing decision is made. To do this, the hearing must be requested in writing within 15 days from the date of the notice of overpayment. Providers who do not request a hearing within 45 days lose the right to a hearing. The overpayment will be deducted from future payments or may be referred to collections. 47

52 Reporting changes DPU needs to know about any changes in the child care situation that affect payment. Changes are required to be reported within 10 days. To make sure the billing forms reach you, DPU needs to know about: Any change in your address or phone number. A change in your name. As part of the listing process, providers agree to notify DHS about: Arrests, convictions or involvement with Child Welfare for anyone age 16 or older in their home or facility. Any persons age 16 or older moving in or out of their home. Please report changes as soon as they happen. To tell DHS about a change, call DPU at (or in the Salem area) or use a Provider Report form (DHS 7496). There is a sample Provider Report form on page 50. This will help keep the billing process quick and efficient. Depending on the change reported, you may be sent a new Child Care Provider Listing form (DHS 7494) to complete. Please return the completed form to the Direct Pay Unit within 10 days. Filling out the Provider Report form (DHS 7496) 1. Write the date the change occurred or will occur. 2. Write the provider/facility name, phone number and the Social Security or Federal Tax ID number. 3. This section is to report changes in your mailing address. If your phone number or address changed or will change, write both the old and the new information. 4. This section is to report changes in the phone number or address where you provide care. 5. If your name has changed or will change, write both the old and new names. 48

53 6. If another person, age 16 or older, has moved or will move into your home, or will be visiting regularly, with unsupervised access to the children in care, write their name, birth date and Social Security Number. 7. (a) If you have been arrested or convicted of a crime or referred to DHS Child Welfare for child abuse, neglect or failure to protect a child, check the boxes that apply and write the date of the action and agency. (b) If a person in your home, age 16 or older, has been arrested or convicted of a crime or referred to DHS Child Welfare for child abuse, neglect or failure to protect a child, check the boxes that apply and write the date of the action and agency. Providers agree to report changes within 10 days of occurrence. 49

54 Provider Report Use this form to report changes to the Direct Pay Unit (DPU) and the Criminal Records Unit (CRU). Child care providers who are registered or certified with Child Care Division will also need to report any changes to CCD at Return this form to DPU at the following address: DPU P.O. Box Salem, Oregon Date when this change occurred or will occur: Telephone: ( if calling from Salem) 2. Identifying Information Provider/Facility Name Phone Number Social Security Number Federal Tax ID Number 3. New Phone Number or Mailing Address Old Mailing Address City State Zip County Phone New Mailing Address City State Zip County Phone 4. New Phone Number or Address Where you Provide Care Old Address Where Care Provided City State Zip County Phone New Address Where Care Provided City State Zip County Phone 5. My Name has s Changed Old Name New Name 6. Someone Age 16 Years or Older Moved into My Home Write that person s name below. Name of Person Date of Birth Social Security Number Name of Person Date of Birth Social Security Number 7. Provider Records Change: a. I have been: Arrested for a crime Convicted of a crime Referred to CW for child abuse, child neglect or failure to protect a child. Date Occurred: Law enforcement agency, court or CW local branch office: b. A person age 16 years or older in my home has been: Arrested for a crime Convicted of a crime Referred to CW for child abuse, child neglect or failure to protect a child. Date Occurred: Law enforcement agency, court or CW local branch office: 50 DHS 7496 (02/08)

55 Reporting child abuse: the provider s role Providers are mandatory reporters Oregon state law requires that people in certain professions, called mandatory reporters, must report child abuse or neglect if they have reasonable cause to suspect it is happening. If you are a child care provider for DHS, or registered or certified with the Child Care Division (CCD), you are a mandatory reporter. Child care providers are subject to mandatory child abuse reporting under the Child Abuse Reporting Law. You must agree to report suspected child abuse to the DHS Child Welfare Program or a law enforcement agency, according to Oregon law, as part of your provider requirements. Importance of reporting abuse We all have a responsibility to protect those who cannot protect themselves. Every year in Oregon there are approximately 60,000 reports of suspected child abuse/neglect made to DHS. Child abuse or neglect is found in more than 10 percent of those reports. Failure to report is a violation of the law and carries a maximum penalty of $1,000. Mandatory reporters who fail to report can also be sued for damages in civil court. However, anyone who makes a good faith report based on reasonable grounds is immune from liability. In other words, you can t get in trouble for reporting child abuse, but you can get in trouble if you don t report it. Most importantly, you may be helping to save a child s life. The Department of Human Services Child Welfare office will assess the information you give, and take further action if necessary. Your name will be kept confidential. Only a court of law can order a reporter s name released. As a mandatory reporter, you are a very important part of the system to protect children. Nearly three-quarters of all child abuse reports come from mandatory reporters. You may be the only person outside the immediate family who sees babies or small children. You may be the only person who knows a child is being abused. 51

56 Reporting child abuse: the provider s role continued Note: It is not your responsibility to prove abuse or neglect happened, or to determine if it fits into the legally recognized definitions. That is the job of professional investigators or law enforcement officers. Your duty if you suspect it: report it. Recognizing child abuse Oregon law recognizes the following types of abuse: Physical injury Oregon law defines physical abuse as an injury to a child that is not accidental. Most parents do not intend to hurt their children, but abuse is defined by the effect on the child, not the motivation of the parents. Physical injury includes: Bruises, cuts, welts Head injuries Poisoning Fractures, sprains Burns or scalds Internal injuries Electrical shocks Death Suspicious injuries may include injuries that: Are in the shape of the article used (electric cord, belt buckle, etc.); Do not match the child s description of how they occurred (fracture from falling off sofa, etc.). Spanking that leaves marks or bruises on a child might be abuse. Bruises anywhere on a baby are serious. Neglect Neglect is the most common form of abuse seen and may have long-term effects. Neglect is endangering a child s health and safety by failing to provide adequate food, clothing, shelter, supervision or medical care. Drug and alcohol exposure also has a severe impact on children. Exposing a child to controlled substances that affects the child s health or safety is now considered physical neglect of a child. 52

57 Neglect also includes exposing a child to illegal activities, such as: Encouraging a child to participate in drug sales or theft; Exposing a child to parental drug abuse; Encouraging a child to use drugs or alcohol. Children who are neglected often: Don t want to leave school; Are constantly tired; Are left alone with no supervision; Have unmet physical, emotional or medical needs. Threat of harm Threat of harm is subjecting a child to a substantial risk of harm to the child s health or welfare. Substantial harm is defined as immobilizing impairment, life-threatening damage, or significant or acute injury to a child s physical, sexual, psychological, or mental development and/ or functioning. Some examples of threat of harm include: A child living with or cared for by a person who has been convicted of child abuse or neglect of any child in the past; A child born to or coming to live with any person who has a child currently out of their home as a result of child abuse or neglect; A newborn whose primary caregiver appears to lack the skills necessary to provide adequate care even though the child has not suffered harm; A child living with a person who is involved in child pornography; Caregiver behavior that is out of control and threatening to a child s safety. For example, driving while intoxicated with children in the car; a caregiver who is not taking prescribed medication; drug or alcohol abuse; or a mental, emotional or physical problem. Mental injury Mental injury is a continuing pattern of rejecting, terrorizing, ignoring, isolating, or corrupting a child, resulting in serious damage to the child. 53

58 Reporting child abuse: the provider s role continued Children with a mental injury often: Have speech or sleep disorders; Fail to grow normally; Are very aggressive or withdrawn; Show an abnormal need for emotional support. Mental injury includes: Rejecting, abandoning or extensive ridiculing of a child; Terrorizing a child by threatening extreme punishment against the child or the child s pets or possessions; Ignoring a child over time by refusing to talk to or show interest in the child s daily activities. This must be so extreme there is no traditional parent-child relationship between the two; Isolating a child by teaching the child to avoid social contact beyond the parent-child relationship; Corrupting a child by teaching inappropriate behavior in areas such as aggression, sexuality or substance abuse; Exposing a child to violence. Sexual abuse and sexual exploitation Any sexual contact in which a child is used to sexually stimulate another person is illegal. This may be anything from rape to fondling to involving a child in pornography. Sexual abuse includes: Incest Rape Sodomy Sexual penetration Fondling Voyeurism Sexual harassment Children who are sexually abused often have: Difficulty walking or sitting; pain or itching in genital area; torn, stained or bloody underclothing; Poor peer relationships; fantasy or infantile behavior; fear of being left with someone; 54

