![](media/image1.wmf){width="2.4993055555555554in"
height="0.9368055555555556in"}

**Measuring Improper Authorizations for Payment in the Child Care
Program**

**Child Care Bureau, Office of Family Assistance**

**Administration for Children and Families**

**Improper Authorization for Payment Data Collection Instructions**

February 16, 2007

**TABLE OF CONTENTS**

**I.** INTRODUCTION [2](#__RefHeading___Toc155167940)

**II.** OVERVIEW [2](#__RefHeading___Toc155167941)

**III.** STATE REPORTING CYCLE [2](#__RefHeading___Toc155167942)

**IV.** GENERATING A SAMPLE OF CASES FOR REVIEW
[2](#__RefHeading___Toc155167943)

Designated Review Period [2](#__RefHeading___Toc155167944)

Sampling Unit [2](#Sampling_Unit)

Selecting the Monthly Sample [2](#__RefHeading___Toc155167946)

**V.** CUSTOMIZING THE *RECORD REVIEW WORKSHEET*
[2](#__RefHeading___Toc155167947)

General Instructions

Review Identification Information [2](#__RefHeading___Toc155167948)

> Column 1: Elements of Eligibility and Payment Authorization and Column
> 2: Analysis of Case Record

Column 3: Findings [2](#__RefHeading___Toc155167951)

Column 4: Results [2](#__RefHeading___Toc155167952)

**VI.** CONDUCTING CASE RECORD REVIEWS [2](#__RefHeading___Toc155167953)

Review Identification Information [2](#__RefHeading___Toc155167954)

Column 1: Elements of Eligibility and Payment Authorization
[2](#__RefHeading___Toc155167955)

Column 2: Analysis of Case Record [2](#__RefHeading___Toc155167956)

Column 3: Findings [2](#__RefHeading___Toc155167957)

Column 4: Results

Case Record Review Examples 21

**VII.** Completing the *data entry form* 24

*Data Entry Form* Examples 27

**VIII.** COMPLETING AND SUBMITTING THE *State Improper AuthorizationS
FOR PAYMENT Report* [2](#__RefHeading___Toc155167960)

Part I - Program Assurances and Certifications
[2](#__RefHeading___Toc155167961)

Part II - Error Measures Reporting [2](#__RefHeading___Toc155167962)

Part III - State Response to Error Measures Findings
[2](#__RefHeading___Toc155167963)

Part III A. (for first reporting cycle only)
[2](#__RefHeading___Toc155167964)

Part III B. (for reporting cycles after the first reporting cycle only)
[2](#__RefHeading___Toc155167965)

APPENDIX A [2](#__RefHeading___Toc155167966)

Glossary [2](#__RefHeading___Toc155167967)

ATTACHMENT 1. [2](#__RefHeading___Toc155167968)

RECORD REVIEW WORKSHEET AND INSTRUCTIONS
[2](#__RefHeading___Toc155167969)

ATTACHMENT 2 [2](#Attachment1)

DATA ENTRY FORM AND INSTRUCTIONS [2](#Attachment1)

ATTACHMENT 3 [2](#Attachment2)

STATE IMPROPER AUTHORIZATIONS FOR PAYMENT REPORT AND INSTRUCTIONS
[2](#__RefHeading___Toc155167973)

[]{#__RefHeading___Toc155167940 .anchor}**I. INTRODUCTION**

This document provides instructions for implementing the required error
rate methodology for the Child Care and Development Fund (CCDF) and
successfully submitting the *State Improper Authorization for Payment
Report* to the Department of Health and Human Services (HHS). These
submissions will assist HHS in complying with the Improper Payments
Information Act of 2002 (IPIA). The IPIA requires Federal agencies to
annually review programs and activities they administer, identify those
that may be susceptible to significant improper payments, and submit a
report on actions taken to reduce improper payments. Per the IPIA,
agencies must adhere to guidance prescribed by the Office of Management
and Budget (OMB). The provisions in this document comply with OMB
Circular A-123, Appendix C that provides guidance for implementing the
Improper Payments Information Act of 2002 (IPIA). These instructions
also comply with the Code of Federal Regulations (CFR), Title 45 --
Public Welfare - Parts 98 and 99, the official regulations for the Child
Care and Development Fund. 45 CFR 98 Subpart K - Error Rate Reporting -
requires States, the District of Columbia and Puerto Rico to measure,
calculate, and report improper payments as well as identify strategies
for reducing future improper payments.

This instruction package provides:

