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The Georgia 57 form serves as a crucial document in the process of securing supplemental supervision for foster children. This form is utilized by the Georgia Department of Human Resources and is specifically designed for the Child Care Referral and Application for Supplemental Supervision. It encompasses several key sections that collect vital information about the foster child, including personal details such as name, date of birth, and ethnicity. Additionally, it requires data regarding the foster care placement, such as the foster parent's contact information and the nature of the childcare arrangement. The form also addresses the eligibility determination process, where the case manager assesses the family unit size and the rate of care in relation to state maximums. Important signatures from both the foster care case manager and the CAPS case manager are required to finalize the application. Timely updates regarding any changes in the child's placement or childcare arrangements must be reported to ensure compliance with regulations. This structured approach aims to facilitate the effective management of childcare services for foster children in Georgia.

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Date Received by CAPS

Georgia Department of Human Resources

CHILD CARE REFERRAL & APPLICATION FOR SUPPLEMENTAL SUPERVISION

___________ County Department of Family and Children Services

A. FOSTER CHILD INFORMATION (To be completed by SSCM)

First Name MI Last Name Sex

Date

Social Security

Child

Child

of

Number

in

in

Birth

 

School

Pre-K

 

 

 

 

Child

in

Head

Start

Child has a disability

Ethnicity (check one):

Hispanic

Not Hispanic

 

Race (check one):

White

Black/African American

Asian

 

American Indian or Alaskan Native

Native Hawaiian or other Pacific Islander

B. FOSTER CARE PLACEMENT INFORMATION (To be completed by SSCM)

Foster Parent's Name

Address

Home Phone

 

 

 

Work Phone #

 

 

 

 

If an informal childcare provider has been chosen, check all that apply:

 

Relative of Child

Care provided in child's home

 

CRC completed

Non-Relative

Care provided in provider's home

 

CPS screening completed

 

 

 

Approved by Foster Care

 

 

 

 

All changes in the child's placement and child care arrangements MUST be reported to the child care case manager within 5 working days.

____________________________________

________________

_______________

Signature of Foster Care Case Manager

Date

Case Load ID #

C. CHILD CARE PROVIDER INFORMATION (To be completed by the SSCM or Foster Parent)

Reason Care is Needed:

Days and Hours Care is Needed:

Date to begin CAPS: _____

Name, Address and Phone # of Childcare Provider:

Phone # :

D. ELIGIBILITY DETERMINATION (To be completed by the CAPS case manager)

1.

Family Unit Size

____

 

4.

Rate Within DFCS Maximum?

Yes

No

2.

UAS Code (check one):

 

 

 

Cost of care if not within maximum $_________

 

 

555 (Pre-K)

557

 

 

 

 

 

3.

Provider is:

 

 

5.

Application Disposition:

Approved

Denied

 

Licensed, Commissioned, or Exempt

 

 

 

 

 

 

 

Registered

 

 

6.

Official Certification Period:

 

 

 

 

Informal- Relative of Child

 

 

___________________ to __________________

 

Informal- Non-Relative

 

 

 

 

 

 

 

Comments:

________________________________

_____________________

_____________________

Signature of CAPS Case Manager

Date

CAPS Case Load ID #

Form 57 (3/2004)

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Form Specifications

Fact Name Description
Purpose The Georgia 57 form is used for child care referral and application for supplemental supervision for foster children.
Governing Law This form is governed by the Georgia Department of Human Services regulations regarding child welfare.
Completion The form must be completed by the Social Services Case Manager (SSCM) or the foster parent, depending on the section.
Reporting Requirement Any changes in the child's placement and child care arrangements must be reported within 5 working days to the child care case manager.

Georgia 57: Usage Guidelines

The Georgia 57 form is a crucial document for foster care and childcare arrangements. Completing this form accurately is essential for ensuring that the necessary services are provided. Follow these steps to fill out the form properly.

  1. Gather Necessary Information: Collect all relevant details about the foster child, foster parents, and childcare providers.
  2. Complete Section A: Fill in the child's first name, middle initial, last name, sex, date of birth, and social security number. Indicate if the child is in school, Pre-K, or Head Start. Note if the child has a disability and check the appropriate ethnicity and race boxes.
  3. Complete Section B: Provide the foster parent's name, address, home phone, and work phone number. If an informal childcare provider is selected, check all applicable boxes regarding their relationship to the child and the care arrangement.
  4. Sign Section B: The foster care case manager must sign and date this section, including their case load ID number.
  5. Complete Section C: State the reason care is needed, the days and hours care is required, and the date to begin CAPS. Include the name, address, and phone number of the childcare provider.
  6. Complete Section D: The CAPS case manager will fill out this section. They will determine family unit size, UAS code, and whether the provider is licensed, commissioned, or exempt. They will also indicate if the application is approved or denied and provide the official certification period.
  7. Sign Section D: The CAPS case manager must sign and date this section, including their case load ID number.