59 Inappropriate interest in, knowledge of, or acting out, of sexual matters; Any of the behavioral problems listed under Mental injury. Persons who sexually abuse children rely on many methods to force children to keep quiet. They may be subtle, telling the child they are doing it for his or her own good or promising the child favors or gifts. Or they may be more blatant, such as a father warning his daughter that if she tells anyone, the family will be broken up and everyone will blame her. The abuser may convince the child they are equal partners, that they have special affection for the child and will be blamed if disclosure is made. Many abusers use threats, telling the child their pets or loved ones will be hurt, that siblings will be targeted, or even the child himself will be killed if he/she tells. Children need adults to provide their basic needs: food, a place to live, clothing, access to family and loved ones. Abusers deliberately emphasize that dependency to make children submit to them. Sexual exploitation is using children in a sexually explicit way for personal gain; for example, to make money, to obtain food stamps or drugs, or to gain status. It also includes using children in prostitution and using children to create pornography. Child selling Child selling includes buying, selling, or trading for legal or physical custody of a child. It does not apply to legitimate adoptions or domestic relations planning. Shaken baby syndrome Shaken baby syndrome describes a head injury caused by holding a child by the arms or trunk and shaking the child severely and repeatedly. Many people do not understand that shaking can cause severe brain injury, blindness or even death. The most common injuries are blood clots around the brain, hemorrhages of the retina, fractures in the growing portion of the bone, injury to the brain, bruises on the extremities, or bruising and injury of the chest. How do I make a report? If you think a child is being abused, report it to the local DHS Child Welfare office or a law enforcement agency right away. Most reports are made by phone because the law requires an oral report. 55

60 Reporting child abuse: the provider s role continued DHS offices are usually open only during business hours, from 8 a.m. to 5 p.m. When a report is made to DHS, we share it with appropriate law enforcement agencies and vice versa. You only need to report to one agency. If you need to report abuse during non-business hours or on weekends, contact your local law enforcement agency or child abuse hotline. A list of phone numbers by county is provided on pages What information should I have? DHS cannot respond unless there is a specific allegation of abuse. For example, Alex seems withdrawn and quiet is not a specific allegation of abuse. If Alex comes to school with bruises on the face and says a parent caused it, that should be reported. Always pay close attention when a child tells you about being abused. The more information you have, the better. If possible, provide the names and addresses of the child and parent; the child s age; the type and extent of abuse; and any other information that will help establish the cause of abuse or identify the abuser. However, make the report even if you don t have all that information. Also, the more quickly you get the information to us, the more likely we can respond effectively. For example, bruises and other physical marks can fade quickly. If you need more information on child abuse and neglect, contact your local DHS Child Welfare office listed on pages You can get a booklet on the law and the symptoms of abuse by contacting your local Child Welfare office, or visiting the DHS Web site at If you would like training on Recognizing and Reporting Child Abuse, contact your local Child Care Resource and Referral office for more information. See the directory on pages

61 Department of Human Services offices for child abuse reporting County Daytime phone numbers Office hours After hours phone numbers Baker local toll free (Main office numbers) Mon.-Fri. 8 am to 12 noon, 1 to 5 pm 911 or local law enforcement agency: Baker County Sheriff Baker City Police Benton local toll free (Dedicated child abuse hotlines) Mon.-Fri. 8 am to 5 pm 911 or local law enforcement agency: Benton County Sheriff Corvallis Police Philomath Police Clackamas local (Dedicated child abuse hotline) Mon.-Fri. 8 am to 5 pm local (Dedicated child abuse hotline) Calls forwarded to Multnomah Co. hotline Clatsop Columbia Coos Crook Curry Deschutes toll free (Dedicated child abuse hotline) toll free (Dedicated child abuse hotline) local toll free (Main office numbers) local (Dedicated child abuse hotline) local (Main office number) local (Dedicated child abuse hotline) Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm local toll free (Main office numbers) Calls are forwarded to Belloni Ranch Douglas local toll free (Main office numbers) Mon.-Fri. 8 am to 5 pm 911 or local law enforcement agency: Douglas County Sheriff Myrtle Creek Police Oakland Police Reedsport Police Roseburg Police Sutherlin Police Winston Police Gilliam Condon office; to The Dalles office (Main office numbers) Mon.-Fri. 8 am to 5 pm 911 or Tri-County Dispatch at

62 Reporting child abuse: the provider s role continued County Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn 58 Daytime phone numbers toll free (Dedicated child abuse hotline) toll free (Dedicated child abuse hotline) local toll free (Main office numbers) toll free (Dedicated child abuse hotline) local (Dedicated child abuse hotline) toll free (Dedicated child abuse hotline) local (Main office number) local toll free (Main office numbers) local toll free (Main office numbers) local toll free (Dedicated child abuse hotlines) local toll free (Dedicated child abuse hotlines) Office hours Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm Mon.-Fri. 8 am to 5 pm Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm Mon.-Fri. 8 am to 5 pm After hours phone numbers 911 or Hood River Sheriff or local law enforcement agency: Jackson County Sheriff Ashland Police Butte Falls Police Central Point Police Eagle Point Police Gold Hill Police Jacksonville Police Medford Police Phoenix Police Rogue River Police Shady Cove Police Talent Police or local law enforcement agency: Josephine Sheriff Grants Pass or local law enforcement agency: Lincoln County Sheriff Lincoln City Police Newport Police Toledo Police or local law enforcement agency: Linn County Sheriff Albany Police Lebanon Police Sweet Home Police

63 County Malheur Marion Morrow Multnomah Polk Daytime phone numbers toll free (Dedicated child abuse hotline) local (Dedicated child abuse hotline) toll free (Main office number) local toll free (Main office numbers) local toll free (Dedicated child abuse hotlines) local Marion office (Dedicated child abuse hotline) toll free Marion office (Main office number) Office hours Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm 911 Mon.-Fri. 8 am to 5 pm days a week 24 hours daily Mon.-Fri. 8 am to 5 pm 911 After hours phone numbers local toll free (Dedicated child abuse hotlines) Calls forwarded to Children s Receiving Center Friday and Saturday nights Sherman local Condon office toll free The Dalles office (Main office numbers) Mon.-Fri. 8 am to 5 pm 911 or Tri-County Dispatch Tillamook toll free (Dedicated child abuse hotline) Mon.-Fri. 8 am to 5 pm 911 Umatilla local toll free (Main office numbers) Mon.-Fri. 8 am to 5 pm 911 or City/County Dispatch option 7 Union local toll free (Main office numbers) Mon.-Fri. 8 am to 5 pm 911 or local law enforcement agency: Union County Sheriff Wallowa local toll free (Main office numbers) Mon.-Fri. 8 am to 5 pm 911 or Wallowa County Sheriff Wasco local toll free (Main office numbers) Mon.-Fri. 8 am to 5 pm 911 or Wasco County Sheriff at

64 Reporting child abuse: the provider s role continued County Daytime phone numbers Office hours After hours phone numbers Washington local (Dedicated child abuse hotline) dial 1, toll free (Main office number) Mon.-Fri. 8 am to 5 pm local (Dedicated child abuse hotline) dial 1, toll free (Main office number) Calls are forwarded to Multnomah County hotline Wheeler local Condon office toll free The Dalles office (Main office numbers) Mon.-Fri. 8 am to 5 pm 911 or Tri-County Dispatch Yamhill local toll free (Main office number) Mon.-Fri. 8 am to 5 pm 911 or local law enforcement agency: Yamhill Communications (dispatch for McMinnville, Sheriff s Office, Amity, Yamhill, Carlton, Willamina, Dayton, and Sheridan) Newberg-Dundee Police Providers agree to report suspected child abuse to Child Welfare or a law enforcement agency. 60