-   An overview of the improper payment authorization for payment review
    methodology, focusing on client methodology

```{=html}
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```
-   Instructions for completing each State component of the review
    methodology

-   A glossary of terms used in the instruction package (Appendix A)

-   A required *Record Review Worksheet* (Attachment 1)

-   A required *Data Entry Form*, with instructions (Attachment 2)

-   A required *State Improper Authorization for Payment Report*, with
    instructions (Attachment 3)

    []{#__RefHeading___Toc155167941 .anchor}**II. OVERVIEW**

The CCDF methodology for measuring improper authorizations for payment
focuses on client eligibility and employs a case record review process
to determine whether child care subsidies were properly authorized.

The CCDF methodology focuses on improper authorizations rather than
actual payments because the Administration for Children and Families
(ACF) believes that improper authorizations are the root cause for many
improper payments. Eligibility and authorization are the first steps in
the child care subsidy process and errors made at this stage in the
process are likely to affect the administration of the entire program.
An improper authorization could likely result in an improper payment

The case record review process is based on the CCDF methodology that was
successfully implemented in two phases of error rate pilots tested by
the Child Care Bureau (CCB) in partnership with States. These pilots
showed that a client eligibility-focused methodology could be
established to accommodate the flexibility in the State processes to
determine eligibility and authorize subsides were consistent enough that
a uniform national methodology that was practical for individual States
to implement could be developed. This was important, as the policies and
processes used for parents to apply for child care services---as well as
the policies and processes used by States, Territories and Tribes to
determine eligibility (including initial eligibility, periodic
redeterminations, or change action)---are unique to each State.

This methodology enables States to determine errors as well as to
identify the types and sources of these errors. The results will provide
States with information that will be useful in developing corrective
action plans to reduce future improper authorizations for payment and
corresponding improper payments.

The CCDF error rate methodology includes the following action steps and
timeline based on the FY 2008 reporting year:

Exhibit 1

  --------- -------------------------------------------------- -------------
  **STEP    **CCDF ERROR RATE METHODOLGY**                     **2008
  \#**                                                         REPORTING
                                                               YEAR
                                                               TIMELINE**

  **1.**    Submit by email to the Child Care Manager in ACF   October, 2007
            Regional Office the State 1) decisions regarding   
            selection of 271 or 276 cases\*, frequency of      
            collecting monthly sampling frames, citation for   
            source of random numbers, 2) plan for fieldwork    
            preparation, and 3) assurance that the State will  
            abide by the monthly sample instructions in        
            \"Measuring Improper Authorizations for Payment in 
            the Child Care Program.\"                          

  **2.**    Select a systematic random statewide sample of     November,
            cases for each month of the designated 12 month    2007
            review period                                      

  **3.**    Customize *Record Review Worksheet*                October
                                                               --December,
                                                               2007

  **4.**    Submit *Record Review Worksheet* to Child Care     December,
            Manager in ACF Regional Office for approval        2007

  **5.**    Conduct case record review process, subsequent to  January -
            approval of customized *Record Review Worksheet*   March, 2008

  **6.**    Complete *Data Entry Forms*                        March, 2008

  **7.**    Complete entry of data from *Data Entry Forms*     March, 2008

  **8.**    Compute five error measures                        April, 2008

  **9.**    Complete *State Improper Authorizations for        June, 2008
            Payment Report*                                    

  **10.**   Submit *State Improper Authorizations for Payment  No later than
            Report*                                            June 30, 2008
  --------- -------------------------------------------------- -------------

\*(See Section IV -- "Generating a Sample of Cases for Review")

-   In subsequent years, States adhere to the above timeline, relative
    to their reporting year. States submit Step 1 information prior to
    drawing the first sample and no later than October of the calendar
    year prior to the reporting year. States receive approval of the
    customized *Record Review Worksheet* prior to conducting case record
    reviews. States choosing to select sampling frames and conduct case
    record reviews throughout the 12 month review period are encouraged
    to submit information identified in Steps 1 and 4 in a timely manner
    to avoid unnecessary delays in implementing the methodology.

    []{#__RefHeading___Toc155167942 .anchor}**III. STATE REPORTING
    CYCLE**

States calculate five error measures, including an estimated annual
amount of improper authorizations for payment once every three years on
a rotational cycle. As can be seen in Exhibit 2, using a stratified
random sample method of selecting states[^1], one third of the total of
52 States were selected to participate each year in the error rate
measurement methodology.

In year one, approximately one third of the total of 52 States (18
States) calculate error rate measures, including the estimated annual
amount of improper CCDF subsidy authorizations. The total of the 18
States' estimated annual amount of improper authorizations for payment
provides the basis to calculate a national error rate and amount in year
one.

In year two, an additional 17 States calculate error rate measures,
including the estimated amount of improper CCDF subsidy authorizations.
The total of the 17 States' estimated annual amount of improper
authorizations for payment combined with the totals from year one
provide the basis to calculate the year two national error rate and
amount.

In year three, the remaining 17 States calculate error rate measures,
including the estimated amount of improper CCDF subsidy authorizations.
The total estimated annual amount of improper authorizations for payment
from all three years are combined and provide the basis to calculate the
year three national error rate and amount.

In year four, the States selected for year one repeat the methodology.
The year four results replace the year one results in the national error
rate and amount calculation.

**Exhibit 2. States Selected By Year of Three Year Reporting Cycle**

![](media/image2.wmf){width="5.196527777777778in"
height="3.3131944444444446in"}

Following completion of a case record review process, data entry,
computation of five error measures, and analysis and response to the
improper authorizations findings, States prepare and submit a *State
Improper Authorizations for Payment Report* (See Attachment 3),
described in Section VIII of these instructions.

To coordinate this effort, States may choose to create an improper
payments planning team (Team). Suggestions for the composition and
responsibilities of the team include the following:

1.  Select a high level management staff member to act as a project
    coordinator. The project coordinator will oversee the entire
    process, including determining which office is responsible for
    obtaining the reviewers, recruiting planning Team members, answering
    internal questions, arranging Team meetings and consulting with Team
    members as needed.

2.  The project coordinator convenes a Team consisting of the team
    leader of the review team, State Lead Agency administrator, and high
    and middle level management staff representatives from program and
    policy, training, and information technology.

3.  The project coordinator assigns responsibilities for completion of
    the required *State Improper Authorizations for Payment Report*,
    including the error rate findings and narrative discussion.

Administration for Children and Families (ACF) will review the *State
Improper Authorization for Payment Reports* submitted by States;
calculate the national error measures and consolidate the findings,
describing the amounts and types of all identified errors adhering to
the requirements found in Appendix C to OMB Circular A--123. This
information will be reported in HHS' annual Performance and
Accountability Report (PAR).

[]{#__RefHeading___Toc155167943 .anchor}**IV. GENERATING A SAMPLE OF
CASES FOR REVIEW**

States select a statewide random sample of at least 271 active cases. A
sample of 271 cases is projected to achieve a State level improper
authorizations for payment rate within five percent precision at the 90%
confidence level.[^2] This Section details steps for the selection
process. The steps include three areas in which States have flexibility
and which are discussed in more detail below: the decision to sample 271
or 276 cases, how frequently monthly sampling frames will be collected,
and the source for the required random numbers. As indicated in Step 1,
Exhibit 1, States are required to submit these decisions by email to the
Child Care Manager in the ACF regional office before the end of October
of the calendar year prior to the reporting year.

[]{#__RefHeading___Toc155167944 .anchor}**Review Period**

The CCB has designated a 12 month review period, based on the Federal
Fiscal Year ending September 30, for the data collection methodology.
The purpose of the 12 month review period is to gain a representative
estimate of the annualized amount of improper authorization for
payments.

The State estimates of the five error measures will be calculated using
all cases examined during the review period. States which choose to
sample 271 cases will randomly select 23 cases for each of the first
seven months and 22 cases for each of the last five months of the 12
month review period (e.g., October - April, 23 cases per month will be
selected and May - September 22 cases per month will be selected.)
Alternatively States may choose to select 23 cases for each month of the
review period, yielding a total of 276 cases. Adding five cases to the
annual required total allows States to select the same number of cases
for each of the 12 review months.

[]{#Sampling_Unit .anchor}**Sampling Unit**

The primary sampling unit for this analysis is an active case (case) for
whom a child care subsidy was authorized for payment during a sample
review month. An authorization for payment is the subsidy amount
authorized during eligibility determination or redetermination for a
sample review month, based on the case record documentation.

Each sampling unit will be identified by the following information:

1.  Sequential number;

2.  Child ID;

3.  County of service; and

4.  Sample month.

States determine their own parameters for creating unique Child IDs,
adhering to the following criteria when creating the Child IDs:

-   Each child in the sampling frame receives a unique Child ID. If
    several children exist within a family, case or household, each
    child will be assigned a unique Child ID.

-   The unique Child ID does not contain identifying information; but
    rather it is linked to a county or State data system, so that the
    county or State can pull the case record if the child were selected
    for the study.

    []{#__RefHeading___Toc155167946 .anchor}**Selecting the Monthly
    Sample**

States create 12 sampling frames of active cases (i.e., one sampling
frame per month for each month in the 12 month review period). The
review period is the Federal Fiscal Year prior to July 1 of the
designated calendar year in which a *State Improper Authorizations for
Payment Report* must be submitted. For example, for a June 30, 2008
submission date, the review period would be October 1, 2006 through
September 30, 2007.

Once each sampling frame has been created, States randomly select the
monthly sample of 22 or 23 cases (271 (or 276) cases during the review
period). Once this process is complete, States randomly select 3
replacement cases for each sampling frame. States use a replacement case
only if a case selected does not meet the study criteria for valid
reasons. Examples of valid reasons include: natural disaster making the
case record unavailable, the case has been referred to a State\'s fraud
investigation unit, or the case is under appeal.

Exhibit 3. Selecting the Monthly Sample

+---------+---------------------------+--------------------------------+
| **      | **Instructions**          | **Examples**                   |
| Steps** |                           |                                |
+---------+---------------------------+--------------------------------+
| **1.    | -   States create a       | **Example one (Select 6        |
| De      |     sampling frame for    | monthly sampling frames, two   |
| termine |     each of the 12 months | times per year):**             |
| fr      |     in the review period. |                                |
| equency |                           | For a June 30, 2009 submission |
| of      | -   States determine how  | date, select 6 monthly         |
| monthly |     frequently they will  | sampling frames for the six    |
| sample  |     create sampling       | months. October 2007 -- March  |
| sele    |     frames.               | 2008 in May 2008. Then select  |
| ction** |                           | the remaining 6 monthly        |
|         | -   States may choose to  | sampling frames for April --   |
|         |     create these lists at | September 2008 in November     |
|         |     the end of each       | 2008                           |
|         |     month, quarterly,     |                                |
|         |     semi-annually, or     | **Example two (Select 12       |
|         |     annually.             | monthly sampling frames, once  |
|         |                           | per year):**                   |
|         | -   The choice will be    |                                |
|         |     based on how often    | For a June 30, 2009 submission |
|         |     States choose to pull | date, select 12 monthly        |
|         |     records and conduct   | sampling frames for October    |
|         |     reviews.              | 2007 -- September 2008 in      |
|         |                           | November 2008.                 |
+---------+---------------------------+--------------------------------+
| **2     | For each month of the 12  | For each month of the 12 month |
| .Create | month review period,      | review period, generate a list |
| 12      | generate a list of all    | of all cases authorized to     |
| Monthly | cases authorized to       | receive a child care payment   |
| S       | receive a child care      | during that review month:      |
| ampling | payment during that       |                                |
| F       | review month:             | -   **Sort the list by county  |
| rames** |                           |     caseload size:** List      |
|         | -   Sort the list by      |     counties with the largest  |
|         |     county caseload size, |     caseload first: e.g.,      |
|         |     listing counties with |     County K (2615 cases),     |
|         |     the largest caseload  |     County R (995 cases),      |
|         |     first to counties     |     County W (971 cases),      |
|         |     with the smallest     |     County M (848 cases)       |
|         |     caseload.             |                                |
|         |                           | -   **List Child ID numbers    |
|         | -   List all Child ID     |     from lowest to highest:**  |
|         |     numbers sequentially, |     e.g., 233124, 233128,      |
|         |     within each county    |     255320.                    |
|         |     from smallest to      |                                |
|         |     largest.              |                                |
+---------+---------------------------+--------------------------------+
| **3.    | -   Calculate a sampling  | -   Assume 31,286 cases in a   |
| Ca      |     interval based on the |     sample month.              |
| lculate |     size of the sampling  |                                |
| S       |     frame and the number  | -   Divide the total number of |
| ampling |     of cases (23 or 22)   |     cases authorized to        |
| I       |     to be selected for    |     receive payment during the |
| nterval |     the sample.           |     sample month (31,286)      |
| to      |                           |     cases, by the number of    |
| Select  | -   Select either 1) 23   |     cases to be selected for   |
| Sample  |     cases for seven       |     the sample (23).           |
| C       |     months and 22 cases   |                                |
| ases.** |     for 5 months to yield | -   Calculate the sampling     |
|         |     271 cases, or 2) 23   |     interval by dividing       |
|         |     cases for each of     |     31,286 cases in the sample |
|         |     twelve months to      |     month by 23, the number of |
|         |     yield 276 cases.      |     cases to be selected in    |
|         |                           |     the sample. (31,286/23 =   |
|         | -   Divide the total      |     1360.3)                    |
|         |     number of cases       |                                |
|         |     listed in the         | -   If the sampling interval   |
|         |     sampling frame (all   |     is a whole number, such as |
|         |     cases authorized to   |     1360, select every         |
|         |     receive payment       |     1360^th^ case from a       |
|         |     during the sample     |     random starting point      |
|         |     month) by the number  |     defined below.             |
|         |     of cases to be        |                                |
|         |     selected for the      | -   If the sampling interval   |
|         |     sample (23 or 22).    |     is not a whole number,     |
|         |                           |     e.g., for 1360.3, round    |
|         | -   When the interval     |     down to randomly select a  |
|         |     computed is not a     |     starting case between the  |
|         |     whole number, round   |     1^st^ and 1360^th^ case or |
|         |     the end of the first  |     for 1360.6, round up to    |
|         |     interval to the       |     select a starting case     |
|         |     nearest whole number. |     between case 1 and case    |
|         |     If the result is x.50 |     1361.                      |
|         |     or more, round up to  |                                |
|         |     select the nearest    |                                |
|         |     whole number (i.e.    |                                |
|         |     x+1). If the result   |                                |
|         |     is x.49 or less,      |                                |
|         |     round down to select  |                                |
|         |     the nearest whole     |                                |
|         |     number (i.e. x).      |                                |
+---------+---------------------------+--------------------------------+
| **4.    | -   Using a random number | -   If the sampling interval   |
| Select  |     table or software,    |     is 1360.3, use a random    |
| Sample  |     select a random       |     number table or software   |
| Cases** |     number within the     |     to select a random number  |
|         |     first sampling        |     that falls within the      |
|         |     interval.             |     first sampling interval of |
|         |                           |     1 --1360 (rounded down).   |
|         | -   Use the random number |                                |
|         |     as the starting point | -   If the random number       |
|         |     to select the first   |     selected is 463, select    |
|         |     case in the sample.   |     case 463 as the first case |
|         |                           |     in the sample.             |
|         | -   From the first case,  |                                |
|         |     use the sampling      | -   If the sampling interval   |
|         |     interval to select    |     is 1360.3, then select the |
|         |     the next case that    |     next case that falls       |
|         |     falls within the      |     within the second sampling |
|         |     second sampling       |     interval, or the case      |
|         |     interval.             |     listed 1823                |
|         |                           |     (463+1360.3=1823.3, which  |
|         | -   Continue to add the   |     rounds to 1823)^.^         |
|         |     sampling interval to  |                                |
|         |     select the next cases | -   The next cases selected    |
|         |     until the sample is   |     would be 3184              |
|         |     complete at 23 or 22  |     (1823.3+1360.3=3183.6,     |
|         |     cases.                |     which rounds to 3184).     |
|         |                           |     Continue until the sample  |
|         | -   When the interval     |     is complete and 23 or 22   |
|         |     computed is not a     |     cases have been selected.  |
|         |     whole number,         |                                |
|         |     continue to add the   | -   If the sampling interval   |
|         |     exact interval        |     is not a whole number,     |
|         |     amounts together      |     e.g., for 1000.3, then     |
|         |     without rounding to   |     select the next case that  |
|         |     determine each        |     falls within the second    |
|         |     interval from which   |     sampling interval, or for  |
|         |     to round the result   |     the case nearest 1007.6,   |
|         |     to select the next    |     ^.^round up to select the  |
|         |     case.                 |     1008^th^ case. Continue to |
|         |                           |     add the intervals to       |
|         |                           |     select the case nearest    |
|         |                           |     2007.9, round up to select |
|         |                           |     the 2008^th^ case. The     |
|         |                           |     next case will be 3008.2   |
|         |                           |     rounded down to be the     |
|         |                           |     3008^th^ case. Continue    |
|         |                           |     until the sample is        |
|         |                           |     complete and 23 or 22      |
|         |                           |     cases have been selected.  |
+---------+---------------------------+--------------------------------+
| **5.    | -   After the sample of   | -   Remove the 23 cases from   |
| Ca      |     23 or 22 cases has    |     the total number of cases  |
| lculate |     been selected, remove |     (such as 23,000)           |
| S       |     the 23 or 22 cases    |     authorized to receive      |
| ampling |     from the sampling     |     payment during the sample  |
| I       |     frame.                |     month. (23,000 -- 23 =     |
| nterval |                           |     22,977)                    |
| to      | ```{=html}                |                                |
| Select  | <!-- -->                  | -   To calculate the sampling  |
| Re-**   | ```                       |     interval, divide the       |
|         | -   Calculate a sampling  |     remaining total number of  |
| **Pl    |     interval based on the |     cases in the sample month  |
| acement |     size of the new       |     ( 22,977), by the number   |
| Cases** |     sampling frame and    |     of cases to be selected as |
|         |     the number of         |     the replacement cases (3). |
|         |     cases (3) to be       |     (22,977/3 = 7659)          |
|         |     selected as           |                                |
|         |     replacement cases.    | -   If the sampling interval   |
|         |                           |     is 7659, select every      |
|         | ```{=html}                |     7659^th^ case from a       |
|         | <!-- -->                  |     random starting point      |
|         | ```                       |     defined below.             |
|         | -   Divide the total      |                                |
|         |     number of cases       |                                |
|         |     listed in the         |                                |
|         |     sampling frame (after |                                |
|         |     removing the 23 or 22 |                                |
|         |     sample cases) by the  |                                |
|         |     number of cases to be |                                |
|         |     selected as           |                                |
|         |     replacements. (3).    |                                |
+---------+---------------------------+--------------------------------+
| **6.    | -   Using a random number | -   If the sampling interval   |
| Select  |     table or software,    |     is 7659, use a random      |
| Re-pl   |     select a random       |     number table or software   |
| acement |     number within the     |     to select a random number  |
| Cases** |     first replacement     |     that falls within the      |
|         |     sampling interval.    |     first replacement sampling |
|         |                           |     interval of 1 -- 7659.     |
|         | -   Use the random number |                                |
|         |     as the starting point | -   If the random number       |
|         |     to select the first   |     selected is 10, select the |
|         |     case in the sample.   |     tenth case as the first    |
|         |                           |     case in the sample.        |
|         | -   From the first case,  |                                |
|         |     select the next case  | -   If the sampling interval   |
|         |     that falls within the |     is 7659, then select the   |
|         |     sampling interval.    |     next two cases that fall   |
|         |                           |     within the sampling        |
|         | ```{=html}                |     interval, or the cases     |
|         | <!-- -->                  |     listed 7669^th.^ and       |
|         | ```                       |     15,328^th^.                |
|         | -   Continue to use the   |                                |
|         |     sampling interval to  |                                |
|         |     select the next cases |                                |
|         |     until 3 replacement   |                                |
|         |     cases have been       |                                |
|         |     selected.             |                                |
+---------+---------------------------+--------------------------------+
| **7.    | -   Based on the          | **Example one (Select 6        |
| Create  |     frequency of monthly  | monthly sampling frames, 2     |
| add     |     sample selection,     | times per year):**             |
| itional |     draw additional       |                                |
| monthly |     sampling frames for   | -   If the 6 month sampling    |
| s       |     each month of the 1,  |     period is October 2007 --  |
| ampling |     3, 6, or 12 month     |     March 2008, in May 2008,   |
| frames  |     sampling period. For  |     generate one sampling      |
| for     |     each month of the     |     frame per month, starting  |
| each    |     sampling period,      |     with the month of October  |
| month   |     repeat the following  |     2007 repeating steps 2 --  |
| of the  |     steps                 |     6 for each month through   |
| s       |                           |     March 2008.                |
| ampling | -   Generate a list of    |                                |
| pe      |     all cases authorized  | -   In November 2008, generate |
| riod.** |     to receive a child    |     one sampling frame per     |
|         |     care payment during   |     month, starting with the   |
|         |     the sample month.     |     month of March 2008,       |
|         |                           |     repeating steps 2 -- 6 for |
|         | -   Divide the total      |     each month through         |
|         |     number of cases       |     September 2008.            |
|         |     listed in the         |                                |
|         |     sampling frame (all   | **Example two (Select 12       |
|         |     cases authorized to   | monthly sampling frames, once  |
|         |     receive payment       | per year):**                   |
|         |     during the sample     |                                |
|         |     month) by the number  | -   If the 12 month sampling   |
|         |     of cases to be        |     period is October 2006 --  |
|         |     selected for the      |     September 2007, generate   |
|         |     sample (23 or 22).    |     one sampling frame per     |
|         |                           |     month, starting with the   |
|         | -   Use a random number   |     month of October 2006      |
|         |     to select the first   |     repeating steps 2 -- 6 for |
|         |     case within the first |     each month.                |
|         |     sampling interval.    |                                |
|         |     From the first case,  |                                |
|         |     use the sampling      |                                |
|         |     interval to select    |                                |
|         |     the next cases until  |                                |
|         |     the sample is         |                                |
|         |     complete at 23 or 22  |                                |
|         |     cases.                |                                |
|         |                           |                                |
|         | -   Calculate a sampling  |                                |
|         |     interval based on the |                                |
|         |     size of the new       |                                |
|         |     sampling frame and    |                                |
|         |     the number of         |                                |
|         |     cases (3) to be       |                                |
|         |     selected as           |                                |
|         |     replacement cases.    |                                |
|         |     Divide the total      |                                |
|         |     number of cases       |                                |
|         |     listed in the         |                                |
|         |     sampling frame (after |                                |
|         |     removing the 23 or 22 |                                |
|         |     sample cases) by the  |                                |
|         |     number of cases to be |                                |
|         |     selected as           |                                |
|         |     replacements (3).     |                                |
|         |                           |                                |
|         | -   Use a random number   |                                |
|         |     to select the first   |                                |
|         |     case within the first |                                |
|         |     replacement sampling  |                                |
|         |     interval. From the    |                                |
|         |     first case, use the   |                                |
|         |     sampling interval to  |                                |
|         |     select the next cases |                                |
|         |     until 3 replacement   |                                |
|         |     cases have been       |                                |
|         |     selected.             |                                |
+---------+---------------------------+--------------------------------+

States then send the original sample list, including the unique child ID
and county of service, to the person/office designated to receive them.
The designated person/office is responsible for making sure case records
are pulled according to the States' agreed upon review schedule and
assigning the case records for review.

[]{#__RefHeading___Toc155167947 .anchor}**V. CUSTOMIZING THE *RECORD
REVIEW WORKSHEET***

States may customize a *Record Review Worksheet* (Attachment 1) based on
the standards contained in their statutes, applicable regulations and
policies in effect at the time of eligibility determination. The
worksheet provides a standardized format to assess and record the
information and documentation existing in the case record needed to
determine if the child was eligible and authorized to receive the
correct subsidy amount. The purpose of customizing the worksheet is to
assist case record reviewers in documenting information during case
record reviews. States may customize by adding, in Column 1, specific
State requirements and, in Column 2, features that assist reviewers in
summarizing their analysis. When completed, the customized *Record
Review Worksheet*:

1.  Identifies the status of each element of eligibility and benefit
    calculation, based on the State plan and other State rules and
    procedures, as documented by the Lead Agency;

2.  Determines the amount of the subsidy payments authorized for the
    sample month; and

3.  Identifies any resulting errors.

In order to accurately determine errors and improper authorizations for
payment, the reviews are to be based on the State standards contained in
statutes, applicable regulations, and policies in effect at the time of
eligibility determination. As a result, States customize the *Record
Review Worksheet* template to conform to the specifics of their CCDF
subsidy program by doing the following:

1.  Review laws, regulations and policies regarding each element
    (application forms, qualifying head of household, etc.);

2.  Review the information on the *Record Review Worksheet* template
    (Attachment 1); and

3.  Based upon this review, develop a list of the appropriate State
    requirements for each element in Column 1 of the *Record Review
    Worksheet* and develop a list of features to assist reviewers in
    summarizing their analysis in Column 2.

States make no changes to Columns 3 or 4. Because reviewers use Column 3
for narrative purposes, there is no reason to customize that Column. The
format for Column 4 must be retained in order to capture all of the
information required in the *Data Entry Form* (Attachment 2).

States provide training and instruction to reviewers. This will assist
States in certifying that the review process is consistent with their
policies and ensuring consistency within the State in interpretation of
what is an error. Using States' customized *Record Review Worksheet* as
