Form Sr 2a-Wp - Child Care And Supervision Component Program Audit Working Paper
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1STATE OF CALIFORNIA–HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
DATE
INITIALS
CHILD CARE AND SUPERVISION COMPONENT
Prepared By
PROGRAM AUDIT WORKING PAPER (SR 2A-WP)
Approved By
PROVIDER NAME:
PROGRAM NAME:
PROGRAM NUMBER:
PROGRAM AUDIT DATE:
SALARY
RATE
EMPLOYEE:
AUDIT PERIOD
Full-Time
Part-Time
$
$
A. DOCUMENTATION REVIEWED:
Employee Timesheets
Agency Payroll Records
Personnel File
Other
Date Hired:
Date Terminated:
Evidence of CCL Compliance:
______
______
______
In file?
YES
NO
Dates:
FP submission
Association
Exemption
______
Child Abuse Index
Duties:
CCS
First Line Supervisor
Other
Admin/Ex. Director
Comments:
B. EXPERIENCE (SR 2A - Column C) (Refer to MPP Sections 11-400r(7) and 11-402.221(c))
Reported Weighting: FTE months
0 - 23 months
(.00)
24 - 47 months
(.15)
48+ months
(.25)
Verified/Weighting: FTE months
0 - 23 months
(.00)
24 - 47 months
(.15)
48+ months
(.25)
Documentation Reviewed:
Resume/Application ............................................
YES
NO
Other - Specify: ________________________
YES
NO
Past Employer Certification .................................
YES
NO
Comments:
If weighting is different from provider’s weighting:
experience not applicable
experience not documented
C. EDUCATION (SR2A - Column D) (Refer to MPP Sections 11-400f(9) and 11-402.221(d), and August 30th Report.)
Reported Weighting:
0 - 59 Units
60+ Units
(.05)
BA - Other
(.10)
BA - Behavioral Science
(.25)
MA - Behavioral Science
(.40)
Verified/Weighting:
0 - 59 Units
60+ Units
(.05)
BA - Other
(.10)
BA - Behavioral Science
(.25)
MA - Behavioral Science
(.40)
Documentation Reviewed:
Diploma
Official Transcripts
Certification from Educational Institution
Foreign Degree
If weighting different from provider’s weighting:
Cannot verify units/degree
Foreign degree not evaluated for equivalency
Degree not from accredited or approved institution
Degree not in a behavioral science
Comments:
SR 2A-WP (12/02)
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