65 Preventing disease: the provider s role Preventing the spread of infectious disease You have an important job as a child care provider. Germs and viruses can spread easily among groups of children. You can help prevent illness in your child care setting by taking the following precautions. To receive more information, contact your local health department or CCR&R. They have booklets and videos available. 1. Exclude children from child care who are obviously ill. The Oregon Public Health Division s rules (OAR ) require that a child with a child care-restrictable disease be excluded from a child care facility as long as the disease is communicable. Examples of child care restrictable diseases include but are not limited to: chickenpox; giardiasis; meningitis; mumps; measles; tuberculosis; head lice; and scabies. In addition, the Public Health Division strongly recommends that children with uncontrollable diarrhea; vomiting; purulent conjunctivitis (discharge from the eyes); fever (oral temperature over 101 degrees F); and/or impetigo (a contagious skin infection) be excluded from the facility as long as symptoms last. More information is available from the county health department. (See telephone book or look online for local phone numbers.) 2. Wash your hands and children s hands frequently. Washing your hands is the most important thing you can do to prevent germs from spreading. Always wash your hands with warm, soapy water, and dry them with a paper towel instead of a cloth towel. Encourage the children in your care to do the same, and help them do it right. Remember to wash your hands: After changing a diaper; Before handling food; Before feeding an infant or toddler; After wiping a nose; After handling pets. 61

66 Preventing disease: the provider s role continued 3. Clean up body fluid spills. Spills of body fluids or products, including blood; feces; nasal and eye discharges; saliva; urine; and vomit should be cleaned up immediately. Wear gloves unless the fluid can be easily contained by the tissue or cloth being used to clean it up. Be careful that none of the body fluid or products you are cleaning get into your eyes, nose, mouth, or any open sores you may have. Clean and disinfect any surfaces, such as counter tops and floors, on which body fluids have been spilled. Discard contaminated material in a plastic bag that has been securely sealed. Mops used to clean up body fluids should be (1) cleaned, (2) rinsed with a disinfecting solution, (3) wrung as dry as possible, and (4) hung to dry completely. Be sure to wash your hands completely. 4. Disinfect surfaces with a bleach solution every day. Germs can spread on any surface. Shared toys, counter tops, toilet seats, door knobs, and sinks can be safely disinfected with a bleach solution to kill germs. Mix a solution of one tablespoon bleach to a gallon of water and keep it handy in a spray bottle. The bleach solution should be made daily. Be sure to disinfect the following surfaces with bleach solution: Hard-surfaced toys; Diapering surfaces; Toilet seats; Faucets and sinks. Visit us on the Web at 5. Be sure all child care children are immunized. Have on file a completed, up-to-date Oregon shot record, called the Certificate of Immunization Status (CIS) form, for each child in your care. The child s immunizations may not be completed depending on the child s age and the shot schedule. You are responsible for notifying parent(s) when a dose is due and have the new doses recorded on the CIS form, signed and dated by the parent. CIS forms and help are available from the local county health department (see telephone book for local county phone numbers). This information is provided by the Oregon Department of Human Services Public Health Division. 62

67 Required immunizations for children in care Oregon state law requires children attending an Oregon school, preschool, head start program or child care facility to be immunized or in the process of completing their immunization schedule. Childhood immunizations start at birth and continue through adolescence. If a vaccination has been missed, the child does not have to start the schedule over, they just need to get caught up. If you have an older child who is behind on their shots or who has never been immunized, check with your doctor or health department for the schedule recommended for that child. (See the recommended immunization schedule that follows.) Recommended Childhood Immunization Schedule for 2009 Recommended Immunization Schedule for Persons Aged 0 Through 6 Years Vaccine Age Birth 1 month 1 HepB 2 months 4 months 6 months Rotavirus 2 RV RV RV 2 Diphtheria, Tetanus, Pertussis DTaP DTaP DTaP Haemophilus influenzae type b 4 Hib Hib Hib 4 Pneumococcal 5 PCV PCV PCV Inactivated Poliovirus 6 IPV IPV Influenza 7 HepB This schedule includes recommendations in effect as of December 15, Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations Tetanus, Diphtheria, should include Pertussis provider 1 assessment, patient preference, and the potential for adverse events. Providers should consult the relevant Advisory Human Papillomavirus 2 see footnote 2 1. Hepatitis B vaccine (HepB). (Minimum age: birth) At birth: Meningococcal MCV Influenza Pneumococcal 5 Hepatitis A After the birth 6 dose: Hepatitis B 7 Inactivated Poliovirus 8 Measles, Mumps, Rubella 9 Varicella 10 visit). This schedule includes recommendations in effect as of December 15, Any Rotavirus dose not administered vaccine (RV). at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations 0 days or older. should include provider assessment, patient preference, and the potential for adverse events. Providers should consult the relevant Advisory 1. Tetanus indicated. and diphtheria toxoids and acellular pertussis vaccine (Tdap). 3. Diphtheria (Minimum age: and 10 tetanus years for toxoids Boostrix and and acellular 11 years pertussis for Adacel) vaccine (DTaP) months see footnote 3 15 months 18 months months Measles, Mumps, Rubella MMR see footnote 8 Varicella 9 Varicella see footnote 9 HepB Hib PCV IPV DTaP Influenza (Yearly) 2 3 years 4 6 years DTaP Range of recommended ages for all groups Range of recommended ages for certain Committee on Immunization Practices statement for detailed recommendations: Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at or by telephone, Tdap Tdap Range of HPV (3 doses) HPV series recommended 6. Inactivated poliovirus vaccine (IPV) ages for all MCV MCV children except birthday and at least 6 months following the previous dose. groups Influenza (Yearly) istered at age 4 through 6 years. See MMWR 7. Influenza PPSVvaccine (seasonal). (Minimum age: 6 months for trivalent inacti Range of recommended HepA Series ages for catch-up Hep lying B medical Series conditions that predispose them to influenza immunization complications), IPV aged Series 2 through 4 years who have had wheezing in the past 12 months. Range of MMR Series recommended ages for certain Varicella than 9 years Series who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose. Committee see MMWR on Immunization Practices statement for detailed recommendations: 8. Measles, mumps, and rubella vaccine (MMR). Clinically (Minimum significant age: 12 months) adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at or by telephone, have elapsed since the first dose. 9. Varicella vaccine. (Minimum age: 12 months) 4. Influenza vaccine (seasonal). 63 have elapsed since the first dose. IPV MMR Varicella 10 HepA (2 doses) HepA Series Meningococcal Recommended 11 Immunization Schedule for Persons Aged 7 Through 18 Years MCV For those who fall behind or start late, see the schedule below and the catch-up schedule Vaccine Age 7 10 years years years PPSV

68 Preventing disease: the provider s role continued NOTE: Recommended ages are flexible, and some doctors may use slightly different schedules. DTaP Hep A Hep B Hib HPV IPV MMR MCV 4 PCV Rota Tdap Var Diphtheria, Tetanus, and Pertussis Hepatitis A Hepatitis B H. Influenza Type B Human Papillomavirus Inactivated Poliovirus Measles, Mumps, and Rubella Meningococcal Pneumococcal Rotavirus Tetanus, Diptheria and Pertussis (for age seven and older) Varicella For help in getting a child immunized, contact a physician or the local county health department immunization coordinator in your area. Look in the phone book for the number of your local county health department, or call SAFENET ( ) for clinic locations. 64

