Form Na 832 - Notice Of Action - Child Care Services
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1
2NOTICE OF ACTION
STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CHILD CARE SERVICES
Notice Date :
Case
Name
:
Number
:
Worker
Name
:
Number
:
Telephone :
Address :
(ADDRESSEE)
Questions? Ask your Worker.
State Hearing: If you think this action is wrong,
you can ask for a hearing. Your benefits may not be
changed if you ask for a hearing before this action
takes place. If you and the county disagree or if
you have not heard back from your worker, do not
wait to ask for a hearing. You must ask for the
hearing before a certain number of days. See the
back of this notice for more information and to find
out how to ask for a hearing.
CHILD CARE SERVICES
NOTICE
If you have selected a new provider who is required to register
You are approved for child care ser vices star ting on
with TrustLine, this provider is not eligible for reimbursement
___________ for ___________________________________.
until he/she is registered with TrustLine. License-exempt child
(DATE)
(NAME OF CHILD(REN)
care providers who are required to be TrustLine-registered
shall be entitled to receive retroactive reimbursement for up to
Your approved activity/program is less than 30 days. Your
120 calendar days from the date child care services were
child care will end on _________________. You will not get
requested and provided, whichever is later, if the provider
another notice when child care services will end. If you get
later becomes TrustLine-registered.
another activity/program, we will send a new child care
approval notice.
REMINDERS
You must tell us before you change child care providers (except in
CHILD CARE REIMBURSEMENT
an emergency) or we may not be able to approve and reimburse
You have chosen an eligible child care provider
the new provider for child care services.
(licensed/license-exempt) who is TrustLine-registered or who
is exempt from TrustLine.
If you choose child care in your home (in-home care), you are
considered the employer. This means you may be responsible for
The county may reimburse child care services only for the
paying at least the state’s minimum wage, social security tax,
hours and days you do your approved activity/program as
Medicare taxes and state worker’s compensation insurance for
follows:
your provider. You may also be responsible for unemployment
taxes.
If you do not choose in-home child care, the provider is responsible
CHILD NAME:
CHILD NAME:
for reporting income and payment of any federal or state income
taxes.
PROVIDER NAME:
PROVIDER NAME:
For more information contact your local child care resource and
CHILD CARE HOURS:
CHILD CARE HOURS:
referral program at (800) 543-7793.
RATE:
RATE:
REIMBURSEMENT LIMIT:
REIMBURSEMENT LIMIT:
CHILD NAME:
CHILD NAME:
PROVIDER NAME:
PROVIDER NAME:
CHILD CARE HOURS:
CHILD CARE HOURS:
RATE:
RATE:
REIMBURSEMENT LIMIT:
REIMBURSEMENT LIMIT:
The child care rate, type and reimbursement limit are based on
Rules: These rules apply. You may review them at your welfare
information you gave us. The rate is the most we can reimburse
office: CalWORKs MPP Sections 47-260, 47-430, 47-620, 47-630;
based on what your child care provider charges or your area’s child
Education Code Sections: 8350-8353, 8357; Welfare & Institutions
care costs, whichever is less. You are responsible to pay any
Code Sections 11322.9, 11323.6, 11323.8, and 11324, or visit
difference above this rate.
or
NA 832 (10/14) REQUIRED FORM - SUBSTITUTES PERMITTED
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