Instructions for Form CFS2000 "Day Care Service Eligibility Application" - Illinois

This document contains official instructions for Form CFS2000, Day Care Service Eligibility Application - a form released and collected by the Illinois Department of Children and Family Services. An up-to-date fillable Form CFS2000 is available for download through this link.

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CFS 2000 Instructions
Rev 7/2019
State of Illinois
Department of Children and Family Services
DAY CARE SERVICE ELIGIBILITYAPPLICATION GUIDELINES and INSTRUCTIONS
THE WORKER HAS, PRIOR TO SUBMITTING FOR APPROVAL, VERIFIED THE
FOLLOWING:
All questions have been appropriately answered or marked N/A on Part I, Part II, and Part III of this
application.
All required documentation has been photocopied and attached to the application:
(Examples of required documentation: pay stubs, proof of employment, self-employment records,
school/training documentation, disability/medical leave certification, special teen parent documentation,
etc.)
Protective Day Care Service/Open Intact Family Services Applications please note:
The Department shall provide child care services to:
Intact families with an open case and whose child/children are under the age of 5, protective need
has been assessed and that day care has been/will be identified in the service plan as a needed
resource for safety reasons.
Intact families with an open case and whose child/children are 5 years of age and older, and whose
parents are working outside the home or who are participating in employment training or
educational programs outside the home that are approved by the Department and any other means
of day care services/pre-school are not available or appropriate (a list of other services attempted
should be attached as documentation.
All Other Protective/Family Maintenance Day Care Service Applications:
Attach the most current copy of the SACWIS Family Service Plan Narrative, Face sheet and relevant
Task sheet(s) stating the need(s) and the outcome goal(s) for day care or the completed and signed CFS
1441 - Safety Plan. When the SACWIS Family Service Plan has not yet been completed and the need
for Protective day care is urgent the worker must provide a copy of the completed SACWIS Family
Service Plan and information as stated above within 90 days after approval of payment for day care
service or day care payment will be subject to cancellation.
If a foster parent is requesting day care for youth in care placed in their home for the purpose of
home-schooling his/her own school age child(ren), the worker must attach to the Day Care
Service Eligibility Application, sufficient documentation and/or reports from the local school
district or principal which substantiates the written curriculum, weekly schedule and approval for
the parent to home school each child in the residence.
For each situation, approval for day care of youth in care is subject to review of information and
approval by the regional Day Care Eligibility Office.
Day Care Service for a youth in care, 13 years or older:
Sufficient written clinical documentation must be submitted with the Day Care Service Eligibility
Application by the worker, which describes clinical diagnosis (the most current DSM edition) and
supports the need for day care.
CFS 2000 Instructions
Rev 7/2019
State of Illinois
Department of Children and Family Services
DAY CARE SERVICE ELIGIBILITYAPPLICATION GUIDELINES and INSTRUCTIONS
THE WORKER HAS, PRIOR TO SUBMITTING FOR APPROVAL, VERIFIED THE
FOLLOWING:
All questions have been appropriately answered or marked N/A on Part I, Part II, and Part III of this
application.
All required documentation has been photocopied and attached to the application:
(Examples of required documentation: pay stubs, proof of employment, self-employment records,
school/training documentation, disability/medical leave certification, special teen parent documentation,
etc.)
Protective Day Care Service/Open Intact Family Services Applications please note:
The Department shall provide child care services to:
Intact families with an open case and whose child/children are under the age of 5, protective need
has been assessed and that day care has been/will be identified in the service plan as a needed
resource for safety reasons.
Intact families with an open case and whose child/children are 5 years of age and older, and whose
parents are working outside the home or who are participating in employment training or
educational programs outside the home that are approved by the Department and any other means
of day care services/pre-school are not available or appropriate (a list of other services attempted
should be attached as documentation.
All Other Protective/Family Maintenance Day Care Service Applications:
Attach the most current copy of the SACWIS Family Service Plan Narrative, Face sheet and relevant
Task sheet(s) stating the need(s) and the outcome goal(s) for day care or the completed and signed CFS
1441 - Safety Plan. When the SACWIS Family Service Plan has not yet been completed and the need
for Protective day care is urgent the worker must provide a copy of the completed SACWIS Family
Service Plan and information as stated above within 90 days after approval of payment for day care
service or day care payment will be subject to cancellation.
If a foster parent is requesting day care for youth in care placed in their home for the purpose of
home-schooling his/her own school age child(ren), the worker must attach to the Day Care
Service Eligibility Application, sufficient documentation and/or reports from the local school
district or principal which substantiates the written curriculum, weekly schedule and approval for
the parent to home school each child in the residence.
For each situation, approval for day care of youth in care is subject to review of information and
approval by the regional Day Care Eligibility Office.
Day Care Service for a youth in care, 13 years or older:
Sufficient written clinical documentation must be submitted with the Day Care Service Eligibility
Application by the worker, which describes clinical diagnosis (the most current DSM edition) and
supports the need for day care.