a guide, reviewers conduct case record reviews of a random sample of
cases that were authorized to receive a child care payment during the
review period.

States must have ACF approval of revisions to the *Record Review
Worksheet* template prior to using it in the record review. States send
customized *Record Review Worksheets* to the Child Care Manager in the
ACF Regional Office no later than the end of December of the calendar
year prior to the reporting year. Approvals will be based primarily on
review of the State plan but will include other formal State documents,
such as State law, State regulations and State policies. States also
assure and certify in the *State Improper Authorizations for Payment
Report* that all the requirements of the child care error rate
methodology are met.

The *Record Review Worksheet* template consists of four sections
designed for the following data collection:

-   [Section I]{.underline}: State Child Care Program Forms -- This is a
    review of application, recertification, and other forms documenting
    changes affecting eligibility to determine their presence, date on
    the form, completeness and that they are current to eligibility
    policies in the sample review month. Typical forms include the
    application form, rights and responsibilities notification form,
    referral form, parental choice form, and parent/provider agreement
    form, if applicable.

-   [Section II]{.underline}: Priority Group Placement -- This is a
    review to determine if the child meets the criteria of
    State-designated priority groups. These groups are identified in the
    State plan. Examples include categories such as special needs,
    foster care, adoptions, TANF, etc.

-   [Section III]{.underline}: General Program Requirements - This is a
    review to determine if the parent of the client meets the State's
    definition of parent, meets the State or county residency
    requirement, is working or attending a job training or educational
    program and meets other general program requirements of the State or
    county. This review is also to determine a child's eligibility for a
    subsidy, if the number of hours of care authorized is consistent
    with the parent(s)\' work/training status, and if services are
    provided by a legally operating provider.

-   [Section IV]{.underline}: Income and Payments -- This is a review to
    determine if the household income meets State requirements, the
    accuracy of computations and the amount of the authorized payment.
    This section also includes computation of the gross improper
    authorization for payment amount. The amount of the improper
    authorization for payment is the difference between the amount of
    the authorized payment for the child in the sample review month and
    the amount that should have been authorized in the sample review
    month based on the case record review. The calculation of improper
    authorization includes both Overauthorizations and
    Underauthorizations.

Each section of the *Record Review Worksheet* template has four columns
designed for the following data collection:

-   Column 1 - This column lists the basic elements of eligibility,
    income requirements, authorized subsidy amount and computations. In
    addition to customizing the *Record Review Worksheet* template,
    States provide descriptions of the forms, documents and information
    to be considered by the reviewer, including any specific questions,
    prompts or form names that can assist the reviewer in identifying or
    assessing the accuracy of the specific element of eligibility.

-   Column 2 -- This column is for the reviewer to provide a detailed
    analysis of the case record.

-   Column 3 -- If an error is cited in the review of a specific
    element, the reviewer describes the cause(s) of the error(s) in
    Column 3

-   Column 4 -- This column provides codes for the reviewer to summarize
    the results of the case review findings.

For further information about completion of the customized *Record
Review Worksheet* as part of the case record reviews, refer to Section
VI of this document.

The following provides a detailed explanation of each section of the
*Record Review Worksheet* template.

[]{#__RefHeading___Toc155167948 .anchor}**Review Identification
Information**

This information includes: \"Child ID,\" \"State,\" \"County,\" \"Sample
Month/Year\" and \"Review Date.\"

**Column 1: Elements of Eligibility and Payment Authorization**

States retain the printed description for each element of Column 1.
States may customize by adding below any printed element section details
that reflect their laws, policies, and procedures. Examples for the
elements follow.

> Section I. State Child Care Program Forms

-   [Element 100]{.underline} Application/Re-determination Forms **---**
    Determine presence, date, and completeness of required eligibility
    forms. Examples include (1) signed and dated CCDF application
    form, (2) child care agreement, (3) voucher or certificate, and (4)
    provider invoice. Specify conditions of dollar error, including (1)
    form expired, (2) no application form, and (3) no documentation of
    income and work hours.

> States might choose to customize this section by listing each required
> form and providing for reviewer check-off for presence, date and
> completeness. An enhancement would be to provide the policy citation,
> including page number, for each required form.
>
> Section II. Priority Group Placement

-   [Element 200]{.underline} Priority Group Placement --- Determine if
    client meets criteria of any State-designated priority groups,
    e.g., (1) teen parent in high school, (2) TANF recipients in
    eligible work activities, (3) working parents on TANF, and/or (4)
    foster parents.

> Some States may find this area to be \"Not Applicable\" because they
> serve all eligible families. Others may wish to customize this section
> by listing any State-designated priority groups.
>
> Section III. General Program Requirements

-   [Element 300]{.underline} Qualifying Head of Household --- Determine
    if client meets parent definition (parent means a parent by blood,
    marriage or adoption and also means a legal guardian, or other
    person standing in loco parentis), e.g., (1) parent, (2)
    step-parent, (3) legal guardian, (4) needy caretaker relative,
    or (5) spouse of same. Determine if child meets citizenship
    requirements as set forth in Federal policy.

> States might customize this section of the worksheet by listing the
> parent definition or providing regulation citations to prompt
> reviewers, for example:

-   Does the client meet the definition of parent as defined by 45 CFR
    98.20; or

-   Other person standing in loco parentis (identification provided)
    defined in Rule XXX as temporary guardian of child.

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```
-   [Element 310]{.underline} Residency --- Determine if client is a
    resident of the State and for what duration, if client is a resident
    of the county and for what duration, and whether there is an
    agreement regarding eligibility among counties.

> Examples to customize the worksheet would be to provide choices for
> reviewer to check-off, such as:

-   Client is a resident of the State and for what duration;

-   Client is a resident of the county and for what duration; and

-   There is an agreement regarding eligibility among counties.

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```
-   [Element 320]{.underline} Parental Work/Training Status --- To
    receive services a child\'s parent or parents must be working or
    attending a job training or educational program, or have a child
    receiving or needing to receive protective services.

> Examples to customize the worksheet include listing categories for
> reviewer to check off, such as qualifying activity (working a minimum
> of 20 hours a week), schedule (attending a job training or educational
> activity 20 hours a week), disability, protective services case and
> other.

-   [Element 330]{.underline} Qualifying Child **---** Determine if
    child is eligible for services, including (1) younger than 13
    years, (2) younger than 19 years and physically or mentally
    incapable of caring for himself or herself, or under court
    supervision, or (3) meets other eligibility requirements defined in
    the State Plan.

> In addition to separately listing the above categories for reviewer
> check-off, States could customize this section of the worksheet by
> listing requirements such as immunization records.

-   [Element 340]{.underline} Qualifying Care --- Determine number of
    hours needing authorization during review period, based on parental
    work/training status or child\'s protective services status.
    Determine hours and type of care authorized.

> States might provide additional prompts for the reviewer. One example
> is to check to see if the hours of care are entered (on the automated
> system) and consistent and, if not, whether exceptions are noted on
> contacts or paper record.

-   [Element 350]{.underline} Qualifying Provider Arrangement ---
    Determine if services are provided by a center-based child care
    provider, a group home child care provider, a family child care
    provider, or an in-home child care provider that is legally
    operating and eligible to receive child care subsidies.

> The worksheet could be customized by separately listing the qualifying
> provider categories for the reviewer to check-off or by providing the
> appropriate policy citation. Any limitations that a State imposes on
> in-home care may be reflected in this section.

-   [Element 360]{.underline} Provider Requirements --- Determine if
    regulatory requirements are met. Regulatory requirements means
    requirements necessary for a provider to legally provide child care
    services in a State or locality, including registration requirements
    established under State, local or tribal law.

> States might provide additional prompts for the reviewer, such as:
> \"Check the provider record status screen to see if a valid license or
> certificate was in effect as of the sample review month.\"
>
> Section IV. Income and Payment

-   [Element 400]{.underline} Income --- Describe income documentation
    verification for household members. Specify time period (e.g., based
    on 4 weeks prior to application) and all income to be considered
    based on State policies and definitions (e.g., head of household
    employment).

> States may customize by separately identifying State-specific data,
> such as head of household employment income; spouse employment income;
> any changes in income reported; income during job training for
> parent/caregiver; child support, if included as part of income; Food
> Stamps, if included as part of income; and loss of income during
> eligibility period.

-   [Element 410]{.underline} Income Eligibility ---Determine if
    household income meets State requirements (e.g., family gross income
    must be within X% of State\'s median income).

> The worksheet could be customized by citing the State policy or by
> providing elements of income policy in list form.

-   [Element 420]{.underline} Payment Amount Authorized--- Determine the
    amount of subsidy payment authorized for a sample review month.
    Determine if the amount authorized was based on income and family
    size and the State\'s payment rate schedule.

-   [Element 430]{.underline} Authorizations/Computations --- Compute
    the difference between the amount authorized to be paid in a sample
    review month and the amount that should have been authorized. This
    difference is the improper authorization for payment amount.
    Indicate if the error amount is an Overauthorization or
    Underauthorization. In cases without errors, this element is not
    applicable so a zero should be placed in the amount of improper
    authorization for payment box.

    **Column 2: Analysis of Case Record**

This Column contains the details for analysis of the case record. The
analysis provides a summary of the case record information as it relates
to the requirements stipulated in Column 1. States must retain the
column heading \"Analysis of Case Record,\" but may choose to customize
Column 2 of the *Record Review Worksheet* to allow for coding to
substitute for a reviewer's written summary. In this example, Column 2
is customized by using \"yes\" or \"no\" columns. In addition, Column 1
has also been customized to include State-specific information.

> **Example of Column 2 Modification of the Record Review Template**

  --------------------------------------------- ------------ ----- ----------
  **310 RESIDENCY\                              **ANALYSIS         
  ELEMENTS OF ELIGIBILITY & PAYMENT             OF CASE            
  AUTHORIZATION (1)\                            RECORD (2)**       
  **Determine if client is a resident of the                       
  State and if client is a resident of the                         
  county.                                                          

                                                Yes          No    Comments

                                                                   

  (1)Is the Client is a resident of the State?                     
  (a client statement indicating residency and                     
  intent to stay is sufficient for non TANF                        
  clients) (Section 414.095(2)(a)2, FS                             
  requirement for TCA clients -- clients are                       
  not eligible for TCC unless previously served                    
  under TCA)                                                       

  (2)Child care authorized by county in which                      
  the parent resides? (School readiness funding                    
  and services are provided based on the county                    
  where the parent resides)                                        
  --------------------------------------------- ------------ ----- ----------

While it is not required, States may choose to ask reviewers to include
photocopies of specific documentation of an authorization error to
support the Column 2 analysis. For example, the reviewer could make a
copy of the client's driver's license (used as proof of residency) that
listed an out of State address.

[]{#__RefHeading___Toc155167951 .anchor}**Column 3: Findings**

Column 3 contains the findings of the case record review and provides
any pertinent facts, questions, or conflicts in information as they
relate to the requirements stipulated in Column 1. Because reviewers use
this Column for narrative purposes, States do not customize Column 3.

[]{#__RefHeading___Toc155167952 .anchor}**Column 4: Results**

States may not customize Column 4. Reviewers identify in Column 4 the
codes that summarize the review findings from Column 3 of the customized
*Record Review Worksheet*. The codes are the following:

1.  Error -- The codes are "0" = no error, "1" = error;

2.  Reason for error -- The codes are "Y" = Yes, the error is due to
    missing or insufficient documentation, "N" = No, the error is not
    due to use of missing or insufficient documentation, and \"NA\" if
    there is no error;

3.  Type of improper authorizations during sample review month -- "U" =
    Underauthorization, "O" = Overauthorization, and \"NA\" = no
    improper authorization; and

4.  Total amount of improper authorization for payment--This is where
    the dollar amount of the improper authorization for payment is
    recorded. This is the difference between the authorized payment
    amount and the amount reviewers found during the review that should
    have been authorized.

Because this coding is transferred to *Data Entry Forms* and then
consolidated to compute the error measures, States must not customize
Column 4.

[]{#__RefHeading___Toc155167953 .anchor}**VI. CONDUCTING CASE RECORD
REVIEWS**

The case record review is considered a quality control function and is
not to be carried out by persons making or approving the eligibility
determinations. Staff selected to complete the review must be
knowledgeable of their State's child care policies. The integrity of the
review findings requires that all reviewers have a shared view of what
constitutes an error for all elements of the review.

Using their chosen coordination strategy, States provide training and
instruction to reviewers sufficient that States can certify that the
review process is consistent with their policies and there is consistent
interpretation of what is an error. To accomplish this inter-reviewer
reliability States may choose to:

-   Discuss, as a group, the initial case reviews and their findings;
    and/or

-   Conduct several "second level" re-reviews to assure inter-reviewer
    consistency.

Using the customized *Record Review Worksheet* as a guide, States
conduct desk record reviews of the random sample of 22 or 23 cases that
were authorized to receive a child care payment during one of the sample
review months. If a case cannot be reviewed for some valid reason, the
cases in the replacement sample (3) are used in the order in which they
were selected.

**General Instructions**

Reviewers use the customized *Record Review Worksheet* to record
analysis of the case record and findings. This documentation provides
the verification that substantiates the eligibility determination and
the amount authorized for payment for the sample review month. Regarding
eligibility status, reviewers examine the most recent eligibility
determination in effect for the sample review month - either the initial
determination or a redetermination and any subsequently reported changes
(e.g., income, or status) that might impact eligibility.

To properly review cases, reviewers must identify and examine the
documentation within the case records that was used to determine
eligibility for a sample review month and calculate payments authorized
for that month.. This documentation may be permanent portions of the
case record (copies of pay stubs, school schedules, birth certificates,
etc.) or information specific to the eligibility period which covers the
sample month (policy in effect for that month). The review also includes
access or inquiry of any relevant screens or files within a State's
automated system, as appropriate and necessary.

**Review Identification Information**

Reviewers complete identifying information for each review in the first
line of the *Record Review Worksheet*. This information includes: the
unique Child ID #, State and County names, the Sample Month/Year and the
Review Date (the date the case record is reviewed).

**Columns 1: Elements of Eligibility and Payment Authorization and
Column 2: Analysis of Case Record**

Column 1: Elements of Eligibility and Payment Authorization includes for
reviewers what forms, documents and information will assist them in
identifying or assessing the accuracy of the specific element of
eligibility.

Column 2: Analysis of Case Record is where reviewers summarize any
pertinent facts, questions, or conflicts in information found in the
case record documentation.

The following identifies each of the elements in Column 1 and the kinds
of information that needs to be reviewed. Instructions follow about what
companion facts, questions, or conflicts in information to insert in
Column 2.

> **Section I. State Child Care Program Forms**

-   **[Element 100]{.underline} Application/Re-determination Forms**
    ***---** Determine presence, date, and completeness of required
    eligibility forms. Examples include (1) signed and dated CCDF
    application form, (2) child care agreement, (3) voucher or
    certificate, and (4) provider invoice. Specify conditions of dollar
    error, including (1) form expired, (2) no application form, and (3)
    no documentation of income and work hours.*

> [Column 1]{.underline} - Reviewers identify all required child care
> subsidy eligibility-related forms in their State, if they are not
> listed in the customized worksheet, and look for them in the case
> record.
>
> [Column 2]{.underline} - Reviewers check to make sure these forms are
> current and completely filled out, including required signatures.
> Reviewers then record facts, questions, or conflicts in information.
>
> **Section II. Priority Group Placement**

-   **[Element 200]{.underline} Priority Group Placemen**t *---
    Determine if client meets criteria of any State-designated priority
    groups, e.g., (1) teen parent in high school, (2) TANF recipients in
    eligible work activities, (3) working parents on TANF, and/or (4)
    foster parents.*

> [Column 1]{.underline} - Reviewers verify if States have designated
> priority group(s).
>
> [Column 2]{.underline} - Reviewers look for and record evidence that
> the case involves a priority group. Reviewers code this element \"NA\"
> if there are no State-designated priority groups.
>
> **Section III. General Program Requirements**

-   **[Element 300]{.underline}** **Qualifying Head of Household** *---
    Determine if client meets parent definition (parent means a parent
    by blood, marriage or adoption and also means a legal guardian, or
    other person standing in loco parentis), e.g., (1) parent, (2)
    step-parent, (3) legal guardian, (4) needy caretaker relative,
    or (5) spouse of same. Determine if child is a citizen, as defined
    by Federal policy.*

> [Column 1]{.underline} - Reviewers consult the list in the customized
> worksheet or refer directly to State policy for requirements for a
> qualifying head of household.
>
> [Column 2]{.underline} - Reviewers check the application form and
> supplementary documentation to determine if the necessary requirements
> are met.

-   **[Element 310]{.underline}** **Residency** *--- Determine if client
    is a resident of the State and for what duration, if client is a
    resident of the county and for what duration, and whether there is
    an agreement regarding eligibility among counties.*

> [Column 1]{.underline}: Reviewers examine the case record for the
> residency documentation required by the State, either customized in
> the worksheet or found in State policy.
>
> [Column 2]{.underline} - Reviewers compare State residency
> requirements with case record documentation.

-   **[Element 320]{.underline} Parental Work/Training Status** *--- To
    receive services a child\'s parent or parents must be working or
    attending a job training or educational program, or have a child
    receiving or needing to receive protective* *services.*

> [Column 1]{.underline} - Reviewers identify State policy requirements
> for parental activity status, if not already on customized worksheet,
> and look for corresponding information in the case record.
>
> [Column 2]{.underline} - Reviewers compare State requirements with
> case record documentation to find out if the child\'s eligibility
> determination was appropriate based on the child\'s protective
> services status or the job/training/educational activity of the
> parent(s).

-   **[Element 330]{.underline} Qualifying Child** ***---** Determine if
    child is eligible for services, including (1) younger than 13
    years, (2) younger than 19 years and physically or mentally
    incapable of caring for himself or herself, or under court
    supervision, or (3) meets other eligibility requirements defined in
    the State Plan.*

> [Column 1]{.underline} - Reviewers identify State policy requirements
> for child eligibility status, if not already on customized worksheet,
> and look for corresponding information about the child in the case
> record.
>
> [Column 2]{.underline} - Reviewers compare information in the case
> record with State policy to find out if the child\'s eligibility
> determination was appropriate to the child\'s age, physical or mental
> needs, and/or other child criteria in State policy.

-   **[Element 340]{.underline} Qualifying Care** *--- Determine number
    of hours needing authorization during review period, based on
    parental work/training status or child\'s protective services
    status. Determine hours and type of care authorized.*

> [Column 1]{.underline} - Reviewers refer to documentation of child
> protective services status or parent job/training/educational
> activity.
>
> [Column 2]{.underline}: Reviewers compare the hours authorized for
> services, as recorded in the case record, with the documentation of
> child protective services status or parent job/training/educational
> activity.

-   **[Element 350]{.underline}** **Qualifying Provider Arrangement**
    *--- Determine if services are provided by a center-based child care
    provider, a group home child care provider, a family child care
    provider, or an in-home child care provider that is legally
    operating and eligible to receive child care subsidies.*

> [Column 1]{.underline} - Reviewers check State policy for allowable
> provider categories and look for documentation of provider category in
> the case record.
>
> [Column 2]{.underline} - Reviewers check provider information in the
> case record to verify that the provider is from an allowable provider
> category.

-   **[Element 360]{.underline}** **Provider Requirements** *---
    Determine if regulatory requirements are met. Regulatory
    requirements are requirements necessary for a provider to legally
    provide child care services in a State or locality, including
    registration requirements established under State, local or tribal
    law.*

> [Column 1]{.underline} - Reviewers check State policy for allowable
> legal provider status and look for documentation of provider category
> in the case record.
>
> [Column 2]{.underline} - Reviewers check provider information in the
> case record to see if there is a license, registration document, or
> other document showing legal provider status.
>
> **Section IV. Income and Payment**

-   **[Element 400]{.underline} Income** *--- Describe income
    documentation verification for household members. Specify time
    period (e.g., based on 4 weeks prior to application) and all income
    to be considered based on State policies and definitions (e.g., head
    of household employment).*

> [Column 1]{.underline} - Look for income verification for household
> members. Income categories may be customized on the worksheet and may
> include such income as
>
> head of household employment income; spouse employment income; any
> changes in income reported; income during job training for
> parent/caregiver; child support, if included as part of income; Food
> Stamps, if included as part of income; and loss of income during
> eligibility period.
>
> [Column 2]{.underline} - Reviewers review and describe how household
> income, both earned and unearned, was verified and computed. This
> includes reviewing the income documentation information in the case
> record used for verification, reviewing compliance with State income
> verification policy, such as the treatment of disregarded income, and
> checking the computations for accuracy.

-   **[Element 410]{.underline} Income Eligibility** *---Determine if
    household income meets State requirements (e.g., family gross income
    must be within X percent of State\'s median income).*

> [Column 1]{.underline} - Reviewers identify the State income
> requirements from State policy, if not included in the customized
> worksheet.
>
> [Column 2]{.underline} - Compare the State income requirements with
> income data found in Element 400.

-   **[Element 420]{.underline} Payment Amount Authorized***---
    Determine the amount of subsidy payment authorized for a sample
    review month. Determine if the amount authorized was based on income
    and family size and the State\'s payment rate schedule.*

> [Column 1]{.underline} - Reviewers locate in the case record the
> amount of subsidy authorized for the sample review month.
>
> [Column 2]{.underline} - Reviewers determine if the amount authorized
> was based on income (Element 400) and State income requirements
> (Element 410).

-   **[Element 430]{.underline} Authorizations of Payment/Computations**
    *--- Compute the difference between the amount authorized to be paid
    in a sample review month and the amount that should have been
    authorized. This difference is the error amount. Indicate if the
    error amount is an Overauthorization or Underauthorization. This is
    the method for calculating the error amount in all cases, including
    those with multiple errors. In cases without errors, this element is
    not applicable.*

> [Column 1]{.underline} - There is no separate action required for
> Column 1.
>
> [Column 2]{.underline} - Reviewers compute the difference, if any,
> between the amount authorized for payment in the sample review month
> and the amount that should have been authorized and record any
> difference, if any. If there are no errors, record as \"NA.\"

**Column 3: Findings**

Reviewers summarize the findings of the analysis from Column 2 for each
element. If an error is cited, include a detailed description of the
cause(s) of the error(s). The description includes whether the error(s)
resulted in an authorized Overauthorization or Underauthorization and
the amount of the Overauthorization or Underauthorization.

When a reviewer discovers more than one authorization error, the
reviewer documents the specific effects of each and selects the error
with the largest dollar value to code as the type of improper
authorization.

This section also includes summaries of any error(s) that did not result
in a dollar amount found in the element.

**Column 4: Results**

Based upon the Column 3 summary, the reviewer completes the coding in
Column 4 for each Element in each Section of the *Record Review
Worksheet*. Column 4 lists the following codes to summarize the review
findings:

1.  Error --Enter the correct code according to the following key: "0" =
    no error, "1" = error;

2.  Reason for error -- Enter "Y" if the error is due to missing or
    insufficient documentation, "N" if the error is not due to missing
    or insufficient documentation, and \"NA\" if there is no error;

3.  Type of improper authorization(s) during sample review month --
    Enter "U" for Underauthorization, "O" for Overauthorization and
    \"NA\" if there is no improperauthorization. (For cases with both
    error types the type of the error responsible for the larger dollar
    amount is coded.); and

4.  Total Amount of Improper Authorization -- Enter the dollar amount of
    the error. This is the difference between the authorized payment
    amount and the amount reviewers found, during the review, that
    should have been authorized.

**Case Record Review Examples**

The following sample case review examples illustrate how to record
analysis and summarize the findings of the case record review across the
Columns of the *Record Review Worksheet*.

[]{#__RefHeading___Toc155167954 .anchor}**Review Identification
Information**

The reviewer completes identifying information for each review in the
first line of the *Record Review Worksheet*. This information includes:
the unique Child ID #, State and County names, the Sample Month/Year and
the Date of the Review (the date the case record is reviewed).

[]{#__RefHeading___Toc155167955 .anchor}**Column 1:** **Elements of
Eligibility** **and Payment Authorization**

Reviewers consider and locate each of the elements specified in Column
1, including any forms, documents and information that can assist the
reviewer in identifying or assessing the accuracy of the specific
element of eligibility.

[]{#__RefHeading___Toc155167956 .anchor}**Column 2: Analysis of Case
Record**

Reviewers complete Column 2 at the point in time the record is reviewed.
Reviewers summarize any pertinent facts, questions, or conflicts in
information found in the case record documentation and the actions taken
by the case worker as they relate to the requirements stipulated in
Column 1.

While it is not required, States may choose to ask reviewers to include
photocopies of specific documentation of an authorization error to
support the Column 2 analysis. Additional documentation helps to support
and clarify the reviewer's Column 2 and Column 3 summaries.

The following example illustrates a Column 2 summary of the results of a
case record analysis using the *Record Review Worksheet* Template.

**Example of a Column 2 Summary of a Case Record Analysis**

**Using the Record Review Worksheet**

  -----------------------------------------------------------------------
  **ELEMENTS OF ELIGIBILITY & PAYMENT         **ANALYSIS OF CASE RECORD
  AUTHORIZATION (1)**                         (2)**
  ------------------------------------------- ---------------------------
  **310 RESIDENCY**                           Copies of the customer's
                                              driver's license and rental
                                              agreement were in the case
                                              record.

  Determine if client is a resident of the    
  State and for what duration, if client is a 
  resident of the county and for what         
  duration, and whether there is an agreement 
  regarding eligibility among counties.       
  -----------------------------------------------------------------------

[]{#__RefHeading___Toc155167957 .anchor}**Column 3: Findings**

Column 3 summarizes the findings of the review for the specific Column 1
element. If an error is cited, reviewers include a detailed description
of the cause(s) of the error(s). The description includes whether the
error(s) resulted in an Overauthorization or Underauthorization and the
amount of the Overauthorization or Underauthorization. This section also
includes summaries of any error(s) reviewers found in any element that
did not result in a dollar error. When a reviewer discovers more than
one authorization error, the reviewer documents the specific effects of
each and selects the error with the largest dollar value to code as the
type of improper authorization in Column 4, with "U" for
Underauthorization, "O" for Overauthorization, and \"NA\" for no
improper authorization. In the event of both an Overauthorization and
Underauthorization, the net difference is also recorded in Column 3 and
is entered in Column 4, #4.

The following example illustrates a Column 2 summary and the Column 3
findings of an authorization error.

**Example of Column 2 Summary and Column 3 Finding**

Using the Record Review Worksheet

  -------------------------------------------------------------------------------------
  **ELEMENTS OF ELIGIBILITY &     **ANALYSIS OF CASE  **FINDINGS (3)**
  PAYMENT AUTHORIZATION (1)**     RECORD (2)**        
  ------------------------------- ------------------- ---------------------------------
  **310 RESIDENCY**               Copies of the       The customer's driver's license
                                  customer's drivers  and rental agreement list an
                                  license and rental  address that is an adjoining
                                  agreement were in   state. The worker failed to apply
                                  the case record.    the policy correctly causing an
                                                      Overauthorization/Ineligibility
                                                      of \$256.

  Determine if client is a                            
  resident of the State and for                       
  what duration, if client is a                       
  resident of the county and for                      
  what duration, and whether                          
  there is an agreement regarding                     
  eligibility among counties.                         
  -------------------------------------------------------------------------------------

The following examples provide additional guidance for several common
case scenarios illustrating Column 3 error summaries.

