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FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures and Training

Lisa C. Fitzpatrick, Assistant Deputy Commissioner Office of Procedures

POLICY DIRECTIVE #07-29-EMP OUT-OF-SCHOOL TIME REFERRALS Date: August 31, 2007

Subtopic(s): Child Care

AUDIENCE

The instructions in this policy directive are for Job Center staff and are informational for all others.

POLICY

Parents/guardians receiving public assistance are required to engage in employment and/or assigned work activities. Child care must be in place before a parent/guardian can be assigned to required activities. Effective immediately, all parents/guardians of school-aged children must be given information and offered a referral to the Department of Youth and Community Development’s (DYCD) Out-of-School-Time (OST) programs for after-school care and/or summer care.

BACKGROUND

New York City has over 550 DYCD-funded OST Programs. All are operated by organizations with extensive experience in providing high quality after-school programs. The programs are licensed by the Department of Health, are free of charge and have no income eligibility requirements. The programs have small group sizes and trained and qualified staff, and offer age-appropriate activities in a supportive environment. In order to meet both the developmental needs of children and the needs of working families, OST programs operate during after-school hours as well as on school holidays and during the summer.

HAVE QUESTIONS ABOUT THIS PROCEDURE? Call 718-557-1313 then press 2 at the prompt followed by 765 or send an e-mail to FIA Call Center Distribution: X

PD #07-29-EMP REQUIRED ACTION

Parents/Guardians Who Indicate Child Care is Needed Before a parent/guardian is assigned to a work-related activity the worker must: • inform the parent/guardian of the child care process and determine eligibility for child care benefits • give the parent/guardian the Important Information about Child Care form (LDSS-4647) • review the LDSS-4647 with the parent/guardian to ensure it is thoroughly understood and signed by the parent/guardian To obtain the list of OST programs by zip code:

Accessing the OST program guide from the DYCD Web Site

• •

Click Here to get to the link, or access the DYCD Web site www.nyc.gov/dycd

On the home page in the left-hand column under the heading “Find a Program Near You” select “After School Programs” In the middle of the page, select “Find a Program” Search by zip code

A list of all OST programs in and around that zip code will appear. Note: If the guide cannot be accessed through the Web site, use the version attached to this procedure (see sample Attachment A). • • • • The OST brochure will be distributed under separate cover

Write the name and address of the OST program(s) in the applicant/participant’s zip code on the Information and Referral Notice (W-113E) Give the parent/guardian contact information for OST programs in his/her own or nearest zip code Give the parent/guardian a New York City: A Parent’s Guide to OST (Out-of-School Time) brochure (see sample Attachment B) Enter comments in NYCWAY: “Referral made to OST”

Note: Copies of the OST brochure in Spanish and other languages will be available by October 2007. In order to obtain additional copies of the OST brochure, Center Directors must follow the current process for obtaining forms from the Forms Warehouse.

FIA Policy, Procedures and Training

Office of Procedures

PD #07-29-EMP Parents/Guardians Who Indicate Child Care is not Needed Child care not needed

For parents/guardians who indicate that no child care is needed or that child care is not a barrier to participating in a work-related activity, the JOS/Worker must: • • • • •

have the parent/guardian annotate on top of the Child Care Provider Enrollment Supplement (CS-274W) “Child Care Not Needed” and initial the statement have the parent/guardian sign and date the CS-274W give the parent/guardian a copy of the CS-274W follow the procedure for scanning and indexing child care documents (see PB #06-157-OPE) access the online Employability Assessment/Employment Plan (EA/EP) and select either:

• • •

Care Type 4 (Not Required – Child Over 13) Care Type 5 (Child Care in Place – Licensed at No Cost) Care Type 6 (Child Care in Place – Informal at No Cost)

access the “Child Care – Care Type Entry” screen enter Care Type 4, 5 or 6 transmit

FIA Policy, Procedures and Training

Office of Procedures

PD #07-29-EMP On the “Child Care Determined at NO COST to Agency” screen, Workers will: • • •

enter “Y” next to: “Free After School Program (OST)” enter “N” next to all other programs which are not selected transmit

When Care Type 4 is selected, action code 933O (applicant) or 133O (participant) will auto post in NYCWAY and allow assignment to activities.

FIA Policy, Procedures and Training

Office of Procedures

PD #07-29-EMP ACS Child Care Pilot Centers

When selecting OST as the child care type in the ACS child care pilot centers, the ACS Worker will: •

Enter Care Type 5 or 6

action code 933Z (applicant) or 133Z (participant) will auto post in NYCWAY a comment in the “Action Comments” and “Comment appended to the 933J/133J” sections will auto post action code 933J (applicant) or 133J (participant) (ACS Referral Back to JOS/Worker) will auto post

FIA Policy, Procedures and Training

Office of Procedures

PD #07-29-EMP NonPilot Centers

When selecting OST as the child care type in nonpilot centers: •

Enter Care Type 5 or 6, action code 933Z (applicant) or 133Z (participant) will auto post in NYCWAY

• • • • •

A comment “Free After School Program (OST)” will appear in the “Action Comments” section

Enter “Y” to accept the action Assign applicant/participant to the appropriate work activity (Back-to-Work [BTW], Training, etc.) Transmit Review the “Activity Inquiry” screen Transmit

FIA Policy, Procedures and Training

Office of Procedures

PD #07-29-EMP •

Review the “Activity Record” screen for a summary of actions taken

PROGRAM IMPLICATIONS Paperless Office System (POS) Implications

There are no POS implications as a result of this procedure.

