Form Sr 2a-Wp-Ctf - Child Care And Supervision Component Program Audit Working Paper
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1STATE OF CALIFORNIA–HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
INITIALS
DATE
PREPARED BY
CHILD CARE AND SUPERVISION COMPONENT
INITIALS
DATE
PROGRAM AUDIT WORKING PAPER (SR 2A-WP-CTF)
APPROVED BY
PROVIDER NAME:
PROGRAM NAME:
PROGRAM NUMBER:
PROGRAM AUDIT DATE:
EMPLOYEE:
SALARY
RATE
AUDIT PERIOD
Full-Time
Part-Time
$
$
A. DOCUMENTATION REVIEWED:
Employee Timesheets
Agency Payroll Records
Personnel File
Other
Date Hired:
Date Terminated:
Evidence of CCL Compliance:
______
______
______
In file?
YES
NO
Dates:
FP submission
Association
Exemption
______
Child Abuse Index
Duties:
CCS
First Line Supervisor
Other
Admin/Ex. Director
Comments:
B. EXPERIENCE (SR 2A-CTF - Column C) (Refer to MPP Sections 11-400r(7) and 11-402.224(d)(e))
Reported Weighting: FTE months
0 - 23 months
(.15)
24 - 47 months
(.30)
48+ months
(.45)
Verified Weighting: FTE months
0 - 23 months
(.15)
24 - 47 months
(.30)
48+ months
(.45)
Documentation Reviewed:
Resume/Application ............................................
YES
NO
Other - Specify: ________________________
YES
NO
Past Employer Certification .................................
YES
NO
Comments:
If weighting is different from provider’s weighting:
experience not applicable
experience not documented
C. EDUCATION (SR 2A-CTF - Column D) (Refer to MPP Sections 11-400f(9) and 11-402.224(d)(e))
Reported Weighting:
0 - 59 Units
(.00)
AA - Behavioral Science
(.25)
BA - Other
(.35)
BA - Behavioral Science
(.45)
MA Degree
(.55)
Verified Weighting:
0 - 59 Units
(.00)
AA - Behavioral Science
(.25)
BA - Other
(.35)
BA - Behavioral Science
(.45)
MA Degree
(.55)
Documentation Reviewed:
Diploma
Official Transcripts
Certification from Educational Institution
Foreign Degree
If weighting different from provider’s weighting:
Cannot verify units/degree
Foreign degree not evaluated for equivalency
Degree not from accredited or approved institution
Degree not in a behavioral science
Comments:
SR 2A-WP-CTF (12/02)
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