> **Example #1 --- One Underauthorization Error**
>
> Findings---The child\'s parent provided her two most recent bi-weekly
> pay stubs at application. The caseworker converted the income as if it
> was weekly income. This error caused the income to be overstated by
> \$300 monthly and resulted in a monthly authorization of \$50 less
> than should have been authorized.
>
> **Example #2 --- Two Overauthorization Errors**
>
> Findings---The child\'s parent provided her two most recent bi-weekly
> pay stubs at recertification. The caseworker used the net income
> figure rather than the gross figure. This caused a \$20
> Overauthorization in the monthly subsidy. On the application the
> parent had listed \$300 monthly in child support. This was the amount
> used by the worker. The case record did not contain any verification
> of this income. Using the required child support screens, the reviewer
> verified that the customer actually received child support of \$400
> monthly. The child support income caused a monthly authorization of
> \$60 more than should have been authorization. The two errors amount
> to an Overauthorization of \$80 coded in Column 4.
>
> **Example #3 --- Two Underauthorization Errors**
>
> Findings---The child\'s parent provided all required information about
> her self-employment income and business costs. The caseworker
> miscalculated the parent's gross income, resulting in an overstatement
> of monthly earnings by \$100. This resulted in an Underauthorization
> of \$15. The worker also failed to include a business cost that was
> documented in the case record. The inclusion of the business cost
> lowered the client's income further resulting in an additional \$10
> Underauthorization. The two errors amount to a \$25
> Underauthorization. This amount is the figure used for the total
> amount of the authorization in Element 430 Column 4.
>
> **Example #4 --- One Error - No dollar value**
>
> Findings---The payment form in the record was signed by the worker but
> not by the supervisor. As this error has no dollar value, enter \"1\"
> for error, \"Y\" for error due to missing or insufficient
> documentation, \"N/A\" for no improper authorization.

**Example #5 - Two Errors - One Overauthorization and One
Underauthorization**

Findings---The client provided all required information about her self -
employment income and her business costs. The caseworker miscalculated
the customer's gross income and this resulted in it being overstated by
\$100 monthly. This would have resulted in an Underauthorization of
\$15. However, the worker also included a business cost that is not
allowed under state policy. The net difference of the two errors, a \$5
Underauthorization, is the amount recorded in the total amount of the
improper authorization in Column 4 in the *Record Review Worksheet*

**Column 4: Results**

Based upon the Column 3 summary, the reviewer completes the coding in
Column 4 for each Element in each Section of the *Record Review
Worksheet*. Column 4 lists the following codes to summarize the review
findings:

> 1\. Error --Enter the correct code according to the following key: "0"
> = no error, "1" = error;
>
> 2\. Reason for error -- Enter "Y" if the error is due to missing or
> insufficient documentation, "N" if the error is not due to missing or
> insufficient documentation, and \"NA\" if there is no error;
>
> 3\. Type of improper authorization(s) during sample review month --
> Enter "U" for Underauthorization, "O" for Overauthorization and \"NA\"
> if there is no improper authorization. (For cases with both error
> types the type of the error responsible for the larger dollar amount
> is coded.); and
>
> 4\. Total Amount of Improper Authorizations for Payment-- Enter the
> dollar amount of the error. This is the difference between the
> authorization amount and the amount reviewers found, during the
> review, that should have been authorized.

**Example of Column 2 Summary, Column 3 Findings and the Column 4
Results**

***~~Using the Record Review Worksheet~~***

+------------------+--------------+----------------+----+------------+
| **ELEMENTS OF    | **ANALYSIS   | **FINDINGS     | *  |            |
| ELIGIBILITY &    | OF CASE      | (3)**          | *R |            |
| PAYMENT          | RECORD (2)** |                | ES |            |
| AUTHORIZATION    |              |                | UL |            |
| (1)**            |              |                | TS |            |
|                  |              |                | (  |            |
|                  |              |                | 4) |            |
|                  |              |                | ** |            |
+------------------+--------------+----------------+----+------------+
| **310            | Copies of    | The customer's | *  |            |
| RESIDENCY**      | the          | driver's       | *3 |            |
|                  | customer's   | license and    | 10 |            |
|                  | driver's     | rental         | R  |            |
|                  | license and  | agreement list | ES |            |
|                  | rental       | an address     | UL |            |
|                  | agreement    | that is in an  | TS |            |
|                  | were in the  | adjoining      | ** |            |
|                  | case record. | state. The     |    |            |
|                  |              | worker failed  |    |            |
|                  |              | to apply the   |    |            |
|                  |              | policy         |    |            |
|                  |              | correctly      |    |            |
|                  |              | causing an     |    |            |
|                  |              | Ove            |    |            |
|                  |              | rauthorization |    |            |
|                  |              | of \$256 for   |    |            |
|                  |              | the monthly    |    |            |
|                  |              | subsidy.       |    |            |
+------------------+--------------+----------------+----+------------+
| Determine if     |              |                | 1  | No Error   |
| client is a      |              |                | \. |            |
| resident of the  |              |                | 1  | Error      |
| State and for    |              |                |    |            |
| what duration,   |              |                |    |            |
| if client is a   |              |                |    |            |
| resident of the  |              |                |    |            |
| county and for   |              |                |    |            |
| what duration,   |              |                |    |            |
| and whether      |              |                |    |            |
| there is an      |              |                |    |            |
| agreement        |              |                |    |            |
| regarding        |              |                |    |            |
| eligibility      |              |                |    |            |
| among counties.  |              |                |    |            |
+------------------+--------------+----------------+----+------------+
|                  |              |                | 2  | Ins        |
|                  |              |                | \. | ufficient/ |
|                  |              |                | N  | Missing    |
|                  |              |                |    |            |
|                  |              |                |    | Doc        |
|                  |              |                |    | umentation |
+------------------+--------------+----------------+----+------------+
|                  |              |                | 3  | Underaut   |
|                  |              |                | \. | horization |
|                  |              |                | O  |            |
|                  |              |                |    | Overaut    |
|                  |              |                |    | horization |
+------------------+--------------+----------------+----+------------+
|                  |              |                | 4  | Total      |
|                  |              |                | \. | Amount of  |
|                  |              |                | \  |            |
|                  |              |                | $2 | Improper   |
|                  |              |                | 56 | Aut        |
|                  |              |                |    | horization |
|                  |              |                |    | for        |
|                  |              |                |    | Payment    |
+------------------+--------------+----------------+----+------------+

**Example of Column 2 Summary, Column 3 Findings and the Column 4
Results**

***~~Using the Record Review Worksheet (Multiple error case)~~***

+------------------+-----------------+-----------------+------+--------+
| **ELEMENTS OF    | **ANALYSIS OF   | **FINDINGS      | *    |        |
| ELIGIBILITY &    | CASE RECORD     | (3)**           | *RES |        |
| PAYMENT          | (2)**           |                 | ULTS |        |
| AUTHORIZATION    |                 |                 | (    |        |
| (1)**            |                 |                 | 4)** |        |
+------------------+-----------------+-----------------+------+--------+
| **400 INCOME**   | The client      | The client      | *    |        |
|                  | provided her    | provided her    | *400 |        |
|                  | two most recent | two most recent | INCO |        |
|                  | bi-weekly pay   | bi-weekly pay   | ME** |        |
|                  | stubs at        | stubs at        |      |        |
|                  | r               | r               |      |        |
|                  | ecertification. | ecertification. |      |        |
|                  | Monthly income  | The caseworker  |      |        |
|                  | amount used in  | used the net    |      |        |
|                  | subsidy         | income figure   |      |        |
|                  | calculation was | rather than the |      |        |
|                  | \$400.          | gross figure.   |      |        |
|                  |                 | This caused a   |      |        |
|                  | The customer    | \$20            |      |        |
|                  | listed \$300 as | Ov              |      |        |
|                  | monthly child   | erauthorization |      |        |
|                  | support income. | for the monthly |      |        |
|                  |                 | subsidy. On the |      |        |
|                  |                 | application the |      |        |
|                  |                 | client had      |      |        |
|                  |                 | listed \$300    |      |        |
|                  |                 | monthly in      |      |        |
|                  |                 | child support.  |      |        |
|                  |                 | This was the    |      |        |
|                  |                 | amount used by  |      |        |
|                  |                 | the worker. The |      |        |
|                  |                 | case record did |      |        |
|                  |                 | not contain any |      |        |
|                  |                 | verification of |      |        |
|                  |                 | this income.    |      |        |
|                  |                 | Using the       |      |        |
|                  |                 | required child  |      |        |
|                  |                 | support screens |      |        |
|                  |                 | the reviewer    |      |        |
|                  |                 | verified that   |      |        |
|                  |                 | the customer    |      |        |
|                  |                 | actually        |      |        |
|                  |                 | received child  |      |        |
|                  |                 | support of      |      |        |
|                  |                 | \$400 monthly.  |      |        |
|                  |                 | The child       |      |        |
|                  |                 | support income  |      |        |
|                  |                 | caused a \$60   |      |        |
|                  |                 | Ov              |      |        |
|                  |                 | erauthorization |      |        |
|                  |                 | for the monthly |      |        |
|                  |                 | subsidy. The    |      |        |
|                  |                 | two error       |      |        |
|                  |                 | amounts         |      |        |
|                  |                 | combined result |      |        |
|                  |                 | in an \$80      |      |        |
|                  |                 | Ov              |      |        |
|                  |                 | erauthorization |      |        |
|                  |                 | for the month.  |      |        |
+------------------+-----------------+-----------------+------+--------+
| Describe income  |                 |                 | 1\.  | No     |
| documentation    |                 |                 | 1    | Error  |
| verification for |                 |                 |      |        |
| each member of   |                 |                 |      | Error  |
| the household.   |                 |                 |      |        |
| Specify time     |                 |                 |      |        |
| period and all   |                 |                 |      |        |
| income to be     |                 |                 |      |        |
| considered,      |                 |                 |      |        |
| e.g., based on 4 |                 |                 |      |        |
| weeks prior to   |                 |                 |      |        |
| application:     |                 |                 |      |        |
| Collect the      |                 |                 |      |        |
| following data:  |                 |                 |      |        |
| (1) head of      |                 |                 |      |        |
| household        |                 |                 |      |        |
| employment       |                 |                 |      |        |
| income, (2)      |                 |                 |      |        |
| spouse           |                 |                 |      |        |
| employment       |                 |                 |      |        |
| income, (3) any  |                 |                 |      |        |
| changes in       |                 |                 |      |        |
| income reported, |                 |                 |      |        |
| (4) income       |                 |                 |      |        |
| during job       |                 |                 |      |        |
| training for     |                 |                 |      |        |
| p                |                 |                 |      |        |
| arent/caregiver, |                 |                 |      |        |
| (5) child        |                 |                 |      |        |
| support, if      |                 |                 |      |        |
| included as part |                 |                 |      |        |
| of income, (6)   |                 |                 |      |        |
| Food Stamps, if  |                 |                 |      |        |
| included as part |                 |                 |      |        |
| of income, and   |                 |                 |      |        |
| (7) loss of      |                 |                 |      |        |
| income during    |                 |                 |      |        |
| eligibility      |                 |                 |      |        |
| period.          |                 |                 |      |        |
+------------------+-----------------+-----------------+------+--------+
|                  |                 |                 | 2\.  | I      |
|                  |                 |                 | Y    | nsuffi |
|                  |                 |                 |      | cient/ |
|                  |                 |                 |      | M      |
|                  |                 |                 |      | issing |
|                  |                 |                 |      |        |
|                  |                 |                 |      | Do     |
|                  |                 |                 |      | cument |
|                  |                 |                 |      | -ation |
+------------------+-----------------+-----------------+------+--------+
|                  |                 |                 | 3\.  | U      |
|                  |                 |                 | O    | nderpa |
|                  |                 |                 |      | y-ment |
|                  |                 |                 |      | Overpa |
|                  |                 |                 |      | y-ment |
+------------------+-----------------+-----------------+------+--------+
|                  |                 |                 | 4\.  | Total  |
|                  |                 |                 | \$80 | Amount |
|                  |                 |                 |      | of     |
|                  |                 |                 |      |        |
|                  |                 |                 |      | Im     |
|                  |                 |                 |      | proper |
|                  |                 |                 |      | Au     |
|                  |                 |                 |      | thoriz |
|                  |                 |                 |      | ations |
|                  |                 |                 |      | for    |
|                  |                 |                 |      | P      |
|                  |                 |                 |      | ayment |
+------------------+-----------------+-----------------+------+--------+

**VII. Completing the *data entry form***

State reviewers record the findings from each *Record Review Worksheet*
onto a *Data Entry Form*. (Attachment 2)

The *Data Entry Form* summarizes the composite results of the record
review documented on the *Record Review Worksheet*. Below is a list of
the information included on the *Data Entry Form*, instructions as
necessary and where the information can be located on the *Record Review
Worksheet*. Note that the term \"authorization\" means the subsidy
payment authorized during eligibility determination or redetermination
for the sample review month. (See Glossary.)

1.  State -- Insert the State name from the first line of the *Record
    Review Worksheet*;

2.  County -- Insert the County name from the first line of the *Record
    Review Worksheet*;

3.  Child ID -- Insert the Child ID from the first line of the *Record
    Review Worksheet*;

4.  Sample Month/Year -- Insert the sample month/year from the first
    line/top of the *Record Review Worksheet*;

5.  Record Review Date -- Insert the Record Review Date from the first
    line of the *Record Review Worksheet*;

6.  One or more errors during sample review month -- Insert the number
    of errors code according to the following key: "0" = no errors, "1"
    = one or more errors. This information is located on the *Record
    Review Worksheet* in Column 4;

7.  Total amount of improper authorization (Underauthorization or
    Overauthorization) during sample review month -- Insert the total
    dollar amount of the improper authorization located on the *Record
    Review Worksheet* in Element 430, Column 4;

8.  Type of improper authorization for payment -- Insert the type of
    improper authorization code according to the following key: "U" =
    Underauthorization, "O" = Overauthorization. Enter \"NA\" if there
    is no authorization error. This information is located on the
    *Record Review Worksheet* in Column 4. (For cases with multiple
    authorization errors, enter the type of improper authorization for
    the larger dollar amount of error.);

9.  Reason for error due to insufficient or missing documentation --
    Insert "Y" if the reason for error was due to insufficient or
    missing documentation, \"N\" if the error was not due to
    insufficient or missing information, and \"NA\" is there is no
    error. This information is located on *Record Review Worksheet* in
    Column 4; and

10. Total authorization amount during sample review month -- Insert the
    total dollar amount included on *Record Review Worksheet* in Element
    420, Column 2.

**Exhibit 5**

Data Entry Form

+-----+--------------------------------------------------+------------+
| **I | **Item**                                         | **Coding** |
| tem |                                                  |            |
| \   |                                                  |            |
| #** |                                                  |            |
+-----+--------------------------------------------------+------------+
| **1 | State                                            |            |
| .** |                                                  |            |
+-----+--------------------------------------------------+------------+
| **2 | County                                           |            |
| .** |                                                  |            |
+-----+--------------------------------------------------+------------+
| **3 | Child ID                                         |            |
| .** |                                                  |            |
+-----+--------------------------------------------------+------------+
| **4 | Sample Month/Year                                |            |
| .** |                                                  |            |
+-----+--------------------------------------------------+------------+
| **5 | Record Review Date                               |            |
| .** |                                                  |            |
+-----+--------------------------------------------------+------------+
| **6 | One or more case errors during sample review     |            |
| .** | month                                            |            |
|     |                                                  |            |
|     | 0= no errors, 1= one or more errors              |            |
+-----+--------------------------------------------------+------------+
| **  | Total amount of Underauthorization or            |            |
| 7** | Overauthorization during sample review month     |            |
+-----+--------------------------------------------------+------------+
| **8 | Type of improper authorization for payment       |            |
| .** |                                                  |            |
|     | (U = Underauthorization, O = Overauthorization   |            |
|     | or NA = No Authorization Error)                  |            |
+-----+--------------------------------------------------+------------+
| **9 | Reason for error due to insufficient or missing  |            |
| .** | documentation                                    |            |
|     |                                                  |            |
|     | (Y = Yes, N = No or NA = No Error)               |            |
+-----+--------------------------------------------------+------------+
| *   | Total Authorization Amount during sample review  |            |
| *10 | month                                            |            |
| .** |                                                  |            |
+-----+--------------------------------------------------+------------+

***Data Entry Form* Examples**

The following example is provided to illustrate a review of one Section
of the customized *Record Review Worksheet*, followed by the manner in
which Columns 2 -- 4 would be completed.

+------------------+---------------+---------------+------+-----------+
| **ELEMENTS OF    | **ANALYSIS OF | **FINDINGS    | *    |           |
| ELIGIBILITY &    | CASE RECORD   | (3)**         | *RES |           |
| PAYMENT          | (2)**         |               | ULTS |           |
| AUTHORIZATION    |               |               | (    |           |
| (1)**            |               |               | 4)** |           |
+------------------+---------------+---------------+------+-----------+
| **310            | Copies of the | The           | *    |           |
| RESIDENCY**      | customer's    | customer's    | *310 |           |
|                  | driver's      | driver's      | R    |           |
|                  | license and   | license and   | ESUL |           |
|                  | rental        | rental        | TS** |           |
|                  | agreement     | agreement     |      |           |
|                  | were in the   | list an       |      |           |
|                  | case record.  | address that  |      |           |
|                  |               | is an         |      |           |
|                  |               | adjoining     |      |           |
|                  |               | state. The    |      |           |
|                  |               | worker failed |      |           |
|                  |               | to apply the  |      |           |
|                  |               | policy        |      |           |
|                  |               | correctly     |      |           |
|                  |               | causing an    |      |           |
|                  |               | Over          |      |           |
|                  |               | authorization |      |           |
|                  |               | of \$256.     |      |           |
+------------------+---------------+---------------+------+-----------+
| Determine if     |               |               | 1\.  | No Error  |
| client is a      |               |               | 1    |           |
| resident of the  |               |               |      | Error     |
| State and for    |               |               |      |           |
| what duration,   |               |               |      |           |
| if client is a   |               |               |      |           |
| resident of the  |               |               |      |           |
| county and for   |               |               |      |           |
| what duration,   |               |               |      |           |
| and whether      |               |               |      |           |
| there is an      |               |               |      |           |
| agreement        |               |               |      |           |
| regarding        |               |               |      |           |
| eligibility      |               |               |      |           |
| among counties.  |               |               |      |           |
+------------------+---------------+---------------+------+-----------+
|                  |               |               | 2\.  | Insu      |
|                  |               |               | N    | fficient/ |
|                  |               |               |      | Missing   |
|                  |               |               |      |           |
|                  |               |               |      | Docu      |
|                  |               |               |      | mentation |
+------------------+---------------+---------------+------+-----------+
|                  |               |               | 3\.  | Underauth |
|                  |               |               | O    | orization |
|                  |               |               |      |           |
|                  |               |               |      | Overauth  |
|                  |               |               |      | orization |
+------------------+---------------+---------------+------+-----------+
|                  |               |               | 4\.  | Total     |
|                  |               |               | \    | Amount of |
|                  |               |               | $256 |           |
|                  |               |               |      | Improper  |
|                  |               |               |      | Auth      |
|                  |               |               |      | orization |
|                  |               |               |      | for       |
|                  |               |               |      | Payment.  |
+------------------+---------------+---------------+------+-----------+

The *Data Entry Form* for the above example would be completed as
follows:

Data Entry Form

+------+-------------------------------------------------+------------+
| **   | **Item**                                        | **Coding** |
| Item |                                                 |            |
| \#** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | State                                           |            |
| 1.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | County                                          |            |
| 2.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | Child ID                                        | 123456     |
| 3.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | Sample Month/Year                               | 10/05      |
| 4.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | Record Review Date                              | MM/DD/YY   |
| 5.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | One or more case errors during sample review    | 1          |
| 6.** | month                                           |            |
|      |                                                 |            |
|      | 0= no errors, 1= one or more errors             |            |
+------+-------------------------------------------------+------------+
| **   | Total amount of Underauthorization or           | \$256      |
| 7.** | Overauthorization during sample review month    |            |
+------+-------------------------------------------------+------------+
| **   | Type of improper authorization for payment      | O          |
| 8.** |                                                 |            |
|      | (U = Underauthorization, O = Overauthorization  |            |
|      | or NA = No Authorization Error)                 |            |
+------+-------------------------------------------------+------------+
| **   | Reason for error due to insufficient or missing | N          |
| 9.** | documentation                                   |            |
|      |                                                 |            |
|      | (Y = Yes, N = No or NA = No Error)              |            |
+------+-------------------------------------------------+------------+
| **1  | Total Authorization Amount during sample review | \$256      |
| 0.** | month                                           |            |
+------+-------------------------------------------------+------------+

The following provides examples of completed *Data Entry Forms* based on
various examples of Column 3 error findings.

> **Example #1 --- One Underauthorization Error**
>
> Findings--- The client provided her two most recent bi-weekly pay
> stubs at application. The caseworker converted the income as if it was
> weekly income. This error caused the income to be overstated by \$300
> monthly and resulted in a \$50 Underauthorization of the monthly
> subsidy*.*

Data Entry Form

+------+-------------------------------------------------+------------+
| **   | **Item**                                        | **Coding** |
| Item |                                                 |            |
| \#** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | State                                           |            |
| 1.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | County                                          |            |
| 2.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | Child ID                                        | 123456     |
| 3.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | Sample Month/Year                               | 10/05      |
| 4.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | Record Review Date                              | MM/DD/YY   |
| 5.** |                                                 |            |
+------+-------------------------------------------------+------------+
| **   | One or more case errors during sample review    | 1          |
| 6.** | month                                           |            |
|      |                                                 |            |
|      | 0= no errors, 1= one or more errors             |            |
+------+-------------------------------------------------+------------+
| **   | Total amount of Underauthorization or           | \$50       |
| 7.** | Overauthorization during sample review month    |            |
+------+-------------------------------------------------+------------+
| **   | Type of improper authorization for payment      | U          |
| 8.** |                                                 |            |
|      | (U = Underauthorization, O = Overauthorization  |            |
|      | or NA = No Authorization Error)                 |            |
+------+-------------------------------------------------+------------+
| **   | Reason for error due to insufficient or missing | N          |
| 9.** | documentation                                   |            |
|      |                                                 |            |
|      | (Y = Yes, N = No or NA = No Error)              |            |
+------+-------------------------------------------------+------------+
| **1  | Total Authorized Authorization Amount during    | \$378      |
| 0.** | sample review month                             |            |
+------+-------------------------------------------------+------------+

> **Example #2 --- Two Overauthorization Errors**
>
> Findings--- The client provided her two most recent bi-weekly pay
> stubs at recertification. The caseworker used the net income figure
> rather than the gross figure. This caused a \$20 Overauthorization in
> the monthly subsidy. On the application the client had listed \$300
> monthly in child support. This was the amount used by the worker. The
> case record did not contain any verification of this income. Using the
> required child support screens the reviewer verified that the customer
> actually received child support of \$400 monthly. The child support
> income caused a \$60 Overauthorization in the monthly amount. The two
> errors discovered in the case record review are coded on the *Data
> Entry Form* as follows: Item 6: \"1\" = one or more errors; Item 7:
> \"\$80\" for the total amount of Overauthorization; Item 8: \"O\" =
> Overauthorization is the type of improper authorization; and Item 9:
> \"Y,\" because the reason for the error was due to missing
> documentation.

Data Entry Form

+-----+--------------------------------------------------+-------------+
| **I | **Item**                                         | **Coding**  |
| tem |                                                  |             |
| \   |                                                  |             |
| #** |                                                  |             |
+-----+--------------------------------------------------+-------------+
| **1 | State                                            |             |
| .** |                                                  |             |
