Exhibit X Returned Allowances Form.xlsx
XLSX spreadsheet 20 KB Posted
- Attached to
- Master Agreement AZ|CTR071408
- Contract number
- CTR071408
- Issued by
- Arizona
About this file
This document is a Returned Allowances Reporting Form issued by the Arizona Department of Child Safety, designed to track and process financial allowances for child care providers. The form provides a structured template for providers to report and return unallocated allowances, with specific instructions for submission to the agency's Payment Processing Unit located in Phoenix, Arizona.
The form requires providers to document detailed participant information including service dates, participant identification numbers, names, service period start and end dates, allowance types, and amounts. The form is specifically intended for returning allowances not distributed to a child during a period when the child was in the provider's care, with a clear directive that allowances for periods when a child was not in care should be processed through a system called Guardian. The document was last updated on 07/28/2023, indicating ongoing maintenance and refinement of the tracking process.
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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 .