Food Stamp Implications

There are no Food Stamp implications as a result of this procedure.

Medicaid Implications

There are no Medicaid implications as a result of this procedure.

LIMITED ENGLISH SPEAKING ABILITY (LESA) AND HEARINGIMPAIRED IMPLICATIONS

For Limited English Speaking Ability (LESA) and hearing-impaired participants, make sure to obtain appropriate interpreter services in accordance with PD #06-12-OPE and PD #06-13-OPE.

FIA Policy, Procedures and Training

Office of Procedures

PD #07-29-EMP FAIR HEARING IMPLICATIONS Avoidance/ Resolution

Ensure that all case actions are processed in accordance with current procedures and that electronic case files are kept up to date. Remember that applicants/participants must receive either adequate or timely and adequate notification of all actions taken on their case.

Conferences

An applicant/participant can request and receive a conference with a Fair Hearing and Conference (FH&C) AJOS/Supervisor I at any time. If an applicant/participant comes to the Job Center requesting a conference, the Receptionist must alert the FH&C Unit that the individual is waiting to be seen. In Model Offices, the Receptionist at Main Reception will issue an FH&C ticket to the applicant/participant to route him/her to the FH&C Unit and does not need to verbally alert the FH&C Unit staff. The FH&C AJOS/Supervisor I will listen to and evaluate any material presented by the applicant/participant, review the case file and discuss the issue(s) with the JOS/Worker responsible for the case and/or the JOS/Worker’s Supervisor. The AJOS/Supervisor I will explain the reason for the Agency’s action(s) to the applicant/participant. If the determination is that the applicant/participant has presented good cause for the infraction or that the outstanding Notice of Intent needs to be withdrawn for other reasons, the FH&C AJOS/Supervisor I will settle in conference (SIC), enter detailed case notes in NYCWAY and forward all verifying documentation submitted by the applicant/participant to the appropriate JOS/Worker for corrective action to be taken. In addition, if the adverse case action still shows on the “Pending” (08) screen in WMS, the AJOS/Supervisor I must prepare and submit a Fair Hearing/Case Update Data Entry Form (LDSS-3722), change the 02 to an 01 if the case has been granted aid continuing (ATC), or prepare and submit a PA Recoupment Data Entry Form (LDSS-3573) to delete a recoupment. The AJOS/Supervisor I must complete a Conference Report (M-186a). If the determination is that the applicant/participant has not shown good cause for the infraction or that the Agency’s action(s) should stand, the AJOS/Supervisor I will explain to the applicant/participant why s/he cannot settle the issue(s) in conference (SIC). The AJOS/Supervisor I must complete an M-186a.

FIA Policy, Procedures and Training

Office of Procedures

PD #07-29-EMP Should the applicant/participant elect to continue his/her appeal by requesting or proceeding to a Fair Hearing, already requested, the FH&C AJOS/Supervisor I is responsible for ensuring that further appeal is properly controlled and that appropriate follow-up action is taken in all phases of the Fair Hearing process. Evidence Packets

All Evidence Packets must contain a detailed history, copies of relevant WMS screen printouts, other documentation relevant to the action taken and copies of NYCWAY “Case Notes” screens.

RELATED ITEM

Employment Process Manual

ATTACHMENTS

LDSS-4647 LDSS-4647-S CS-274W CS-274W-S Attachment A Attachment B

FIA Policy, Procedures and Training

Important Information about Child Care (Rev. 7/99) Important Information about Child Care (Spanish) (Rev. 7/99) Child Care Provider Enrollment Supplement (Rev. 4/07) Child Care Provider Enrollment Supplement (Spanish) (Rev. 5/07) Directory Out-of-School Time Programs – Job Center Zip Codes OST Brochure A Parent’s Guide to OST

Office of Procedures

LDSS-4647 (Rev. 7/99)

NEW YORK STATE

Important Information about Child Care If you are receiving Temporary Assistance and need child care in order to participate in work activities, please read this notice. It will tell you about your rights and responsibilities and about how to locate a child care provider.

Your Rights Your cash assistance cannot be reduced or ended because you are not participating in work activities if the reason you are not participating is because you don’t have appropriate, accessible, affordable and suitable child care. You have the right to receive information about how to locate a child care provider. This information could be provided in a number of ways. • Your worker can give you the name and telephone number of a Child Care Resource and Referral Program or other similar program which can help you find a child care provider; or • Your worker can give you a list with the name, address and telephone numbers of child care providers. You have the right to choose the child care provider for your child. This could be a provider who is licensed or registered or it could be a relative, a friend of the family or a trusted neighbor. If you are unable to find a child care provider on your own, your worker must provide you with two choices of child care providers. At least one of these choices must be a child care provider who is licensed or registered with the State of New York or with New York City Department of Health. You have the right to be excused from your work activity if you have a child under 13 years of age and you are unable to find a child care provider that is appropriate, accessible, affordable and suitable. However, the time you are excused from your work activity will still count toward your 60 month limits of federally funded and cash Temporary Assistance. • Appropriate means the provider is open for the hours and days needed for you to participate in your work activity, and is willing to care for your child(ren) including any special needs your child has. • Accessible means that you are able to get to the provider by driving your own car or by public transportation and the provider is located within a reasonable distance from your home and work. Your worker must tell you what is considered a reasonable distance for your community. • Unsuitable means the physical or mental condition of the provider or the physical condition of the home would be detrimental to the health or safety of your child(ren). • Affordable means you have enough money to pay your share of the child care cost, if you are required to pay a share of the costs. You have the right to request a fair hearing to appeal the decision to reduce or end your Temporary Assistance if you feel your worker made the wrong decision regarding your refusal to comply with your work activities due to a lack of child care.

