Verification of Child Care Costs 400-28-130

 

Child Care Request for Payment 400-28-130-05

(Revised 10/1/20 ML #3574)

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NDAC 75-02-01.3-06

 

Child care costs incurred for a calendar month must be verified by using and completing the SFN 616, Child Care Request for Payment form, or through the submission of provider payment request through the Self Service Portal (SSP). It is the responsibility of the child care provider to complete the Child Care Request for Payment form, or submit the provider payment request through the SSP each month.

 

Both the caretaker and the provider are required to sign and date the SFN 616, Child Care Request for Payment form AFTER the form has been completed.

 

When submitting a payment request through the SSP, it is not necessary to also obtain a signed SFN 616.

Either the caretaker or the provider may submit the form to the county office.

If the form is not complete, the form should be returned to the caretaker or provider for completion. Column 3 of the SFN 616 can be left blank and still be accepted as a completed form. When left blank, no additional absent hours are allowed.

 

Completed forms must be processed with 21 days from the date the completed form is received in the county office.

 

The county office must document on the form the date the form was received in the county office.

Note: Forms received after business hours, on weekends or holidays are considered received on the next business day.

 

If a provider or a caretaker is not available or refuses to complete or date the Child Care Request for Payment form, the eligibility worker will be expected to explore all avenues of locating the person who needs to complete, sign, or date the form. If the information needed to complete the form can be reasonably established by the provider or caretaker, payment can be made without completion by the missing party. A third part may attest to the accuracy of the billing report form only if the individual who needs to complete the form cannot be located. All actions taken must be documented in the system case narrative.