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The California SR 10 form plays a crucial role in the financial auditing process for Group Homes and Foster Family Agencies. This form must be completed by a Certified Public Accountant (CPA) as part of the required financial audit. If the CPA has not provided written documentation that confirms the required cost data reports were audited, the SR 10 form is essential. It ensures that all financial information is accurately presented and fairly stated in relation to the overall financial statements. The form requests important details such as the corporate name, program numbers, fiscal year, and contact information. Additionally, it includes a section for supplementary cost data reports, which, while not mandatory, offer valuable insights for further analysis. Compliance with the False Claims Act is also a key aspect of this form, as the CPA must certify that the information provided is true and correct. Proper submission of the completed SR 10 form to the California Department of Social Services is necessary for maintaining compliance and transparency in financial reporting.
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY |
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES |
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
Sacramento, California 95814.
GROUP HOME OR FOSTER FAMILY AGENCY CORPORATE NAME
PROGRAM NUMBERS(S)
STREET ADDRESS
PROGRAM FISCAL YEAR
CITY, STATE, AND ZIP CODE
PROVIDER PHONE NUMBER
The attached supplementary cost data reports are presented for the purposes of additional analysis and are not a required part of the basic financial statements but are required as supplementary information by the California Department of Social Services in accordance with Manual of Policies and Procedures Section
Check only the forms which apply: |
SR 3___ SR 4___ FCR 12FFA___ |
In compliance with the False Claims Act (31 U.S.C.
PRINTED NAME OF CPA
SIGNATURE OF CPA
DATE
ADDRESS
CITY, STATE AND ZIP CODE
SR 10 (2/06)
Form Specifications
| Fact Name | Description |
|---|---|
| Purpose of the SR 10 Form | The SR 10 form is used for the Certification of Audited Cost Data by Group Homes or Foster Family Agencies in California. |
| Who Completes the Form | A Certified Public Accountant (CPA) must complete and submit the SR 10 form as part of the financial audit process. |
| Submission Details | The completed form should be sent to the California Department of Social Services, specifically to the Program and Financial Audits Bureau. |
| Supplementary Information | Supplementary cost data reports are included with the SR 10 form for additional analysis, though they are not required as part of the basic financial statements. |
| Governing Law | This form is governed by the California Department of Social Services Manual of Policies and Procedures Section 11-405.214 and the False Claims Act (31 U.S.C. §3729-3733). |
California Sr 10: Usage Guidelines
The California SR 10 form is an important document that must be completed and submitted by a Certified Public Accountant (CPA) as part of a financial audit for Group Homes or Foster Family Agencies. Following the steps below will ensure that the form is filled out correctly and submitted to the appropriate agency.
- Obtain the California SR 10 form. Ensure you have the most recent version available.
- At the top of the form, enter the Group Home or Foster Family Agency corporate name.
- Fill in the program number(s) associated with the agency.
- Provide the street address of the agency.
- Indicate the program fiscal year in the format MO/YR-MO/YR.
- Complete the city, state, and ZIP code fields.
- Enter the provider phone number for contact purposes.
- Check the boxes for the forms that apply: SR 3, SR 4, or FCR 12FFA.
- In the certification section, the CPA must print their name.
- The CPA should then sign the form.
- Fill in the date of signing.
- Provide the address of the CPA.
- Complete the city, state, and ZIP code for the CPA's address.
- Review the completed form for accuracy before submission.
- Send the completed and signed form to the California Department of Social Services at the specified address: Program and Financial Audits Bureau, Attention: Financial Audits Unit Manager, 744 P Street, MS 9-23, Sacramento, California 95814.
Your Questions, Answered
What is the purpose of the California SR 10 form?
The California SR 10 form serves as a certification of audited cost data for Group Homes or Foster Family Agencies. It must be completed by a Certified Public Accountant (CPA) as part of the financial audit process. This form confirms that the required cost data reports have been audited and that the information is accurately presented in relation to the overall financial statements.
Who is required to submit the SR 10 form?
Any Group Home or Foster Family Agency that undergoes a financial audit must submit the SR 10 form. This requirement applies if the CPA has not provided separate written documentation that verifies the cost data reports were audited and fairly represented. Essentially, if you are involved in providing care services and are subject to an audit, you will need to complete this form.
Where should the completed SR 10 form be sent?
Once the SR 10 form is completed and signed by the CPA, it should be sent to the California Department of Social Services. Specifically, it should be addressed to the Program and Financial Audits Bureau, Attention: Financial Audits Unit Manager, at 744 P Street, MS 9-23, Sacramento, California 95814. Make sure to send it to the correct address to ensure timely processing.
What additional information is included with the SR 10 form?
The SR 10 form may be accompanied by supplementary cost data reports. While these reports are not required as part of the basic financial statements, they are necessary for additional analysis as mandated by the California Department of Social Services. The CPA will confirm that these supplementary reports have been audited and are fairly stated in relation to the main financial statements.
What is the significance of the False Claims Act certification on the SR 10 form?
The certification regarding the False Claims Act included in the SR 10 form is crucial. It ensures that the information provided is true and correct. By signing this certification, the CPA is asserting that they have conducted the audit with integrity and that the data reported complies with legal standards. This adds a layer of accountability and trust in the financial reporting process.
Common mistakes
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Failing to have a Certified Public Accountant (CPA) complete the form. The California SR 10 form requires a CPA's involvement to ensure the accuracy and compliance of the financial data.
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Not providing the correct corporate name or program number. This information is crucial for identifying the entity being audited and for proper record-keeping.
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Omitting the fiscal year information. The fiscal year is essential for understanding the timeframe of the financial data being reported.