69 Resources and other information Child Care Resource and Referral services DHS contracts with local Child Care Resource and Referral agencies to provide services to providers and parents. These agencies are a source of information about the DHS Child Care program and help families find child care. They also can help providers with DHS billing and payment questions. Local Child Care Resource and Referral agencies (CCR&Rs) are often able to provide the following services: Information on services available to child care providers; Information on the U.S. Department of Agriculture (USDA) Child Care Food Program; Training, such as CPR and first aid; child development; health and safety; business practices; etc.; Support groups for child care providers to meet and discuss common problems; Guidance on problems collecting payment from families; Help with the DHS billing and payment system. A list of the local CCR&R agencies providing these services is shown on the following pages. 65

70 Resources and other information continued Child care resources and referral offices County Agency & Address Phone Numbers Network Office Oregon Child Care Resource and Referral Network 805 Liberty St. NE Suite 2 Salem OR Baker Child Care Resource & Referral 1575 Dewey Ave Baker City, OR , Benton Clackamas Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Family Connections 6500 SW Pacific Blvd Albany, OR Child Care Resource & Referral SE 97th Ave Clackamas, OR Family Care Connection Clatsop County Extension Office 2001 Marine Drive Astoria, OR Child Care Resource & Referral 1001 SW Baseline Hillsboro, OR CARE Connections 1988 Newmark Coos Bay, OR Neighbor Impact Child Care Resources 2303 SW First St, Suite A Redmond, OR Care Connections Curry County Office 586 Fifth Street Suite 200 Brookings, OR Neighbor Impact Child Care Resources 2303 SW First St, Suite A Redmond, OR Lane Family Connections -LCC 4000 E 30th Ave, Bldg 24 Eugene, OR Child Care Partners 400 E Scenic Dr. The Dalles, OR , , , x118 or x121, x x118 or x121, , ,

71 County Agency & Address Phone Numbers Grant Child Care Resource & Referral 118 Washington St Canyon City, OR , Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Child Care Resource & Referral 90 W Washington Burns, OR Child Care Partners 400 E Scenic Dr The Dalles, OR Child Care Resource Network of Southern Oregon 673 Market St. Medford, OR Neighbor Impact Child Care Resources 2303 SW First St, Suite A Redmond, OR Child Care Resource Network of Southern Oregon 673 Market St. Medford, OR Child Care Resource Network of Southern Oregon Klamath and Lake Office 403 Pine Street Klamath Falls, OR Child Care Resource Network of Southern Oregon Klamath and Lake Office 403 Pine Street Klamath Falls, OR Family Connections of Lane & Douglas Counties LCC 4000 E 30th Ave, Bldg 24 Eugene, OR Family Care Connection 29 SE Second St. Newport, OR Family Connections 6500 SW Pacific Blvd. Albany, OR Child Care Resource & Referral 375 SW 2nd Ave Ontario, OR , , , x118 or x121, , , , ,

72 Resources and other information continued County Agency & Address Phone Numbers Marion Child Care Information Service 2475 Center St NE Salem, OR , Morrow Multnomah Child Care Resource & Referral 110 NE 4th Street Hermiston, OR CCR&R of Multnomah County 1006 SE Grand, Suite 100B Portland, OR , , Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill Child Care Information Service 2475 Center St NE Salem, OR Child Care Partners 400 E Scenic Dr. The Dalles, OR Family Care Connections Clatsop County Extension Office 2001 Marine Drive Room 210 Astoria, OR Child Care Resource & Referral 110 NE 4th St Hermiston, OR Child Care Resource & Referral 1916 Island Ave. LaGrande, OR Child Care Resource and Referral 104 Litch St. Enterprise, OR Child Care Partners 400 E Scenic Dr. The Dalles, OR Child Care Resource & Referral 1001 SW Baseline Hillsboro, OR Child Care Partners 400 E Scenic Dr. The Dalles, OR Child Care Information Service 2475 Center St NE Salem, OR , , , , , , , ,

73 Nutrition education and reimbursements from U.S. Department of Agriculture (USDA) Providers listed with DHS may qualify to receive nutrition education, and reimbursements from USDA for meals fed to children in care. Providers must be at least 18 years old, providing care in their home, preparing meals for children and meet USDA criteria. Once you sign up for the program, a program representative will train you in how to serve USDA meals according to USDA guidelines, and keep track of the meals that you serve. They will also train you in how to keep track of the children you serve, including their in and out times. You then send your paperwork to your sponsor at the end of the month and receive a reimbursement check based on the number of qualifying meals claimed. Children need to eat foods with the right nutrients in order to be healthy, grow as they are meant to, and learn good eating habits that will last a lifetime. Eating the right foods will also help them function well in school. By serving them nutritious, tasty foods, they will learn to appreciate the wide variety of healthful food choices that are available. To get started, once you have completed the process of becoming listed as a DHS family child care provider, contact the USDA Child and Adult Care Food Program sponsor in your area. The following table lists sponsors, their phone numbers and where they are located. Sponsors serve the county they are located in and some adjacent counties. 69

74 Resources and other information continued USDA Sponsor List: Find your county in the middle column to find the USDA sponsor for your area. Note: some counties are served by more than one sponsor. Sponsor Counties served Phone number American Red Cross (Spanish bilingual staff) Benton, Lane, Lincoln, Linn (541) (866) Child Care Development Services, Inc (Russian, Spanish and Vietnamese bilingual staff) Clackamas, Columbia, Marion, Multnomah, Washington, Yamhill (503) (800) ext 2509 Crook-Deschutes-Jefferson Child Care Council (Spanish bilingual staff) Crook, Deschutes, Harney, Jefferson (541) Jackson-Josephine 4-C Council Jackson, Josephine, Klamath, Lake (541) Mid-Columbia Community Action Council (Spanish bilingual staff) Hood River, Sherman, Wasco (541) Northwest Nutrition Service, Inc. (Chinese, Vietnamese, Spanish and Russian bilingual staff) Nutrition First (Russian and Spanish bilingual staff) Clackamas, Clatsop, Columbia, Hood River, Marion, Multnomah, Polk, Tillamook, Wasco, Washington, Yamhill Benton, Lincoln, Linn, Marion, Polk, Tillamook, Yamhill (503) (800) (503) (800) Oregon Child Development Coalition (Spanish bilingual staff) Southwestern Child and Adult Care Food Program (Spanish bilingual staff) United Community Action Network Jackson, Josephine (541) (877) Coos, Curry (541) (800) ext 7096 Douglas (541) (800)

75 Children, Adults and Families Step 1: Child Care Payment Worksheet Fill out this worksheet to get an estimate of a family s child care costs. Write down the total amount you charge for the month. (If you charge by the hour, multiply the hourly charge by the number of hours to get the monthly charge.) Monthly Charge $ Step 2: Subtract the Department of Human Services (DHS) maximum rate limit. The DHS maximum rate limits can be found in the Child Care Provider Guide (DHS 7492) and the Parent s Guide to Child Care (DHS 7478). (Be sure to use the rate in the column for the number of hours authorized by DHS.) Subtract DHS Payment $ Subtotal: This is the difference between what you charge and what DHS pays. If you charge less than DHS pays, put 0 on this line. Subtotal $ Step 3: Add the family s co-pay amount printed on the billing form to the subtotal. If the family doesn t have a co-pay, put 0 on this line. Add Co-pay $ This number is an estimate of the amount you will need to collect from the family. YOUR TOTAL $ Call your local Child Care Resource and Referral (CCR&R) agency or the Direct Pay Unit (DPU) with questions about this worksheet. DHS 7492W (1/08) 71

76 What do I need to give my child care parents to help them qualify for the credit? You need to provide a receipt to your child care parents each time they pay you for your services. You should also keep track of the amount each parent pays throughout the year and issue an end-of-year statement for each child. The receipts and year-end statements you provide to your child care parents should show: Sample receipt: Your Place Kid s Center Judy Jones, Sole Proprietor 123 Our Place Road, Town OR Date: May 31 FEIN: Paid by: S.A. Smith For: Joey Smith Child care dates: 5/1 to 5/31 Amount: Four hundred twenty-five dollars $ Method of payment: Check #1116 Received by: Judy Jones Signature: Judy Jones For more information the working family child care credit. Telephone: Asistencia en español: Gratis de prefijo de Oregon TTY (hearing or speech impaired; machine only): Americans with Disabilities Act (ADA): the help numbers above for information in alternative formats (Rev ) Oregon Working Family Child Care Credit Information for Child Care Providers 72

