Case Notes: Child Care Subsidy

Information to record in each applicable FACS tab of the Interview Notebook during an Child Care interview or renewal and prior to taking action on an application or review includes:

Case Information Tab:

  • Describe the type of action being processed (Application, Annual Review, Change, etc.)
  • Document the initial request date and how the application was received.
  • Document when and how the interview was completed.
  • Document that the client was informed of their rights and responsibilities.
  • Document that the client was referred to EBT specialist to receive his or her child care card.
  • Document verification Requested: Document what verification has been requested. List items in enough detail that someone else would be able to process the case or answer any questions. Document if no further verification was needed.

Typical case info notes will include, but are not limited to:

  1. LTC app/renewal/change submitted on 00/00/00. Phone interview conducted 00/00/00 with _____.

    AMD-92 issued on 00/00/00 requesting ______.

  2. Child Care renewal received 00/00/00, via OKDHSLive! was screened for completion.
  3. Interview completed on 00/00/00 with client.

Intake / Household Tab:

  • Document all individuals included in the child care household, including children who do not receive a child care benefit.
  • Document any adult non-relative and their child(ren) living in the home and if the adult non-relative is acting in the role of a spouse.
  • Document if there is a child receiving SSI who will be approved on another case.
  • Document if child care is needed for any new children who enter the home.
  • Document if any member of the child care household is temporarily absent and for what reason.
  • Explore and document all special circumstances* and program eligibility as applicable for each household member:

Typical Intake / Household notes will include, but are not limited to:

  1. HH consists of two adults, Maury and Mary, and their three children Mark, Matt, and Madeline. Child Care services are only for Madeline.
  2. HH consists of 1 adult, Teresa, and her two children, Tim and Tyson. Tyson is a newborn who needs to be added to child care benefit.
  3. HH consists of two adults, Will and Wendy, and their two children (2 year old twin girls Sara and Shelly. Wendy is currently expecting and has now been put on bedrest for the remainder of her pregnancy. Child care is needed for the times that Will is at work.

Income Tab:

  • Document how income was verified and calculated, including which income was used for what month in cases where unfinished issuance is needed.
  • Document earned and unearned income for the entire child care household.
  • Explain why adult non-relative’s income is being considered or not.
  • For any siblings, age 17 or younger, of children receiving a child care benefit, document all earned and unearned income and whether it is exempted or included.
  • Document when an adoptive parent’s income is not considered.
  • Record if the minimum wage requirement is being met for self-employed individuals.
  • Explore and document other earned and unearned income sources for all household members such as:

Typical income notes will include, but are not limited to:

  1. Rick is employed at ______, start date 00/00/00, pay rate is $00.00, he is paid bi-weekly, on Fridays. Client provided the following pay stubs: 00/00/00 $00.00 Partial Check – Not representative, not included 00/00/00 $000.00 First full pay period, check used to anticipate income 000.000 * 2.15 = $000.00
  2. Tanya states that she is self-employed as a ______ and declared business expenses. She started the business on 00/00/00. She provided ledgers for ____ through _______. Month $00.00.

    Month $00.00 Total 00.00/2 = $00.00 ½ Business Expense = $00.00. She meets the minimum wage requirement for child care.

  3. Client receives regular bi-weekly child support of $000 by wage assignment, income verified by Ki1 screen. 000 x 2.15 = $000 / month.

Resource Tab:

  • Document client’s statement that their resources do not exceed 1 million dollars.

Typical resource notes will include, but are not limited to:

  1. Client states that they only have $2,000 in a checking account. Declares that their resources do not exceed 1 million dollars.

Deprivation Tab:

  • Document the type of deprivation and which child is deprived.
  • Record if the client is willing to pursue child support or claims a good cause exemption for each child.
  • Explain any good cause exemption request.
  • State which absent parent is related to which child in the case of multiple absent parents.
  • Record that child support forms were completed on all children in the household including those who do not receive child care.
  • Document that CCPI screens were checked on all Family Group Numbers (FGNs) on the case.

Typical Deprivation notes will include, but are not limited to:

  1. HH consists of two adults, Walt and Kim, and three children, Rich, Brianna, and
    Caleb. Deprivation exists for Rich as his mom Kim and his father Tom, divorced three years ago. HH is willing to pursue child support and child support forms were completed.
  2. HH consists of 1 adult, Sharon, and her daughter Tina. Deprivation exists for Tina, as her mom Sharon and her father Sean are recently separated. A protective order has been issued and client declares good cause for not pursuing child support. Good Cause form was completed and sent to CSS. ADM-92 was issued to request verification of the PO and give client 30 days of PE child care while verification was pending.

Child Care/ Child Care Service Tab:

  • Document the date verification is received and when child care will be approved.
  • Record and explain any reason the child care date is different than the date verification is received.
  • Document the Need factor and how it was verified. This must include days and hours the parent / caretaker meets one of the need factors including their travel time.
  • Document the child’s need for care and record days and hours care is provided by any other source (friend, relative, school, etc.)
  • Record the unit type and number of units based on the client’s need factor and hours the child requires care.
  • Document whether school age children attend a traditional or year-round school.
  • Document the child care provider chosen for each child.
  • Explain which provider is co-pay exempt in the case of multiple providers.
  • Record any authorized representative.

Typical Child Care Services case notes will include, but are not limited to:

  1. Verification was received on 00/00/00. Child care will begin the next week on 00/00/00 as that is the date the client requested, first date of job.
  2. Client attends class 10:00 AM to 2 PM, Monday – Friday with 30 minutes of travel time. Schedule was submitted. Unit type is Weekly 5. Child care will begin on 00/00/00, the first day of class.


Document any phone conversations used for verification. Provide the name and contact number of the verifier, and detail what information was provided.

Explain any discrepancies between information received on documents provided and/or information stated by the client verbally and/or information showing on the case.

** Cover Social Services Tab in Interview to document any other needs that the client may have**

**Special Circumstances: Worker must explore special circumstances with client, but documentation of special circumstances is only required if applicable. For more information on how to explore and document special circumstances refer to Child Care Subsidy Policy or Quest.

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