If the Day Care Provider is a license-exempt facility operator/owner/employee or an
(related/unrelated) unlicensed individual, the worker must:
(a) Conduct an on-site visit and complete form CFS 2003-On-Site Visit License Exempt and
Unlicensed Day Care Provider which must be submitted with the day care service application;
and
(b) Complete CFS 2000 Day Care Service Eligibility Application; and,
The Caseworker/investigator shall check the DCFS Fingerprint Search System database, located
online at: https//fingerprintsearch.dcfs.illinois.gov/ to determine if DCFS has a fingerprint record
for the day care provider and all household members eighteen and older. Current and maiden
names should be checked. The fingerprint search system will conduct a search and display a
message, indicating fingerprint exist or fingerprint is not on file. If print exist, send the completed
CFS 718-D to the regional Day Care Service Eligibility Unit for processing. If prints are not on
file, staple the fingerprint search result to the CFS 718-D and send the individual for
fingerprinting. Department or POS caseworkers and their supervisors will complete a background
check on the license-exempt or unlicensed day care provider, for all household members 13 years
and older (household members 13 through 17 require parental/guardian consent), and any
assistants or substitutes the day care provider may use. Results of the background check must be
on file before the initial eligibility redetermination for day care is requested (approximately six
months after formal daycare service eligibility approval). The date of the request for background
history check and the date in which the results were provided to the Permanency Worker will be
documented on the CFS 2000 – Day Care Service Eligibility Application.
(c) Ensure the following:
Unrelated/Unlicensed Day Care Providers
o Fingerprinting (through a Department-authorized vendor);
o CFS 718-D Authorization for Background Check for Unlicensed and License-
Exempt Child Care.
o On the CFS 2000 – Part III/Section (B), the worker or supervisor will document the
date when the CFS 718-D (CANTS, SOR and FBI background checks) and fingerprint
receipt were submitted to the Department’s Background Check Unit (BCU) for
processing.
The caseworker and/or supervisor will document the potential day care service
provider’s final result’s finding in the child’s case file.
Related/Unlicensed Day Care Providers
o For related/unlicensed day care providers, a SACWIS system background check
(CANTS and SOR) is required.
On the CFS 2000 – Part III/Section (B), the worker or supervisor will document
the date when the SACWIS-based CANTS and SOR checks were
completed.
All required background check information (CANTS,SOR and FBI, if applicable) and results must be on
file with the worker and in the child/family case file during the eligibility period (every 6 months or as
requested) before an eligibility or redetermination is requested, otherwise day care service is subject to
delay, denial or cancellation.
For New Day Care Service providers:
New Day Care Provider will complete and attach to the Day Care Service Eligibility Application a signed
copy of the IRS W-9 form (www.irs.gov).
Current Rate Certification form:
Completed by Day Care Providers who are identified as licensed centers, licensed day care homes or
licensed-exempt centers/facilities (if a current one is not on file in the regional Day Care Office).
REQUIRED EMPLOYMENT-RELATED DOCUMENTATION/ATTACHMENTS FOR ALL
APPLICANTS
Applicant(s) criteria for eligibility for requested day care services:
• If you are employed, please provide at least two (2) copies of your most recent paycheck
stubs/statements (within 45 days of the date in which the application has been submitted). If
you do not have two (2) current paycheck stubs/statements, please have your employer
provide the following in a letter format: (Note: Employment letters are subject to review,
verification and approval.)
a. Must be on company letterhead;
b. Must state that you are a current employee;
c. Must state the days and the number of hours you work per week;
d. Be signed and dated by your employer, with a daytime phone number.
• If you are employed, but paid in cash or money order, you must provide a copy of the last
two money orders, cashier checks, and a notarized letter from your employer with the same
information as mentioned in the above statement. If the information is found to be falsified,
DCFS reserves the right to recoup funds and/or prosecute.
• If you are self-employed or a self-employed business owner, sufficient proof of business
expenses and assets is necessary to determine day care eligibility, such as: (Note: All
documentation is subject to review and approval)
a. Copies of office lease/mortgage, booth rent receipt (hair salon) monthly utility bills (2)
(phone, electric, etc.), and/or
b. Current business bank statement; list of assets; cashed/deposited signed checks, and/or
c. Copies of (redacted) contracts, and/or
d. Signed and submitted IRS income tax forms Form 1040, Schedule SE (self-employed),
Schedule C (Profit or Loss from Business) and all supporting supplemental
documentation.
e. If the information is found to be falsified, DCFS reserves the right to recoup funds and/or
prosecute.
• If you are attending school and/or employment-related training, you must provide a copy
of your current school and/or training schedule on the school/training facility letterhead and,
if applicable, a course attendance verification letter with the official school seal.
