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Record Review Worksheet for 2014-2016 (ACF-403)

Published: April 24, 2014
Categories:
Child Care Development Fund (CCDF) Reporting
Topics:
Data Reporting, Program Integrity, States/Territories
Types:
Form

OMB Control Number: 0970-0323
Expiration Date: September 30, 2015

CHILD ID#                                 STATE:                                    COUNTY:                                      SAMPLE MONTH/YEAR:                                                       REVIEW DATE:

ELEMENTS OF ELIGIBILITY & PAYMENT DETERMINATION (1)

ANALYSIS OF CASE RECORD (2)

FINDINGS (3)

Results(4)

SECTION I. STATE CHILD CARE PROGRAM FORMS

100 APPLICATION/REDETERMINATION FORMS

Determine whether required eligibility forms meet all State and Federal policies in effect during the sample review month. Examples include (1) application form, (2) child care agreement, and (3) voucher or certificate, as applicable.

 

 

100 RESULTS

1 No Error / Error
2 Insufficient/ Missing Documentation

SECTION II. PRIORITY GROUP PLACEMENT

200 PRIORITY GROUP PLACEMENT

Determine whether client meets criteria of any State-designated priority group, e.g., special needs or low income.

 

 

200 RESULTS

1 No Error / Error
2 Insufficient/ Missing Documentation

SECTION III. GENERAL PROGRAM REQUIREMENTS

300 QUALIFYING HEAD OF HOUSEHOLD

Determine whether 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
2 Insufficient/ Missing Documentation

310 RESIDENCY

Determine whether client is a resident according to State policy.

 

 

310 RESULTS

1 No Error / Error
2 Insufficient/ Missing Documentation

 

 

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 under the State’s definition.

 

 

320 RESULTS

1 No Error / Error
2 Insufficient/ Missing Documentation

330 QUALIFYING CHILD

Determine if child meets eligibility criteria 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, and (4) if child meets citizenship/qualified alien status as set forth in Federal policy.

 

 

330 RESULTS

1 No Error / Error
2 Insufficient/ Missing Documentation

340 QUALIFYING CARE

Determine number of hours of care authorized during review period based on State policy.

 

 

340 RESULTS

1 No Error / Error
2 Insufficient/ Missing Documentation

350 QUALIFYING CARE AND PROVIDER ARRANGEMENT

Determine whether 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, and that the provider met all regulatory requirements.

 

 

350 RESULTS

1 No Error / Error
2 Insufficient/ Missing Documentation

SECTION IV. INCOME AND AUTHORIZATION

400 INCOME / INCOME STANDARDS / PARENTAL FEE CALCULATION

*Describe income verification and calculations for household members. Specify time period (e.g., based on 4 weeks prior to application) and all income to be considered based on State policies and definitions (e.g., head of household employment).

*Determine whether household income meets State requirements (e.g., family gross income must be within X percent of State's median income).

*Identify the eligibility worker’s subsidy amount for a sample review month.

*Determine whether the subsidy amount was based on income and family size, the State's payment rate schedule, and any sliding fee schedule, if applicable.

 

 

400 RESULTS

1 No Error / Error
2 Insufficient/ Missing Documentation

410 PAYMENT / COMPUTATIONS

Compare the eligibility worker's subsidy amount with the reviewer's subsidy amount. If there is a difference, compare the reviewer’s subsidy amount to the sample month payment amount.

  • If the sample month payment amount is greater,the difference is an overpayment.
  • If the sample month payment amount is less, the difference is an underpayment.

 

 

410 RESULTS

  1. No Error / Error
  2. Insufficient/ Missing Documentation
  3. Overpayment Underpayment
  4. Total Amount of Improper Payment
  5. Total Payment Amount for Sample Month

The coding for the Results Column for Elements 100 – 400 is as follows: 1: "0" = no error, "1" = error; 2: "Y" = error due to missing or insufficient documentation, "N"
= error not due to missing or insufficient documentation, and "NA" = no error. The coding for the Results Column for Element 410 is as follows: 1: "0" = no error, "1" = error; 2: "Y" = error due to missing or insufficient documentation, "N" = error not due to missing or insufficient documentation, and "NA" = no error; 3: “U” = Underpayment, “O” = Overpayment, and "NA" = no improper payment; 4: Enter dollar amount of error; 5: Total Payment Amount for Sample Month.

"THE PAPERWORK REDUCTION ACT OF 1995" Public reporting for this collection of information is estimated to average 6.33 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.