+-----+--------------------------------------------------+-------------+
| **2 | County                                           |             |
| .** |                                                  |             |
+-----+--------------------------------------------------+-------------+
| **3 | Child ID                                         | 654321      |
| .** |                                                  |             |
+-----+--------------------------------------------------+-------------+
| **4 | Sample Month/Year                                | 10/05       |
| .** |                                                  |             |
+-----+--------------------------------------------------+-------------+
| **5 | Record Review Date                               | MM/DD/YY    |
| .** |                                                  |             |
+-----+--------------------------------------------------+-------------+
| **6 | One or more case errors during sample review     | 1           |
| .** | month                                            |             |
|     |                                                  |             |
|     | 0= no errors, 1= one or more errors              |             |
+-----+--------------------------------------------------+-------------+
| **7 | Total amount of Underauthorization or            | \$80        |
| .** | Overauthorization during sample review month     |             |
+-----+--------------------------------------------------+-------------+
| **8 | Type of improper authorization for payment       | O           |
| .** |                                                  |             |
|     | (U = Underauthorization, O = Overauthorization   |             |
|     | or NA = No Authorization Error)                  |             |
+-----+--------------------------------------------------+-------------+
| **9 | Reason for error due to insufficient or missing  | Y           |
| .** | documentation                                    |             |
|     |                                                  |             |
|     | (Y = Yes, N = No or NA = No Error)               |             |
+-----+--------------------------------------------------+-------------+
| *   | Total Amount of Authorization during sample      | \$495       |
| *10 | review month                                     |             |
| .** |                                                  |             |
+-----+--------------------------------------------------+-------------+

> **Example #3 --- Two Underauthorization Errors**
>
> Findings--- The client provided all required information about her
> self-employment income and business costs. The caseworker
> miscalculated the customer's gross income resulting in an
> overstatement of earnings by \$100 monthly. This resulted in an
> Underauthorization of \$15. The worker also failed to include a
> business cost that was documented in the case record. The inclusion of
> the business cost would have lowered the client's income further
> resulting in an additional \$10 Underauthorization. The two errors
> amount to a total \$25 Underauthorization. This amount is the figure
> used in for the total amount of the improper authorization in Element
> 430 Column 4. The two errors discovered in the case record review are
> coded on the *Data Entry Form* as follows: Item 6: \"1\" = one or more
> errors; Item 7: \"\$25\" for the total amount of the
> Underauthorization; Item 8: \"U\" = Underauthorization is the type of
> improper authorization; and Item 9: \"Yes,\" because the reason for
> the error was due to the worker's failure to adequately document the
> eligibility determination.

Data Entry Form

+-----+---------------------------------------------------+-----------+
| **I | **Item**                                          | *         |
| tem |                                                   | *Coding** |
| \   |                                                   |           |
| #** |                                                   |           |
+-----+---------------------------------------------------+-----------+
| **1 | State                                             |           |
| .** |                                                   |           |
+-----+---------------------------------------------------+-----------+
| **2 | County                                            |           |
| .** |                                                   |           |
+-----+---------------------------------------------------+-----------+
| **3 | Child ID                                          | 135791    |
| .** |                                                   |           |
+-----+---------------------------------------------------+-----------+
| **4 | Sample Month/Year                                 | 10/05     |
| .** |                                                   |           |
+-----+---------------------------------------------------+-----------+
| **5 | Record Review Date                                | MM/DD/YY  |
| .** |                                                   |           |
+-----+---------------------------------------------------+-----------+
| **6 | One or more case errors during sample review      | 1         |
| .** | month                                             |           |
|     |                                                   |           |
|     | 0= no errors, 1= one or more errors               |           |
+-----+---------------------------------------------------+-----------+
| **7 | Total amount of Underauthorization or             | \$25      |
| .** | Overauthorization during sample review month      |           |
+-----+---------------------------------------------------+-----------+
| **8 | Type of improper authorization for payment        | U         |
| .** |                                                   |           |
|     | (U = Underauthorization, O = Overauthorization or |           |
|     | NA = No Authorization Error)                      |           |
+-----+---------------------------------------------------+-----------+
| **9 | Reason for error due to insufficient or missing   | Y         |
| .** | documentation                                     |           |
|     |                                                   |           |
|     | (Y = Yes, N = No or NA = No Error)                |           |
+-----+---------------------------------------------------+-----------+
| *   | Total Authorization Amount during sample review   | \$192     |
| *10 | month                                             |           |
| .** |                                                   |           |
+-----+---------------------------------------------------+-----------+

> **Example #4 --- One Error - No dollar value**
>
> Findings---The payment form in the record was signed by the worker but
> not by the supervisor. This is an error but with no dollar value. The
> *Data Entry* Form is coded as follows: Item 6: \"1\" = one or more
> errors; Item 7: \"\$0\" = no dollar value.; Item 8: \"NA\" no
> authorization error; Item 9: \"Y\" = error due to insufficient or
> missing documentation; and Item 10:.\"\$260\" = the total
> authorization amount during the sample review month.

Data Entry Form

+-----+----------------------------------------------------+-----------+
| **I | **Item**                                           | *         |
| tem |                                                    | *Coding** |
| \   |                                                    |           |
| #** |                                                    |           |
+-----+----------------------------------------------------+-----------+
| **1 | State                                              |           |
| .** |                                                    |           |
+-----+----------------------------------------------------+-----------+
| **2 | County                                             |           |
| .** |                                                    |           |
+-----+----------------------------------------------------+-----------+
| **3 | Child ID                                           | 246802    |
| .** |                                                    |           |
+-----+----------------------------------------------------+-----------+
| **4 | Sample Month/Year                                  | 10/05     |
| .** |                                                    |           |
+-----+----------------------------------------------------+-----------+
| **5 | Record Review Date                                 | MM/DD/YY  |
| .** |                                                    |           |
+-----+----------------------------------------------------+-----------+
| **6 | One or more case errors during sample review month | 1         |
| .** |                                                    |           |
|     | 0= no errors, 1= one or more errors                |           |
+-----+----------------------------------------------------+-----------+
| **7 | Total amount of Underauthorization or              | \$0       |
| .** | Overauthorization during sample review month       |           |
+-----+----------------------------------------------------+-----------+
| **8 | Type of improper authorization for payment         | N/A       |
| .** |                                                    |           |
|     | (U = Underauthorization, O = Overauthorization, or |           |
|     | NA = No Authorization Error)                       |           |
+-----+----------------------------------------------------+-----------+
| **9 | Reason for error due to insufficient or missing    | Y         |
| .** | documentation                                      |           |
+-----+----------------------------------------------------+-----------+
| *   | Total Authorization Amount during sample review    | \$260     |
| *10 | month                                              |           |
| .** |                                                    |           |
+-----+----------------------------------------------------+-----------+

[]{#__RefHeading___Toc155167960 .anchor}

**Example #5 - Two Errors - One Overauthorization and One
Underauthorization**

> Findings---The client provided all required information about her
> self - employment income and her business costs. The caseworker
> miscalculated the customer's gross income and this resulted in it
> being overstated by \$100 monthly. This would have resulted in an
> Underauthorization of \$15. However, the worker also included a
> business cost that is not allowed under state policy. The net
> difference of the two errors, a \$5 Underauthorization, is the amount
> recorded in the total amount of the improper authorization in Column 4
> in the *Record Review Worksheet.* As the income calculation error was
> the larger of the two errors, it is the one coded in Column 4. The
> errors discovered in the case record review are coded on the Data
> Entry Form as follows: Item 6: \"1\" = one or more errors; Item 7:
> \"\$5 for the net amount of the improper authorization; Item 8:
> \"U\" - Underauthorization is the type of improper authorization; and
> Item 9: \"N\" because the reason for the error was not due to
> insufficient or missing documentation.
>
> []{.mark}

[]{.mark}

Data Entry Form

+-----+---------------------------------------------------+------------+
| **I | **Item**                                          | **Coding** |
| tem |                                                   |            |
| \   |                                                   |            |
| #** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **1 | State                                             |            |
| .** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **2 | County                                            |            |
| .** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **3 | Child ID                                          | 135791     |
| .** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **4 | Sample Month/Year                                 | 10/05      |
| .** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **5 | Record Review Date                                |            |
| .** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **6 | One or more case errors during sample review      | 1          |
| .** | month                                             |            |
|     |                                                   |            |
|     | 0= no errors, 1= one or more errors               |            |
+-----+---------------------------------------------------+------------+
| **7 | Total amount of Underauthorization or             | \$5        |
| .** | Overauthorization during sample review month      |            |
+-----+---------------------------------------------------+------------+
| **8 | Type of improper authorization for payment        | U          |
| .** |                                                   |            |
|     | (U = Underauthorization, O = Overauthorization or |            |
|     | NA = No Authorization Error)                      |            |
+-----+---------------------------------------------------+------------+
| **9 | Reason for error due to insufficient or missing   | N          |
| .** | documentation                                     |            |
|     |                                                   |            |
|     | (Y = Yes, N = No or NA = No Error)                |            |
+-----+---------------------------------------------------+------------+
| *   | Total Authorization Amount during sample review   | \$192      |
| *10 | month                                             |            |
| .** |                                                   |            |
+-----+---------------------------------------------------+------------+

**VIII. COMPLETING AND SUBMITTING THE *State Improper AuthorizationS FOR
Payment Report***

The *State Improper Authorizations for Payment Report* consists of three
Parts:

-   Part I - Program Assurances and Certifications

-   Part II - Error Measures Reporting

-   Part III - State Response to Error Measures Findings

The process that follows is for States that chose to create an Improper
Payments Planning Team. If other strategies are selected, States
complete the tasks consistent with their alternative strategies.

1.  Project coordinator solicits from the reviewers observations about
    the review process and the findings.

2.  Project coordinator convenes Team to analyze the findings, reviewer
    observations~~,~~ and discuss causes.

3.  Individual Team members consult with various staffs and bring
    findings/recommendations to the team (e.g., the quality control (QC)
    representative, the information technology (IT) representative).

4.  Team considers information from the various offices (e.g., QC and
    IT) and agrees on findings/recommendations to include in the report.

5.  Assigned Team member prepares draft of report.

6.  Team reviews, comments, approves report for submission to Lead
    Agency administration for approval.

7.  Assigned team member obtains necessary approvals.

8.  Assigned team member submits *State Improper Authorizations for
    Payment Report* electronically to the Regional Child Care Manager in
    their ACF Regional Office. Assigned team member also sends original
    signature page to the Regional Child Care Manager.

States report findings in the *State Improper Authorizations for Payment
Report*, included as Attachment 3, on or before June 30 of the reporting
year. States provide the following information:

[]{#__RefHeading___Toc155167961 .anchor}**Part I - Program Assurances
and Certifications**

States insert identifying information of the agent authorized to assure
and certify that:

1.  The data collection process, including sample selection and case
    record reviews, adhered to all requirements of the \"Measuring
    Improper Authorizations in the Child Care and Development Fund
    (CCDF) Program\" instructions and regulations at 45 CFR 98 Subpart
    K;

2.  The reviews were not conducted by persons who make or approve the
    eligibility determinations;

3.  All reviewers have been trained to ensure that the review process is
    consistent with State policies and that there is consistency within
    the State in interpretation of what is an error;

4.  The State agrees to retain *Record Review Worksheets, Data Entry
    Forms,* the *State Improper Authorizations for Payment Report* and
    any revisions, and any other records pertinent to the case reviews
    and submission of error rate reports for five years from the date of
    submission of the *State Improper Authorizations for Payment Report*
    or final revision submitted, whichever date is later; and

5.  The State understands that this information, including the sampled
    case records and calculations, are subject to Federal review.

The required information is \"Submission Date,\" \"Name,\"
\"Signature,\" \"Title," "State,"\" State Agency,\" \"Telephone
Number,\" \"E-mail Address,\" and \"Federal Fiscal Year.\"

[]{#__RefHeading___Toc155167962 .anchor}**Part II - Error Measures
Reporting**

Following completion of the *Data Entry Forms*, States consolidate all
the data in order to compute the error measures for input into the
*State Improper Authorizations for Payment Report*. It is recommended
that States enter all data fields from each *Data Entry Form* into a
database or spreadsheet for error measure computation. Using software to
consolidate all of the data improves accuracy and allows for easier
analyses of the results from the case record review process**.**

Once the data have been entered into a spreadsheet or database, States
use the table in Part II of the *State Improper Authorizations for
Payment Report* to record information necessary to compute and record
error measures.

The following are the templates for Part II of the *State Improper
Authorizations for Payment Report*.

**Improper Authorizations for Payment** Reporting

  --------- ------------------------------------------------------ ----------
  **Item                                                           
  \#**                                                             

  **1.**    Number of cases sampled                                

  **2.**    Total amount of authorizations for payment for sampled \$
            cases in the review period                             

  **3.**    Total number of sampled cases with improper            
            authorizations for payment                             

  **4.**    Total amount of improper authorizations for payment    \$
            for the review period                                  

  **5.**    Total number of improper authorizations for payment    
            due to missing or insufficient documentation           

  **6.**    Percentage of cases with an error                      

  **7.**    Percentage of cases with an improper authorization for 
            payment                                                

  **8.**    Percentage of improper authorizations for payment      

  **9.**    Average amount of improper authorizations for payment  \$

  **10.**   Estimated annual amount of improper authorizations for \$
            payment                                                
  --------- ------------------------------------------------------ ----------

**11. Number of replacement cases used each month of the 12 month review
period.**

+-----------------------------------------+----------------------------+
| **Month**                               | **\# Replacement**         |
|                                         |                            |
|                                         | **Cases Used**             |
+-----------------------------------------+----------------------------+
| **October**                             |                            |
+-----------------------------------------+----------------------------+
| **November**                            |                            |
+-----------------------------------------+----------------------------+
| **December**                            |                            |
+-----------------------------------------+----------------------------+
| **January**                             |                            |
+-----------------------------------------+----------------------------+
| **February**                            |                            |
+-----------------------------------------+----------------------------+
| **March**                               |                            |
+-----------------------------------------+----------------------------+
| **April**                               |                            |
+-----------------------------------------+----------------------------+
| **May**                                 |                            |
+-----------------------------------------+----------------------------+
| **June**                                |                            |
+-----------------------------------------+----------------------------+
| **July**                                |                            |
+-----------------------------------------+----------------------------+
| **August**                              |                            |
+-----------------------------------------+----------------------------+
| **September**                           |                            |
+-----------------------------------------+----------------------------+

[General Instructions:]{.underline}

Round all entries to the nearest dollar. Omit cents. If the result
contains .50 cents or more, round up to the nearest dollar. If the
result contains .49 cents or less, round down to the nearest dollar. The
instructions for all Items in Part II follow. Note that the term
\"authorization\" means subsidy payment authorized during eligibility
determination or redetermination. (See Glossary)

1.  *Number of cases sampled* -- The sample size for all states is set
    at 271 (or 276) cases.

2.  *Total amount of payments authorized for the sampled cases in the
    review period* -- Compute the sum of all authorizations for the 271
    (or 276) sampled cases. The amount paid is captured on Line 10 of
    each of the 271 (or 276) *Data Entry Forms*.

3.  *Total number of sampled cases with improper authorizations for
    payment* -- Compute the number of all cases with either an
    Overauthorization or Underauthorization. This would be the total
    number of cases with a dollar value in Line 7 of the *Data Entry
    Form*.

4.  *Total amount of improper authorizations for payment for the review
    period* -- Compute the sum of all improper authorizations for
    payment listed in Line 7 of the *Data Entry Form*.

5.  *Total number of improper authorizations for payment due to missing
    or insufficient documentation* -- Compute the sum of all cases with
    a "Yes" coding in Line 19 of the *Data Entry Form.*

6.  *Percentage of cases with an error* -- Divide the total number of
    all cases with an error (any case with an error coding in Line 6 of
    the *Data Entry Form*) by 271 (or 276) and multiply by 100.

7.  *Percentage of cases with an improper authorization* *for payment*--
    Divide the total number of all cases with an authorization error
    (see #3 above) by 271 (or 276) and multiply by 100.

8.  *Percentage of improper authorizations for payment (for the review
    period)* -- Compute the sum of all amounts listed in Line 7 of the
    *Data Entry Forms* (see #4 above) divided by the sum of all
    authorizations for the 271 (or 276) sampled cases (see #2 above) and
    multiply by 100. Add Underauthorizations to (not subtract from) the
    total of Overauthorizations.

9.  *Average amount of improper authorization* *for payment* -- Compute
    the sum of all amounts listed in Line 7 of the *Data Entry Forms*
    (see #4 above) divided by the total number of cases with an amount
    other than zero in Line 8 of the *Data Entry Form* (see \# 3 above).

10. *Estimated annual amount of improper authorizations for payment* --
    Multiply the percentage of authorizations for payment made in error
    for the review period (see \# 8 above) by the total dollar amount of
    child care authorizations for payment that the State made during the
    12 month review period.

> 11\. Number of replacement cases used each month of the 12 month
> review period.

[]{#__RefHeading___Toc155167963 .anchor}**Part III - State Response to
Error Measures Findings**

Using the coordination process selected, States provide narrative
responses, or enter data into tables provided, in Part III.

Note: States complete and submit Part III A only as part of their first
cycle reporting only. States complete and submit Part III B only for all
subsequent reporting cycles.

[]{#__RefHeading___Toc155167964 .anchor}**Part III A. (for first
reporting cycle only)**

12A. In addition to the State assurances and certifications that the
improper authorizations for payments data collection process, including
case record reviews, adhered to all requirements of the \"Measuring
Improper Authorizations for Payment in the Child Care and Development
Fund (CCDF) Program\" instructions, describe your fieldwork preparation,
sampling method, and record review process.

States provide a brief overview of their improper authorizations for
payment data collection activity including processes for coordinating
tasks and preparing responses for the *State Improper Authorizations for
Payment Report*, sampling methodology, method used to collect and
consolidate data, preparation and training provided to case record
review staff, and the record review process. (For example, did reviewers
conduct reviews as part of established site visits or did county staff
pull and send records to a central State location?)

13A. Estimate the percentage of improper authorizations for payment that
is attributable to missing or insufficient documentation. (Example - 30
percent of the cases with an improper authorization for payment were due
to missing or insufficient documentation.) Provide examples of the most
frequently missed or insufficient documentation.

Provide examples of the most frequently identified causes of improper
authorizations for payment other than missing or insufficient
documentation.

To obtain this estimate, divide the total number of errors attributable
to missing or insufficient documentation (Item #10 of Data Entry Form)
by the total number of cases with errors (Item #7 of the Data Entry
Form).

14A. What are the actions that will be taken to correct the causes of
improper authorizations for payment that were identified during the case
record review process in order to reduce errors in the future?

States use their coordination process (team or other procedure) to
determine steps that could be taken to address the various causes of
improper authorizations for payment that were identified. (For example,
teams could decide that supervisors of new child care eligibility
workers will review all eligibility determinations for six months rather
than the current three months.)

15A. What is the amount of actual improper payments the State expects to
recover as a result of the review?

Include in State responses how many cases the State has referred for
investigation/further action to recover these funds, as well as any
other actions being taken to date. Quality control staffs and State
fraud teams can provide past data upon which to base expected recovery
data.

16A. Describe the information systems and other infrastructure that
assist the State in identifying and reducing improper authorizations and
improper payments. If the Lead Agency does not have these tools,
describe actions to be taken to acquire the necessary information
systems and other infrastructure.

States provide a brief overview of the ways in which automation is used
to prevent improper authorizations and improper payments and to support
identification and recovery efforts. (For example, a State child care
information system that is integrated with the child support information
system will prevent eligibility determinations that do not consider
child support income.)

17A. Detail the actions the State is currently taking or plans to take
in the future to ensure that the Lead Agency and eligibility workers
will be accountable for reducing improper authorizations and improper
payments? Describe any Federal or State statutory or regulatory barriers
which may limit the State's corrective action in reducing and recovering
improper payments.

Include in the response to this question actions such as use of
performance measures to address accuracy of eligibility determination.
An example of a State regulatory barrier is the setting of a threshold
under which alleged improper payments will not be pursued.

18A. What are the error rate targets for the next reporting cycle? Enter
the targets for percentage of cases with an error, percentage of cases
with an improper authorization for payment, percentage of improper
authorizations for payment, average amount of improper authorization for
payment, and estimated annual amount of improper authorizations for
payment into the table provided.

States enter data into the table provided. No narrative is necessary.

[]{#__RefHeading___Toc155167965 .anchor}**Part III B. (for reporting
cycles after the first reporting cycle only)**

12B. In addition to the State assurance and certification that the
improper authorizations for payment data collection process, including
sample selection and case record reviews, adhered to all requirements of
the \"Measuring Improper Authorizations for Payment in the Child Care
and Development Fund (CCDF) Program\" instructions, describe your
fieldwork preparation, sampling method, and record review process.

States provide a brief overview of their improper authorizations for
payment data collection activity including processes for coordinating
tasks and preparing responses for the *State Improper Authorizations for
Payment Report*, sampling methodology, method used to collect and
consolidate data, preparation and training provided to case record
review staff, and the record review process. (For example, did reviewers
conduct reviews as part of established site visits or did county staff
pull and send records to a central State location?)

13B. Estimate the percentage of improper authorizations for payment that
is attributable to missing or insufficient documentation. Provide
examples of the most frequently missed or insufficient documentation.

To obtain this estimate, divide the total number of errors attributable
to missing or insufficient documentation (Item #10 of Data Entry Form)
by the total number of cases with errors (Item #7 of the Data Entry
Form).

Provide examples of the most frequent identified causes of the improper
authorizations for payment other than missing or insufficient
documentation.

14B. What are the actions that will be taken to correct the causes of
improper authorizations for payment identified during the case record
review process in order to reduce errors in the future?

States use their coordination process (team or other procedure) to
determine steps that could be taken to address the various causes of
improper authorizations for payment that were identified. (For example,
teams could decide that supervisors of new child care eligibility
workers will review all eligibility determinations for six months rather
than the current three months.)

15B. What is the amount of actual improper payments the State expects to
recover as a result of the review?

Include in State responses how many cases the State has referred for
investigation/further action to recover these funds, as well as any
other actions being taken to date. Quality control staffs and State
fraud teams can provide past data upon which to base expected recovery
data.

16B. Describe the information systems and other infrastructure that
assist the State in identifying and reducing improper authorizations and
improper payments. If the Lead Agency does not have these tools,
describe actions to be taken to acquire the necessary information
systems and other infrastructure.

States provide a brief overview of the ways in which automation is used
to prevent improper authorizations and improper payments and to support
identification and recovery efforts. (For example, a State child care
information system that is integrated with the child support information
system will prevent eligibility determinations that do not consider
child support income.)

17B. What steps is the State taking to ensure that the Lead Agency and
eligibility workers will be accountable for reducing improper payments?
Describe any Federal or State statutory or regulatory barriers which may
limit the State's corrective action in reducing and recovering improper
payments.

States provide a brief overview of the ways in which automation is used
to prevent improper authorizations and payments and to support
identification and recovery efforts. (For example, a State child care
information system that is integrated with the child support information
system will prevent eligibility determinations that do not consider
child support income.)

18B. Provide the error rate targets for the prior and current cycles and
targets for the next cycle for: percentage of cases with an error,
percentage of cases with an improper authorization for payment,
percentage of improper authorizations for payment, average amount of
improper authorization for payment, and estimated annual amount of
improper authorizations for payment. Enter the data into the table
provided.

States enter data into the table provided. No narrative is necessary.

For the second reporting cycle, the data is found in Items #6-10 of the
first *State Improper Authorizations for Payment Report* submitted by
States. The targets are at Item #17A of that report.

For the third, and subsequent reporting cycles, the data and targets are
at Item #17B of the previous report.

19B. Describe if the State met targets set in the previous cycle and, if
not, provide an explanation of why the State did not meet its targets.

States indicate if the data for the current cycle, reported in Item
#17B, met the targets established. States explain why any targets were
not met. (For example, a State may have exceeded the target reduction in
percentage of improper authorizations for payment for the review period,
but the percentage of cases with errors increased. The errors that were
made included new areas needing corrective action or errors due to
migration to a new automated system.

20B. Discuss causes of errors and improper authorizations for payment
identified in the prior cycle and actions that were taken to correct
those causes in order to reduce error rates.

If targets for the current cycle were met, States identify the causes of
errors in the prior cycle and the responses that were effective in
helping to meet the target. (For example, if manual miscalculation of
eligible hours of subsidized child care was a major cause of error in
the prior cycle, an effective response might have been a switch to
automated calculation of eligible hours.)

[]{#__RefHeading___Toc155167966 .anchor}**APPENDIX A**

[]{#__RefHeading___Toc155167967 .anchor}**Glossary**

Active Case (Case) - A case (child) for which a child care subsidy was
authorized for payment during a sample review month. A case is the
primary sampling unit for this analysis.

Authorization for Payment (Authorization) - An authorization for payment
is the subsidy amount authorized during eligibility determination or
redetermination for a sample review month.

Average Amount of Improper Authorization for Payment-- The average
amount of improper authorization for payment is the average amount of
money the State authorized improperly to be paid per child during the
