3729-3733 I certify that the information on this form is true and correct. PRINTED NAME OF CPA ADDRESS SR 10 2/06 SIGNATURE OF CPA DATE. CALIFORNIA DEPARTMENT OF SOCIAL SERVICES STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CERTIFICATION OF AUDITED COST DATA The Group Home or Foster Family Agency corporation should have their Certified Public Accountant CPA complete and submit this form as part of the required financial audit if the CPA has not otherwise provided written documentation which clearly shows that the required cost data reports were audited and that the information was fairly stated in all material respects in relation to the basic financial statements taken as a whole. Please have the completed and signed form sent to California Department of Social Services Program and Financial Audits Bureau ATTENTION Financial Audits Unit Manager 744 P Street MS 9-23 Sacramento California 95814. GROUP HOME OR FOSTER FAMILY AGENCY CORPORATE NAME PROGRAM NUMBERS S STREET ADDRESS ....
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How to fill out the CA SR 10 online
The CA SR 10 is a critical form used by group homes and foster family agencies in California to report audited cost data. This guide aims to provide clear, step-by-step instructions for users to successfully complete and submit the form online.
Follow the steps to accurately complete the CA SR 10 form.
- Click ‘Get Form’ button to access the document and open it in the editor.
- Enter the group home or foster family agency corporate name in the designated field.
- Provide the program number(s) in the corresponding section of the form.
- Fill out the street address where the agency is located, ensuring all necessary details are included.
- Input the program fiscal year in the format of month/year to month/year within the specified area.
- Indicate the city, state, and ZIP code of the agency's location.
- List the provider phone number for further contact within the provided space.
- Check the boxes next to the forms that apply: SR 3, SR 4, or FCR 12FFA.
- Sign and date the form where indicated to certify that the information provided is true and correct.
- Print the form or save it as a PDF after reviewing all entered information for accuracy.
- Submit the completed form as instructed, ensuring it reaches the California Department of Social Services.
Complete your CA SR 10 form online today for a streamlined filing process.
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