Exhibit X Returned Allowances Form.xlsx
XLSX spreadsheet 20 KB Posted
- Attached to
- Master Agreement AZ|CTR071411
- Contract number
- CTR071411
- Issued by
- Arizona
About this file
This document is a Returned Allowances Reporting Form issued by the Arizona Department of Child Safety, designed for tracking and returning allowances that were not distributed to children during specific service periods. The form is intended to be used by providers who have received payments for child care services and need to return unused or improperly allocated funds. The remittance address is located in Phoenix, Arizona, with specific instructions for processing and submission.
The form provides a structured template for reporting detailed participant information, including participant identification numbers, names, service dates, allowance types, and amounts. Providers are instructed to use this form specifically for returning allowances paid for periods when a child was in their care but not fully utilized, with a note that periods when a child was not in care should be processed differently through the Guardian system. The document was last updated on 07/28/2023, indicating ongoing refinement of the reporting process for child care allowance management.
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Text version
Returned Allowances Tracking
| Provider Name: | Date: | |||||
| Provider ID: | ||||||
| Total: | $0.00 | |||||
| Participant Information | Service Dates | Allowances | ||||
| PI Number | Last Name | First Name | Start Date | End Date | Type | Amount |
Contact Person: Remit to: Arizona Department of Child Safety Payment Processing Unit PO Box 6030, Site Code C010-01 Phoenix, AZ 85005-6030
| Phone #: |
| E-mail: |
*Use this form to return allowances that were not distributed to the child, but were paid for a period when the child was in your care. Do not use this form to return allowances paid for periods when the child was not in your care. Those should be reversed and automatically collected through Guardian.
&"-,Bold"&14Arizona Department of Child Safety Returned Allowances Reporting Form*
Updated 07/28/2023 Created 05/25/2018
File details come from the government source that posted it. Updated .