LDSS-4647 (Rev. 7/99) REVERSE

NEW YORK STATE

Your Responsibilities It is your responsibility to look for and choose a child care provider. If you are unable to find a child care provider, you must do the following. 1.

Let your worker know what you have done to find a provider and ask for help in finding a provider.

Follow up on all referrals you are given by your worker or other programs that are helping you locate a provider. This means you must contact or visit all providers that you are referred to until you are able to choose a provider that is appropriate, accessible, suitable and affordable.

If you have contacted all providers and are still not able to choose any of these providers, you must let your worker know in writing which providers you contacted and when and why you did not choose any of these providers. Your reasons must include one of the following. • The provider was not open for the days or hours needed or could not care for your child’s special needs. • You were unable to get to the provider by car or public transportation. • The provider was not located within a reasonable distance from your home or work activity. Each social services district has a different meaning of “reasonable distance”. The district must tell you what reasonable distance means in your district.

• Friends, relatives or neighbors you considered or contacted were unsuitable. 4.

If you show that you are unable to locate a provider, your worker must offer you a choice of two providers. At least one of these choices must be a child care provider who is licensed or registered with the State of New York or New York City Department of Health. You must choose one of these providers or show why they are not appropriate, accessible, affordable or suitable.

You must continue to look for a child care provider and follow up on all referrals during the time you are excused from your work activity.

If you cannot show that you were unable to locate a provider and that the two choices of providers offered to you were not appropriate, accessible, affordable, or suitable, then your Temporary Assistance cash grant will be reduced if you fail to participate in your work activity.

I have read and understand the above information.

________________________ Client’s Name

____________ Date

LDSS-4647-S (7/99)

ESTADO DE NUEVA YORK YORK

Información Importante acerca del Cuidado de Niños Si usted está recibiendo Asistencia Temporal y necesita cuidado de niños o cuidado infantil para poder participar en actividades laborales, por favor lea esta notificación. Este aviso le dará a conocer sus derechos y sus responsabilidades; también le proveerá información sobre cómo localizar a un(a) proveedor(a) de cuidado de niños.

Sus Derechos Su asistencia en efectivo no puede ser reducida o cancelada debido a que usted no está participando en actividades laborales si la razón por la que usted no está participando se debe a que usted no cuenta con un(a) proveedor(a) de cuidado infantil conveniente, accesible, razonable en costo y apropiado. Usted tiene el derecho de recibir información acerca de cómo localizar a un(a) proveedor(a) de cuidado infantil. Esta información se le puede proveer de varias maneras. •

Su trabajador(a) puede darle el nombre y el número de teléfono de un Programa de Recursos y Referencias de Cuidado Infantil u otro programa similar que le puede ayudar a encontrar un(a) proveedor(a) de cuidado infantil; o

•

Su trabajador(a) puede darle una lista con el nombre, la dirección y los números de teléfono de proveedores de cuidado infantil.

Usted tiene el derecho de escoger al/a la proveedor(a) de cuidado infantil adecuado(a) para su niño(a). Éste o ésta podría ser un(a) proveedor(a) licenciado(a) o registrado(a), o podría ser un familiar, un(a) amigo(a) de la familia o un(a) vecino(a) de confianza. Si usted no puede encontrar a un proveedor(a) de cuidado infantil por su cuenta, su trabajador(a) debe proveerle dos selecciones de proveedores de cuidado infantil. Por lo menos una de esas selecciones debe ser un(a) proveedor(a) de cuidado infantil licenciado(a) o registrado(a) con el Estado de Nueva York o con el Departamento de Salud de la Ciudad de Nueva York. Usted tiene el derecho de ser excusado(a) de su actividad laboral si usted tiene un(a) hijo(a) de 13 años o menos y usted no puede encontrar a un(a) proveedor(a) de cuidado infantil que sea conveniente, accesible, razonable y apropiado. Sin embargo, el tiempo que usted está excusado de su actividad laboral todavía contará hacia su límite de 60 meses de Asistencia Temporal federal o en efectivo. •

Conveniente significa que el/la proveeror(a) opera durante las horas y los días que necesita para que usted participe en su actividad laboral, y está dispuesto(a) a cuidar a sus hijos y proveer servicios para cualquier necesidad que su hijo(a) pueda tener.

•

Accesible significa que usted puede llegar al lugar de trabajo del/de la proveedor(a) manejando su propio automóvil o por transportación pública, y que el/la proveedor(a) está localizado(a) dentro de una distancia razonable de su hogar y trabajo. Su trabajador(a) debe darle a conocer la distancia que se considera razonable en su comunidad.