review period. This rate is determined by dividing the gross amount
(overpayments plus underpayments) of improper authorizations for payment
in the sample by the number of cases in the sample that had an improper
authorization for payment.

Case Record -- The physical record or case file. The case record is
usually maintained by and located in the local eligibility office, but
also may include information maintained in computer files and fiscal
records pertaining to the payment.

County -- This is the primary legal division of most States. The term
county includes independent municipalities. Most counties are
functioning governmental units, whose powers and functions vary from
State to State.

Documentation -- Documentation is a written or printed statement or a
copy of a document furnishing information. For purposes of this review,
documentation may also be information contained on automated systems.

Eligibility Action -- Eligibility action is the action that is taken on
a case that determines the authorized payment amount. It is the basis
for the sample review month's authorization.

Error -- An error is any violation or misapplication of law, regulation,
or policy governing the administration of CCDF grant funds, regardless
of whether such violation results in an improper authorization for
payment.

Estimated Annual Amount of Improper Authorizations for Payment -- This
measure projects the amount of improper authorizations for payment the
State has made on an annual basis for the fiscal year being reviewed.
This amount is determined by multiplying the Percentage of Improper
Authorizations for Payment by the total dollar amount of child care
authorizations for payment that the State made during the twelve month
review period.

Improper Authorization for Payment (Improper Authorization) -- An
improper authorization for payment is an amount authorized for payment
during the client eligibility process that should not have been
authorized or was authorized in an incorrect amount under applicable
law, regulation, or policy.

Overauthorization for Payment (Overauthorization) -- An
overauthorization for payment is an improper authorization for payment
that exceeds the amount that should have been authorized.

Percentage of Cases with an Error (Case Error Rate) -- This measure is
the percentage of cases with an error, regardless of whether the error
ultimately results in an improper payment. This rate is determined by
dividing the number of sampled cases with an error by the total number
of cases reviewed in the sample and then multiplying by 100.

Percentage of Cases with an Improper Authorization for Payment -- This
measure is the percentage of cases in the sample with an error that
resulted in an improper authorization for payment. The percentage is
determined by dividing the number of sampled cases with an error that
resulted in an improper authorization for payment by the total number of
sample cases for the review period and then multiplying by 100.

Percentage of Improper Authorizations for Payment -- This measure is the
percentage of improper authorizations for payment for the review period.
This rate is determined by dividing the gross amount of improper
authorizations for payment in the sample (Overauthorizations plus
Underauthorizations) by the total dollar amount of child care
authorizations for payment in the sample cases and then multiplying by
100.

Recertification -- This is an eligibility action taken to authorize a
payment amount for an additional period immediately following the
expiring certification period.

Review Month - The review month refers to a specific month for which a
sampling of cases is created. For example, January is a sample review
month with a sampling frame created from all of the cases in January.

Review Period -- The review period is the Federal Fiscal Year prior to
July 1 of the designated calendar year in which a *State Improper
Payments Report* must be submitted. For example, for a July 1, 2008
submission date, the review period would be October 1, 2006 through
September 30, 2007.

Sampling Frame -- The sampling frame is the list of sampling units
(total population or universe) authorized to receive a child care
payments during the sample month. The sample of cases for each sample
review month is drawn from the sampling frame.

Sampling Unit -- The sampling unit is a child for whom a child care
payment was authorized during the sample review month.

State -- The term State includes the 50 States, the District of
Columbia, and Puerto Rico.

Underauthorization for Payment (Underauthorization) -- An
Underauthorization for payment is an improper authorization for payment
that is less than the amount that should have been authorized

[]{#__RefHeading___Toc155167968 .anchor}**ATTACHMENT 1.**

[]{#__RefHeading___Toc155167969 .anchor}**RECORD REVIEW WORKSHEET
(TEMPLATE)**

  --------------- ------------ ------------- --------------- ----------------
  **CHILD ID#**   **STATE:**   **COUNTY:**   **SAMPLE        **REVIEW DATE:**
                                             MONTH/YEAR:**   

  --------------- ------------ ------------- --------------- ----------------

+---------------------+----------------+----------------+---+--------+
| **ELEMENTS OF       | **ANALYSIS OF  | **FINDINGS     | * |        |
| ELIGIBILITY &       | CASE RECORD    | (3)**          | * |        |
| PAYMENT             | (2)**          |                | R |        |
| AUTHORIZATION (1)** |                |                | E |        |
|                     |                |                | S |        |
|                     |                |                | U |        |
|                     |                |                | L |        |
|                     |                |                | T |        |
|                     |                |                | S |        |
|                     |                |                | ( |        |
|                     |                |                | 4 |        |
|                     |                |                | ) |        |
|                     |                |                | * |        |
|                     |                |                | * |        |
+=====================+================+================+===+========+
| **SECTION I. STATE  |                |                |   |        |
| CHILD CARE PROGRAM  |                |                |   |        |
| FORMS**             |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
| **100               |                |                | * |        |
| APPLICATI           |                |                | * |        |
| ON/RE-DETERMINATION |                |                | 1 |        |
| FORMS**             |                |                | 0 |        |
|                     |                |                | 0 |        |
|                     |                |                | R |        |
|                     |                |                | E |        |
|                     |                |                | S |        |
|                     |                |                | U |        |
|                     |                |                | L |        |
|                     |                |                | T |        |
|                     |                |                | S |        |
|                     |                |                | * |        |
|                     |                |                | * |        |
+---------------------+----------------+----------------+---+--------+
| Determine presence, |                |                | 1 | No     |
| date, and           |                |                | \ | Error  |
| completeness of     |                |                | . |        |
| required            |                |                |   | Error  |
| eligibility forms.  |                |                |   |        |
| Examples include    |                |                |   |        |
| (1) signed and      |                |                |   |        |
| dated CCDF          |                |                |   |        |
| application form,   |                |                |   |        |
| (2) child care      |                |                |   |        |
| agreement, (3)      |                |                |   |        |
| voucher or          |                |                |   |        |
| certificate, and    |                |                |   |        |
| (4) provider        |                |                |   |        |
| invoice. Specify    |                |                |   |        |
| conditions of       |                |                |   |        |
| dollar error,       |                |                |   |        |
| including (1) form  |                |                |   |        |
| expired, (2) no     |                |                |   |        |
| application form,   |                |                |   |        |
| and (3) no          |                |                |   |        |
| documentation of    |                |                |   |        |
| income and work     |                |                |   |        |
| hours.              |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 2 | I      |
|                     |                |                | \ | nsuffi |
|                     |                |                | . | cient/ |
|                     |                |                |   | M      |
|                     |                |                |   | issing |
|                     |                |                |   |        |
|                     |                |                |   | D      |
|                     |                |                |   | ocumen |
|                     |                |                |   | tation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 3 | Undera |
|                     |                |                | \ | uthori |
|                     |                |                | . | zation |
|                     |                |                |   |        |
|                     |                |                |   | Overa  |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 4 | Total  |
|                     |                |                | \ | Amount |
|                     |                |                | . | of     |
|                     |                |                | \ |        |
|                     |                |                | $ | Im     |
|                     |                |                |   | proper |
|                     |                |                |   | A      |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
|                     |                |                |   | for    |
|                     |                |                |   | P      |
|                     |                |                |   | ayment |
+---------------------+----------------+----------------+---+--------+
| **SECTION II.       |                |                |   |        |
| PRIORITY GROUP      |                |                |   |        |
| PLACEMENT**         |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
| **200 PRIORITY      |                |                | * |        |
| GROUP PLACEMENT**   |                |                | * |        |
|                     |                |                | 2 |        |
|                     |                |                | 0 |        |
|                     |                |                | 0 |        |
|                     |                |                | R |        |
|                     |                |                | E |        |
|                     |                |                | S |        |
|                     |                |                | U |        |
|                     |                |                | L |        |
|                     |                |                | T |        |
|                     |                |                | S |        |
|                     |                |                | * |        |
|                     |                |                | * |        |
+---------------------+----------------+----------------+---+--------+
| Determine if client |                |                | 1 | No     |
| meets criteria of   |                |                | \ | Error  |
| any                 |                |                | . |        |
| State-designated    |                |                |   | Error  |
| priority groups,    |                |                |   |        |
| e.g., (1) teen      |                |                |   |        |
| parent in high      |                |                |   |        |
| school, (2) TANF    |                |                |   |        |
| recipients in       |                |                |   |        |
| eligible work       |                |                |   |        |
| activities, (3)     |                |                |   |        |
| working parents on  |                |                |   |        |
| TANF, and/or (4)    |                |                |   |        |
| foster parents etc. |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 2 | I      |
|                     |                |                | \ | nsuffi |
|                     |                |                | . | cient/ |
|                     |                |                |   | M      |
|                     |                |                |   | issing |
|                     |                |                |   |        |
|                     |                |                |   | D      |
|                     |                |                |   | ocumen |
|                     |                |                |   | tation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 3 | Undera |
|                     |                |                | \ | uthori |
|                     |                |                | . | zation |
|                     |                |                |   |        |
|                     |                |                |   | Overa  |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 4 | Total  |
|                     |                |                | \ | Amount |
|                     |                |                | . | of     |
|                     |                |                | \ |        |
|                     |                |                | $ | Im     |
|                     |                |                |   | proper |
|                     |                |                |   | A      |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
|                     |                |                |   | for    |
|                     |                |                |   | P      |
|                     |                |                |   | ayment |
+---------------------+----------------+----------------+---+--------+
| **SECTION III.      |                |                |   |        |
| GENERAL PROGRAM     |                |                |   |        |
| REQUIREMENTS**      |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
| **300 QUALIFYING    |                |                | * |        |
| HEAD OF HOUSEHOLD** |                |                | * |        |
|                     |                |                | 3 |        |
|                     |                |                | 0 |        |
|                     |                |                | 0 |        |
|                     |                |                | R |        |
|                     |                |                | E |        |
|                     |                |                | S |        |
|                     |                |                | U |        |
|                     |                |                | L |        |
|                     |                |                | T |        |
|                     |                |                | S |        |
|                     |                |                | * |        |
|                     |                |                | * |        |
+---------------------+----------------+----------------+---+--------+
| Determine if client |                |                | 1 | No     |
| meets parent        |                |                | \ | Error  |
| definition (parent  |                |                | . |        |
| means a parent by   |                |                |   | Error  |
| blood, marriage or  |                |                |   |        |
| adoption and also   |                |                |   |        |
| means a legal       |                |                |   |        |
| guardian, or other  |                |                |   |        |
| person standing in  |                |                |   |        |
| loco parentis),     |                |                |   |        |
| e.g., (1) parent,   |                |                |   |        |
| (2) step-parent,    |                |                |   |        |
| (3) legal guardian, |                |                |   |        |
| (4) needy caretaker |                |                |   |        |
| relative, or (5)    |                |                |   |        |
| spouse of same.     |                |                |   |        |
| Determine if child  |                |                |   |        |
| meets citizenship   |                |                |   |        |
| requirements as set |                |                |   |        |
| forth in Federal    |                |                |   |        |
| policy.             |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 2 | I      |
|                     |                |                | \ | nsuffi |
|                     |                |                | . | cient/ |
|                     |                |                |   | M      |
|                     |                |                |   | issing |
|                     |                |                |   |        |
|                     |                |                |   | D      |
|                     |                |                |   | ocumen |
|                     |                |                |   | tation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 3 | Undera |
|                     |                |                | \ | uthori |
|                     |                |                | . | zation |
|                     |                |                |   |        |
|                     |                |                |   | Overa  |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 4 | Total  |
|                     |                |                | \ | Amount |
|                     |                |                | . | of     |
|                     |                |                | \ |        |
|                     |                |                | $ | Im     |
|                     |                |                |   | proper |
|                     |                |                |   | A      |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
|                     |                |                |   | for    |
|                     |                |                |   | P      |
|                     |                |                |   | ayment |
+---------------------+----------------+----------------+---+--------+
| **310 RESIDENCY**   |                |                | * |        |
|                     |                |                | * |        |
|                     |                |                | 3 |        |
|                     |                |                | 1 |        |
|                     |                |                | 0 |        |
|                     |                |                | R |        |
|                     |                |                | E |        |
|                     |                |                | S |        |
|                     |                |                | U |        |
|                     |                |                | L |        |
|                     |                |                | T |        |
|                     |                |                | S |        |
|                     |                |                | * |        |
|                     |                |                | * |        |
+---------------------+----------------+----------------+---+--------+
| Determine if client |                |                | 1 | No     |
| is a resident of    |                |                | \ | Error  |
| the State and for   |                |                | . |        |
| what duration, if   |                |                |   | Error  |
| client is a         |                |                |   |        |
| resident of the     |                |                |   |        |
| county and for what |                |                |   |        |
| duration, and       |                |                |   |        |
| whether there is an |                |                |   |        |
| agreement regarding |                |                |   |        |
| eligibility among   |                |                |   |        |
| counties.           |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 2 | I      |
|                     |                |                | \ | nsuffi |
|                     |                |                | . | cient/ |
|                     |                |                |   | M      |
|                     |                |                |   | issing |
|                     |                |                |   |        |
|                     |                |                |   | D      |
|                     |                |                |   | ocumen |
|                     |                |                |   | tation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 3 | Undera |
|                     |                |                | \ | uthori |
|                     |                |                | . | zation |
|                     |                |                |   |        |
|                     |                |                |   | Overa  |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 4 | Total  |
|                     |                |                | \ | Amount |
|                     |                |                | . | of     |
|                     |                |                | \ |        |
|                     |                |                | $ | Im     |
|                     |                |                |   | proper |
|                     |                |                |   | A      |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
|                     |                |                |   | for    |
|                     |                |                |   | P      |
|                     |                |                |   | ayment |
+---------------------+----------------+----------------+---+--------+
| **320 HOUSEHOLD     |                |                | * |        |
| MEMBERS**           |                |                | * |        |
|                     |                |                | 3 |        |
|                     |                |                | 2 |        |
|                     |                |                | 0 |        |
|                     |                |                | R |        |
|                     |                |                | E |        |
|                     |                |                | S |        |
|                     |                |                | U |        |
|                     |                |                | L |        |
|                     |                |                | T |        |
|                     |                |                | S |        |
|                     |                |                | * |        |
|                     |                |                | * |        |
+---------------------+----------------+----------------+---+--------+
| To receive services |                |                | 1 | No     |
| a child\'s parent   |                |                | \ | Error  |
| or parents must be  |                |                | . |        |
| working or          |                |                |   | Error  |
| attending a job     |                |                |   |        |
| training or         |                |                |   |        |
| educational program |                |                |   |        |
| or have a child     |                |                |   |        |
| receiving or        |                |                |   |        |
| needing to receive  |                |                |   |        |
| protective          |                |                |   |        |
| services.           |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 2 | I      |
|                     |                |                | \ | nsuffi |
|                     |                |                | . | cient/ |
|                     |                |                |   | M      |
|                     |                |                |   | issing |
|                     |                |                |   |        |
|                     |                |                |   | D      |
|                     |                |                |   | ocumen |
|                     |                |                |   | tation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 3 | Undera |
|                     |                |                | \ | uthori |
|                     |                |                | . | zation |
|                     |                |                |   |        |
|                     |                |                |   | Overa  |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 4 | Total  |
|                     |                |                | \ | Amount |
|                     |                |                | . | of     |
|                     |                |                | \ |        |
|                     |                |                | $ | Im     |
|                     |                |                |   | proper |
|                     |                |                |   | A      |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
|                     |                |                |   | for    |
|                     |                |                |   | P      |
|                     |                |                |   | ayment |
+---------------------+----------------+----------------+---+--------+
| **330 QUALIFYING    |                |                | * |        |
| CHILD**             |                |                | * |        |
|                     |                |                | 3 |        |
|                     |                |                | 3 |        |
|                     |                |                | 0 |        |
|                     |                |                | R |        |
|                     |                |                | E |        |
|                     |                |                | S |        |
|                     |                |                | U |        |
|                     |                |                | L |        |
|                     |                |                | T |        |
|                     |                |                | S |        |
|                     |                |                | * |        |
|                     |                |                | * |        |
+---------------------+----------------+----------------+---+--------+
| Determine if child  |                |                | 1 | No     |
| is eligible for     |                |                | \ | Error  |
| services, including |                |                | . |        |
| (1) younger than 13 |                |                |   | Error  |
| years, (2) younger  |                |                |   |        |
| than 19 years and   |                |                |   |        |
| physically or       |                |                |   |        |
| mentally incapable  |                |                |   |        |
| of caring for       |                |                |   |        |
| himself or herself, |                |                |   |        |
| or under court      |                |                |   |        |
| supervision or (3)  |                |                |   |        |
| meets other         |                |                |   |        |
| eligibility         |                |                |   |        |
| requirements        |                |                |   |        |
| defined in the      |                |                |   |        |
| State Plan.         |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 2 | I      |
|                     |                |                | \ | nsuffi |
|                     |                |                | . | cient/ |
|                     |                |                |   | M      |
|                     |                |                |   | issing |
|                     |                |                |   |        |
|                     |                |                |   | D      |
|                     |                |                |   | ocumen |
|                     |                |                |   | tation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 3 | Undera |
|                     |                |                | \ | uthori |
|                     |                |                | . | zation |
|                     |                |                |   |        |
|                     |                |                |   | Overa  |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 4 | Total  |
|                     |                |                | \ | Amount |
|                     |                |                | . | of     |
|                     |                |                | \ |        |
|                     |                |                | $ | Im     |
|                     |                |                |   | proper |
|                     |                |                |   | A      |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
|                     |                |                |   | for    |
|                     |                |                |   | P      |
|                     |                |                |   | ayment |
+---------------------+----------------+----------------+---+--------+
| **340 QUALIFYING    |                |                | * |        |
| CARE**              |                |                | * |        |
|                     |                |                | 3 |        |
|                     |                |                | 4 |        |
|                     |                |                | 0 |        |
|                     |                |                | R |        |
|                     |                |                | E |        |
|                     |                |                | S |        |
|                     |                |                | U |        |
|                     |                |                | L |        |
|                     |                |                | T |        |
|                     |                |                | S |        |
|                     |                |                | * |        |
|                     |                |                | * |        |
+---------------------+----------------+----------------+---+--------+
| Determine number of |                |                | 1 | No     |
| hours needing       |                |                | \ | Error  |
| authorization       |                |                | . |        |
| during review       |                |                |   | Error  |
| period, based on    |                |                |   |        |
| parental            |                |                |   |        |
| work/training       |                |                |   |        |
| status or child\'s  |                |                |   |        |
| protective services |                |                |   |        |
| status. Determine   |                |                |   |        |
| hours and type of   |                |                |   |        |
| care authorized.    |                |                |   |        |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 2 | I      |
|                     |                |                | \ | nsuffi |
|                     |                |                | . | cient/ |
|                     |                |                |   | M      |
|                     |                |                |   | issing |
|                     |                |                |   |        |
|                     |                |                |   | D      |
|                     |                |                |   | ocumen |
|                     |                |                |   | tation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 3 | Undera |
|                     |                |                | \ | uthori |
|                     |                |                | . | zation |
|                     |                |                |   |        |
|                     |                |                |   | Overa  |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
+---------------------+----------------+----------------+---+--------+
|                     |                |                | 4 | Total  |
|                     |                |                | \ | Amount |
|                     |                |                | . | of     |
|                     |                |                | \ |        |
|                     |                |                | $ | Im     |
|                     |                |                |   | proper |
|                     |                |                |   | A      |
|                     |                |                |   | uthori |
|                     |                |                |   | zation |
|                     |                |                |   | for    |
|                     |                |                |   | P      |
|                     |                |                |   | ayment |
+---------------------+----------------+----------------+---+--------+

+---------------------+---+---------------+---+---------------+---+---+--------+
| **350 QUALIFYING    |   |               |   |               | * |   |        |
| PROVIDER            |   |               |   |               | * |   |        |
| ARRANGEMENT**       |   |               |   |               | 3 |   |        |
|                     |   |               |   |               | 5 |   |        |
|                     |   |               |   |               | 0 |   |        |
|                     |   |               |   |               | R |   |        |
|                     |   |               |   |               | E |   |        |
|                     |   |               |   |               | S |   |        |
|                     |   |               |   |               | U |   |        |
|                     |   |               |   |               | L |   |        |
|                     |   |               |   |               | T |   |        |
|                     |   |               |   |               | S |   |        |
|                     |   |               |   |               | * |   |        |
|                     |   |               |   |               | * |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| Determine if        |   |               |   |               | 1 |   | No     |
