Form Sr 7 - Social Worker Direct Contact Contract Weighting Worksheet

Download a blank fillable Form Sr 7 - Social Worker Direct Contact Contract Weighting Worksheet in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Sr 7 - Social Worker Direct Contact Contract Weighting Worksheet with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

SOCIAL WORKER DIRECT CONTACT CONTRACT WEIGHTING WORKSHEET (SR 7)

SOCIAL WORKER

PROFESSIONAL LEVEL

CONTRACT PERIOD

ATTACH COPY OF GROUP HOME/SOCIAL WORKER CONTRACT WHICH SHOWS SERVICES TO BE PROVIDED AND

TERMS OF PAYMENT.

Does the contract reimburse only for those hours spent in direct contact with children being served,

and not for such activities as intake, discharge, quarter reports, training, supervision, or the

YES

development of plans or the assessments of needs, etc.? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Does the group home have another social worker who performs the ancillary activities listed above?

YES

If not, who takes care of these duties?__________________________________________________

Is the contract social worker expected to perform ancillary activities for which he/she is not

YES

reimbursed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(If so, the written contract may not be an accurate representation of the actual agreement between

the provider and social worker.)

MPP Section 11-400(d)(6) states that a social worker eligible for double weighting shall be an

independent contractor as provided by state and federal laws, including Section 3353 of the California

YES

Labor Code. Is this contractor independent according to the criteria in the Labor Code? . . . . . . . . . . .

Does the group home have the right to exercise control over the social work activities

YES

performed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES

Does the group home have the right to terminate the relationship at will? . . . . . . . . . . . . . . . . . . . .

YES

Is the work of the social worker performed under the supervision of the group home? . . . . . . . . . .

(“YES” answers to any of the questions above indicate an employer/employee relationship rather

than an independent contractor.)

Does this social worker qualify for double weighting for direct contact contract SW services

according to MPP Sections 11-400(d)(6) and 11-402.222(d)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

YES

SR 7 (12/02)