•

Razonable significa que usted tiene suficiente dinero para pagar su porción del costo de cuidado infantil, si se le requiere que pague una porción del costo.

•

Inapropiado(a) se refiere a la condición física o mental del proveedor(a) o la condición física del hogar que sería detrimental para la salud o seguridad de su(s) hijo(s).

Usted tiene el derecho de solicitar una audiencia imparcial para apelar la decisión de reducir o cancelar sus beneficios de Asistencia Temporal si usted cree que su trabajador(a) tomó una decisión incorrecta con respecto a la falta de cumplimiento de sus actividades laborales debido a la carencia de cuidado infantil.

LDSS-4647-S (7/99) REVERSO

ESTADO DE NUEVA YORK

Sus Responsabilidades Es su responsabilidad buscar y escoger a un(a) proveedor(a) de cuidado de niños o cuidado infantil. Si usted no puede encontrar a un(a) proveedor(a) de cuidado infantil, usted debe hacer lo siguiente: 1.

Hacerle saber a su trabajador(a) lo que usted ha hecho para encontrar a un(a) proveedor(a), y pedirle ayuda para encontrar a un(a) proveedor(a).

Llamar a todas las referencias que su trabajador(a) le ha provisto o llamar a otros programas que están ayudándole a conseguir a un(a) proveedor(a). Esto significa que usted debe ponerse en contacto o visitar a todos los proveedores a los que usted ha sido referido hasta que usted pueda escoger un(a) proveeror(a) conveniente, accesible, razonable y apropiado.

Si usted se ha contactado con todos los proveedores y todavía no puede escoger a algún proveedor(a), usted debe hacerle saber a su trabajador(a) por escrito sobre los proveedores que usted contactó, y por qué usted no escogió a alguno de estos proveedores. Sus razones deben incluir uno de lo siguiente: •

El proveedor(a) no estaba abierto durante los días y las horas que yo necesitaba o no podía cuidar a su hijo(a) con necesidades especiales.

•

Usted no podía llegar al proveedor(a) por automóvil o por transporte público.

•

El proveedor(a) no estaba localizado dentro de una distancia razonable de su hogar o de su actividad laboral. Cada distrito de servicios sociales tiene una descripción diferente de lo que representa una “distancia razonable.” El distrito debe decirle qué representa una distancia razonable en su distrito.

•

Los amigos, familiares o vecinos que usted consideró o con los que se puso en contacto no eran apropiados.

Si usted demuestra que no puede localizar a su proveedor(a), su trabajador(a) debe ofrecerle una selección de dos proveedores. Por lo menos una de estas selecciones debe ser un(a) proveedor(a) de cuidado con licensia o registrado con el Estado de Nueva York o con el Departamento de Salud de la Ciudad de Nueva York. Usted debe escoger uno de estos proveedores o explicar por qué éstos no son convenientes, accesibles, razonables o apropiados.

Usted debe continuar buscando a un proveedor(a) de cuidado infantil y debe llamar a todas las referencias durante el tiempo en el que usted ha sido excusado de su actividad laboral

Si usted no puede demostrar que usted no pudo localizar a un(a) proveedor(a) y que las dos selecciones de proveedores que se le ofreció no fueron convenientes, accesibles, razonables o apropiadas entonces sus beneficios de Asistencia Temporal en efectivo serán reducidos si usted no logra participar en su actividad laboral.

He leído y comprendo la información citada anteriormente. _________________________________ Nombre del Cliente

_________________ Fecha

nyc

CS-274W (FACE) REV. 4/07

ACS

Child Care Provider Enrollment Supplement*

NYC Administration for Children’s Services Division of Child Care and Head Start

To be used with LDSS-4699/LDSS-4700 for all unregulated providers PARENT/CARETAKER'S NAME:

CASE NUMBER:

ADDRESS:

SOCIAL SECURITY NUMBER (OPTIONAL, SEE BELOW):¹

TELEPHONE:

PROVIDER'S NAME:

ACCIS CASE NUMBER:

DATE OF BIRTH:²

ADDRESS WHERE CARE IS GIVEN:

PROVIDER'S ADDRESS (IF DIFFERENT):

TELEPHONE:

PROVIDER’S SOCIAL SECURITY/LICENSE NUMBER/EIN

¹ The parent/caretaker may, but does not have to, list his/her Social Security number. You cannot be required to disclose your Social Security number as a condition of eligibility for child care services. If provided, your Social Security number will be used to assist in identifying your child care file. It may also be used by Federal, State and local agencies to prevent duplication of services and fraud, and for Federal reporting. ² If the provider is less than 18 years old, the Employment of Minors Form must be completed.

