Stipend & Reimbursement Forms Processed by TRI
All forms are located in the Stipend & Reimbursement Group on the TRI website: http://triwou.org/groups/page/149/stipends-andreimbursements Mail forms to: TRI/Central Coordination of CCR&R Western Oregon University 345 Monmouth Ave N. Monmouth, OR 97361
Email forms to:
[email protected]
Form
Description
DHS Provider Training Stipends
Payment to DHS Listed Providers that have taken eligible trainings through the CCR&R.
Additional details
Non-Relative Provider Regulated Subsidy (FFN)
Relative Provider Exempt LEHRC (FFN)
Pre-list requirements: RRCAN First Aid/CPR Introduction to Child Care Health and Safety Eligible Stipends: Orientation Continued Professional Development
Pre-list requirements: Introduction to Child Care Health and Safety Eligible stipends: Orientation First Aid/CPR (after becoming listed) In-person RRCAN (after becoming listed) Continued Professional Development
Food Handlers Card is available at no cost to provider, if working towards Enhanced Rate – ADD link
Food Handlers Card is available at no cost to provider, if working towards Enhanced Rate - ADD Link
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Languages Form Available in English Spanish
Form
Description
Additional details
Providers will receive a stipend of $12.00 per hour for attending the following trainings: DHS Provider Orientation 6 hours of required continued professional development
Providers will receive a stipend of $12.00 per hour for attending the following trainings: DHS Provider Orientation
6 hours of optional continued professional development Regulated Subsidy Enhanced Rate Providers will receive a stipend of $12.00 per hour for attending the following trainings: DHS Provider Orientation 8 hours of required continued professional development 4 hours of optional continued professional development
Exempt LEHRC Enhanced Rate Providers will receive a stipend of $12.00 per hour for attending the following trainings: DHS Provider Orientation 8 hours of required continued professional development 4 hours of optional continued professional development
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Languages Form Available in
Form
License Exempt Family Child Care Provider Training Reimbursement (SEIU)
Description
For License Exempt Family Child Care Providers (FFN, LEHRC, RS) participating in the subsidy program. Providers may be reimbursed for the cost of events: community trainings college credit classes workshops seminars conferences
Licensed Family Child Care Provider Training Reimbursement
Providers will be reimbursed up to $300.00 per event. For Licensed Family Child Care Providers (Registered Family and Certified Family) for taking First Aid/CPR through a non-CCR&R agency. Providers will be reimbursed up to $55.00.
First Aid/CPR Training Reimbursement for Aide 1 and Assistant 1
For Aide 1 (Center-based care) and Assistant 1 (Family-based care) for taking First Aid/CPR. Aide 1s and Assistant 1s will be reimbursed for the cost of trainings taken on or after October 16, 2018 until present.
Additional details
Languages Form Available in
Providers are eligible for event reimbursements from April 1, 2018 through ____
English Spanish
License Exempt Family Child Care Provider Training Reimbursement Requirements: 1 form per event reimbursement WOU Substitute W-9 Proof of cost/attendance/receipt
Providers are eligible if they are RF or CF. License Family Child Care Provider Training Reimbursement Requirements: Completed form WOU Substitute W-9 Receipt Aide 1s are eligible if they work in a Certified Center. Assistant 1s are eligible if they work in family child care. First Aid/CPR Training Reimbursement for Aide 1 and Assistant 1 Providers Requirements: Completed form WOU Substitute W-9 Receipt
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English Spanish Russian Vietnamese Traditional Chinese
English Spanish Russian Vietnamese Traditional Chinese
Form
Safety & Quality Enhancement Dollars Form
Description
For License Exempt family providers who need assistance in meeting DHS Health & Safety requirements as indicated on the DHS Provider Listing Form.
Additional details
*If a family child care business or center-based program submits for all staff, they must complete the reimbursement form and Substitute W-9 under their Business Name and note the names of all Aide 1 or Assistant 1 eligible for this reimbursement. Safety & Quality Enhancement Dollars Form Requirements: Completed form WOU Substitute W-9 Receipt
Languages Form Available in
English Spanish Russian Vietnamese Traditional Chinese
The reimbursement form covers equipment, installations, and repairs to help provider meet DHS Health and Safety Requirements.
CCR&R/SDA Training Reimbursement
Providers will be reimbursed for up to $250.00. For CCR&Rs who provide no cost trainings to License Exempt providers.
CCR&R/SDA Training Reimbursement form is due within 15 days after the end of each quarter.
English
Reimbursement is covered based upon CCR&Rs cost.