Your Questions, Answered

What is the purpose of the Georgia 57 form?

The Georgia 57 form is used to apply for supplemental supervision for children in foster care. It serves as a referral and application for child care, ensuring that children receive the necessary support and supervision while in the care of foster parents or informal childcare providers.

Who is responsible for completing the Georgia 57 form?

The form is primarily completed by the Social Services Case Manager (SSCM) in collaboration with the foster parent. The SSCM gathers essential information about the child, the foster care placement, and the childcare provider.

What information is required in the child information section?

This section requires details about the child, including their name, date of birth, social security number, and whether they have a disability. Additionally, it asks for the child’s ethnicity and race, which helps in understanding the demographics of children in care.

What details must be provided about the foster care placement?

The foster care placement section requires the name and contact information of the foster parent. It also includes options for informal childcare providers, where the SSCM must check relevant boxes regarding the caregiver's relationship to the child and whether necessary screenings have been completed.

What are the responsibilities of the foster care case manager?

The foster care case manager is responsible for signing the form and ensuring that any changes in the child's placement or childcare arrangements are reported within five working days. This is crucial for maintaining accurate records and ensuring the child's welfare.

What information is needed from the childcare provider?

The form requires the name, address, and phone number of the childcare provider. Additionally, it asks for the reason care is needed, the days and hours care is required, and the start date for the CAPS program.

How is eligibility determined for childcare assistance?

Eligibility is assessed by the CAPS case manager, who evaluates family unit size, the UAS code, and whether the cost of care falls within the Department of Family and Children Services (DFCS) maximum rates. The form also indicates whether the childcare provider is licensed, registered, or informal.

What does the application disposition section indicate?

This section informs whether the application for childcare assistance has been approved or denied. It is crucial for foster parents to understand the outcome, as it directly affects the availability of childcare support.

What is the significance of the official certification period?

The official certification period indicates the timeframe during which the childcare assistance is valid. It is important for both the foster parents and the childcare provider to be aware of these dates to ensure continuous support and compliance with regulations.

Where can I find assistance if I have questions about the Georgia 57 form?

If you have questions about the Georgia 57 form or the application process, it is advisable to contact your local Department of Family and Children Services office. They can provide guidance and clarification on any aspect of the form and its requirements.

Common mistakes

  1. Incomplete Information: Failing to fill out all required fields can lead to delays. Each section must be completed thoroughly.

  2. Incorrect Dates: Entering the wrong date for the child’s birth or the start date for care can cause issues with eligibility.

  3. Missing Signatures: Not signing the form where indicated can result in the application being rejected. Ensure all necessary signatures are present.

  4. Improper Ethnicity and Race Selection: Failing to accurately check the appropriate boxes for ethnicity and race can lead to complications in processing.

  5. Not Reporting Changes: Any changes in the child’s placement or care arrangements must be reported within 5 working days. Ignoring this can affect the application.

  6. Incorrect Contact Information: Providing outdated or incorrect contact information for the childcare provider can hinder communication and processing.

  7. Failure to Include Disability Information: If the child has a disability, this must be noted. Omitting this information may affect eligibility for additional support.

  8. Not Checking Provider Status: It’s crucial to accurately indicate whether the childcare provider is licensed, registered, or exempt. Misclassification can lead to denial.

  9. Ignoring Maximum Rate Limits: Not checking if the cost of care exceeds the DFCS maximum can result in unexpected expenses and application denial.

  10. Neglecting Comments Section: The comments section is an opportunity to clarify any special circumstances. Leaving it blank may lead to misunderstandings.

Documents used along the form

The Georgia 57 form is an important document used in the child care referral and application process for supplemental supervision. When dealing with child care arrangements, there are several other forms and documents that often accompany this application. Understanding these related documents can help streamline the process and ensure compliance with state regulations.