• Web based courses - A foster parent or subsidized adoptive parent/guardian (of child 0 to 3
years) attending an on-line course from home may be eligible if: The class is offered only at
a regularly scheduled time. (i.e., 11:00 am every Monday and Wednesday) or; the parent must
leave the home to have access to a computer. The youth in care for whom day care is
requested must be under the age of twelve, (except during the summer or school breaks). If
the youth in care is 13 years or older, sufficient written clinical documentation must be
submitted with this application by the worker, which describes clinical diagnosis (DSM 5 or
most current edition) and supports the need for day care.
Care shall not be authorized during the hours the child is in school, in therapy or is home
schooled or in a two-parent/caregiver family when the other parent/caregiver is available to
care for the child. The assigned Caseworker or Investigator shall:
1. Confirm class is only offered at regularly scheduled time by collecting the current class
schedule along with an official stamped letter from the school/program Registrar’s office
which verifies the student’s current status; and submit it to the Day Care Service
Eligibility staff for review and is subject to approval by Day Care Service Eligibility staff.
If necessary, contact with the educational facility should be made to confirm attendance.
2. The Caseworker or Investigator should provide documentation of the name and phone
number of the person who was contacted. Day Care Service Eligibility staff should not
approve care for a web-based course that the parent may take at any time. Confirm the
child(ren) for whom care is requested is under the age of twelve or if 13 years or older,
provide written documentation as detailed above.
Day Care Service Eligibility staff may:
Approve the case for the length of the current session or grading period but no longer than (6) months,
if the applicant and/or co-applicant is determined to be eligible and the need for care has been established.
If the Applicant is/are disabled or on medical leave, they must provide a completed CFS 604 –
Medical Evaluation of an Adult in a Foster or Adoptive Home describing
• (a) the onset date of the Applicant’s disability and/or leave and current condition(s),
medication, and treatment
• (b) how the disability impairs your ability to care for the child(ren), and
• (c) the expected duration of the disability or medical leave. The form must be completed and
signed by the applicant’s doctor and dated within 45 days of submitting the day care service
application.
• Teen Parent special required documentation includes, but is not limited to: Copy of the service
plan indicating the need for the appropriate recommended day care as described in Procedures
302.330, applicant’s employment schedule, and/or school/class schedule.
• Applicants requesting Therapeutic Day Care for Youth in Care, caseworkers must also submit
a completed CFS 399-1 Clinical Referral Form. The CFS 399 Clinical Staffing Summary should
also be submitted along with other supporting documentation of service need.
• Military service documentation: To document military service away from home, the applicant
must furnish a copy of the military order(s) from the appropriate branch of the military that details
the length and location of the assignment as well as any money allowances for clothing and
housing.
BACKGROUND CHECK CLEARANCE RESULTS
PLEASE NOTE: As part of the full day care services eligibility application packet, the child’s caseworker or
assigned investigator must complete and provide results of the following background checks:
Unrelated/Unlicensed Day Care Providers
o Fingerprinting (through a Department-authorized vendor);
o CFS 718-D Authorization for Background Check for Unlicensed and License-Exempt Child
Care.
On the CFS 2000 – Part III/Section (B), the worker or supervisor will document the date when
the CFS 718-D (CANTS, SOR and FBI background checks) and fingerprint receipt were
submitted to the Department’s Background Check Unit (BCU) for processing.
o The caseworker and/or supervisor will document the potential day care service provider’s final
result’s finding in the child’s case file.
Related/Unlicensed Day Care Providers
o For related/unlicensed day care providers, a SACWIS system background check (CANTS and
SOR) is required.
On the CFS 2000 – Part III/Section (B), the worker or supervisor will document the date when
the SACWIS-based CANTS and SOR checks were completed.
The Caseworker/Investigator is required to assist the day care provider, their employees or substitutes in gathering
the necessary personal information to complete a background check. The Worker is responsible for insuring that
the day care provider, all household members, and any assistants or substitutes (age 13 and over) does not have
an indicated CANTS report or allegations of any barrable criminal offense indictment(s). If the child is in a
Licensed Exempt facility, the Worker must also complete the CFS 2003, On-Site Visit License-Exempt and
Unlicensed Day Care Provider form and file a copy in each child’s case file. Worker and supervisor
determination and disposition is required for potential day care providers whose background history includes
misdemeanor or felony convictions.
The worker and parent, foster parent, teen parent, relative caregiver, adoptive parent, or guardian must insure that
there are no health or safety hazards in the home or center/facility prior to the child(ren) being placed in the care
of the day care provider (documented on a CFS 2003 form). The caseworker shall make at least quarterly visits
thereafter unless problems have been identified which require more frequent visits.
PLEASE NOTE: A person must be 18 years old or older to provide any form of day care services. The
provider/employee’s Background Check results must be dispositioned by the worker and supervisor and is on file
with the worker and child/family case file during the eligibility period (every 6 months or as requested).
Noncompliance with these instructions will result in the delay and/or denial of day care service payment approval.
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