77 What is the Oregon working family child care credit? The Oregon working family child care credit is families. The credit is based on: How do my child care parents qualify to claim this credit? 1. The parent must have a minimum amount of earned income.* mum amount of investment income.* 3. The parent also must have adjusted gross income that is less than the limits based on their household size. - attend school at least part time or the parent * Earned income and investment income have the same meaning for this credit as for the federal earned income credit. The amounts change each year and can be found in the Oregon income tax instruction booklet. What is a qualifying child? child who: OR credit for a child with a disability. AND - - parent under a decree of divorce or separate maintenance or a written declaration such as need receipts from you at the time of payment. The - (See our sample receipt on the inside panel.) What if I don t want to share my Social Security number with my child care parents? receipts you give to your child care parents. You employees. website at Once your number is receipts. What if I don t have a Social Security number? related items such as child care receipts. Use What if someone else pays the child care? end statement. My child care parents still owe me money for watching their children. Do I have to give them a year-end statement? Yes. You need to provide a year-end statement to your child care parents even though they have amounts they actually paid during the year. Child care expenses that do not qualify not include - not working or attending school. 73

78 Provider Name: Month Year Be sure to include A.M. and P.M. School children may have two in and out times. Do not bill for hours when child is in school. Attendance Log Child s Name: Monthly Total Time In Time Out Time In Time Out Daily Total Child s Name: Monthly Total Time In Time Out Time In Time Out Daily Total Child s Name: Monthly Total Time In Time Out Time In Time Out Daily Total DHS 7471 (3/99) 74

79 Web sites Department of Human Services Child Care Program: Oregon Center for Career Development (Oregon Registry) Background checks rules: Oregon Employment Department Child Care Division: Oregon Child Care Training Oregon Child Care Resource and Referral Network AFSCME Council 75 SEIU Local

80 Oregon Department of Human Services DHS 7492 (Rev. 3/2010)

Child Care Provider Listing Form Parent: Please give this form to your child care provider immediately.

Child Care Provider Listing Form Parent: Please give this form to your child care provider immediately. Child Care Provider Listing Form Parent: Please give this form to your child care provider immediately. Instructions to provider Keep this page for your records. 1. Please answer completely and sign the

More information

Application for Employment Related Day Care (ERDC) Program

Application for Employment Related Day Care (ERDC) Program Application for Employment Related Day Care (ERDC) Program Please read these instructions before filling out this application. Answer all questions. Do not write in the shaded areas. To contact our office

More information

Iowa Department of Human Services

Iowa Department of Human Services What Are My Rights? You have the right to: Iowa Department of Human Services Apply for any program. File an application in person, by telephone, on line, by fax or mail at any local DHS office. Have someone

More information

Application & Renewal Form

Application & Renewal Form Section A: I want health insurance for: (Check ( ) the category or categories that match your situation.) Myself, my spouse (or other parent of my children) and our children under age 19 who live with

More information

CHILDCARE ASSISTANCE PROGRAMS PARENT AND PROVIDER GUIDE

CHILDCARE ASSISTANCE PROGRAMS PARENT AND PROVIDER GUIDE CHILDCARE ASSISTANCE PROGRAMS PARENT AND PROVIDER GUIDE Ramsey County Community Human Services and Think Small Contents Customer Service Standards What child care programs are available? Who should you

More information

Application Information for Children s Health Insurance Program (CHIP), Children s Medicaid, and CHIP perinatal coverage

Application Information for Children s Health Insurance Program (CHIP), Children s Medicaid, and CHIP perinatal coverage Application Information for Children s Health Insurance Program (CHIP), Children s Medicaid, and CHIP perinatal coverage CHIP CHIP covers children from birth through age 18 who do not qualify for Medicaid

More information

225 Long Avenue Hillside, NJ 07205 Phone: (973) 923-1433 Fax: (973) 923-1311 www.ccccunion.org

225 Long Avenue Hillside, NJ 07205 Phone: (973) 923-1433 Fax: (973) 923-1311 www.ccccunion.org PROVIDER APPLICATION FORM FOR FAMILY CHILD CARE REGISTRATION 225 Long Avenue Hillside, NJ 07205 Phone: (973) 923-1433 Fax: (973) 923-1311 www.ccccunion.org Please print all information. Attach additional

More information

NOTICE OF DIRECT CERTIFICATION

NOTICE OF DIRECT CERTIFICATION East Catholic School 2001 Ardmore Blvd. Pittsburgh, PA 15221 Phone: 412/351-5403 Fax: 412/273-9114 www.eastcatholicschool.org Dear Parent/Guardian: Children need healthy meals to learn. East Catholic School

More information

Children s Protective Services Program

Children s Protective Services Program A Parent s Guide to Working with Children s Protective Services Children s Protective Services Program Michigan Department of Human Services Dear Parent: We know that every parent wants to do the best

More information

L E T T E R T O H O U S E H O L D

L E T T E R T O H O U S E H O L D Free and Reduced Price School Meals Letter to Households Page 1 of 1 L E T T E R T O H O U S E H O L D Dear Parent/Guardian: School Year 2014 2015 * * * * * * * * * * * * * * * NEW THIS SCHOOL YEAR!!!

More information

Instructions to fill out this Application

Instructions to fill out this Application Application Information for Children s Health Insurance Program (CHIP), Children s Medicaid, and CHIP perinatal coverage CHIP CHIP offers health care for children, from birth to age 18, whose families

More information

Georgia Department of Human Services Georgia Senior Supplemental Nutrition Assistance Program (SNAP) Application

Georgia Department of Human Services Georgia Senior Supplemental Nutrition Assistance Program (SNAP) Application Georgia Department of Human Services Georgia Senior Supplemental Nutrition Assistance Program (SNAP) Application This application is used for individuals applying for the Supplemental Nutrition Assistance

More information

CHILD CARE PROVIDER REIMBURSEMENT GUIDE

CHILD CARE PROVIDER REIMBURSEMENT GUIDE CHILD CARE PROVIDER REIMBURSEMENT GUIDE for Licensed, Registered, and In-Process Providers South Dakota Department of Social Services Division of Child Care Services 910 East Sioux Avenue Pierre, SD 57501

More information

Billing and Payment in the Child Care and Development Fund (CCDF) A Training for Child Care Providers In the Child Care Scholarship Program

Billing and Payment in the Child Care and Development Fund (CCDF) A Training for Child Care Providers In the Child Care Scholarship Program Billing and Payment in the Child Care and Development Fund (CCDF) A Training for Child Care Providers In the Child Care Scholarship Program 1 Webinar Attendance Policy You will only receive a certificate

More information

Child Care Financial Assistance Program

Child Care Financial Assistance Program Child Care Financial Assistance Program Provider Handbook Agency of Human Services 1 Table of Contents What is the Child Care Financial Assistance Program... 3 What is BFIS (Bright Futures Information

More information

Apply for Free and Reduced Price Meals OR Prepay for Meals Online!

