DCC 94 Form PDF Details

Understanding the intricacies of child care management within the Commonwealth of Kentucky requires familiarity with specific forms and procedures, among which is the DCC-94E form, a crucial document for child care providers. This form, issued by the Cabinet for Health and Family Services under the Department of Community Based Services Division of Child Care, serves as a daily attendance record that is not only mandatory but foundational for ensuring accountability and compliance with state regulations outlined in 922 KAR 2:160. It demands that providers meticulously record the arrival and departure times of each child, ensuring these entries are validated by a parent or a designated individual weekly. Accuracy in completing this form is paramount, as it directly influences the provider's billing process and compliance with Kentucky Revised Statutes (KRS) 13A.130, aiming to eliminate fraudulent practices and ensure providers are fairly compensated for their services. The form also outlines the consequences of inaccuracies, including potential non-payment and recoupment of funds, stressing the importance of diligent record-keeping in the broader context of child care provision and regulatory adherence within Kentucky.

QuestionAnswer
Form NameDCC 94 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other nameskentucky dcc 94e form, dcc94, dcc 94e form, kentucky child care attendance form

Form Preview Example

DCC-94E

COMMONWEALTH OF KENTUCKY

 

 

 

 

 

R

(R.07/13)

Cabinet for Health and Family Services

 

 

 

 

 

 

 

922 KAR 2:160

Department of Community Based Services

 

 

 

 

 

 

 

 

Division of Child Care

Page

 

 

 

of

 

Child Care Daily Attendance Record

 

 

 

 

 

 

 

Provider's Name

Provider's Registered/Certified/Licensed #

 

 

Week of:

 

 

 

 

 

 

 

--

 

 

 

 

 

 

(mm/dd/yyyy)

 

through

(mm/dd/yyyy)

Daily Attendance Record: Enter the child’s full name as listed on the DCC-97, Provider Billing Form. The physical arrival/departure time, including a.m. and

p.m., of each child must be recorded daily. A parent or the parent's designated person (i.e., somone other than a child care employee) must sign at the end of each week for each child to verify accuracy. If a child arrives/depart by bus, the child care employee must record the time and initial daily. DO NOT RECORD INFORMATION IN ADVACE or make alterations to this form. No other version of this from will be accepted. This form must be fully completed.

Child's Name

(as it appears on

PBF)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Time In

Time Out

Time In

Time Out

Time In

Time Out

Time In

Time Out

Time In

Time Out

Time In

Time Out

Time In

Time Out

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials

Initials

Initials

Initials

Initials

Initials

Initials

Initials

Initials

Initials

Initials

Initials

Initials

Initials

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Parent

or Designated Person to Verify Accuracy of Attendance for the week

I certify that I have not altered this form in accordance with KRS 13A.130, and this information was used when completing the DCC-97, Provider Billing Form. I understand

that if I or staff acting on the child care provider’s behalf does not bill accurately in accordance with 922 KAR 2:160 for a child, the child care provider will not be paid for

days that are not verified and will be required to pay back any overpayment. An overpayment may be pursued as an intentional program violation in accordance with 922 KAR

2:020.

Licensee/On-Site Director or Certified/Registered Provider’s Signature: _________________________________________________ Date: _________________ __

“Licensee”, as defined by 922 KAR 2:090, is an owner or operator of a child care center to include sole proprietor, corporation, Limited Liability Company, partnership, association or organization. NOTE: MISSING SIGNATURES MAY RESULT IN NON-PAYMENT OR RECOUPMENT OF CCAP PAYMENT IN ACCORDANCE WITH 922 KAR 2:160 and 922 KAR 2:020.

Cabinet for Health and Family Services

 

Web Site: http://chfs.ky.gov/

An Equal Opportunity Employer M/F/D

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