| services are        |   |               |   |               | \ |   | Error  |
| provided by a       |   |               |   |               | . |   |        |
| center-based child  |   |               |   |               |   |   | Error  |
| care provider, a    |   |               |   |               |   |   |        |
| group home child    |   |               |   |               |   |   |        |
| care provider, a    |   |               |   |               |   |   |        |
| family child care   |   |               |   |               |   |   |        |
| provider or an      |   |               |   |               |   |   |        |
| in-home child care  |   |               |   |               |   |   |        |
| provider that is    |   |               |   |               |   |   |        |
| legally operating   |   |               |   |               |   |   |        |
| and eligible to     |   |               |   |               |   |   |        |
| receive child care  |   |               |   |               |   |   |        |
| subsidies.          |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               | 2 |   | I      |
|                     |   |               |   |               | \ |   | nsuffi |
|                     |   |               |   |               | . |   | cient/ |
|                     |   |               |   |               |   |   | M      |
|                     |   |               |   |               |   |   | issing |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | D      |
|                     |   |               |   |               |   |   | ocumen |
|                     |   |               |   |               |   |   | tation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               | 3 |   | Undera |
|                     |   |               |   |               | \ |   | uthori |
|                     |   |               |   |               | . |   | zation |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | Overa  |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               | 4 |   | Total  |
|                     |   |               |   |               | \ |   | Amount |
|                     |   |               |   |               | . |   | of     |
|                     |   |               |   |               | \ |   |        |
|                     |   |               |   |               | $ |   | Im     |
|                     |   |               |   |               |   |   | proper |
|                     |   |               |   |               |   |   | A      |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
|                     |   |               |   |               |   |   | for    |
|                     |   |               |   |               |   |   | P      |
|                     |   |               |   |               |   |   | ayment |
+---------------------+---+---------------+---+---------------+---+---+--------+
| **360 PROVIDER      |   |               |   |               | * |   |        |
| REQUIREMENTS**      |   |               |   |               | * |   |        |
|                     |   |               |   |               | 3 |   |        |
|                     |   |               |   |               | 6 |   |        |
|                     |   |               |   |               | 0 |   |        |
|                     |   |               |   |               | R |   |        |
|                     |   |               |   |               | E |   |        |
|                     |   |               |   |               | S |   |        |
|                     |   |               |   |               | U |   |        |
|                     |   |               |   |               | L |   |        |
|                     |   |               |   |               | T |   |        |
|                     |   |               |   |               | S |   |        |
|                     |   |               |   |               | * |   |        |
|                     |   |               |   |               | * |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| Determine if        |   |               |   |               | 1 |   | No     |
| regulatory          |   |               |   |               | \ |   | Error  |
| requirements are    |   |               |   |               | . |   |        |
| met. Regulatory     |   |               |   |               |   |   | Error  |
| requirements means  |   |               |   |               |   |   |        |
| requirements        |   |               |   |               |   |   |        |
| necessary for a     |   |               |   |               |   |   |        |
| provider to legally |   |               |   |               |   |   |        |
| provide child care  |   |               |   |               |   |   |        |
| services in a State |   |               |   |               |   |   |        |
| or locality,        |   |               |   |               |   |   |        |
| including           |   |               |   |               |   |   |        |
| registration        |   |               |   |               |   |   |        |
| requirements        |   |               |   |               |   |   |        |
| established under   |   |               |   |               |   |   |        |
| State, local, or    |   |               |   |               |   |   |        |
| tribal law.         |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               | 2 |   | I      |
|                     |   |               |   |               | \ |   | nsuffi |
|                     |   |               |   |               | . |   | cient/ |
|                     |   |               |   |               |   |   | M      |
|                     |   |               |   |               |   |   | issing |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | D      |
|                     |   |               |   |               |   |   | ocumen |
|                     |   |               |   |               |   |   | tation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               | 3 |   | Undera |
|                     |   |               |   |               | \ |   | uthori |
|                     |   |               |   |               | . |   | zation |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | Overa  |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               | 4 |   | Total  |
|                     |   |               |   |               | \ |   | Amount |
|                     |   |               |   |               | . |   | of     |
|                     |   |               |   |               | \ |   |        |
|                     |   |               |   |               | $ |   | Im     |
|                     |   |               |   |               |   |   | proper |
|                     |   |               |   |               |   |   | A      |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
|                     |   |               |   |               |   |   | for    |
|                     |   |               |   |               |   |   | P      |
|                     |   |               |   |               |   |   | ayment |
+---------------------+---+---------------+---+---------------+---+---+--------+
| **SECTION IV.       |   |               |   |               |   |   |        |
| INCOME AND          |   |               |   |               |   |   |        |
| PAYMENTS**          |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| **400 INCOME\       |   |               |   |               |   | * |        |
| **                  |   |               |   |               |   | * |        |
|                     |   |               |   |               |   | 4 |        |
|                     |   |               |   |               |   | 0 |        |
|                     |   |               |   |               |   | 0 |        |
|                     |   |               |   |               |   | R |        |
|                     |   |               |   |               |   | E |        |
|                     |   |               |   |               |   | S |        |
|                     |   |               |   |               |   | U |        |
|                     |   |               |   |               |   | L |        |
|                     |   |               |   |               |   | T |        |
|                     |   |               |   |               |   | S |        |
|                     |   |               |   |               |   | * |        |
|                     |   |               |   |               |   | * |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| Describe income     |   |               |   |               |   | 1 | No     |
| documentation       |   |               |   |               |   | \ | Error  |
| verification for    |   |               |   |               |   | . |        |
| household members.  |   |               |   |               |   |   | Error  |
| Specify time period |   |               |   |               |   |   |        |
| (e.g., based on     |   |               |   |               |   |   |        |
| four weeks prior to |   |               |   |               |   |   |        |
| application) and    |   |               |   |               |   |   |        |
| all income to be    |   |               |   |               |   |   |        |
| considered based on |   |               |   |               |   |   |        |
| State policies and  |   |               |   |               |   |   |        |
| definitions (e.g.,  |   |               |   |               |   |   |        |
| head of household   |   |               |   |               |   |   |        |
| employment).        |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 2 | I      |
|                     |   |               |   |               |   | \ | nsuffi |
|                     |   |               |   |               |   | . | cient/ |
|                     |   |               |   |               |   |   | M      |
|                     |   |               |   |               |   |   | issing |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | D      |
|                     |   |               |   |               |   |   | ocumen |
|                     |   |               |   |               |   |   | tation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 3 | Undera |
|                     |   |               |   |               |   | \ | uthori |
|                     |   |               |   |               |   | . | zation |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | Overa  |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 4 | Total  |
|                     |   |               |   |               |   | \ | Amount |
|                     |   |               |   |               |   | . | of     |
|                     |   |               |   |               |   | \ |        |
|                     |   |               |   |               |   | $ | Im     |
|                     |   |               |   |               |   |   | proper |
|                     |   |               |   |               |   |   | A      |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
|                     |   |               |   |               |   |   | for    |
|                     |   |               |   |               |   |   | P      |
|                     |   |               |   |               |   |   | ayment |
+---------------------+---+---------------+---+---------------+---+---+--------+
| **410 INCOME        |   |               |   |               |   | * |        |
| ELIGIBILITY**       |   |               |   |               |   | * |        |
|                     |   |               |   |               |   | 4 |        |
|                     |   |               |   |               |   | 1 |        |
|                     |   |               |   |               |   | 0 |        |
|                     |   |               |   |               |   | R |        |
|                     |   |               |   |               |   | E |        |
|                     |   |               |   |               |   | S |        |
|                     |   |               |   |               |   | U |        |
|                     |   |               |   |               |   | L |        |
|                     |   |               |   |               |   | T |        |
|                     |   |               |   |               |   | S |        |
|                     |   |               |   |               |   | * |        |
|                     |   |               |   |               |   | * |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| Determine if        |   |               |   |               |   | 1 | No     |
| household income    |   |               |   |               |   | \ | Error  |
| meets State         |   |               |   |               |   | . |        |
| requirements (e.g., |   |               |   |               |   |   | Error  |
| family gross income |   |               |   |               |   |   |        |
| must be within X    |   |               |   |               |   |   |        |
| percent of State\'s |   |               |   |               |   |   |        |
| median income).     |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 2 | I      |
|                     |   |               |   |               |   | \ | nsuffi |
|                     |   |               |   |               |   | . | cient/ |
|                     |   |               |   |               |   |   | M      |
|                     |   |               |   |               |   |   | issing |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | D      |
|                     |   |               |   |               |   |   | ocumen |
|                     |   |               |   |               |   |   | tation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 3 | Undera |
|                     |   |               |   |               |   | \ | uthori |
|                     |   |               |   |               |   | . | zation |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | Overa  |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 4 | Total  |
|                     |   |               |   |               |   | \ | Amount |
|                     |   |               |   |               |   | . | of     |
|                     |   |               |   |               |   | \ |        |
|                     |   |               |   |               |   | $ | Im     |
|                     |   |               |   |               |   |   | proper |
|                     |   |               |   |               |   |   | A      |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
|                     |   |               |   |               |   |   | for    |
|                     |   |               |   |               |   |   | P      |
|                     |   |               |   |               |   |   | ayment |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| **420 PAYMENT       |   |               |   |               |   | * |        |
| AMOUNT AUTHORIZED** |   |               |   |               |   | * |        |
|                     |   |               |   |               |   | 4 |        |
|                     |   |               |   |               |   | 2 |        |
|                     |   |               |   |               |   | 0 |        |
|                     |   |               |   |               |   | R |        |
|                     |   |               |   |               |   | E |        |
|                     |   |               |   |               |   | S |        |
|                     |   |               |   |               |   | U |        |
|                     |   |               |   |               |   | L |        |
|                     |   |               |   |               |   | T |        |
|                     |   |               |   |               |   | S |        |
|                     |   |               |   |               |   | * |        |
|                     |   |               |   |               |   | * |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| Determine the       |   |               |   |               |   | 1 | No     |
| amount of subsidy   |   |               |   |               |   | \ | Error  |
| payment authorized  |   |               |   |               |   | . |        |
| for the sample      |   |               |   |               |   |   | Error  |
| review month.       |   |               |   |               |   |   |        |
| Determine if the    |   |               |   |               |   |   |        |
| amount authorized   |   |               |   |               |   |   |        |
| was based on income |   |               |   |               |   |   |        |
| and family size and |   |               |   |               |   |   |        |
| the State\'s        |   |               |   |               |   |   |        |
| payment rate        |   |               |   |               |   |   |        |
| schedule.           |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 2 | I      |
|                     |   |               |   |               |   | \ | nsuffi |
|                     |   |               |   |               |   | . | cient/ |
|                     |   |               |   |               |   |   | M      |
|                     |   |               |   |               |   |   | issing |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | D      |
|                     |   |               |   |               |   |   | ocumen |
|                     |   |               |   |               |   |   | tation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 3 | Undera |
|                     |   |               |   |               |   | \ | uthori |
|                     |   |               |   |               |   | . | zation |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | Overa  |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 4 | Total  |
|                     |   |               |   |               |   | \ | Amount |
|                     |   |               |   |               |   | . | of     |
|                     |   |               |   |               |   | \ |        |
|                     |   |               |   |               |   | $ | Im     |
|                     |   |               |   |               |   |   | proper |
|                     |   |               |   |               |   |   | A      |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
|                     |   |               |   |               |   |   | for    |
|                     |   |               |   |               |   |   | P      |
|                     |   |               |   |               |   |   | ayment |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| **430               |   |               |   |               |   | * |        |
| PAYM                |   |               |   |               |   | * |        |
| ENTS/COMPUTATIONS** |   |               |   |               |   | 4 |        |
|                     |   |               |   |               |   | 3 |        |
|                     |   |               |   |               |   | 0 |        |
|                     |   |               |   |               |   | R |        |
|                     |   |               |   |               |   | E |        |
|                     |   |               |   |               |   | S |        |
|                     |   |               |   |               |   | U |        |
|                     |   |               |   |               |   | L |        |
|                     |   |               |   |               |   | T |        |
|                     |   |               |   |               |   | S |        |
|                     |   |               |   |               |   | * |        |
|                     |   |               |   |               |   | * |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
| Compute the         |   |               |   |               |   | 1 | No     |
| difference between  |   |               |   |               |   | \ | Error  |
| the amount          |   |               |   |               |   | . |        |
| authorized to be    |   |               |   |               |   |   | Error  |
| paid in the sample  |   |               |   |               |   |   |        |
| review month and    |   |               |   |               |   |   |        |
| the amount that     |   |               |   |               |   |   |        |
| should have been    |   |               |   |               |   |   |        |
| authorized. This    |   |               |   |               |   |   |        |
| difference is the   |   |               |   |               |   |   |        |
| error amount.       |   |               |   |               |   |   |        |
| Indicate if the     |   |               |   |               |   |   |        |
| error amount is an  |   |               |   |               |   |   |        |
| Overauthorization   |   |               |   |               |   |   |        |
| or                  |   |               |   |               |   |   |        |
| Underauthorization. |   |               |   |               |   |   |        |
| This is the method  |   |               |   |               |   |   |        |
| for calculating the |   |               |   |               |   |   |        |
| error amount in all |   |               |   |               |   |   |        |
| cases, including    |   |               |   |               |   |   |        |
| those with multiple |   |               |   |               |   |   |        |
| errors. In cases    |   |               |   |               |   |   |        |
| without errors this |   |               |   |               |   |   |        |
| element is not      |   |               |   |               |   |   |        |
| applicable.         |   |               |   |               |   |   |        |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 2 | I      |
|                     |   |               |   |               |   | \ | nsuffi |
|                     |   |               |   |               |   | . | cient/ |
|                     |   |               |   |               |   |   | M      |
|                     |   |               |   |               |   |   | issing |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | D      |
|                     |   |               |   |               |   |   | ocumen |
|                     |   |               |   |               |   |   | tation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 3 | Undera |
|                     |   |               |   |               |   | \ | uthori |
|                     |   |               |   |               |   | . | zation |
|                     |   |               |   |               |   |   |        |
|                     |   |               |   |               |   |   | Overa  |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
+---------------------+---+---------------+---+---------------+---+---+--------+
|                     |   |               |   |               |   | 4 | Total  |
|                     |   |               |   |               |   | \ | Amount |
|                     |   |               |   |               |   | . | of     |
|                     |   |               |   |               |   | \ |        |
|                     |   |               |   |               |   | $ | Im     |
|                     |   |               |   |               |   |   | proper |
|                     |   |               |   |               |   |   | A      |
|                     |   |               |   |               |   |   | uthori |
|                     |   |               |   |               |   |   | zation |
|                     |   |               |   |               |   |   | for    |
|                     |   |               |   |               |   |   | P      |
|                     |   |               |   |               |   |   | ayment |
+---------------------+---+---------------+---+---------------+---+---+--------+

\"THE PAPERWORK REDUCTION ACT OF 1995\"

Public reporting for this collection of information is estimated to
average 13.88 hours per response, including the time for reviewing
instructions, gathering and maintaining the data needed, and reviewing
the collection of information.

An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently
valid OMB control number.

**INSTRUCTIONS FOR COMPLETING**

***RECORD REVIEW WORKSHEET***

**General Instructions**

Reviewers use the customized *Record Review Worksheet* to record
analysis of the case record and findings. This documentation provides
the verification that substantiates the eligibility determination and
the amount of subsidy authorized for the sample review month. Regarding
eligibility status, reviewers examine the most recent eligibility
determination in effect for the sample review month - either the initial
determination or a redetermination and any subsequently reported changes
(e.g., income, or status) that might impact eligibility.

To properly review cases, reviewers must identify and examine the
documentation within the case records that was used to determine sample
review month eligibility and calculate authorization for payment. This
documentation may be permanent portions of the case record or
information specific to the eligibility period which covers the sample
month. The review also includes access or inquiry of any relevant
screens or files within a State\'s automated system, as appropriate and
necessary.

**Review Identification Information**

The reviewer completes identifying information for each review in the
first line of the *Record Review Worksheet*. This information includes:
the unique Child ID #, State and County names, the Sample Month/Year and
the Review Date. The Review Date is the date the case record is
reviewed.

**Columns 1: Elements of Eligibility and Payment Authorization and
Column 2: Analysis of Case Record**

Column I: Elements of Eligibility and Payment Authorization includes for
reviewers what forms, documents and information will assist them in
identifying or assessing the accuracy of the specific element of
eligibility.

Column 2: Analysis of Case Record is where reviewers summarize any
pertinent facts, questions, or conflicts in information found in the
case record documentation.

The following identifies each of the elements in Column 1 and the kinds
of information that needs to be reviewed. Instructions follow about what
companion facts, questions, or conflicts in information to insert in
Column 2.

**Section I. State Child Care Program Forms**

-   **[Element 100]{.underline} Application/Re-determination Forms**
    ***---** Determine presence, date, and completeness of required
    eligibility forms. Examples include (1) signed and dated CCDF
    application form, (2) child care agreement, (3) voucher or
    certificate, and (4) provider invoice. Specify conditions of dollar
    error, including (1) form expired, (2) no application form, and (3)
    no documentation of income and work hours.*

> [Column 1]{.underline} - Reviewers identify all required child care
> subsidy eligibility-related forms in their State, if they are not
> listed in the customized worksheet, and look for them in the case
> record.
>
> [Column 2]{.underline} - Reviewers check to make sure these forms are
> current and completely filled out, including required signatures.
> Reviewers then record facts, questions, or conflicts in information.

**Section II. Priority Group Placement**

-   **[Element 200]{.underline} Priority Group Placemen**t *---
    Determine if client meets criteria of any State-designated priority
    groups, e.g., (1) teen parent in high school, (2) TANF recipients in
    eligible work activities, (3) working parents on TANF, and/or (4)
    foster parents.*

> [Column 1]{.underline} - Reviewers verify if States have designated
> priority group(s).
>
> [Column 2]{.underline} - Reviewers look for and record evidence that
> the case involves a priority group. Reviewers code this element \"NA\"
> if there are no State-designated priority groups.

**Section III. General Program Requirements**

-   **[Element 300]{.underline}** **Qualifying Head of Household** *---
    Determine if client meets parent definition (parent means a parent
    by blood, marriage or adoption and also means a legal guardian, or
    other person standing in loco parentis), e.g., (1) parent, (2)
    step-parent, (3) legal guardian, (4) needy caretaker relative,
    or (5) spouse of same. Determine if child meets citizenship
    requirements as set forth in Federal policy.*

> [Column 1]{.underline} - Reviewers consult the list in the customized
> worksheet or refer directly to State policy for requirements for a
> qualifying head of household.
>
> [Column 2]{.underline} - Reviewers check the application form and
> supplementary documentation to determine if the necessary requirements
> are met.

-   **[Element 310]{.underline}** **Residency** *--- Determine if client
    is a resident of the State and for what duration, if client is a
    resident of the county and for what duration, and whether there is
    an agreement regarding eligibility among counties.*

> [Column 1]{.underline}: Reviewers examine the case record for the
> residency documentation required by the State, either customized in
> the worksheet or found in State policy.
>
> [Column 2]{.underline} - Reviewers compare State residency
> requirements with case record documentation.

-   **[Element 320]{.underline} Parental Work/Training Status** *--- To
    receive services a child\'s parent or parents must be working or
    attending a job training or educational program, or have a child
    receiving or needing to receive protective* *services.*

> [Column 1]{.underline} - Reviewers identify State policy requirements
> for parental activity status, if not already on customized worksheet,
> and look for corresponding information in the case record.
>
> [Column 2]{.underline} - Reviewers compare State requirements with
> case record documentation to find out if the child\'s eligibility
> determination was appropriate based on the child\'s protective
> services status or the job/training/educational activity of the
> parent(s).

-   **[Element 330]{.underline} Qualifying Child** ***---** Determine if
    child is eligible for services, including (1) younger than 13
    years, (2) younger than 19 years and physically or mentally
    incapable of caring for himself or herself, or under court
    supervision, or (3) meets other eligibility requirements defined in
    the State Plan.*

> [Column 1]{.underline} - Reviewers identify State policy requirements
> for child eligibility status, if not already on customized worksheet,
> and look for corresponding information about the child in the case
> record.
>
> [Column 2]{.underline} - Reviewers compare information in the case
> record with State policy to find out if the child\'s eligibility
> determination was appropriate to the child\'s age, physical or mental
> needs, and/or other child criteria in State policy.

-   **[Element 340]{.underline} Qualifying Care** *--- Determine number
    of hours needing authorization during review period, based on
    parental work/training status or child\'s protective services
    status. Determine hours and type of care authorized.*

> [Column 1]{.underline} - Reviewers refer to documentation of child
> protective services status or parent job/training/educational
> activity.
>
> [Column 2]{.underline}: Reviewers compare the hours authorized for
> services, as recorded in the case record, with the documentation of
> child protective services status or parent job/training/educational
> activity.

-   **[Element 350]{.underline}** **Qualifying Provider Arrangement**
    *--- Determine if services are provided by a center-based child care
    provider, a group home child care provider, a family child care
    provider, or an in-home child care provider that is legally
    operating and eligible to receive child care subsidies.*

> [Column 1]{.underline} - Reviewers check State policy for allowable
> provider categories and look for documentation of provider category in
> the case record.
>
> [Column 2]{.underline} - Reviewers check provider information in the
> case record to verify that the provider is from an allowable provider
> category.

-   **[Element 360]{.underline}** **Provider Requirements** *---
    Determine if regulatory requirements are met. Regulatory
    requirements are requirements necessary for a provider to legally
    provide child care services in a State or locality, including
    registration requirements established under State, local or tribal
    law.*

> [Column 1]{.underline} - Reviewers check State policy for allowable
> legal provider status and look for documentation of provider category
> in the case record.
>
> [Column 2]{.underline} - Reviewers check provider information in the
> case record to see if there is a license, registration document, or
> other document showing legal provider status.

**Section IV. Income and Payment**

-   **[Element 400]{.underline} Income** *--- Describe income
    documentation verification for household members. Specify time
    period (e.g., based on 4 weeks prior to application) and all income
    to be considered based on State policies and definitions (e.g., head
    of household employment).*

> [Column 1]{.underline} - Look for income verification for each
> household member. Income categories may be customized on the worksheet
> and may include such income as head of household employment income;
> spouse employment income; any changes in income reported; income
> during job training for parent/caregiver; child support, if included
> as part of income; Food Stamps, if included as part of income; and
> loss of income during eligibility period.
>
> [Column 2]{.underline} - Reviewers review and describe how household
> income, both earned and unearned, was verified and computed. This
> includes reviewing the income documentation information in the case
> record used for verification, reviewing compliance with State income
> verification policy, such as the treatment of disregarded income, and
> checking the computations for accuracy.

-   **[Element 410]{.underline} Income Eligibility** *---Determine if
    household income meets State requirements (e.g., family gross income
    must be within X percent of State\'s median income).*

> [Column 1]{.underline} - Reviewers identify the State income
> requirements from State policy, if not included in the customized
> worksheet.
>
> [Column 2]{.underline} - Compare the State income requirements with
> income data found in Element 400.

-   **[Element 420]{.underline} Amount Authorized***--- Determine the
    amount of subsidy payment authorized for payment for a sample review
    month. Determine if the amount authorized was based on income and
    family size and the State\'s payment rate schedule.*

> [Column 1]{.underline} - Reviewers locate in the case record the
> amount of subsidy authorized for the sample review month.
>
> [Column 2]{.underline} - Reviewers determine if the amount authorized
> was based on income (Element 400) and State income requirements
> (Element 410).

-   **[Element 430]{.underline} Payments/Computations** *--- Compute the
    difference between the amount authorized to be paid in a sample
    review month and the amount that should have been authorized. This
    difference is the error amount. Indicate if the error amount is an
    Overauthorization or Underauthorization. This is the method for
    calculating the error amount in all cases, including those with
    multiple errors. In cases without errors, this element is not
    applicable.*