Apply for Free and Reduced Price Meals OR Prepay for Meals Online! Stafford County Public Schools Apply for Free and Reduced Price Meals OR Prepay for Meals Online! Dear Parent/Guardian, Stafford County Public Schools Is pleased to announce the availability of applying

More information

Windsor School Food Service

Windsor School Food Service Windsor School Food Service Date: 08/01/14 To: Parents/Guardians: From: Dana Plant, Director of Food Service RE: School Breakfast/Lunch Program Updates Dear Parents/Guardians of Children attending the

More information

Kansas Department for Children and Families Grandparents as Caregivers Cash Assistance Application

Kansas Department for Children and Families Grandparents as Caregivers Cash Assistance Application Kansas Department for Children and amilies Grandparents as Caregivers Cash Assistance Application ollow These Steps to Apply Agency Use Only Initial Review ES-3100.9 Rev. 7-12 Complete this form or go

More information

Child Abuse, Child Neglect:

Child Abuse, Child Neglect: Child Abuse, Child Neglect: What Out of Home Caregivers Should Know if They Are Investigated Written by South Carolina Appleseed Legal Justice Center With editing and assistance from the Children s Law

More information

MEDICAID. For SSI-related persons. Iowa Department of Human Services. Comm. 28 (Rev.7/10) PRINTED ON RECYCLED PAPER

MEDICAID. For SSI-related persons. Iowa Department of Human Services. Comm. 28 (Rev.7/10) PRINTED ON RECYCLED PAPER MEDICAID For SSI-related persons Comm. 28 (Rev.7/10) PRINTED ON RECYCLED PAPER Iowa Department of Human Services DHS POLICY ON NONDISCRIMINATION No person shall be discriminated against because of race,

More information

HARTLAND CONSOLIDATED SCHOOLS

HARTLAND CONSOLIDATED SCHOOLS HARTLAND CONSOLIDATED SCHOOLS Lisa Archey, Student Nutrition Director 10632 Hibner Rd. Telephone (810) 626 2867 Hartland, MI 48353 Fax (810) 626 2869 FREQUENTLY ASKED QUESTIONS ABOUT FREE AND REDUCED PRICE

More information

Medicaid Presumptive Eligibility Instructions for Providers September 2015

Medicaid Presumptive Eligibility Instructions for Providers September 2015 Medicaid Presumptive Eligibility Instructions for Providers September 2015 KC 3767 (R-7-15) 0 MEDICAID PRESUMPTIVE ELIGIBILITY PROGRAM OVERVIEW The Medicaid Presumptive Eligibility (MPE) program is one

More information

International Baccalaureate World Schools

International Baccalaureate World Schools California Department of Education School Nutrition Programs Nutrition Services Division Pricing Letter to Household (REV. 6/2015) International Baccalaureate World Schools Primary Years, Middle Years,

More information

APPLICATION FOR HEALTH CARE COVERAGE FOR UNINSURED CHILDREN AND ADULTS

APPLICATION FOR HEALTH CARE COVERAGE FOR UNINSURED CHILDREN AND ADULTS APPLICATION FOR HEALTH CARE COVERAGE FOR UNINSURED CHILDREN AND ADULTS 1. Please read the enclosed brochure for important information. 2. You may use this application to apply for Special Care for adults

More information

Health Insurance for Illinois Families. Rod R. Blagojevich, Governor

Health Insurance for Illinois Families. Rod R. Blagojevich, Governor Health Insurance for Illinois Families Rod R. Blagojevich, Governor KC 2378KC (R-3-04) IL478-2437 KidCare and FamilyCare Plans KidCare and FamilyCare are health insurance plans for Illinois residents.

More information

A Guide to Child Protective Services for Relatives

A Guide to Child Protective Services for Relatives State of Alaska Department of Health & Social Services Office of Children s Services Caring for children is one of the most important jobs of every community. Relatives play an essential role in helping

More information

HIPAA NOTICE OF PRIVACY PRACTICES

HIPAA NOTICE OF PRIVACY PRACTICES HIPAA NOTICE OF PRIVACY PRACTICES Marden Rehabilitation Associates, Inc. Marden Rehabilitation Associates of Ohio, Inc. Marden Rehabilitation Associates of West Virginia Health Care Plus Preferred Care

More information

WHAT YOU MUST DO TO RECEIVE UNEMPLOYMENT BENEFITS

WHAT YOU MUST DO TO RECEIVE UNEMPLOYMENT BENEFITS Rev. 01/2014 Office of Unemployment Insurance Administration Unemployment Claims Unit PO Box 94094, Room 386 Baton Rouge, Louisiana 70804-9096 Unemployment Benefits Rights and Responsibilities (Benefits

More information

9. WILL THE INFORMATION I GIVE BE CHECKED? Yes and we may also ask you to send written proof.

9. WILL THE INFORMATION I GIVE BE CHECKED? Yes and we may also ask you to send written proof. Dear Parent/Guardian: Children need healthy meals to learn. Your child s school offers healthy meals every school day. Your childr en may qualify for free meals or for reduced price meals. 1. DO I NEED

More information

**Keep in mind that you do not need to mail this print-out to your local application site.**

**Keep in mind that you do not need to mail this print-out to your local application site.** **Keep in mind that you do not need to mail this print-out to your local application site.** Thank you for using PEAK to apply for benefits! Uni Cycle, your application has been submitted to Boulder on

More information

There are other Medicaid programs that require a different application from this one.

There are other Medicaid programs that require a different application from this one. MEDICAID APPLICATION FOR Qualified Medicare Beneficiaries (QMB) Specified Low Income Medicare Beneficiaries (SLIMB) Qualified Individuals 1 (QI) Working Disabled Individuals (WDI) INFORMATION FOR THE APPLICANT

More information

Enrollment Forms Packet (EFP)

Enrollment Forms Packet (EFP) Enrollment Forms Packet (EFP) Please review the information below. Based on r student(s) grade and applicable circumstances, are required to submit documentation in order to complete this step in the enrollment

More information

Welcome to the Illinois Child Care Assistance Program (CCAP) a child care provider s guide

Welcome to the Illinois Child Care Assistance Program (CCAP) a child care provider s guide State of Illinois Rod R. Blagojevich, Governor Department of Human Services Carol L. Adams, Ph.D., Secretary Welcome to the Illinois Child Care Assistance Program (CCAP) a child care provider s guide Welcome!

More information

You will need to mail or fax us copies of items that apply to your case. See the next page for a list of these items.

You will need to mail or fax us copies of items that apply to your case. See the next page for a list of these items. Getting started: Health care for children CHIP and Children s Medicaid These programs offer health-care benefits for newborns and children age 18 and younger who live in Texas. With these programs, your

More information

Rights and Responsibilities

Rights and Responsibilities Rights and Responsibilities Child Support Enforcement (CSE) 1-877-631-9973 Eligibility Requirements As a condition of eligibility, recipients are required to receive CSE services and do not have the option

More information

REHABILITATION REVIEW APPLICATION INSTRUCTIONS

REHABILITATION REVIEW APPLICATION INSTRUCTIONS DEPARTMENT OF HEALTH SERVICES Office of Legal Counsel F-83263 (05/2014) STATE OF WISCONSIN REHABILITATION REVIEW APPLICATION INSTRUCTIONS The Rehabilitation Review Application consists of eight sections,

More information

ADMISSION PACKET IMPORTANT SUBMISSION INSTRUCTIONS

ADMISSION PACKET IMPORTANT SUBMISSION INSTRUCTIONS ADMISSION PACKET IMPORTANT SUBMISSION INSTRUCTIONS This OREGON VETERANS HOME ADMISSION PACKET contains the forms required by the Oregon Department of Veterans Affairs (ODVA) to apply for residency at one

More information

Floyd Healthcare Management, Inc. Notice of Privacy Practices

Floyd Healthcare Management, Inc. Notice of Privacy Practices Floyd Healthcare Management, Inc. Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

Instructions for Completing a Medicare Savings Program (MSP) Application

Instructions for Completing a Medicare Savings Program (MSP) Application Instructions for Completing a Medicare Savings Program (MSP) Application The attached Department of Human Services (DHS) Health Services Application is used to apply for Medicare Savings Programs (MSP)

More information

2015-2016 Dependent Aggregate Verification

2015-2016 Dependent Aggregate Verification V5- DEP FORM 2015-2016 Dependent Aggregate Verification Your 2015-2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called Aggregate Verification. Northern is required

More information

Application form completely filled out and signed.

