Get Foster Family Agency Data And Certification Sheet (fcr 1ffa) - Dss Cahwnet

This guide provides a comprehensive overview of how to accurately fill out the Foster Family Agency Data And Certification Sheet (fcr 1ffa) online. Following these detailed instructions will help ensure that your submission is complete and meets the required standards.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the data section, enter the following information: For the agency fiscal year, indicate the starting and ending month and year. For licensee name, provide the name listed on the FFA license.
3. In the agency name field, enter the common name of the organization. Please ensure that the mailing address matches the address on file with the Department, including the number, street, and postal code.
4. For the business address, enter the street number and name where the program's office is located. Be sure to include the city, state, and zip code as well.
5. Next, fill in the administrator's name and their telephone number. If a different contact person is involved, provide their name and contact details.
6. Identify the name of the program for which a rate is being requested and any additional CCL licenses that the agency holds, including their types and licensed capacities.
7. Fill in the agent for service of process, including their mailing address and contact details. Additionally, enter the board president's name and phone number.
8. In the certification section, indicate whether the program of services has remained the same as submitted previously. If changes have occurred, attach a new program statement.
9. Confirm that the FFA rate does not duplicate costs found in any group home rate set by the department. If it does, provide an explanation.
10. Once all fields are accurately filled, ensure that both the person preparing the rate request and the administrator sign the form, including their titles and the date of signing.
11. Finally, submit the form along with the completed rate request package to the appropriate department for processing.

Start filing your documents online today to ensure your timely submission.