Provider/Agency Name: ___________________________________________________________________ ACCIS Provider Number (if available): _______________________________________________________ Provider's License Type: _________________________ License Number: _________________________ Expiration Date: ________ / ________ / ________ MM

YYYY

Provider Rate (All providers, except ACS-contracted programs, must complete this section.) My weekly child care rates are as follows: Indicate the rate charged for each age level

INFANT Under 18 months

TODDLER PRESCHOOL SCHOOL-AGE 18 months – 3 years – under 3 years under 6 years 6 – 12 years

Full time (30 hours or more per week) Part time (15 – 29 hours per week) Hourly (1 – 14 hours per week but less than 3 hours per day)

*ATTENTION: 1. Regulated/licensed providers are not required to complete the LDSS-4699 or the LDSS-4700. They should complete only pages 1 and 2 of this form and return to the parent/legal guardian. Regulated providers without an ACCIS number must also submit a copy of their license along with the competed CS-274W. 2. Informal providers must provide documentation of BOTH their identification and their address in order to be paid by ACS. Please ask your JOS/ACS Worker for the Proof of ID and Residency for Your Child Care Provider or "Babysitter" (CS-574FF), which is the list of approved types of ID.

nyc

CS-274W (REVERSE) REV. 4/07

ACS

Indicate the weekly schedule(s) of child care services for the child(ren) listed below: Child’s Name

CHILD'S NAME

NYC Administration for Children’s Services Division of Child Care and Head Start

CHILD'S NAME

MONTH

DAY

YEAR

MONTH

DAY

YEAR

MONTH

DAY

YEAR

MONTH

DAY

YEAR

MONTH

DAY

YEAR

MONTH

DAY

YEAR

From

Date of Birth Date Care Began Weekly Schedule

From

Monday Tuesday Wednesday Thursday Friday Saturday Sunday OFFICE USE ONLY

Total Hours per Week ACS Child Care Rate

I acknowledge that receiving payment from the City of New York for child care services provided does not make me an employee of the City of New York. I am an employee of the parent/legal guardian of the child for whom I provide care.

Provider Certification

I am enrolling this child in a child care program. I understand that I will be paid only after the child's attendance data is received by ACS and for so long as the above parent/guardian is engaged in an FIA-approved activity or employed. If the parent/guardian fails to meet these criteria, I will be sent a letter from ACS informing me that ACS will no longer pay for child care. I agree that the amount I am charging this parent is not more than the amount I charge for other children of the same age. I understand that I cannot be paid if I do not list all my rates. I will allow the parent/guardian of the children named on this form unlimited access to his/her children and the premises and will make myself available whenever the children are in my care. I certify that the statements above are accurate and true to the best of my knowledge. I understand that providing false information may lead to the suspension or termination of payments and the recovery of any payments to which I was not entitled. Provider's Name (print clearly): ____________________________________

Official Title (if applicable): _________________

Signature: ________________________________________________________________________

Date: _________________

Parent/Guardian Certification I certify that I have reviewed the above information and that it is correct. I understand I must report any changes to ACS. Parent/Guardian's Name: ___________________________________________________________________________________ Parent/Guardian's Signature: _________________________________________________________

For Agency Use Only:

Is child care authorized for this applicant/participant? Yes

Agency-approved start date for child care: ________ / ________ / ________ MM

YYYY

Date: _______________

nyc

ACS

CS-274W-S (FACE) REV. 5/07

NYC Administration for Children’s Services Division of Child Care and Head Start

Suplemento de Inscripción del Proveedor de Cuidado Infantil* (a ser usado con LDSS-4699-S/LDSS-4700s para todos los proveedores no regulados) NOMBRE DE LA/DEL MADRE/PADRE/CUIDADOR:

NÚMERO DEL CASO:

DIRECCIÓN: NÚMERO DE SEGURO SOCIAL (OPCIONAL, VEA MÁS ABAJO):¹

TELÉFONO:

NÚMERO DE CASO ACCIS FECHA DE NACIMIENTO:²

NOMBRE DEL PROVEEDOR:

DIRECCIÓN EN DONDE SE CUIDA AL/A LOS NIÑO(S):

DIRECCIÓN DEL PROVEEDOR (SI ES DISTINTA):

TELÉFONO:

NÚMERO DE SEGURO SOCIAL/NÚMERO DE LICENCIA/EIN

¹ La madre, el padre o el cuidador puede proporcionar su número de Seguro Social, pero no está obligado(a) a ello. No se le exige a usted que revele su número de Seguro Social como condición de elegibilidad de servicios de cuidado infantil. Si lo proporciona, su número de Seguro Social será utilizado para la identificación de su expediente de cuidado infantil. También puede ser usado por agencias Federales, Estatales o locales para evitar el fraude y la duplicación de servicios, y para elaborar informes Federales. ² Si el proveedor es menor de 18 años, el Formulario de Empleo de Menores (Employment of Minors Form) tiene que llenarse.

