Reimbursement
How to initiate an Enrollment

Required Forms that Need to be Completed and Returned In Order to Start Reimbursement Payment for Your Services.

• SubContracted and Non-SubContracted Providers

  • IRS W-9 Form
  • Survey of Services and Proposed Rates and Fees
  • Holiday Schedule (Centers only)
  • Non-subcontracted Provider Agreement (Non-subcontracted only)
  • Payment Information Form
  • Authorization Agreement for Automatic Direct Deposit - must include a VOIDED check or savings deposit slip
    
    
• Informal (Relative/Non-Relative) Providers
  • IRS W-9 Form
  • Abuse Background Check - You MUST complete Section II in its entirety before submitting to CCC or your PAYMENT will be delayed
  • Provider Affidavit
  • Payment Information Form
  • Relative/Non-Relative Affidavit
  • Non-subcontracted Provider Agreement
  • Authorization Agreement for Automatic Direct Deposit - must include a VOIDED check or savings deposit slip

Other Financial Information for all Providers

Maximum Rate Schedule for 2008-2009

Direct Deposit

• Required by all providers

• Saves mail delays and/or lost checks

• Saves trips to the bank

Provider Early Payment Program

• Available to contracted providers only

• Provides two payments per month instead of one

• Early payment received by direct deposit only

• Must have at least two scholarship children in care for homes and must have at least five for centers

Finance's Responsibility

• We strive to have all attendance rosters processed and ready for reimbursement payment by the 20th of every month.

The Certificate/Voucher for Child Care Scholarship

• This form is used when a client has not yet selected a child care program at the time of their eligibility determination.

• The client will present the Certificate /Voucher form to the child care program of their choice.

• An individual form will be issued for each child in the family needing child care services.

• The child care provider must contact CCC the day the child begins care to obtain a confirmation number in order for reimbursement payment to begin.

• This confirmation number will match the Notice of Enrollment form confirmation number that is being provided for your records.

• The CCC phone number and department to contact are located at the bottom of the Certificate/Voucher for Child Care Scholarship form.

The Notice of Child Care Enrollment

• This “system” generated form is produced after confirmation of acceptance of the child has been made with the program.

• Once the enrollment has been processed and the paperwork is completed, the form will be mailed to both the child care program and the parent.

How to Complete an Enrollment/Attendance Verification Roster

• In the top left-hand corner write your name, address, Provider ID/Social Security Number and phone number; write child(ren)'s name, and child ID number in the spaces provided (if not already done for you).

• In the bottom left corner instructions are listed on how to mark your attendance roster
  S=start date, E=excused absence, H=holiday, T=terminated, N=enrolled, non reimbursable

• YOU MUST SIGN AND DATE the Enrollment/Attendance Certification (Roster) and return to the Finance Department at CCC in Pinellas Park by the 3rd of the following month, (i.e. if you cared for the children in January you must have the attendance roster in to finance by February 3rd).
  
  Attendance rosters received after the 3rd of the month are considered LATE.

*Finance must receive your completed and signed attendance roster by the 3rd of the month in order to pay you by the 20th of the month.

1099-MISC Forms mailed to all providers by January 31st of each year based on checks received from January 1st through December 31st, not the reimbursement period.

Click here to go to Forms for Providers