Application form completely filled out and signed. x INTERIOR REGIONAL HOUSING AUTHORITY Tribal Equity Advantage Mortgage (TEAM) Program 828 27 th Avenue i Fairbanks, Alaska 99701 Phone: (907) 452-8315 i Fax: (907) 452-8324 Applicant Name: Date of Application:

More information

Foster/Adoptive Parent INFORMATIONAL BOOKLET

Foster/Adoptive Parent INFORMATIONAL BOOKLET Foster/Adoptive Parent INFORMATIONAL BOOKLET TABLE OF CONTENTS Welcome 3 The Need for Foster Care and Adoption 4 Who are the Children? 6 Requirements 7 Am I ready? 10 Can relatives and friends do this?

More information

New York Lifeline Application

New York Lifeline Application New York Lifeline is a government program that provides a monthly discount on home or mobile telephone services. Only ONE Lifeline discount is allowed per household. Members of a household are not permitted

More information

Maniilaq Association Employment & Training P.O. Box 256 Kotzebue, AK 99752 1-800-478-3312 Ext: 7021 Fax: 1-866-832-9350 scholarships@maniilaq.

Maniilaq Association Employment & Training P.O. Box 256 Kotzebue, AK 99752 1-800-478-3312 Ext: 7021 Fax: 1-866-832-9350 scholarships@maniilaq. Maniilaq Association Employment & Training P.O. Box 256 Kotzebue, AK 99752 1-800-478-3312 Ext: 7021 Fax: 1-866-832-9350 [email protected] We will not process applications without a background report,

More information

Trumbull Career and Technical Center 528 Educational Highway Warren, Ohio 44483 Toll Free 1-866-737-6925

Trumbull Career and Technical Center 528 Educational Highway Warren, Ohio 44483 Toll Free 1-866-737-6925 Trumbull Career and Technical Center 528 Educational Highway Warren, Ohio 44483 Toll Free 1-866-737-6925 Dear Parent/Guardian: Children need healthy meals to learn. TCTC offers healthy meals every school

More information

Child & Adult Care Food Program Program Rules. Sponsored by. Child Care Development Services. 123 E Powell Blvd, Ste 300 Gresham, OR 97030

Child & Adult Care Food Program Program Rules. Sponsored by. Child Care Development Services. 123 E Powell Blvd, Ste 300 Gresham, OR 97030 Child & Adult Care Food Program Sponsored by Child Care Development Services 123 E Powell Blvd, Ste 300 Gresham, OR 97030 Coordinator 503-489-2509 Table of Contents 1. Who Is Eligible Providers 2. Who

More information

Your Medical Record Rights in Oregon

Your Medical Record Rights in Oregon Your Medical Record Rights in Oregon (A Guide to Consumer Rights under HIPAA) JOY PRITTS, JD NINA L. KUDSZUS HEALTH POLICY INSTITUTE GEORGETOWN UNIVERSITY Your Medical Record Rights in Oregon (A Guide

More information

Check below to indicate the type of credit for which you are applying. Married Applicants may apply for a separate account.

Check below to indicate the type of credit for which you are applying. Married Applicants may apply for a separate account. CREDIT CARD APPLICATION A table that includes the APRs and other required cost disclosures for credit card applications is on the next page of this application. Check below to indicate the type of credit

More information

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance NEW JERSEY HOME ENERGY PROGRAMS Home Energy Assistance Universal Service Fund Weatherization Assistance Home Energy Assistance (HEA)/Universal Service Fund (USF) and Weatherization Application Home Energy

More information

VILLAGE REHAB PROGRAM

VILLAGE REHAB PROGRAM I N T E R I O R R E G I O N A L H O U S I N G A U T H O R I T Y 8 2 8 2 7 T H A v e n u e F a i r b a n k s, A l a s k a 9 9 7 0 1 P h o n e : ( 9 0 7 ) 1-8 0 0-4 7 8-4 7 4 2 F a x : ( 9 0 7 ) 4 5 2-8

More information

ADOPTING A CHILD IN MICHIGAN. STATE OF MICHIGAN Department of Human Services

ADOPTING A CHILD IN MICHIGAN. STATE OF MICHIGAN Department of Human Services ADOPTING A CHILD IN MICHIGAN STATE OF MICHIGAN Department of Human Services Michigan Department of Human Services Adoption Services Table of Contents A. Introduction... 1 B. Definitions... 1 C. Common

More information

Health Benefits for Workers with Disabilities Application

Health Benefits for Workers with Disabilities Application Illinois Department of Public Aid Health Benefits for Workers with Disabilities Application Note: This is NOT an application for cash assistance, food stamps or enrollment in the Medicaid spenddown program.

More information

KIDCARE MEMBER HANDBOOK

KIDCARE MEMBER HANDBOOK KIDCARE MEMBER HANDBOOK KC 3793 (N-3-02) THIS HANDBOOK IS ONLY FOR CHILDREN AND PREGNANT WOMEN. IF YOU ARE AN ADULT AND NOT PREGNANT, YOU SHOULD CALL YOUR ILLINOIS DEPARTMENT OF HUMAN SERVICES (DHS) LOCAL

More information

Short Term Disability Income Plan. Benefit Booklet

Short Term Disability Income Plan. Benefit Booklet LifeMap Assurance Company 100 SW Market Street P.O. Box 1271, MS E-3A Portland, OR 97207-1271 (503) 721-7161 (800) 794-5390 Short Term Disability Income Plan Benefit Booklet OREGON PUBLIC EMPLOYEES UNION

More information

Credit Card Agreement for Best Buy Retail Cards in Capital One, N.A.

Credit Card Agreement for Best Buy Retail Cards in Capital One, N.A. Credit Card Agreement for Best Buy Retail Cards in Capital One, N.A. There are two parts to this Credit Card Agreement: Capital One Pricing Information and the Capital One Customer Agreement. The Pricing

More information

Child Support Enforcement in Oregon

Child Support Enforcement in Oregon Child Support Enforcement in Oregon If you are confused about the laws regarding child support, you are not alone. Many people have questions about child support establishment, modification, and enforcement.

More information

Visa Credit Card Cardmember Agreement

Visa Credit Card Cardmember Agreement Visa Credit Card Cardmember Agreement In this Agreement the words You, Your and Yourself mean each and all of those who apply for the card or who sign this Agreement. Card means the Visa Credit Card and

More information

A Guide For Representative Payees

A Guide For Representative Payees A Guide For Representative Payees Contact Social Security Visit our website Our website, www.socialsecurity.gov, is a valuable resource for information about all of Social Security s programs. At our website

More information

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Paternity & Support Branch

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Paternity & Support Branch SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Paternity & Support Branch PRINT YOUR NAME STREET ADDRESS CITY, STATE AND ZIP CODE SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE WRITTEN SOMEONE ELSE

More information

State of Oregon - Board of Licensed Social Workers 3218 Pringle Rd. SE, Ste. 240, Salem, OR 97302 (503) 378-5735 [email protected].