Nombre del/de la Proveedor/Agencia: _______________________________________________________ Núm. de ACCIS del Proveedor (si disponible): ________________________________________________ Tipo de licencia del proveedor: ___________________ Núm. de licencia: _________________________ Fecha de Vencimiento: ________ / ________ / ________ DÍA

MES

AÑO

Tarifas del Proveedor (Todo proveedor, excepto programas contratados por ACS, tienen que llenar esta sección.) Mis tarifas semanales de cuidado infantil son las siguientes: Indique la tarifa cobrada para cada grupo de edad

BEBÉ

Menor de 18 meses

NIÑO PEQUEÑO

18 meses – menor de 3 años de edad

PRE-ESCOLAR 3 años – menor de 6 años

EDAD ESCOLAR 6–12 años

Tiempo completo (30 horas o más a la semana) Tiempo parcial (15–29 horas a la semana) Por hora (1–14 horas a la semana pero menos de 3 horas al día)

*ATENCIÓN: 1. Los proveedores con licencia/regulados no tienen que llenar el LDSS-4699-S o el LDSS-4700S. Solamente deben llenar las páginas 1 y 2 de este formulario y devolvérselas al/a la padre/madre/tutor. Los proveedores regulados sin número de ACCIS también tienen que presentar una copia de la licencia junto con el CS-274W-S llenado. 2. Los proveedores informales deben proporcionar documentación de AMBOS su identificación y su dirección para poder recibir pagos por parte de HRA. Favor de pedirle a su Trabajador de JOS/ACS el formulario Prueba de Identidad y Domicilio de su Proveedor de Cuidado Infantil o “Niñera” (CS-574FFS), que consiste en la lista de tipos de identificación admisibles.

nyc

ACS

CS-274W-S (REVERSE) REV. 5/07

NYC Administration for Children’s Services Division of Child Care and Head Start

Indique el horario semanal de cuidado infantil para cada niño nombrado más abajo: Nombre del Niño Fecha de Nacimiento Fecha de Inicio de Cuidado Horario Semanal

NOMBRE DEL NIÑO

MES

DÍA

AÑO

MES

DÍA

AÑO

MES

DÍA

AÑO

MES

DÍA

AÑO

MES

DÍA

AÑO

MES

DÍA

AÑO

NOMBRE DEL NIÑO

Lunes Martes Miércoles Jueves Viernes Sábado Domingo OFFICE USE ONLY

Total Hours per Week ACS Child Care Rate

Yo entiendo que el hecho de recibir pagos por parte de la Ciudad de Nueva York por servicios de cuidado infantil no significa que soy un empleado de la misma. Soy empleado del/de la padre/madre/tutor del niño a quien le presto cuidado. Certificación del Proveedor Estoy inscribiendo a este niño en un programa de cuidado infantil. Entiendo que seré pagado solo después de que la FIA reciba los datos de asistencia del niño siempre y cuando el/la antemencionado(a) padre/madre/tutor esté trabajando o participando en una actividad aprobada por la FIA. En caso de que el/la padre/madre/tutor no reúna estos criterios, la FIA me enviará una carta avisándome de que la FIA ya no pagará por el cuidado infantil. Yo doy fe de que la cantidad que le estoy cobrando a este/a padre/madre no es más de la que cobro por otros niños de la misma edad. Entiendo que no se me pagará si no indico todas mis tarifas. Yo le permitiré al/a la padre/madre/tutor de los niños nombrados en este formulario acceso ilimitado a sus niños y al local de cuidado, y estaré disponible siempre que los niños estén bajo mi cuidado. Doy fe de que las declaraciones más arriba son verídicas y exactas, según mi leal saber y entender. Entiendo que el proporcionar información falsa puede resultar en la suspensión o terminación de pagos y la recuperación de cualquier pago al cual yo no haya tenido derecho. Nombre del Proveedor (en letra de molde): ______________________ Cargo Oficial (si corresponde): _________________ Firma: ____________________________________________________________________________ Fecha: _________________

Certificación del/de la Padre/Madre/Tutor Doy fe de que he leído y repasado la información más arriba y que la misma es correcta. Entiendo que tengo que reportar cualquier cambio a la FIA. Nombre del/de la Padre/Madre/Tutor: __________________________________________________________________________ Firma del/de la Padre/Madre/Tutor: ___________________________________________________ Fecha: _________________

For Agency Use Only: Is child care authorized for this applicant/participant? Yes No Agency-approved start date for child care: ________ / ________ / ________ MM

YYYY

Attachment A

Michael R. Bloomberg, Mayor

Jeanne B. Mullgrav, Commissioner

Department of Youth and Community Development Out-of-School Time Programs Directory of Programs with Additional Year-Round Services Bronx

Pages 1-3

Brooklyn

Pages 4-5

Manhattan

Page 6

Queens

Page 7

For additional information about OST Programs please contact Youthline at 1-800-246-4646, or visit us on the web at www.nyc.gov/dycd To learn about other NYC programs please call 311

Attachment A

Out-of-School Time Programs Zip Code

Agency

Site

Address

Contact

Service Level

Bronx 10451

East Side House Settlement, Inc.

Patterson Community Center 340 Morris Avenue, Bronx 10451

Blakeney James, Program Director, (718) 993-2744

Option 1 Elementary

10452

New Settlement Apartments

1512 Townsend Avenue, Bronx 10452

Maria Santana, Program Director, (718) 716-8000

Option 1 Elementary

10452

Women's Housing and Economic Development Corporation (WHEDCO

Rafael Hernandez Dual Language Magnet School (PS /

1220 Gerard Avenue, Bronx 10452

Matta Dael, Program Director, (718) 839-1128

Option 1 Elementary

10452

Woodycrest Center For Human Development

PS 126 - Dr. Marjorie H. Dunbar - 09X126

175 West 166th Street, Bronx 10452

Gloria Portillo-Calo, Program Director, (718) 538-4708

Option 1 Elementary

10453

Good Shepherd Services/Bronx

University Heights Day Care 2167 University Avenue, Bronx 10453

Diaz Nancy, Program Director, (718) 365-7755

Option 1 Elementary

10453

Good Shepherd Services/Bronx

Public School 79 - Creston Elementary School

125 E. 181st Street, Bronx 10453 Ruiz Germaine, Program Director, (718) 933-7439

Option 1 Elementary

10453

Supportive Childrens Advocacy Network (SCAN)

Public School 230 - Dr. Roland N. Patterson School

275 Harlem River Park Bridge , Bronx 10453

Chisolm Cynthia, Program Director, (718) 583-6626

Option 1 Elementary

10454

East Side House Settlement, Inc.