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Incorrectly checking the applicable forms. Only the relevant forms, such as SR 3, SR 4, or FCR 12FFA, should be checked. Incorrect selections can lead to confusion and delays in processing.
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Not signing and dating the form. The signature of the CPA is a vital part of the certification process. Without it, the form may be considered incomplete.
Documents used along the form
The California SR 10 form is essential for Group Homes and Foster Family Agencies as part of the financial audit process. Alongside this form, several other documents are commonly used to ensure compliance and provide necessary information. Here’s a brief overview of these related forms.
- SR 3 Form: This form is used to report the costs associated with providing care and services in a group home or foster family agency. It details the financial operations and is crucial for the auditing process.
- SR 4 Form: This document captures the financial data related to the agency’s administrative costs. It helps auditors assess the overall financial health and operational efficiency of the organization.
- FCR 12FFA Form: This form is specifically for Foster Family Agencies. It provides a comprehensive report on the financial activities and is necessary for fulfilling state requirements.
- Annual Financial Statement: This document summarizes the overall financial position of the agency. It includes income statements, balance sheets, and cash flow statements, which are vital for a thorough audit.
- Supplementary Cost Data Reports: These reports offer additional insights into specific costs incurred by the agency. Although not mandatory, they enhance the understanding of financial performance during audits.
Utilizing these forms in conjunction with the SR 10 ensures a complete and accurate representation of financial data. Proper documentation supports compliance with state regulations and promotes transparency in financial reporting.
Similar forms
The California SR 10 form is a crucial document for Group Homes and Foster Family Agencies, primarily used for financial audits. Several other documents share similar purposes or functions. Here’s a list of eight documents that are comparable to the SR 10 form:
- SR 3 Form: This form is also related to financial audits and is used to report specific cost data, ensuring transparency and compliance with state regulations.
- SR 4 Form: Like the SR 10, the SR 4 form collects financial information from agencies, focusing on different aspects of operational costs and funding sources.
- FCR 12FFA: This document is used for reporting financial conditions of foster family agencies, similar to how the SR 10 addresses group homes.
- Form 990: Nonprofit organizations, including foster agencies, must file this form with the IRS, providing a comprehensive overview of their financial status and activities.
- Annual Financial Statement: This document offers a summary of an organization's financial performance over a year, akin to the SR 10's role in presenting audited cost data.
- Cost Allocation Plan: This plan outlines how costs are distributed among various programs, similar to the financial transparency goals of the SR 10.
- Budget Report: Agencies prepare this report to project future income and expenses, paralleling the SR 10's focus on financial accountability.
- Auditor's Report: This report provides an independent assessment of an agency's financial statements, much like the certification provided in the SR 10 form.
Dos and Don'ts
When filling out the California SR 10 form, it is important to follow specific guidelines to ensure accuracy and compliance. Below is a list of things to do and avoid during this process.
- Do ensure that your Certified Public Accountant (CPA) completes the form.
- Do provide accurate and complete information regarding your organization, including the corporate name and program numbers.
- Do include the correct fiscal year dates in the specified format (MO/YR-MO/YR).
- Do send the completed form to the address provided: California Department of Social Services, Program and Financial Audits Bureau.
- Don't forget to check only the forms that apply to your situation (SR 3, SR 4, FCR 12FFA).
- Don't leave any sections blank; all required fields must be filled out to avoid delays.
Following these guidelines will help ensure that your submission is processed smoothly and meets all necessary requirements.
Misconceptions
Misconceptions about the California SR 10 form can lead to confusion among group homes and foster family agencies. Here are seven common misunderstandings:
- The SR 10 form is optional. Many believe that submitting the SR 10 form is not mandatory. In reality, it is a required part of the financial audit process for group homes and foster family agencies.
- Only financial statements are necessary. Some think that only the basic financial statements need to be audited. However, the SR 10 form and supplementary cost data reports are also essential for a complete audit.
- Any accountant can complete the SR 10 form. It's a common misconception that any accountant can sign off on this form. Only a Certified Public Accountant (CPA) is qualified to complete and submit the SR 10 form.
- The supplementary reports are not important. Many agencies underestimate the significance of the supplementary cost data reports. These reports provide additional analysis and are required by the California Department of Social Services.
- Filing the SR 10 form is the final step. Some believe that submitting the SR 10 form concludes the audit process. In fact, it is just one part of a larger auditing procedure that must be followed.
- The SR 10 form can be submitted at any time. There is a misconception that the timing of the SR 10 submission is flexible. It must be submitted within the designated time frame as part of the financial audit requirements.
- Providing false information has no consequences. Some individuals think that inaccuracies on the SR 10 form won't lead to repercussions. However, submitting false information can result in serious legal implications under the False Claims Act.
Understanding these misconceptions can help ensure compliance and promote transparency in financial reporting for group homes and foster family agencies.
Key takeaways
When filling out and using the California SR 10 form, consider the following key points:
- The SR 10 form is essential for Group Homes or Foster Family Agencies to submit audited cost data.
- A Certified Public Accountant (CPA) must complete the form as part of the financial audit process.
- If the CPA has already provided written documentation of the audited cost data, the SR 10 form may not be necessary.
- The completed form must be sent to the California Department of Social Services at the specified address.
- Supplementary cost data reports are not required but are necessary for additional analysis.
- These supplementary reports must also be audited and should relate to the basic financial statements.
- Check only the applicable forms (SR 3, SR 4, FCR 12FFA) when submitting the SR 10 form.
- Certification of the information on the form is required under the False Claims Act, ensuring accuracy and truthfulness.
By adhering to these guidelines, organizations can ensure compliance and facilitate a smoother audit process.