Effective Date: 12/7/98
The minimum requirements for documents that comprise a client's case record are:
- Child Care Application - Form 3455, Form 3455S*
- Approval of Request for Child Care Payments - Form 3455A, 3455AS*
- Denial of Request for Child Care Payments - Form 4179, 4179S*
- Notice of Cancellation for Child Care Payments - Form 4178, 4178S*
- Child Care Certificates - Form 3492, 3492A, or 3492B
- Request for Additional Information - Form 4480, 4480S*
- Request for a Child Care Provider Change - Form 3455G, 3455GS*
- Request for Redetermination Information - Form 3455E, 3455ES*
- Request for Reimbursement - Form 3455F
- Two most recent and consecutive pay stubs or other income documentation
- Responsibility and Service Plan (RSP) or other appropriate local office documentation
*Spanish version of the form.
The documents listed above are not required to be physically maintained in the same case record.
CCR&R Directors and Site Administered Providers must establish adequate internal controls to ensure that files are maintained in a logical fashion and retrieval is possible without excessive delays.
If possible, documents comprising the file should be original, including original signatures, and be complete.
A case record may also contain other information in addition to the minimum requirements. Examples of other information are case notes, documentation of a phone conversation, and written correspondence.