Exhibit VIII Personal Allowance Ledger.pdf
PDF 93 KB Posted
- Attached to
- Master Agreement AZ|CTR071439
- Contract number
- CTR071439
- Issued by
- Arizona
About this file
The document is a Congregate Care Personal Allowance Ledger issued by the Arizona Department of Child Safety (DCS), designed as a standardized tracking form for documenting personal allowance distributions and purchases for children in out-of-home care facilities. This form is specifically an Exhibit VIII template dated 05/24, intended to be used by licensed child care agencies and operating facilities to maintain financial records for youth under the department's care.
The ledger provides a structured method for tracking personal allowances, including emergency money, special needs funds, graduation money, and school supplies expenses. The form requires detailed documentation for each transaction, including the date, description of distribution or purchase, payment method, amount, and requires signatures from both the child (if 12 years or older) and staff member. The form mandates that all receipts must be kept with the log for one year, ensuring comprehensive financial accountability and transparency for personal allowances given to children in congregate care settings.
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Text version
CONGREGATE CARE
PERSONAL ALLOWANCE LEDGER
ARIZONA DEPARTMENT OF CHILD SAFETYExhibit VIII (05/24)
Exhibit VIII - Instructions
1. Enter the name of the child.
2. Enter the child’s date of birth.
3. Enter name of the licensed agency and operating facility in which the youth is currently placed.
4. Enter the child’s placement date.
5. Enter the date when the log was started.
6. Enter the date of log entry.
7. Select whether this entry is a distribution of allowance to the child or an allowance purchase made by the youth.
8. Enter the description of the entry.
9. Utilizing the drop-down menu on Payment Method, indicate the method the allowance payment was distributed to the child.
10. Enter the total allowance distribution or purchase amount made.
11. Have the child sign their name on the signature line for their allowance distribution or purchase.
12. Have the staff who is completing allowance distribution or purchase sign their name on the signature line
13. Include any supporting receipts or confirmations.
14. Have the member who is completing the allowance ledger audit sign their name and date on the Audit signature line.
15. When the allowance ledger is completed, the out of home provider staff member shall sign and file the allowance ledger in the child’s client file.
CONGREGATE CARE
PERSONAL ALLOWANCE LEDGER
ARIZONA DEPARTMENT OF CHILD SAFETYExhibit VIII (05/24)
Date Description of Distribution or Purchase Payment Method
Amount
Signature (signed by both Child and Staff)
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Distribution
Purchase
Date of Birth Placement Date Date Log StartedProvider's Name | Facility Name
Exhibit VIII
Child's Name (Last, First, M.I.)
Document all Personal Allowances given to child and all purchases made with monthly money. Any emergency money, special needs money, graduation money, school supplies and fees money and other auxiliary payments. Receipts must be kept with this log for one (1) year.
Date Date
Date
Audit Signature
Child's Signature (if child is 12 years old or older)
Out-of-Home Providers Signature
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