California Form Sr 10 PDF Details

In California, ensuring financial transparency and compliance within the realms of Group Homes or Foster Family Agencies (FFAs) is of paramount importance. To facilitate this, the California Department of Social Services mandates the submission of the SR 10 form as a critical part of the required financial audit process. This form, essentially a Certification of Audited Cost Data, must be completed and submitted by a Certified Public Accountant (CPA) representing the entity. The SR 10 form serves as verification that the financial audits cover the required cost data reports and confirm that the information presented is accurate and fairly stated in correlation with the basic financial statements. Accompanying this certification, the CPA must also provide supplementary cost data reports for additional analysis, as stipulated by the Manual of Policies and Procedures Section 11-405.214. This requirement underscores the California Department of Social Services’ commitment to ensuring the integrity and transparency of financial audits within these organizations. Moreover, by adhering to the False Claims Act, the CPA’s certification amplifies the accountability aspect, assuring that the data reported is truthful and correct. The submission details and processes outlined for the SR 10 form highlight its role in fostering a transparent and compliant financial framework for Group Homes and FFAs in California.

QuestionAnswer
Form NameCalifornia Form Sr 10
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namessr10 certification of audited cost data form

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CERTIFICATION OF

AUDITED COST DATA

The Group Home or Foster Family Agency corporation should have their Certified Public Accountant (CPA) complete and submit this form as part of the required financial audit if the CPA has not otherwise provided written documentation which clearly shows that the required cost data reports were audited and that the information was fairly stated in all material respects in relation to the basic financial statements taken as a whole.

Please have the completed and signed form sent to:

California Department of Social Services

Program and Financial Audits Bureau

ATTENTION: Financial Audits Unit Manager

744 P Street, MS 9-23

Sacramento, California 95814.

GROUP HOME OR FOSTER FAMILY AGENCY CORPORATE NAME

PROGRAM NUMBERS(S)

STREET ADDRESS

PROGRAM FISCAL YEAR (MO/YR-MO/YR)

CITY, STATE, AND ZIP CODE

PROVIDER PHONE NUMBER

The attached supplementary cost data reports are presented for the purposes of additional analysis and are not a required part of the basic financial statements but are required as supplementary information by the California Department of Social Services in accordance with Manual of Policies and Procedures Section 11-405.214. Such information has been subjected to the auditing procedures applied in the audit of the basic financial statements, and in our opinion, is fairly stated in all material respects in relation to the basic fianancial statements taken as a whole.

Check only the forms which apply:

SR 3___ SR 4___ FCR 12FFA___

In compliance with the False Claims Act (31 U.S.C. §3729-3733), I certify that the information on this form is true and correct.

PRINTED NAME OF CPA

SIGNATURE OF CPA

DATE

ADDRESS

CITY, STATE AND ZIP CODE

SR 10 (2/06)

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