  • Form 56 - Child Care Provider Application: This form is used by individuals or organizations wishing to become licensed child care providers. It collects essential information about the provider's qualifications, background, and the type of care they offer.
  • Form 58 - Child Care Payment Authorization: This document authorizes the payment for child care services. It outlines the terms of payment and ensures that funds are allocated correctly for the child’s care.
  • Form 59 - Child Care Provider Agreement: This agreement is between the child care provider and the family. It details the expectations, responsibilities, and rights of both parties, ensuring clarity in the caregiver relationship.
  • Form 60 - Child Care Attendance Record: This form tracks the attendance of children in care. It is crucial for verifying hours of care provided and is often required for payment processing and compliance checks.
  • Form 61 - Child Care Health and Safety Checklist: This checklist is used to ensure that child care environments meet health and safety standards. It helps assess whether the facility or home is suitable for children.
  • Form 62 - Child Care Incident Report: This report is used to document any incidents or accidents that occur while a child is in care. It is essential for maintaining safety records and addressing any issues that arise promptly.

Familiarizing yourself with these forms can make navigating the child care system smoother and more efficient. Each document plays a vital role in ensuring the safety, well-being, and proper care of children in foster and child care settings.

Similar forms

The Georgia 57 form is a vital document used in the child care referral and application process for supplemental supervision in foster care settings. Several other documents share similar purposes or functions. Here’s a list of eight documents that resemble the Georgia 57 form:

  • Child Care Application Form: This document collects information about the child and the family’s needs for child care services, similar to the Georgia 57 form's focus on child care provider information.
  • Foster Care Placement Agreement: This agreement outlines the terms of the child's placement with a foster family, mirroring the placement information section of the Georgia 57 form.
  • Eligibility Verification Form: This form is used to determine a family's eligibility for child care assistance, akin to the eligibility determination section found in the Georgia 57 form.
  • Child Development Assessment: This assessment evaluates a child's developmental needs, paralleling the focus on the child's specific needs in the Georgia 57 form.
  • Provider Background Check Form: This document ensures that child care providers meet safety standards, similar to the checks mentioned in the Georgia 57 form regarding the caregiver's qualifications.
  • Child Care Subsidy Application: This application helps families apply for financial assistance for child care, reflecting the financial considerations present in the Georgia 57 form.
  • Foster Care Review Report: This report reviews the child's progress in foster care, much like the ongoing assessments required in the Georgia 57 form.
  • Service Plan for Foster Children: This plan outlines the services needed for a child in foster care, similar to how the Georgia 57 form details the care requirements for the child.

Dos and Don'ts

When filling out the Georgia 57 form, it's important to follow certain guidelines to ensure the process goes smoothly. Here are six things you should and shouldn't do:

  • Do: Provide accurate and complete information for each section of the form.
  • Do: Double-check the child's details, such as name, date of birth, and Social Security number.
  • Do: Report any changes in the child's placement or childcare arrangements within 5 working days.
  • Do: Ensure that the childcare provider's information is correct, including their name and contact details.
  • Don't: Leave any sections of the form blank. Incomplete forms can cause delays.
  • Don't: Forget to sign and date the form before submitting it.

Misconceptions

Understanding the Georgia 57 form can be challenging, and there are several misconceptions that often arise. Here are four common misunderstandings:

  • It's only for foster children. Many believe that the Georgia 57 form is exclusively for children in foster care. In reality, it can also be used for children in informal care arrangements, including those cared for by relatives or non-relatives.
  • Completion is solely the responsibility of the foster parent. Some people think only foster parents need to fill out this form. However, the form requires input from various parties, including the Child and Family Services case manager, to ensure all information is accurate and complete.
  • All child care providers must be licensed. There's a misconception that only licensed providers can be listed on the form. While licensed providers are preferred, informal caregivers can also be included as long as certain criteria are met, such as completing background checks.
  • The form is not time-sensitive. Many assume that there is no urgency in submitting the Georgia 57 form. In fact, any changes in a child's placement or care arrangements must be reported to the case manager within five working days to ensure proper support and funding.

Clearing up these misconceptions can help families navigate the child care system more effectively and ensure that children receive the care they need.

Key takeaways

When filling out and using the Georgia 57 form, keep these key takeaways in mind:

  • Complete All Sections: Ensure that every section of the form is filled out accurately. Missing information can delay the processing of the application.
  • Report Changes Promptly: Any changes in the child's placement or childcare arrangements must be reported to the case manager within five working days.
  • Eligibility Criteria: Be aware of the eligibility requirements. The CAPS case manager will determine if the childcare provider meets the necessary standards.
  • Signature Requirement: Both the foster care case manager and the CAPS case manager must sign the form. This is crucial for validating the application.