> [Column 1]{.underline} - There is no separate action required for
> Column 1.
>
> [Column 2]{.underline} - Reviewers compute the difference, if any,
> between the amount authorized for payment in the sample review month
> and the amount that should have been authorized and record any
> difference, if any. If there are no errors, record as \"NA.\"

**Column 3: Findings**

Reviewers summarize the findings of the analysis from Column 2 for each
element. If an error is cited, reviewers include a detailed description
of the cause(s) of the error(s). The description includes whether the
error(s) resulted in an Overauthorization or Underauthorization and the
amount.

When a reviewer discovers more than one authorization error, the
reviewer documents the specific effects of each and selects the error
with the largest dollar value to code as the type of improper
authorization for payment. In the event of both an Overauthorization and
Underauthorization, the net difference is also recorded in Column 3 and
is entered in Column 4, #4.

This section also includes summaries of any error(s) that did not result
in a dollar amount found in the element.

**Column 4: Results**

Based upon the Column 3 summary, the reviewer completes the coding in
Column 4 for each Element in each Section of the *Record Review
Worksheet*. Column 4 lists the following codes to summarize the review
findings:

> 1\. Error --Enter the correct code according to the following key: "0"
> = no error, "1" = error;
>
> 2\. Reason for error -- Enter "Y" if the error is due to missing or
> insufficient documentation, "N" if the error is not due to missing or
> insufficient documentation, and \"NA\" if there is no error;
>
> 3\. Type of improper authorization for payment during sample review
> month -- Enter "U" for Underauthorization, "O" for Overauthorization
> and \"NA\" if there is no improper authorizations for payment. (For
> cases with both error types the type of the error for the larger
> dollar amount is coded.); and
>
> 4\. Total Amount of Improper Authorizations for Payment -- Enter the
> dollar amount of the error. This is the difference between the
> authorized payment amount and the amount that should have been
> authorized, as determined in the case review process.

[]{#Attachment1 .anchor}**ATTACHMENT 2**

**DATA ENTRY FORM AND INSTRUCTIONS**

+-----+---------------------------------------------------+------------+
| **I | **Item**                                          | **Coding** |
| tem |                                                   |            |
| \   |                                                   |            |
| #** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **  | State                                             |            |
| 1** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **  | County                                            |            |
| 2** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **  | Child ID                                          |            |
| 3** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **  | Sample Month/Year                                 |            |
| 4** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **  | Record Review Date                                |            |
| 5** |                                                   |            |
+-----+---------------------------------------------------+------------+
| **  | One or more case errors during sample review      |            |
| 6** | month                                             |            |
|     |                                                   |            |
|     | 0= no errors, 1= one or more errors               |            |
+-----+---------------------------------------------------+------------+
| **  | Total amount of Underauthorization or             |            |
| 7** | Overauthorization during sample review month      |            |
+-----+---------------------------------------------------+------------+
| **  | Type of improper authorization for payment        |            |
| 8** |                                                   |            |
|     | (U = Underauthorization, O = Overauthorization or |            |
|     | NA = No Agency Authorization Error)               |            |
+-----+---------------------------------------------------+------------+
| **  | Reason for error due to insufficient or missing   |            |
| 9** | documentation                                     |            |
|     |                                                   |            |
|     | (Y = Yes, N = No or NA = No Error)                |            |
+-----+---------------------------------------------------+------------+
| **1 | Total Authorization Amount during sample review   |            |
| 0** | month                                             |            |
+-----+---------------------------------------------------+------------+

\"THE PAPERWORK REDUCTION ACT OF 1995\"

Public reporting for this collection of information is estimated to
average .1388 hours per response, including the time for reviewing
instructions, gathering and maintaining the data needed, and reviewing
the collection of information.

An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently
valid OMB control number.

**INSTRUCTIONS FOR COMPLETING THE DATA ENTRY FORM**

State reviewers record the findings from each *Record Review Worksheet*
onto a *Data Entry Form*. A *Data Entry Form* must be completed for each
case review.

The *Data Entry Form* summarizes the composite results of the record
review documented on the *Record Review Worksheet*. Below is a list of
the information included on the *Data Entry Form*, instructions as
necessary and where the information can be located on the *Record Review
Worksheet*. Note that the term \"authorization\" means subsidy amounts
authorized during eligibility determination/redetermination. (See
Glossary.)

1.  State -- Insert the State name from the first line of the *Record
    Review Worksheet*;

2.  County -- Insert the County name from the first line of the *Record
    Review Worksheet*;

3.  Child ID -- Insert the Child ID from the first line of the *Record
    Review Worksheet*;

4.  Sample Month/Year -- Insert the sample month/year from the first
    line/top of the *Record Review Worksheet*;

5.  Date of record review -- Insert the Record Review Date from the
    first line of the *Record Review Worksheet*;

6.  One or more errors during sample review month -- Insert the number
    of errors code according to the following key: "0" = no errors, "1"
    = one or more errors. This information is located on the *Record
    Review Worksheet* in Column 4;

7.  Total amount of improper authorizations for payment
    (Underauthorization and Overauthorization) during sample review
    month -- Insert the total dollar amount of the improper
    authorization for payment located on the *Record Review Worksheet*
    in Element 430, Column 4;

8.  Type of improper authorization for payment -- Insert the type of
    improper authorization for payment code according to the following
    key: "U" = Underauthorization, "O" = Overauthorization. Enter \"NA\"
    if there is no agency authorization error. This information is
    located on the *Record Review Worksheet* in Column 4. (For cases
    with multiple authorization errors, enter the type of improper
    authorization for payment for the larger dollar amount of error.);

9.  Reason for error due to insufficient or missing documentation --
    Insert "Y" = Yes if the reason for error was due to insufficient or
    missing documentation; \"N\" = No if the error was not due to
    insufficient or missing documentation; and \"NA\" if there is no
    error. This information is located on *Record Review Worksheet*,
    Column 4;

10. Total authorization amount during sample review month -- Insert the
    total dollar amount included on *Record Review Worksheet* in Element
    420, Column 2.

    []{#Attachment2 .anchor}**ATTACHMENT 3**

    []{#__RefHeading___Toc155167973 .anchor}**STATE IMPROPER
    AUTHORIZATIONS FOR PAYMENT REPORT AND INSTRUCTIONS**

**PART I. PROGRAM ASSURANCES AND CERTIFICATIONS**

The Lead Agency, named below, assures and certifies that:

[]{.mark}

1.  The data collection process, including sample selection and case
    record reviews, adhered to all requirements of the \"Measuring
    Improper Authorizations for Payment in the Child Care and
    Development Fund (CCDF) Program\" instructions and regulations at 45
    CFR 98 Subpart K;

2.  The reviews were not conducted by persons who make or approve the
    eligibility determinations;

3.  All reviewers have been trained to ensure that the review process is
    consistent with State policies and that there is consistency within
    the State in interpretation of what is an error;

4.  The State agrees to retain *Record Review Worksheets, Data Entry
    Forms,* the *State Improper Authorizations for Payment Report* and
    any revisions, and any other records pertinent to the case reviews
    and submission of error rate reports for five years from the date of
    submission of the *State Improper Authorizations for Payment Report*
    or final revision submitted, whichever date is later; and

5.  The State understands that this information, including the sampled
    case records and

> calculations are subject to Federal review.

  ---------------- ------- -- ------------------------------------------------
  **Submission                
  Date:**                     

  **Name:**                   

  **Signature:**              

  **Title:**                  

  **State:**                  

  **State                     
  Agency:**                   

  **Phone                     
  Number:**                   

  **E-mail:**                 

  **Fiscal Year:**            
  ---------------- ------- -- ------------------------------------------------

**PART II. ERROR MEASURES REPORTING**

**Improper Authorizations for Payment** Reporting

  --------- -------------------------------------------------- -------------
  **Item                                                       
  \#**                                                         

  **1.**    Number of cases sampled                            

  **2.**    Total amount of authorizations for sampled cases   \$
            in the review period.                              

  **3.**    Total number of sampled cases with improper        
            authorizations for payment                         

  **4.**    Total amount of improper authorizations for        \$
            payment for the review period                      

  **5.**    Total number of improper authorizations for        
            payment due to missing or insufficient             
            documentation                                      

  **6.**    Percentage of cases with an error                  

  **7.**    Percentage of cases with an improper authorization 
            for payment                                        

  **8.**    Percentage of improper authorizations for payment  
            (for the review period)                            

  **9.**    Average amount of improper authorization for       \$
            payment                                            

  **10.**   Estimated annual amount of improper authorizations \$
            for payment                                        
  --------- -------------------------------------------------- -------------

**11. States indicate how many replacement cases were used each month of
the 12 month review period.**

+-----------------------------------------+----------------------------+
| **Month**                               | **\# Replacement**         |
|                                         |                            |
|                                         | **Cases Used**             |
+-----------------------------------------+----------------------------+
| **October**                             |                            |
+-----------------------------------------+----------------------------+
| **November**                            |                            |
+-----------------------------------------+----------------------------+
| **December**                            |                            |
+-----------------------------------------+----------------------------+
| **January**                             |                            |
+-----------------------------------------+----------------------------+
| **February**                            |                            |
+-----------------------------------------+----------------------------+
| **March**                               |                            |
+-----------------------------------------+----------------------------+
| **April**                               |                            |
+-----------------------------------------+----------------------------+
| **May**                                 |                            |
+-----------------------------------------+----------------------------+
| **June**                                |                            |
+-----------------------------------------+----------------------------+
| **July**                                |                            |
+-----------------------------------------+----------------------------+
| **August**                              |                            |
+-----------------------------------------+----------------------------+
| **September**                           |                            |
+-----------------------------------------+----------------------------+

**PART III. STATE RESPONSE TO ERROR MEASURES FINDINGS**

States complete and submit Part III A only as part of their first cycle
reporting only. States complete and submit Part III B only for all
subsequent reporting cycles.

**Part III A. (for first reporting cycle only)**

Provide a concise response to each of the Items in Part III A. Item 17A
does not require a narrative response. Use supplemental pages, as
necessary. Clearly label each supplemental page with the State name and
Item number.

  -------- ---------------------------------------------------------------
  **Item   []{.mark}
  \#**     

  **12     In addition to the State assurance and certification that the
  A.**     improper authorizations for payment data collection process
           adhered to the \"Improper Authorizations for Payment Data
           Collection Instructions,\" describe your fieldwork preparation,
           sampling method, and record review process
  -------- ---------------------------------------------------------------

+------+---------------------------------------------------------------+
| **   |                                                               |
| Item |                                                               |
| \#** |                                                               |
+------+---------------------------------------------------------------+
| **13 | Estimate the portion of the percentage of improper            |
| A.** | authorizations for payment that is attributable to missing or |
|      | insufficient documentation. Provide examples of the most      |
|      | frequently missed or insufficient documentation.              |
|      |                                                               |
|      | Provide examples of the most frequent identified causes of    |
|      | the improper authorizations for payment other than missing or |
|      | insufficient documentation.                                   |
+------+---------------------------------------------------------------+

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **14A.**   What are the actions that will be taken to correct the causes
             of improper authorizations for payment identified during the
             case record review process in order to reduce errors in the
             future?
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **15A.**   What is the amount of actual improper payments the State
             expects to recover as a result of the review?
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **16A.**   Describe the information systems and other infrastructure that
             assist the State in identifying and reducing improper
             authorizations and improper payments. If the Lead Agency does
             not have these tools, describe actions to be taken to acquire
             the necessary information systems and other infrastructure.
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **17A.**   What steps is the State taking to ensure that the Lead Agency
             and eligibility workers will be accountable for reducing
             improper authorizations and improper payments? Describe any
             Federal or State statutory or regulatory barriers which may
             limit the State's corrective action in reducing and recovering
             improper payments.
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **18A.**   What are the error rate targets for the amount of errors and
             improper authorizations for payment to be used in the next
             reporting cycle?
  ---------- ---------------------------------------------------------------

  ---------------------------------------------- ------------------------
  **Error Measures**                             **Target**

  Percentage of cases with an error              

  Percentage of cases with an improper           
  authorization for payment                      

  Percentage of improper authorizations for      
  payment                                        

  Average amount of improper authorization for   
  payment                                        

  Estimated annual amount of improper            
  authorizations for payment                     
  ---------------------------------------------- ------------------------

\"THE PAPERWORK REDUCTION ACT OF 1995\"

Public reporting for this collection of information is estimated to
average 374 hours per response, including the time for reviewing
instructions, gathering and maintaining the data needed, and reviewing
the collection of information.

An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently
valid OMB control number.

**Part III B. (for reporting cycles after first reporting cycle)**

Provide a concise written response to each of the Items in Part III A.
Item 17B does not require a narrative response. Use supplemental pages,
as necessary. Clearly label each supplemental page with the State name
and Item number.

  -------- ---------------------------------------------------------------
  **Item   []{.mark}
  \#**     

  **12     In addition to the State assurance and certification that the
  B.**     improper authorizations for payment data collection process
           adhered to the \"Improper Authorizations for Payment Data
           Collection Instructions,\" describe your fieldwork preparation,
           sampling method, and record review process
  -------- ---------------------------------------------------------------

+------+---------------------------------------------------------------+
| **   |                                                               |
| Item |                                                               |
| \#** |                                                               |
+------+---------------------------------------------------------------+
| **13 | Estimate the portion of the percentage of authorizations made |
| B.** | in error that is attributable to missing or insufficient      |
|      | documentation. Provide examples of the most frequent          |
|      | identified missing or insufficient documentation.             |
|      |                                                               |
|      | Provide examples of the most frequently identified causes of  |
|      | the improper authorizations for payment other than missing or |
|      | insufficient documentation.                                   |
+------+---------------------------------------------------------------+

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **14B.**   What are the actions that will be taken to correct the causes
             of improper authorizations for payment identified during the
             case record review process in order to reduce errors in the
             future?
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **15B.**   What is the amount of actual improper payments the State
             expects to recover as a result of the review (if any)?
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **16B.**   Describe the information systems and other infrastructure that
             assist the State in identifying and reducing improper
             authorizations and improper payments. If the Lead Agency does
             not have these tools, describe actions to be taken to acquire
             the necessary information systems and other infrastructure.
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **17B.**   What steps is the State taking to ensure that the Lead Agency
             and eligibility workers will be accountable for reducing
             improper authorizations and improper payments? Describe any
             Federal or State statutory or regulatory barriers which may
             limit the State's corrective action in reducing and recovering
             improper payments.
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **18B.**   Provide the error rate targets from the prior and current
             cycles and targets for the next cycle.
  ---------- ---------------------------------------------------------------

  -------------------- ------------ ------------ ----------- ----------- ----------
  **Error Measures**   **Previous   **Previous   **Current   **Current   **Target
                       Cycle Data** Cycle        Cycle       Cycle       for Next
                                    Target**     Data**      Target**    Cycle**

  Percentage of cases                                                    
  with an error                                                          

  Percentage of cases                                                    
  with an improper                                                       
  authorization for                                                      
  payment                                                                

  Percentage of                                                          
  improper                                                               
  authorizations for                                                     
  payment                                                                

  Average amount of                                                      
  improper                                                               
  authorizations for                                                     
  payment                                                                

  Estimated annual                                                       
  amount of improper                                                     
  authorizations for                                                     
  payment                                                                
  -------------------- ------------ ------------ ----------- ----------- ----------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **19.B**   Describe if the State met targets set in the previous cycle
             and, if not, provide an explanation of why the State did not
             meet its targets.
  ---------- ---------------------------------------------------------------

  ---------- ---------------------------------------------------------------
  **Item     
  \#**       

  **20.B**   Discuss causes of errors and improper authorizations for
             payment identified in the prior cycle and actions that were
             taken to correct those causes in order to reduce error rates.
  ---------- ---------------------------------------------------------------

\"THE PAPERWORK REDUCTION ACT OF 1995\"

Public reporting for this collection of information is estimated to
average 374 hours per response, including the time for reviewing
instructions, gathering and maintaining the data needed, and reviewing
the collection of information.

An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently
valid OMB control number.

**INSTRUCTIONS FOR COMPLETING STATE IMPROPER AUTHORIZATIONS FOR PAYMENT
REPORT**

All States are required to complete and submit this report in accordance
with these instructions on behalf of the State agency administering the
Child Care and Development Fund.

Due Dates: This report must be submitted every three federal fiscal
years on or before June 30 of the reporting year.

Distribution: Submit by email a copy of the *State Improper
Authorizations for Payment Report* to the Regional Child Care Manager in
your ACF Regional Office. The original signature page (with original
signatures) must also be submitted to the Regional Child Care Manager.

**Part I. Program Assurances and Certifications**

States insert identifying information and signature of the agent
authorized to assure and certify that:

> 1\. The data collection process, including case record reviews,
> adhered to all requirements of the \"Measuring Improper Authorizations
> for Payment in the Child Care and Development Fund (CCDF) Program\"
> instructions and regulations at 45 CFR 98 Subpart K;
>
> 2\. The reviews were not conducted by persons who make or approve the
> eligibility determinations;
>
> 3\. All reviewers have been trained to ensure that the review process
> is consistent with State policies and that there is consistency within
> the State in interpretation of what is an error;
>
> 4\. The State agrees to retain *Record Review Worksheets, Data Entry
> Forms,* the *State Improper Authorizations for Payment Report* and any
> revisions, and any other records pertinent to the case reviews and
> submission of error rate reports for five years from the date of
> submission of the *State Improper Authorizations for Payment Report*
> or final revision submitted, whichever date is later; and
>
> 5\. The State understands that this information, including the sampled
> case records and calculations, are subject to Federal review.

**Part II. Error Measures Reporting**

[General Instructions]{.underline}

Round all entries to the nearest dollar. Omit cents. If .50 cents or
more round up to the nearest dollar. If .49 cents or less round down to
the nearest dollar. Note that the term \"authorization\" means subsidies
authorized during eligibility determination/redetermination. (See
Glossary.)

1.  *Number of cases sampled* -- The sample size for all states is set
    at 271 (or 276) cases.

2.  *Total amount of authorizations for payment in cases selected for
    sampling in the review period* -- Compute the sum of all
    authorizations for payment for the 271 (or 276) sampled cases. The
    amount of payment authorized is captured on Line 10 of each of the
    271 *Data Entry Forms*.

3.  *Total number of sampled cases with improper authorizations* *for
    payment* -- Compute the sum of all cases with either an
    Overauthorization or Underauthorization. This would be the total
    number of cases with an amount other than \"0\" in Line 7 of the
    *Data Entry Form*.

4.  *Total amount of improper authorizations for payment for the review
    period* -- Compute the sum of all improper authorizations for
    payment listed in Line 7 of the *Data Entry Form*.

5.  *Total number of improper authorizations for payment due to missing
    or insufficient documentation* -- Compute the sum of all cases with
    a "Yes" coding in Line 9 of the *Data Entry Form.*

6.  *Percentage of cases with an error* -- Divide the total number of
    all cases with an error (any case with an error coding in Line 6 of
    the *Data Entry Form*) by 271 (or 276) and multiply by 100.

7.  *Percentage of cases with an improper authorization for payment* --
    Divide the total number of all cases with an authorization error
    (see #3 above) by 271 and multiply by 100.

8.  *Percentage of improper authorizations for payment (for the review
    period)* -- Compute the sum of all amounts listed in Line 7 of the
    *Data Entry Forms* (see #4 above) divided by the sum of all
    authorizations for payment for the 271 (or 276) sampled cases (see
    #2 above) multiplied by 100. Add Underauthorizations to (not
    subtract from) the total of Overauthorizations.

9.  *Average amount of improper authorization for payment* -- Compute
    the sum of all amounts listed in Line 8 of the *Data Entry Forms*
    (see #4 above) divided by the total number of cases with an amount
    other than zero in Line 7 of the *Data Entry Form* (see \# 3 above).

10. *Estimated annual amount of improper authorizations* *for payment*--
    Multiply the percentage of authorizations made in error for the
    review period (see \# 8 above) by the total dollar amount of child
    care authorizations that the State paid during the 12 month review
    period.

> 11\. Number of replacement cases used each month of the 12 month
> review period.

**Part III. State Response to Error Measures Findings:**

Using the coordination process selected, States provide narrative
responses, or enter data into tables provided, in Part III.

Note: States complete and submit Part III A only as part of their first
cycle reporting only. States complete and submit Part III B only for all
subsequent reporting cycles.

**Part III A. (for first reporting cycle only)**

> 12A. In addition to the State assurance and certification that the
> improper authorizations data collection process, including case record
> reviews, adhered to all requirements of the \"Measuring Improper
> Authorizations in the Child Care and Development Fund (CCDF) Program\"
> instructions, describe your fieldwork preparation, sampling method,
> and record review process.
>
> 13A. Estimate the portion of improper authorizations for payment that
> is attributable to missing or insufficient documentation. Provide
> examples of the most frequently missed or insufficient documentation.
>
> Provide examples of the most frequently identified causes of the
> improper authorizations other than missing or insufficient
> documentation.
>
> 14A. What are the actions that will be taken to correct the causes of
> improper authorizations identified during the case record review
> process in order to reduce errors in the future?
>
> 15A. What is the amount of actual improper payments the State expects
> to recover as a result of the review (if any)?
>
> 16A. Describe the information systems and other infrastructure that
> assist the State in identifying and reducing improper authorizations
> and improper payments. If the Lead Agency does not have these tools,
> describe actions to be taken to acquire the necessary information
> systems and other infrastructure.
>
> 17A. What steps is the State taking to ensure that the Lead Agency and
> eligibility workers will be accountable for reducing improper
> authorizations and improper payments? Describe any Federal or State
> statutory or regulatory barriers which may limit the State's
> corrective action in reducing and recovering improper payments.
>
> 18A. What are the error rate targets to be used in the next reporting
> cycle? Enter the targets for percentage of cases with an error,
> percentage of cases with an improper authorization for payment,
> percentage of improper authorizations for payment, average amount of
> improper authorization for payment, and estimated annual amount of
> improper authorizations for payment into the table provided.

**Part III B. (for reporting cycles after the first reporting cycle
only)**

> 12B. In addition to the State assurance and certification that the
> improper authorizations data collection process, including case record
> reviews, adhered to all requirements of the \"Measuring Improper
> Authorizations in the Child Care and Development Fund (CCDF) Program\"
> instructions, describe your fieldwork preparation, sampling method,
> and record review process.
>
> 13B. Estimate the portion of the percentage of improper authorizations
> for payment that is attributable to missing or insufficient
> documentation. Provide examples of the most frequent identified
> missing or insufficient documentation.
>
> Provide examples of the most frequently identified causes of the
> improper authorizations other than missing or insufficient
> documentation.
>
> 14B. What are the actions that will be taken to correct those causes
> in order to reduce errors in the future?
>
> 15B. What is the amount of actual improper payments the State expects
> to recover as a result of the review (if any)?
>
> 16B. Describe the information systems and other infrastructure that
> assist the State in identifying and reducing improper authorizations.
> If the Lead Agency does not have these tools, describe actions to be
> taken to acquire the necessary information systems and other
> infrastructure.
>
> 17B. What steps is the State taking to ensure that the Lead Agency and
> eligibility workers will be accountable for reducing improper
> authorizations and improper payments? Describe any Federal or State
> statutory or regulatory barriers which may limit the State's
> corrective action in reducing and recovering improper payments.
>
> 18B. Provide the error rate targets for the prior and current cycles
> and targets for the next cycle for: percentage of cases with an error,
> percentage of cases with an improper authorization for payment,
> percentage of improper authorizations for payment, average amount of
> improper authorization for payment, and estimated annual amount of
> improper authorizations for payment. Enter the data into the table
> provided.
>
> 19B. Describe if the State met targets set in the previous cycle and,
> if not, provide an explanation of why the State did not meet its
> targets.
>
> 20B. Discuss causes of errors and improper authorizations identified
> in the prior cycle and subsequent actions that were taken to reduce
> error rates.

[^1]: The sample of 52 States was stratified by region (10 total), with
    the regions randomly ordered. States were sorted within regions by
    caseload, from the most cases to the least cases. Every third State
    on the list was then selected, using a random start number the first
    and second years. The third year included those States not selected
    in year one or year two. Each year this will yield a mix of
    county-administered and State-administered States and States serving
    both small and large numbers of children annually.

[^2]: To illustrate the use of confidence limits, two assumptions must
    be made: (1) the eligibility error rate variable is the percent of
    clients who exhibit an eligibility error during the review month;
    and (2) 271 cases are sampled and 50% show an eligibility error
    (this is the most conservative assumption about the error rate in
    terms of yielding the largest confidence interval). The confidence
    limits are calculated as follows: \[m = 1.645(SQRT(p(1-p)/n))\],
    where m is the 90% confidence limit (or interval), SQRT is the
    square root, n is the sample size, and p is the proportion of the
    sample found to be in error. Following the assumptions, the
    confidence interval would be calculated as \[m =
    1.645(SQRT(.5(.5)/100) = .05 (or 5%)\]. The 90% confidence interval
    can be described in two ways: (1) with 90% confidence, the error
    rate for this sampled population is between 45% and 55%; or (2) with
    90% confidence, 50% of the population is in error with a margin of
    error for this estimate of +/- 5%. Selecting at least 271 cases
    assures that the confidence limits are +/- 5% or less.