Measuring Improper Authorizations for Payment in the Child Care Program:
Improper Authorization for Payment Data Collection Instructions [Approved August 31, 2007]
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OMB Control No. 0970-0323
Expiration date: 08/31/2010
ATTACHMENT 1. RECORD REVIEW WORKSHEET (TEMPLATE) (ACF-400)
CHILD ID# STATE: COUNTY: SAMPLE MONTH/YEAR: REVIEW DATE:
SECTION I. STATE CHILD CARE PROGRAM FORMS |
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| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4)4 | |
| 100 APPLICATION/RE-DETERMINATION FORMS Determine presence, date, and completeness of required eligibility forms. Examples include (1) signed and dated CCDF application form, (2) child care agreement, (3) voucher or certificate, and (4) provider invoice. Specify conditions of dollar error, including (1) form expired, (2) no application form, and (3) no documentation of income and work hours. |
100 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
SECTION II. PRIORITY GROUP PLACEMENT |
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| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 200 PRIORITY GROUP PLACEMENT Determine if client meets criteria of any State-designated priority groups, e.g., (1) teen parent in high school, (2) TANF recipients in eligible work activities, (3) working parents with very low incomes, and/or (4) foster parents etc. |
200 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
SECTION III. GENERAL PROGRAM REQUIREMENTS |
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| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 300 QUALIFYING HEAD OF HOUSEHOLD Determine if client meets parent definition (parent means a parent by blood, marriage or adoption and also means a legal guardian, or other person standing in loco parentis), e.g., (1) parent, (2) step-parent, (3) legal guardian, (4) needy caretaker relative, or (5) spouse of same. |
300 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 310 RESIDENCY Determine if client is a resident of the State and for what duration, if client is a resident of the county and for what duration, and whether there is an agreement regarding eligibility among counties. |
310 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 320 PARENTAL WORK/TRAINING STATUS To receive services a child's parent or parents must be working or attending a job training or educational program or have a child receiving or needing to receive protective services. |
320 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 330 QUALIFYING CHILD Determine if child is eligible for services, including (1) younger than 13 years, (2) younger than 19 years and physically or mentally incapable of caring for himself or herself, or under court supervision or (3) meets other eligibility requirements defined in the State Plan. Determine if child meets citizenship requirements as set forth in Federal policy. |
330 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 340 QUALIFYING CARE Determine number of hours needing authorization during review period, based on parental work/training status or child's protective services status. Determine hours and type of care authorized. |
340 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 350 QUALIFYING PROVIDER ARRANGEMENT Determine if services are provided by a center-based child care provider, a group home child care provider, a family child care provider or an in-home child care provider that is legally operating and eligible to receive child care subsidies. |
350 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 360 PROVIDER REQUIREMENTS Determine if regulatory requirements are met. Regulatory requirements means requirements necessary for a provider to legally provide child care services in a State or locality, including registration requirements established under State, local, or tribal law. |
360 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
SECTION IV. INCOME AND AUTHORIZATIONS |
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| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 400 INCOME Describe income documentation verification for household members. Specify time period (e.g., based on four weeks prior to application) and all income to be considered based on State policies and definitions (e.g., head of household employment). |
400 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 410 INCOME ELIGIBILITY Determine if household income meets State requirements (e.g., family gross income must be within X percent of State's median income). |
410 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4)4 | |
| 420 PAYMENT AMOUNT AUTHORIZED Determine the amount of subsidy payment authorized for the sample review month. Determine if the amount authorized was based on income and family size, the State's payment rate schedule, and any sliding fee schedule, if applicable. |
420 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
| ELEMENTS OF ELIGIBILITY & PAYMENT AUTHORIZATION (1) | ANALYSIS OF CASE RECORD (2) | FINDINGS (3) | RESULTS (4) | |
| 430 AUTHORIZATIONS/COMPUTATIONS Compute the difference between the amount authorized to be paid in the sample review month and the amount that should have been authorized. This difference is the error amount. Indicate if the error amount is an Overauthorization or Underauthorization. This is the method for calculating the error amount in all cases, including those with multiple errors. In cases without errors this element is not applicable. |
430 RESULTS | |||
| 1. | No Error Error |
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| 2. | Insufficient/ Missing Documentation | |||
| 3. | Underauthorization Overauthorization | |||
| 4. $ | Total Amount of Improper Authorization for Payment | |||
"THE PAPERWORK REDUCTION ACT OF 1995"
Public reporting for this collection of information is estimated to average 15.43 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
4The coding for the Results Column is as follows: Element 1: "0" = no error, "1" = error; Element 2: "Y" = error due to missing or insufficient documentation, "N" = error not due to missing or insufficient documentation, and "NA" = no error; and Element 3: "U" = Underauthorization, "O" = Overauthorization, and "NA = no improper authorization for payment.
Instructions for Completing Record Review Worksheet: >>