Lead Testing Reimbursement
For the following providers: License Exempt/DHS listed Providers who are in the process of becoming listed Registered Family Certified Family Certified Center
Lead Testing Reimbursement Requirements: Completed form WOU Substitute W-9 Receipt (if corrective action was needed) Lead Testing Reimbursement for licensed programs is available until June 30, 2019.
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English Spanish Russian Vietnamese Traditional Chinese
Form
WOU Substitute W-9 Form
W-8BEN
Description
Reimbursement covers the cost of the lead testing, shipping, and corrective action. Required along with every stipend or reimbursement.
Additional details
Processing of stipend or reimbursement will be put on hold if an incomplete or illegible WOU Substitute W-9 form is received.
Required along with the WOU Substitute W-9 Form if/when a provider checks the “Foreign Alien or Entity” box on the WOU Substitute W-9.
I:\Train\CCCCR&R\LEHRC\Information Sheet\Stipend and Reimbursement, Support and Incentive Information Sheet 7-10-19.docx
Languages Form Available in
English Spanish Russian Vietnamese Traditional Chinese English
Spark Supports and Incentive Forms Processed by TRI
All forms are located in the Spark Portfolio Materials Group on the TRI website: http://triwou.org/materials/home/77/spark-portfoliomaterials Mail forms to: TRI/Oregon’s Spark Western Oregon University 345 Monmouth Ave N. Monmouth, OR 97361
Email forms to:
[email protected]
Form
Spark Request for Support Form
Description
Eligibility: Programs designated Commitment to Quality (C2Q) and above. Exemptions: Preschool Promise and Head Start. (programs already receiving public funds for quality improvements). What is it? Spark Support Funds help offset costs of increased quality that will help programs become star rated or apply for a higher star rating. Allowed expenditures: Curricula Equipment Supplies Materials for the classroom
Additional details
Amount: Dependent on program licensed capacity. Small (1-20) = $1,000 Medium (21-49) = $1,500 Large (50+) = $2,000 Licensed capacity is independently verified by CCRIS when program applies. Accredited programs receive funds based on the accredited program schedule. Required by accompany form: WOU Substitute W-9
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Languages Form Available in English Spanish Russian
Form
Description
Additional details
Languages Form Available in
Computers needed to access internet support Training
Disallowed expenditures: Capital improvements Sectarian materials (e.g. religious texts) Personal use not related to program improvement Operating cost (electric bill, water, rent, etc.) Programs are required to keep receipts for expenditures in case of an audit. Request for Enhanced Support Form for Focused Network Participants
Eligibility: Programs participating in a Focused Family Child Care Network. (eligibility determined by FCCN) Allowed expenditures: Curricula Equipment Supplies Materials for the classroom Computers needed to access internet support Training Disallowed expenditures: Capital improvements Sectarian materials (e.g. religious texts)
Amount: Dependent on program licensed capacity. Small (1-20) = $2,000 Medium (21-49) = $3000 Large (50+) = $4,000 Licensed capacity is independently verified by CCRIS when program applies. If any support funds were previously received by the program, they are deducted for the total amount eligible for. Unlicensed programs can receive $500 while they are working on licensing. Program completes a detailed budget worksheet on the form.
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English Spanish Russian
Form
Description
Personal use not related to program improvement Operating cost (electric bill, water, rent, etc.)
Additional details
Languages Form Available in
QIS signs form approving the plan. Required by accompany form: WOU Substitute W-9
Programs are required to keep receipts for expenditures in case of an audit. Request for Payment of Incentive Funds
Eligibility: Programs receiving a star rating. Programs that are not eligible for incentives include: Preschool Promise Head Start Allowed/Disallowed expenditures: There are no requirements or restrictions on Incentive Funds.
Amount of incentive funds depends on both licensed capacity and star rating. Licensed capacity verified by CCRIS. Accredited programs receive funds based on an accredited program schedule. Form completed and processed by TRI after rating WOU Substitute W-9 will be requested from the program if they have not previously received funds.
Environment Rating Scales (ERS) Training Assessment Memorandum of Understanding (MOU) and Stipend Form
Eligibility: Programs who agree to participate in an ERS Training Assessment and who commit to the following: Coordinating a date and time for the assessment take place with a Quality Improvement Specialist and/or TRI designated staff Permitting TRI/CCR&R staff to conduct a 3 - 4-hour on-site observation with a brief interview before the assessment begins
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English
Form
Description
Additional details
Agreeing to 2 – 4 adults (the “assessment team”) participating in the observation (1 person who is the “Spark Assessor” and the other(s) who are in training) Receiving a “Continuous Quality Improvement ERS Assessment Report” within 2 weeks of the assessment Filling out a WOU Substitute W-9 form to receive a $150.00 stipend and submit with this form Allowing TRI to use summarized data gathered during the assessment for evaluation purposes
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Languages Form Available in