Child Care Handbook 47-3.1: Revised CalWORKs Child Care Request Form and Referral Process
Effective Date: 05/01/09
Published Date: 04/23/09
Published By: D126
This handbook is being published to notify all Employment Services staff of the revision of the CalWORKs Child Care Request Form (CCRF), #42-10 and the modified process for completing and submitting CCRF’s. The purpose of this revision is to minimize the amount of information required in completing a CCRF and to streamline the referral process. To ensure we are in compliance with requirements for Personal Identifiable Information (PII), Employment Counselors (ECs) will no longer fax CCRF’s. The revised CCRF is an electronic form and will replace the old CCRF. All old stock should be destroyed.
Effective May 1, 2009 ECs must use the revised CCRF and forward them to the appropriate Stage One Child Care agency via email. Both Stage One Child Care agencies have a designated email address that all CCRF’s must be forwarded to. As of the effective date, the Stage One Child Care agencies will only accept CCRF’s emailed from the ECs and EC Supervisors. They will no longer process faxed CCRF’s or forms brought in by participants. Listed below are the designated Stage One Child Care agency’s email addresses for CCRF’s:
South County - 4C’s Email: firstname.lastname@example.org
(Servicing: Fremont, Newark, Union City, Hayward, San Leandro, San Lorenzo, and Castro Valley)
North County - Child Care Links Email: email@example.com
(Servicing: Oakland, Alameda, Albany, Berkeley, and Emeryville)
East County - Child Care Links Email: firstname.lastname@example.org
(Servicing: Pleasanton, Dublin, Livermore, and Sunol)
When a participant makes a request for childcare services, eligibility must be determined within 30 days of the request. Once the participant is determined eligible, child care services must be authorized using the revised CCRF.
In all instances where a participant has requested childcare services within the allowable timeframes and has been determined eligible, a CCRF must be completed. See examples below.
- If a participant is already receiving childcare services from a provider and child care subsidy is needed, they must request it. The request must be within 30 days of the first day that they receive childcare services. If child care is authorized, a CCRF must be completed. Refer to Child Care Newsletter 05-01: Child Care Retroactive Payments.
- If a participant begins an approved Welfare to Work (WTW) activity and childcare is needed, a CCRF Child Care Newsletter: 08-03 Child Care Request Form Timeframes.
Process for Completing and Submitting CCRF:
I. Employment Counselors shall:
Review request for child care per verbal request or form #42-2, Request for Child Care / Transportation form.
Verify activity schedule and determine participant’s eligibility for child care.
If not eligible for child care, a childcare denial notice must be sent.
Access online CCRF from the forms section of the Intranet.
Save blank CCRF on “Y” drive. (Click on link for detailed instructions on how to ‘Save’)
- Click ‘File’;
- Select ‘Save As’;
- Select “Y” drive and double click; and,
- ‘Save As’ CCRF.
Complete CCRF on computer entering all required information. (Click link for CCRF)
Print two (2) copies of CCRF once final:
- One (1) copy shall be given to or mailed to participant.
- One (1) copy shall be sent to Web Files for imaging.
Email CCRF to the appropriate Stage One Child Care agency.
- Click on file and select Send To: Mail Recipient (as attachment).
Enter the designated email address for the appropriate Stage One Child Care agency and send email.
- If CCRF authorized beyond 30 days, submit to supervisor for review via email.
Document child care approval or denial in Case Comments.
- Save completed CCRF in ‘Y’ drive. (Click on link for detailed instructions on how to ‘Save’)
- Save under CCRF folder with the participants first andlast name and the date issued.
II. Employment Counselor Supervisors shall:
Provide an explanation in the notes section if CCRF is approved beyond 30 days.
Enter their name and phone number in the notes section of CCRF.
Submit CCRF via email to the appropriate Stage One Child Care agency, and send a copy to the EC so that it can be sent to Web Files for imaging.
Important Notes: If a CCRF is authorized beyond 90 days, then the EC Supervisor will forward CCRF with a summary of the facts as to the reason for the delay in completing the authorization to Program Planning and Support. The Child Care Program Specialist will review, approve or deny and forward to the appropriate Stage One Child Care agency and EC Supervisor.
Child Care Newsletter 05-01: Child Care Retroactive Payments
Child Care Newsletter 08-02: Child Care Request Form Time Period Guidelines
Child Care Newsletter 08-03: Child Care Request Form Timeframes
Child Care Authorization Form
Instructions for Saving Online Forms
Yolanda Baldovinos, Director
Social Services Agency