Form Sr 2 A - Child Care And Supervision Component Program Worksheet Page 2
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1
2INSTRUCTIONS TO COMPLETE
CHILD CARE AND SUPERVISION COMPONENT PROGRAM WORKSHEET (SR2A)
PROVIDER NAME:
Enter the provider/licensee name shown on the
COLUMN D - EDUCATION
Group Home Program Rate Application (SR1).
0 - 59 UNITS - Enter 0 for staff with this number of college units.
MONTH/YEAR:
Month and year for hours worked
60+ UNIT - Enter .05 for staff with 60 or more college units.
CCS/FIRST - LINE SUPERVISPOR:
List names of all staff members who
BA - Other - Enter .10 for staff with BA in a major other than
are performing child care and first-line supervision activities.
behavioral science.
COLUMN A - PAID-AWAKE HOURS - Enter the total number of paid-
BA - Behavioral Science - Enter .25 for staff with a BA in
awake hours for each individual providing child care and first-line
behavioral science.
supervision, including hours of paid vacation or sick leave.
MA - Behavioral Science - Enter .40 for staff with a MA in
(Maximum weekly totals per individual cannot exceed 54 hours.)
behavioral science.
Transfer to SR 2, Column (2).
COLUMN E - TRAINING
COLUMN B - VERIFIED HOURS - Providers do not complete - for FCARB
40+HOURS - Enter .10 for all staff if the provider furnishes 40 or
use only.
more hours of formal training per year/FTE (Full-Time Equivalent)
COLUMN C - EXPERIENCE
for child care staff.
0-23 MONTHS - For staff with this amount of residential child care
COLUMN F - WEIGHTING
experience, enter 0.
Enter 1.0 plus the sum of the weightings from Columns C, D, and
24-47 MONTHS - For staff with this amount of residential child
E.
care experience, enter .15.
(Maximum total cannot exceed 1.75.)
48+ MONTHS - For staff with this amount of residential child care
COLUMN G - TOTAL WEIGHTED HOURS
experience, enter .25.
Multiply Column A times Column F.
COLUMN A - TOTAL
Enter the grand total paid awake hours, transfer to SR 2, Column
2.
COLUMN G - TOTAL
Enter the grand total weighted hours; transfer to SR 2,
Column (3).
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