Eastside House @ PS 220

468 East 140th Street, Bronx 10454

Tuesday Brown, Program Director, (718) 665-3083

Option 1 Elementary

10454

East Side House Settlement, Inc.

Mill Brook Community Center 201 St. Ann's Avenue, Bronx 10454

Michele Mcpherson, Program Director, (718) 585-1254

Option 1 Elementary

Monday, April 09, 2007

Page 1 of 7

Attachment A

Zip Code

Agency

Site

10455

Citizens Advice Bureau, Inc.

Public School 130 - Abram Stevens Hewitt Elementar

10456

New Settlement Apartments

10456

Address

Service Level

Clermont Nancy, Program Director, (718) 292-3452

Option 1 Elementary

After School Program at CES 1340 Sheridan Avenue, Bronx 88 10456

Kim Wilson, Program Director, (718) 538-8051

Option 1 Elementary

The After School Corporation

Public School 2

1260 Franklin Avenue, Bronx 10456

Melissa Garcia, Program Director, (718) 620-0724

Option 1 Elementary

10456

Kips Bay Boys & Girls Club

Public School 140 - Eagle Elementary School

916 Eagle Avenue, Bronx 10456

Terrence Rice, Program Director, (718) 893-8254

Option 1 Elementary

10457

New York City Mission Society

Community Elementary School 28 - Mount Hope School

1861 Anthony Avenue, Bronx 10457

Maldonado Aida, Program Director, (718) 583-7200

Option 1 Elementary

10457

Supportive Childrens Advocacy Network (SCAN)

Public School 42 (X) Claremont School

1537 Washington Avenue, Bronx 10457

Edge Wendy, Program Director, (718) 583-7366

Option 1 Elementary

10457

The After School Corporation

Public School 58 (X)

459 East 176th Street, Bronx 10457

Gracie Johnson, Program Director, (347) 278-0953

Option 1 Elementary

10458

Mosholu Montefiore Community Center, Inc.

Public School 8 - Isaac Varian School

3010 Briggs Avenue, Bronx 10458

AsafBur Tura, Program Director, (917) 416-7353

Option 1 Elementary

10459

Simpson Street Development Association, Inc.

IS 217 - Rafael Hernandez School (EL)

977 Fox Street, Bronx 10459

Hazel Robinson, Program Director, (718) 589-1510

Option 1 Elementary

10459

Sports and Arts In Schools Foundation, Inc.

Public School 134X

1330 Bristow Street, Bronx 10459 Phil Ambrosio, Program Director, (718) 328-3351

Option 1 Elementary

10460

Casita Maria, Inc.

Public School 50

1550 Vyse Ave, Bronx 10460

Option 1 Elementary

Monday, April 09, 2007

750 Prospect Avenue, Bronx 10455

Contact

Rivera Marta, Program Director, (718) 589-2230

Page 2 of 7

Attachment A

Zip Code

Agency

Site

Address

Contact

Service Level

10460

Kips Bay Boys & Girls Club

Community Elementary School 102 - Joseph O. Loreta

1827 Archer Street, Bronx 10460

10466

Mosholu Montefiore Community Center, Inc.

Public School 21 - Phillip M. Sheridan Elementary

715 E. 225th Street, Bronx 10466 Croft Ivan, Program Director, (646) 529-8733

Option 1 Elementary

10467

Neighborhood Initiatives Development Corporation

Public School 96 - Richard Rodgers Elementary Scho

650 Waring Avenue, Bronx 10467 Christy Olsen, Program Director, (718) 231-9800

Option 1 Elementary

Monday, April 09, 2007

Alberto(Al) Rodriguez, Program Director, (718) 893-8254

Option 1 Elementary

Page 3 of 7

Attachment A

Zip Code

Agency

Site

Address

Contact

Service Level

Brooklyn 11206

The After School Corporation

Beginning With Children Charter School

11 Bartlett Street, Brooklyn 11206 DelRio Nancy, Program Director, (917) 328-2855

Option 1 Elementary

11207

Brooklyn Bureau of Community Services

Public School 149 - The Danny Kaye Elementary

700 Sutter Avenue, Brooklyn 11207

Morrancie Donna, Program Director, (347) 834-3097

Option 1 Elementary

11207

Brooklyn Bureau of Community Services

Public School 174 - Dumont Elementary School

574 Dumont Avenue, Brooklyn 11207

Morrancie Donna, Program Director, (347) 834-3097

Option 1 Elementary

11207

Brooklyn Bureau of Community Services

Public School 306 - Ethan Allen Elementary School

970 Vermont Street, Brooklyn 11207

Yancy Larry, Program Director, (718) 649-4119

Option 1 Elementary

11207

Groundwork Inc.

