Get Ca Scd 1755b - Santa Clara County 2017-2026

The CA SCD 1755B form is crucial for child care providers billing for services rendered to clients under the CalWORKs Employment Services Program in Santa Clara County. This guide provides clear, step-by-step instructions to assist you in successfully completing the form online.

Follow the steps to complete the CA SCD 1755B form accurately.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Provide the necessary information in Section 1. Indicate if there is a new address by checking ‘Yes’ if applicable. Enter your provider/site name, billing address, telephone number, and social security number or Tax I.D. number, depending on your licensing status.
3. In Section 2, select the appropriate option regarding your provider type: Licensed or Licensed-Exempt. If you are licensed, include your facility license number.
4. For Section 3, indicate where child care services are provided. Options include Family Day Care Home, Child’s Home, other locations, or Child Care Center. If you choose 'Other,' please provide an explanation.
5. In Section 4, specify whether you are including an annual registration fee for the billing month.
6. In Section 5, enter the child's name and their school hours. If applicable, check the box indicating that the child is not in school and provide the age of the child.
7. Fill out Section 6 with the total number of hours, days, weeks, or months for billing. Below, select the appropriate rate category that corresponds to the time frame indicated.
8. In Section 7, enter the rate you charge for child care services and explain the rate category used referencing the 'Child Care Provider’s Guide to CalWORKs Child Care.'
9. Finally, in Section 8, calculate the requested monthly total by multiplying the numbers entered in Section 6 by the rate in Section 7 and enter the result.
10. Review the certification statements, sign, date the form, and return it to the parent on the first working day following the billing month.

Start completing the CA SCD 1755B form now to ensure accurate billing for your child care services.