State of Oregon - Board of Licensed Social Workers 3218 Pringle Rd. SE, Ste. 240, Salem, OR 97302 (503) 378-5735 Oregon.BLSW@state.or. State of Oregon - Board of Licensed Social Workers 3218 Pringle Rd. SE, Ste. 240, Salem, OR 97302 (503) 378-5735 [email protected] LCSW License Renewal Application License Number: Renewal Date (end

More information

To apply for the Colorado HIBI program, fill out the attached application and either fax or mail it with a:

To apply for the Colorado HIBI program, fill out the attached application and either fax or mail it with a: Dear Applicant, The Colorado Health Insurance Buy-In (HIBI) program may reimburse health insurance premiums, copays, deductibles and coinsurance for a Medicaid client if the health insurance plan is cost-effective

More information

Long Term Care Program Medical Assistance Application

Long Term Care Program Medical Assistance Application Long Term Care Program Medical Assistance Application Instructions: This is an application for Medical Assistance that will cover some or all of the costs of persons who stay in approved Long Term Care

More information

Garland s Christian Counseling Center

Garland s Christian Counseling Center Garland s Christian Counseling Center : PERSONAL DATA Name: Email: Home Phone: Address: Cell Phone: Work Phone: (Street, City, Zip Code) DL #, ST & Exp : SS#: DOB: Sex: Please circle where we may leave

More information

LEGAL BRIEF RESOLVING CREDIT PROBLEMS March 2014

LEGAL BRIEF RESOLVING CREDIT PROBLEMS March 2014 LEGAL BRIEF RESOLVING CREDIT PROBLEMS March 2014 PREPARED BY NELLIS LAW CENTER, 4428 England Ave (Bldg 18), Nellis AFB, Nevada 89191-6505 702-652-5407, Appt. Line 702-652-7531 If the problems you are experiencing

More information

MASTER'S SOCIAL WORKER LICENSE ENDORSEMENT APPLICATION PACKET

MASTER'S SOCIAL WORKER LICENSE ENDORSEMENT APPLICATION PACKET Michigan Department of Licensing and Regulatory Affairs Bureau of Health Care Services Board of Social Work PO Box 30670 Lansing MI 48909 (517) 335-0918 www.michigan.gov/healthlicense Page 1 of 16 INCLUDED

More information

The Licensing Division will not process an incomplete application or an application submitted before the application fee is paid

The Licensing Division will not process an incomplete application or an application submitted before the application fee is paid Dear License Applicant: All residential and nonresidential programs required to be licensed under Minnesota Statutes, Chapter 245A, Human Services Licensing Act, must complete a license application, the

More information

Medicaid and Long-Term Care Supplemental Application for Medicaid and Insurance Affordability Programs

Medicaid and Long-Term Care Supplemental Application for Medicaid and Insurance Affordability Programs Medicaid and Long-Term Care Supplemental Application for Medicaid and Insurance Affordability Programs This form is utilized in conjunction with the application for Medicaid and Insurance Affordability

More information

The application must include the signature of the victim or of the claimant if the victim is under the age of 18 years old.

The application must include the signature of the victim or of the claimant if the victim is under the age of 18 years old. Denver Crime Victim Compensation Application Check List In order to ensure that your application is processed as quickly as possible, please review the following checklist: The incident must have been

More information

Arizona Form 2013 Individual Amended Income Tax Return 140X

Arizona Form 2013 Individual Amended Income Tax Return 140X Arizona Form 2013 Individual Amended Income Tax Return 140X Phone Numbers For information or help, call one of the numbers listed: Phoenix (602) 255-3381 From area codes 520 and 928, toll-free (800) 352-4090

More information

3.1 Kindergarten students must be 5 years old on or before September 1 st.

3.1 Kindergarten students must be 5 years old on or before September 1 st. 201. ADMISSION OF STUDENTS Date Adopted: October 22, 2015 1. Purpose 1.1 The Green Woods Charter School adheres to the State law requiring admission to be open by lottery and/or established criteria, including

More information

A GUIDE TO CHILD WELFARE SERVICES

A GUIDE TO CHILD WELFARE SERVICES A GUIDE TO CHILD WELFARE SERVICES State of Hawaii Department of Human Services Social Services Division Child Welfare Services Branch Revised March 2013 NEIL ABERCROMBIE GOVERNOR PATRICIA McMANAMAN DIRECTOR

More information

2015-2016 Dependent Verification

2015-2016 Dependent Verification V6- DEP FORM 2015-2016 Dependent Verification Your 2015-2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. Northern must compare information

More information

Appeal Request Form. APPEAL INFORMATION Primary contact name (first, middle, last, and suffix): Maiden or other name: Eligibility notice date:

Appeal Request Form. APPEAL INFORMATION Primary contact name (first, middle, last, and suffix): Maiden or other name: Eligibility notice date: Appeal Request Form If you would like to submit an appeal to Cover Oregon and/or the Oregon Health Authority for any of the reasons listed below, this form must be filled out completely. You can fill out

More information

Understanding Financial Aid. with the help of a few real characters

Understanding Financial Aid. with the help of a few real characters Understanding Financial Aid with the help of a few real characters Financial Aid Terms FAFSA: Free Application for Federal Student Aid; the online form you and your parents submit (if you are age 24 or

More information

Debtors Rights: Dealing with Collection Agencies

Debtors Rights: Dealing with Collection Agencies Debtors Rights: Dealing with Collection Agencies Are you being contacted by debt collection agencies? This publication should help you understand debt collection practices and your rights when dealing

More information

Important Notice regarding your Family Child Care License Renewal

Important Notice regarding your Family Child Care License Renewal The Commonwealth of Massachusetts Thomas L. Weber, Acting Commissioner Important tice regarding your Family Child Care License Renewal Your Family Child Care License is due for renewal. In order to maintain

More information

Your Medical Record Rights in Arizona

Your Medical Record Rights in Arizona Your Medical Record Rights in Arizona (A Guide to Consumer Rights under HIPAA) JOY PRITTS, JD NINA L. KUDSZUS HEALTH POLICY INSTITUTE GEORGETOWN UNIVERSITY Your Medical Record Rights in Arizona (A Guide

More information

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance NEW JERSEY HOME ENERGY PROGRAMS Home Energy Assistance Universal Service Fund Weatherization Assistance Home Energy Assistance (HEA)/Universal Service Fund (USF) and Weatherization Application Home Energy

More information

Flexible Spending Account Employee Guide

Flexible Spending Account Employee Guide WHAT IS A FLEXIBLE SPENDING ACCOUNT (FSA)? A Flexible Spending Account, sometimes referred to as a Section 125 Plan, is a company-sponsored program, which allows you to voluntarily set aside pre-tax dollars

More information

VISA CLASSIC CONSUMER CREDIT CARD AGREEMENT

VISA CLASSIC CONSUMER CREDIT CARD AGREEMENT VISA CLASSIC CONSUMER CREDIT CARD AGREEMENT In this Agreement, Agreement means this Consumer Credit Card Agreement. Disclosure means the Credit Card Account Opening Disclosure. The Account Opening Disclosure

More information

New York State Crime Victims Board

New York State Crime Victims Board New York State Crime Victims Board Claim Application and Instructions 1 Columbia Circle, Suite 200 Albany, NY 12203-6383 (518) 457-8727 55 Hanson Place, Room 1000 Brooklyn, NY 11217-1523 (718) 923-4325

More information

Share Secured Visa Credit Card Agreement. 10.99% when you open your accounts, based on your credit worthiness.

Share Secured Visa Credit Card Agreement. 10.99% when you open your accounts, based on your credit worthiness. Share Secured Visa Credit Card Agreement Interest Rates and Interest Charges ANNUAL PERCENTAGE RATE (APR) for Purchases APR for Balance Transfers 10.99% 10.99% when you open your accounts, based on your

More information

DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292

DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292 DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292 COMMUNITY PHARMACY PERMIT APPLICATION AND INFORMATION August 2012

More information

LUMP-SUM DEATH PAYMENT, RESIDUAL LUMP-SUM, AND ANNUITIES UNPAID AT DEATH

LUMP-SUM DEATH PAYMENT, RESIDUAL LUMP-SUM, AND ANNUITIES UNPAID AT DEATH For Use With Form AA-21 LUMP-SUM DEATH PAYMENT, RESIDUAL LUMP-SUM, AND ANNUITIES UNPAID AT DEATH Railroad Retirement Board Visit our Web site at http://www.rrb.gov FORM RB-21 (12-02) Paperwork Reduction

More information

Fair Credit Reporting Act Compliance Guide

Fair Credit Reporting Act Compliance Guide Fair Credit Reporting Act Compliance Guide FAIR CREDIT REPORTING ACT TABLE OF CONTENTS Page I. INTRODUCTION...1 A. Increased Applicant and Employee Rights...1 B. What is a "Consumer Report?"...1 C. What

More information