Public School 260 Breuckelen Elementary School

875 Williams Avenue, Brooklyn 11207

Katrina Huffman, Program Director, (718) 346-2200

Option 1 Elementary

11207

Groundwork Inc.

Public School 328 - Phyllis Wheatley Elementary Sc

330 Alabama Avenue, Brooklyn 11207

Tanya Wiggins, Program Director, (718) 346-2200

Option 1 Elementary

11208

Cypress Hills Local Development Corporation

Public School 65 - Little Red 158 Richmond Street, Brooklyn School House of Cypr 11208

Sureeta Collins, Program Director, (718) 715-8605

Option 1 Elementary

11212

The Salvation Army Community Center

Brownsville Community Center

Powell Denise, Program Director, (718) 345-2488

Option 1 Elementary

11212

YWCA of the City of New York (Main Branch)

Public School 327 - Dr. Rose 111 Bristol Street, Brooklyn 11212 Stefanie Santos-Diaz, Program B. English school Director, (212) 755-4500

Option 1 Elementary

11213

Friends of Crown Heights Educational Center

Public School 221 791 Empire Boulevard, Brooklyn Touissant L'Ouverture School 11213

Dublin Osbourne, Program Director, (718) 467-4270

Option 1 Elementary

11213

George C. Conliffe Child Care Center

Mourning Yvette, Program Director, (718) 778-1498

Option 1 Elementary

Monday, April 09, 2007

280 Riverdale Avenue, Brooklyn 11212

1435 Prospect Place, Brooklyn 11213

Page 4 of 7

Attachment A

Zip Code

Agency

Site

Address

Contact

Service Level

11216

The Salvation Army Community Center

Bedford Community Center

601 Lafayette Avenue, Brooklyn 11216

Guerin Ceilia, Program Director, (718) 638-1607

Option 1 Elementary

11221

Builders For Family & Youth of Diocese of Brooklyn (BFFY)

Public School 106 - Edward Everett Hale Elementary

1314 Putnam Avenue, Brooklyn 11221

Yaritza Reyes, Program Director, (718) 574-0260

Option 1 Elementary

11221

The Salvation Army Community Center

Bushwick Community Center 1151 Bushwick Avenue, Brooklyn Sylvester Ingrid, Program Director, 11221 (718) 455-4103

Option 1 Elementary

11226

Flatbush Action Community Day Care Center, Inc.

525 Parkside Avenue, Brooklyn 11226

Cosbert Olive, Program Director, (718) 693-9891

Option 1 Elementary

11233

Sports and Arts In Schools Foundation, Inc.

Public School 40 - Carver Elementary Opt 1

265 Ralph Avenue, Brooklyn 11233

Lloyd Webber-Bey, Program Director, (718) 455-9445

Option 1 Elementary

11236

Sesame Flyers International, Inc.

Intermediate School 68 Isaac Bildersee School PS

956 East 82nd Street, Brooklyn 11236

Marie Joseph, Program Director, (718) 241-3847

Option 1 Elementary

Monday, April 09, 2007

Page 5 of 7

Attachment A

Zip Code

Agency

Site

Address

Contact

Service Level

Manhattan 10029

Northside Center for Child Develop.

1301 5th Avenue, New York 10029

Judy Thoms, Program Director, (212) 426-3415

Option 1 Elementary

10029

Boys & Girls Harbor, Inc

1 East 104th Street, New York 10029

Wallace Bernadette, Program Director, (212) 427-2244

Option 1 Elementary

10029

Union Settlement Association

Washington Houses Community Center

1775 Third Avenue, New York 10029

Portericker Steven, Program Director, (212) 828-6120

Option 1 Elementary

10032

Community Association of Progressive Dominicans

Public School 28 - Wright Brothers Elementary Scho

475 West 155th Street, New York Elizabeth Jimenez, Program 10032 Director, (646) 208-2198

Option 1 Elementary

10032

The Childrens Aid Society

Public School 8 - Luis Belliard Elementary School

465 West 167th Street, New York Elizabeth Blanco, Program Director, 10032 (212) 740-8655

Option 1 Elementary

10033

Alianza Dominicana, Inc.

Public School 132 - Juan Pablo Duarte Elementary S

185 Wadsworth Avenue, New York 10033

Option 1 Elementary

Monday, April 09, 2007

Guillermo Angel, Program Director, (917) 470-8957

Page 6 of 7

Attachment A

Zip Code

Agency

Site

Address

Contact

Service Level

Queens 11691

Federation Employment & Guidance Services (FEGS)

Intermediate School 43, Elementary School

160 Beach 29th Street, Far Rockaway 11691

Doniele leggs, Program Director, (718) 471-7875

Option 1 Elementary

11691

Safe Space

Public School 215 - Lucretia Mott Elementary Schoo

535 Briar Place, Far Rockaway 11691

Diana Rodriquez, Program Director, (347) 489-0857

Option 1 Elementary

Monday, April 09, 2007

Page 7 of 7

Attachment B

[PDF] family independence administration - Free Download PDF (2024)

References