California Form Aap 2 PDF Details

The State of California requires all employers to withhold a portion of employee's wages and send it to the state in the form of Aap 2 taxes. This article will provide an overview of what this tax is, how it is calculated, and who is responsible for paying it. Employers should be sure to familiarize themselves with these requirements in order to ensure compliance with state law.

QuestionAnswer
Form NameCalifornia Form Aap 2
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesDeferred, medi, ADOPTIONS, placements

Form Preview Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

PAYMENT INSTRUCTIONS ADOPTION ASSISTANCE PROGRAM

DISTRIBUTION:

Original

:

County Welfare Department

Copy

:

Agency File

 

 

 

 

 

AAP PAYMENT CASE NUMBER

 

 

 

 

 

STATE ADOPTIONS CASE NUMBER

 

 

ADA

 

 

 

 

 

ADOPTION AGENCY CASE NUMBER

 

 

 

CHILD’S ADOPTIVE NAME

CHILD’S BIRTHDATE

Adoption Finalization Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date initial AAP Agreement (AD 4320) was signed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This is a: (Check applicable items) Please send Notice of Action for the following checked items.

 

 

 

 

 

 

 

■

New case; Form AAP 4, Eligibility Certification - Adoption Assistance Program

■ Change in amount or duration of payment due to:

 

 

 

 

 

 

 

 

is attached, please send Notice of Action.

 

 

 

 

 

 

 

 

 

(Check (✔) one)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

■ Denial, please send Notice of Action.

 

 

 

 

 

 

 

 

 

 

 

 

■

Completed reassessment.

 

 

 

 

 

 

 

 

 

 

 

 

■ Change in need or circumstances.

■ Deferred payment agreement, please send Notice of Action.

 

 

 

 

■

Case Terminated.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

■ Change in child’s name, payee name or address.

 

 

 

 

 

 

 

 

 

■

Benefit Extension

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

■

Overpayment requiring collection.

 

 

 

 

 

 

 

 

 

 

 

 

 

■ Child/youth has a mental or physical disability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

■ Child/youth meets one of the five participation

Reason for the denial, termination or overpayment to be stated on the Notice of Action:

 

 

 

 

criteria per Welfare and Institutions Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 11403(b)(1) through (5)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please start or change payments as follows:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total monthly payment amount: ■ $

 

 

or ■ No cash payment, Medi-Cal only

 

 

 

 

 

 

 

The following checked rate structure equals the total monthly payment amount:

 

 

 

 

 

 

 

■

AAP Basic Rate: $

 

 

 

■

Specialized Care Increment: $

 

 

 

 

 

 

 

 

■

Dual Agency Rate: $

 

 

 

■

Supplemental Rate: $

 

 

 

 

 

 

 

 

■ Rate Classification Level (RCL):

 

 

■ State Approved Facility Rate: $

 

 

 

 

 

 

 

 

Start date:

 

 

 

 

 

 

 

Date of Reassessment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If applicable, check one:

■The child is placed outside of the adoptive home: Name of the out-of-home placement facility:

■One check to be issued to the facility.

■Two checks to be issued:

$

 

 

to be paid to the facility

$

 

 

to be paid to the adoptive parent

 

 

■The child is eligible to receive Wraparound services: Name of Wraparound provider:

■One check to be issued to the provider.

■Two checks to be issued:

$

 

to be paid to the Wraparound provider

$

 

to be paid to the adoptive parent

Health Insurance

■The family reports that the child has no health insurance.

■The family reports that the child has health insurance with:__________________________________________________________________

PAYEE NAME

 

 

SIGNATURE OF AUTHORIZED OFFICIAL OF ADOPTION AGENCY

 

 

 

 

▲

 

 

 

 

 

 

 

 

PAYEE ADDRESS

(NO.)

(STREET)

ADOPTION AGENCY MAILING ADDRESS

 

 

 

 

 

 

 

 

(CITY)

(STATE)

(ZIP)

 

 

 

 

 

 

 

 

 

PAYEE TELEPHONE NUMBER

 

 

TELEPHONE NUMBER

DATE

 

 

 

 

 

 

PAYEE EMAIL ADDRESS

 

 

 

 

 

AAP 2 (9/13)

California Form Aap 2 isn’t the one you’re looking for?

Related Documents